and one more time.
6 Reasons Healthcare Is So Expensive in the U.S.
^^I know this to be true because I work in the industry and have done so for over a decade. I'm not some random citizen talking out the side of my a.... you're hearing it from the horses mouth. Its too many of me's being paid a wage + benefits just to figure out how each big insurance company and mom and pop baby company wants us to bill the claim form, add this, take that off, put this over there, move this over here. we didnt get it, can you send it again, we still didnt get it the 3rd time even though you sent it certified mail. now the bill automatically drops to the patient to make them go chase their own insurance about getting paid. The customer is pissed, so they call Who? both the hospital/clinic they had the services done and their insurance company. thats two different customer service reps in two different places you have to pay to tell you "sorry mam, umm, we're working on it."
You have billing systems, you have IT people that put these systems together
you have IT people who keep the system together just in case you run into daily errors.
You have people who bill out claims physically
you have mailroom people who have to get the claims. you have places where you have to purchase the blank claim forms from. then you have billers to put the bills on the claim forms. this is for the non electronic billing.
for the electronic billing. you have more IT people and possibly a 3rd party you pay to be a clearing house to do EDI (electronic data interchange). meaning they can translate what would be a physical looking claim with fields/boxes and data in it to a format Ansi X12 or the like. and make sure its readable by quite a few insurance companies(not all but a lot). most companies would love to get to a place where they are billing out claims electronically at a 90% clip. meaning 90% of their entire claims billed is done electronically. but you dont understand even with that 10% if that were doable. that 10% = 1000's of claims per month. I would go out on a limb and say most places are around 70%. places i've worked for are aroun the 80 to 90 range. thats because i've worked for very large, well funded companies.
Before that you have to make sure the patient is eligible and who they are eligible with. you cant just take their word for it. thats why they ask for a copy of your insurance card. and even then they have to double check to make sure you are currently covered at that very moment of service or items you purchased.
thats an entire department called the eligibility dept. you then need access to every payer's website(not all of them even provider provider access to see eligibility or claims information stupid i know. ) Or you need another 3rd party to help you do eligibility checks electronically why your actual workers complete the fall outs where the system couldnt match the patient's to their information(name is slightly off, date of birth aint right, or their home address if off, etc, etc. wait who's the subscriber on the policy? crap, we billed the claim out as if this kid was the subscriber. he's not ,his dad is. but they have the exact same why? because thats Jr. oops someone for got to put in JR. that goes back and forth 5 times before someone catches the error. you're paying people X amt per hour, + benefits to figure that out. Ridiculous. and I'm saying this as an employee of this current system. universal heatlhcare would put some of the companies i have worked for out of business. BUTTTTTT, the government will have a hiring spree. you wont need nearly as many people to do the job as we do now pre universal. but you will need more than is currently employed with medicare, the Veterans affairs(VA), and medicaid(state) post universal healthcare.
its terribly inefficient.
If you have one insurance company(the gov) and one network that your doctors belong to( the Gov Network).
Guess how the claims will look? All the same. So the software companies could be different if they like for different states just to give private companies a chance at a government contract but the overall export of the claims physical forms will be completely gone.
Way less paper.. save more trees(go green) no one tells you this stuff because not even bernie knows this. only someone who works in the system would know this.
Now no need for any 3rd party eligibility systems. there's one database we're all in linked to our social security number. now they can be safer and give us all some new health ID number but its the same thing. one number, one database. there is no confusion on if the person is eligible or not. are they a citizen? YES. then their eligible . simple, easy. quick.
the speed of the claims payment will be insane. yes doctors could make less but not less to the point of not being well paid. but they will also collect more of their money because they wont need a fancy software and extra people to make sure everything is perfect when billing since its all the same and all out of the same database. imagine being a doctor and having to wait MONTHS to get paid for something you did 3 months ago or 6 months ago. vs universal where you get paid in 2 weeks tops. if you're not getting paid in 2 weeks. you the doctor tried to bill something that was incorrect either due to a lack of education or you're trying to pull a fast one on the gov. so that claim will be sent back for more medical records to prove what you billed is true.
and remember this is just the #1 reason why it costs so much. there are obviously other issues.
6 Reasons Healthcare Is So Expensive in the U.S.
^^I know this to be true because I work in the industry and have done so for over a decade. I'm not some random citizen talking out the side of my a.... you're hearing it from the horses mouth. Its too many of me's being paid a wage + benefits just to figure out how each big insurance company and mom and pop baby company wants us to bill the claim form, add this, take that off, put this over there, move this over here. we didnt get it, can you send it again, we still didnt get it the 3rd time even though you sent it certified mail. now the bill automatically drops to the patient to make them go chase their own insurance about getting paid. The customer is pissed, so they call Who? both the hospital/clinic they had the services done and their insurance company. thats two different customer service reps in two different places you have to pay to tell you "sorry mam, umm, we're working on it."
You have billing systems, you have IT people that put these systems together
you have IT people who keep the system together just in case you run into daily errors.
You have people who bill out claims physically
you have mailroom people who have to get the claims. you have places where you have to purchase the blank claim forms from. then you have billers to put the bills on the claim forms. this is for the non electronic billing.
for the electronic billing. you have more IT people and possibly a 3rd party you pay to be a clearing house to do EDI (electronic data interchange). meaning they can translate what would be a physical looking claim with fields/boxes and data in it to a format Ansi X12 or the like. and make sure its readable by quite a few insurance companies(not all but a lot). most companies would love to get to a place where they are billing out claims electronically at a 90% clip. meaning 90% of their entire claims billed is done electronically. but you dont understand even with that 10% if that were doable. that 10% = 1000's of claims per month. I would go out on a limb and say most places are around 70%. places i've worked for are aroun the 80 to 90 range. thats because i've worked for very large, well funded companies.
Before that you have to make sure the patient is eligible and who they are eligible with. you cant just take their word for it. thats why they ask for a copy of your insurance card. and even then they have to double check to make sure you are currently covered at that very moment of service or items you purchased.
thats an entire department called the eligibility dept. you then need access to every payer's website(not all of them even provider provider access to see eligibility or claims information stupid i know. ) Or you need another 3rd party to help you do eligibility checks electronically why your actual workers complete the fall outs where the system couldnt match the patient's to their information(name is slightly off, date of birth aint right, or their home address if off, etc, etc. wait who's the subscriber on the policy? crap, we billed the claim out as if this kid was the subscriber. he's not ,his dad is. but they have the exact same why? because thats Jr. oops someone for got to put in JR. that goes back and forth 5 times before someone catches the error. you're paying people X amt per hour, + benefits to figure that out. Ridiculous. and I'm saying this as an employee of this current system. universal heatlhcare would put some of the companies i have worked for out of business. BUTTTTTT, the government will have a hiring spree. you wont need nearly as many people to do the job as we do now pre universal. but you will need more than is currently employed with medicare, the Veterans affairs(VA), and medicaid(state) post universal healthcare.
its terribly inefficient.
If you have one insurance company(the gov) and one network that your doctors belong to( the Gov Network).
Guess how the claims will look? All the same. So the software companies could be different if they like for different states just to give private companies a chance at a government contract but the overall export of the claims physical forms will be completely gone.
Way less paper.. save more trees(go green) no one tells you this stuff because not even bernie knows this. only someone who works in the system would know this.
Now no need for any 3rd party eligibility systems. there's one database we're all in linked to our social security number. now they can be safer and give us all some new health ID number but its the same thing. one number, one database. there is no confusion on if the person is eligible or not. are they a citizen? YES. then their eligible . simple, easy. quick.
the speed of the claims payment will be insane. yes doctors could make less but not less to the point of not being well paid. but they will also collect more of their money because they wont need a fancy software and extra people to make sure everything is perfect when billing since its all the same and all out of the same database. imagine being a doctor and having to wait MONTHS to get paid for something you did 3 months ago or 6 months ago. vs universal where you get paid in 2 weeks tops. if you're not getting paid in 2 weeks. you the doctor tried to bill something that was incorrect either due to a lack of education or you're trying to pull a fast one on the gov. so that claim will be sent back for more medical records to prove what you billed is true.
and remember this is just the #1 reason why it costs so much. there are obviously other issues.
