Get better soon
Monday November 30th 2009, 10:37 pm
Filed under: Politics

A stunning item in the Newsweek issue that arrived today:

They write about the Cleveland Clinic, showing the various ways in which it has cut costs while improving patient outcomes and how it hopes to be a model for ways in which the delivery of healthcare could be reformed.

But there is one major problem they can do nothing about.  They describe the clinic’s clerks.  Picking up the phone to deal with the “thousands of different health plans from the hundreds of companies all over the country” and getting “put on hold like anyone else who calls an insurance company.”  Industry estimates, they say, are that the average cost of handling a phone call is $3 to each party. “This is the hidden cost of competition…”

So, one might wonder, reading that, how many phone calls are there per case?

What dropped my jaw was what they said next: there are 2,000 doctors at Cleveland. They have to keep 1,400 clerks to deal with those companies. And they know, their CEO says, that the insurers have just as many people working on each of those cases, doing everything they can to examine them.  And then if they can in any way they will deny or at least delay each claim for as long as possible.

Which is one big reason why the overhead for private insurers averages out, Cleveland Clinic’s CEO says, at 29% vs. Medicare’s 3%.  (As an aside, I have read that the Blue Crosses of California run at about 50%.)  That’s just on the insurers’ end in terms of the lost money that could have been spent on actual care of human beings in actual medical need.

Cleveland, it should be noted, told insurers what its average maternity cost was and offered to simply charge that average fee per baby delivered to each, freeing themselves and all those insurance plans all the costs of all that wrangling and nitpicking.  Spend that premium money on the patients instead! Please!

Not a single one took them up on it.

We need a public option. Now.

21 Comments so far
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My husband and several of his colleagues, with over 200 years of health insurance experience in a well-known national compny, have been saying for thirty years that the ONLY way to achieve successful and blanket coverage for the entire population was “single payer”–and their jobs would have been on the line!

Comment by Abby 11.30.09 @ 11:29 pm

I was at an eye specialist’s office late one Friday afternoon for a routine appointment. I could overhear the office manager getting horrible run-around from another patient’s insurance company over a surgery that had to be completed within 48 hours or permanent blindness would result.

My doctor didn’t have operating privileges at a hospital in her county, her county didn’t have any retina specialists, and her insurance wouldn’t cover her surgery outside of her own county. And anyone who had any approval authority to override this policy had already gone home for the weekend. This was the Bay Area, too!

I never did hear the end result of all the phone tag. I really hope she got her surgery…

Comment by Deb Bouchard 12.01.09 @ 1:43 am

I left the US in 1991 just before Penna Blue Cross and Blue Shield turned “for profit.” I’ve been able to observe the chaos from a distance.

I think a Federal public option could be joined by State Public option as different states have different needs. Did you read about how Hawaii’s state plan may exempt them from the fed. option? There are other good models in place.

BTW read this in the NYTimes and thought “That is SOOOO Alison.”

Comment by LynnM 12.01.09 @ 1:53 am

More and more, insurance looks like it is not.

Comment by sherry in idaho 12.01.09 @ 4:20 am

When I worked for a cardiologist (as his nurse) this was exactly our experience. Our insurance clerk spent HOURS on hold, just trying to get a pacemaker authorized, for instance. Hey, folks, cardiology is not always leisurely medicine. Somethings need to happen NOW!

Comment by Barbara-Kay 12.01.09 @ 5:23 am

The haggling is ridiculous. My son-in-law fractured his ankle last February, was brought to the emergency room and had to have surgery. Though the hospital was in the network, the covering emergency room doctor
at the same hospital wasn’t and the insurance company would only pay 60%
instead of the normal 80% for the entire bill including the surgery.

Something needs to be done in this country and I agree with you.

Comment by Joansie 12.01.09 @ 6:29 am

May I forward a link of this post to my father-in-law who is dead set against a public system?

I’m not saying it’s a perfect one – waiting times can be ridiculous for surgeries, for instance – but in my very humble opinion, I don’t believe it’s that discouraging either…

Comment by Suzanne in Mtl 12.01.09 @ 6:39 am

and yet, I can understand why my friends in the private sector have concerns. There is no question that we need a uniform pay system that focuses on providing needed care and services rather than always looking for a way to say no.
It would help if the current public funded programs paid more than 30% and that not for 6 months post care.
and then there is tort reform….
the list goes on and on and on

Comment by Holly 12.01.09 @ 7:05 am

I spent yesterday going back and forth from gyno’s office and breast care center – prescription, referral, prescription, referral and on, and on and on.
I heard in both office clerks arguing with insurance companies. I felt so sorry for them

Oh by the way, I sent a big group of fruit flowers to the Breast Center today because they told me “see you next year.” Best 4 words you can ever hear – it means you back on the “average” range.


Comment by afton 12.01.09 @ 7:43 am

Ack. Just…ack. I can’t bear it.

Comment by suburbancorrespondent 12.01.09 @ 9:00 am

I’m with all your commenters, and the single payer option doesn’t even affect me. I’m plenty .old enough to be on Medicare, plus AARP secondary, and while not perfect, it really isn’t bad.

After all that, we NEED some humor –

An English professor wrote the words: “A woman without her man is nothing” on the chalkboard and asked the students to punctuate it correctly.
All of the males in the class wrote: “A woman, without her man, is nothing.”
All the females in the class wrote: “A woman: without her, man is nothing.”

Comment by Don Meyer 12.01.09 @ 10:28 am

Our Canadian system isn’t perfect, but it has always worked for me. If I’m in need of hospital care – I get it. If I need to see a doctor – I see him/her. I’m sure many of my countrypeople have had horrible experiences, but knock wood, I have not.
I just wishe there was a way to have universal health care universally. Those that need it, get it. period.

Comment by Sandra 12.01.09 @ 12:19 pm

No one says EVERYONE needs to go the public route but it MUST be available.
No one should die because treatment was out of their price range.

Comment by Diana Troldahl 12.01.09 @ 12:36 pm

Heh, I was going to post the same link as LynnM. Great minds!

And I’m with you on the single-payer system.

Comment by RobinH 12.01.09 @ 1:17 pm

Go register. Be sure everyone you know is registered. Go vote when you can. Be sure everyone you know goes and votes. Go.Vote. And write your Senators daily if possible. They need to know we want a public plan more than we want them if they don’t pass a robust one.

Comment by Judy 12.01.09 @ 3:29 pm

Oh, most definitely YES! How do we not know this yet?

Comment by Jocelyn 12.01.09 @ 3:45 pm

I know, know, know that we need a reform; I just get all trembly thinkin’ about any, any, any government official havin’ a hand in it.
After all, they’ve just been so thrifty with our Social Security funds. _rolls eyes around and around_

Comment by Toni Smoky-Mountains 12.01.09 @ 4:26 pm

It’s taking so long. I am so discouraged. I’ve worked in a pediatric clinic. The largest department was people just handling the insurance issues. One thing to know is that often times there is a person that “specializes” in dealing with each particular insurance. You can ask about that person if you need help. They can also tell you which insurance they have the most trouble with. Once upon a time I had an insurance card and upon presenting it, the receptionist said, “Oh, you have GOOD insurance!” Sadly, that is no more. Another good thing to ask if you are having trouble is, “do you have any suggestions?”
Once on being told “no, that is not covered”, asking the question told me what hoops to jump through to get it covered.
However as this new deductable starts with this new year, I am at the point that I simply can’t pay any more. And since I can’t pay, I can’t have the care or medicine I need. I’ll have insurance, I just won’t be able to use it.
So, this waiting till they get it right, is too long for me.

Comment by kmom 12.01.09 @ 8:04 pm

Amen, sister.

We’ve just been told that our Cobra medical coverage for October was not valid, that we didn’t pay. We did, but due to administrative snafus of various sorts, they are claiming that our payment was for the previous month and October wasn’t covered. Paul had quite a number of doctor visits, a minor surgery, an MRI and various other things happen in the month of October. It’s got to add up to thousands of dollars.

It’s crazy, and we will of course appeal it but I have very little hope that they will change their tune. I’m just really praying for a miracle.

It shouldn’t take a miracle to be covered for decent health care. God knows we need a public option.

Comment by Beckett 12.02.09 @ 7:13 pm

A single risk pool/single payer option would allow everyone to focus on what is best for the patient. Now, despite paying premiums out of pocket costs are rising. Unless you have unlimited free time, fighting with your insurance company becomes impossible. I work in an FQHC (federally qualified health center) – most of our patients are uninsured or underinsured(high deductible plans for example). Our staff spends countless hours haggling with the insurance companies of our insured clients – prior authorizations – often for medications that were covered a month ago.

What a waste of resources!

I do not hold out great hope for the current plan. I fear by the time it makes it through both the house and senate it will be so full of compromises and amendments that doing nothing would be better. I say do it right the first time or do not do it at all. But then again, my days are spent caring for people who have not been able to access health care in years, or can not afford life sustaining medications (or food, or housing).

Comment by wildknits 12.02.09 @ 8:35 pm

I could not agree with you more — as of Dec 15 I will be totally uninsured — just wingin’ it here, hoping I don’t get sick anytime in the next 6.5 years, until medicare kicks in

Comment by Bev 12.03.09 @ 9:19 am

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