I will try and make this short and sweet. A big problem with the way health care is today is the following. 1. a patient goes to a doctor’s office, pays or doesn’t pay a co-pay, sees doctor or has a procedure, leaves, then one day receives a bill for whatever the insurance company didn’t pay. So what happened in the middle?????
Well the doctor recorded some notes, someone in the office did their best to code things, this gets sent to AR, then forwarded to the health care insurance provider, they just apply rules to line items, don’t read nor care what they are, the difference goes to the patient. the problems?
- Duplicates, I have two invoices at home which show the health care insurance company paying for the same visit on two different invoices, happens a a lot
- I have invoices where there are charges for things that never happened
- Regardless of how good or bad the doctors do, they get paid. I went in for a lower stomach ache, the doctor said go ahead and take your trip to Jamaica, you are just backed up. Lucky I had a friend who is a PA and I am not a moron. I asked, how do I know if I have an appendicitis? she said get a CT Scan. So I went into the doctor’s office again and said, how do I know if I have a appendicitis, he said, it is the great pretender and you just don’t know. go to Jamaica, I said what about a CT Scan, he said, oh that would do it. So I get schedule for a cat scan, have the cat scan, then they say… you need a colonoscopy, so I do that, immediately after the surgery they say you need your appendix taken out now, I say OK. They take it out and the doctor who did the colonoscopy comes in and say, I can’t believe they sent you to have a colonoscopy, the extra clearly showed you had an appendicitis brewing.
Moral of the story, there is no benefit for doctors to do a great job only good enough not to get sued.
- Bills are submitted to patients for approval and customer satisfaction rating. this is done online for ones who have computers and opt for email notifications, paper for those who don’t have a computer
- Poor ratings are investigated by the National Health Quality Assurance program, also customers choose insurance providers based on the quality score and price. disputes are go through the government HQAP arbitrator
- Enough poor ratings and medical providers or doctors lose their license to practice. Good ratings and the medical professionals and providers get rich.
Simple and puts the controls where they should be, the customer. Good is rewarded, bad is punished.
Like to hear your idea’s, complain or wine all you want, but only if you have a solution to back it up.