My idea for fixxing Healthcare

[AllentownJake]

Insurance companies are taken out of the business of deciding prior authorizations, denials, and appeals.

An independent group is set up by the government that is a partnership between government, healthcare advocates, and the insurance industry to oversee those funtions. The group does the prior authorization, denial, and appeal function for all insurnace and medicaid and medicare programs.

When a person needs a prior authorization, doctors who work for this body recieve the information without knowing anything about the insurance other than than the relevant medical data. They do not know whether it is a government or private insurer's claim or procedure needing approval. If the procedure is not covered by the plan, it is taken to a seperate body for appeals that is also independent however, insurance specific information will be needed for that as well. This only goes for procedures and drugs that are covered.

This takes the financial incentive to deny and delay by the doctors making approvals (they get bonuses with cost savings). It allows for doctors to only consider the best interest of the patient when making decisions...not best interest of the insurance company.

[glowing]

1. Take insurance out of healthcare.. the two in one sentence is an oxymoron.

Insurance makes a profit only if you don't get sick. Since so many people actually do get sick, they start denying care. Eventually, with healthcare and annual visits to the Doc, wellness will increase.. AND people need to be educated on how to eat and given time to exercise and prepare balanced meals.

[AllentownJake]

3. It's a step

to phasing them out. I don't think we can remove them in one fail swoop and replace them with universal healthcare. We can make the business enviroment unfriendly so they get out voluntarily. This is a step in that direction.

[shraby]

4. Congress has promised to "phase out" insurance

companies since I came of age and paid attention..in the 1960s..if it isn't done in one fell swoop it won't ever get done. There is too much money to be made by insurance companies and congressmen to be any different. Government one payer health care similar to medicare with medicaid into the mix. Nothing less will do the job.

[AllentownJake]

8. Nixon, Ford, Reagan, Bush I, Bush II

When in those time periods could we have done it.

[Hutzpa]

13. This is an excellent idea Jake

freezing them out will eventually get them out the business completely, also, don't forget the Pharmaceuticals they are partly responsible for higher health insurance as insurance companies are in the business of making money as oppose to taking care of patients.

:thumbsup:

[AllentownJake]

15. Yep

Alot of them will close up shop. If there is a government group also competing with them like Obama wants eventually they will all go out of business because they won't be able to compete with the overhead of executive and marketing costs or end up being TPAs for the government systems.

I work for a good guy.

[DailyGrind51]

19. Really, there should be no profit in funding healthcare delivery.

[AllentownJake]

20. I fully agree

However, I don't believe there is the political enviroment to implement that system in 2008.

If you try it you may end up with another 1994 and than we won't try any reform for another 14 years.

[OHdem10]

2. The only way Health Care Reform can work is to get the Insurance

Cos out of the way. However, which company was Congress more than
willing to prop up and save.---AIG (Insurance).

Insurance Companies have always stood in the way of genuine Health
Care reform. I do not see much change.

[Thrill]

5. Don't foget to send it to Change.gov

[demodonkey]

6. How about if we just cut the crap and take care of sick people. Period.

Screw the "pre-certs", co-pays, prior authorizations, appeals, denials, and tying up courts of law with healthcare issues. Save all this money spent on all this garbage, and use it instead to TAKE CARE OF THE SICK AND DISABLED!

Taking care of the sick, not the CEOs. What a novel idea.

[Fovea]

7. If AIG proves nothing else.

It shows that we are pwned by big money.
We either kill them, or we live under them.

[Democrat 4 Ever]

9. I am the Billing Supervisor of a small practice of one psychiatrist

and six psychologists. A huge amount of my staff's time (two employees) is spent each day getting pre-certs for care. An employee can be on the line for up to one hour for each patient to get the authorizations we need to treat this person. We get disconnected, bounced from person to person, we get one person who will verify they have insurance then we have to go to another number to get the authorization for mental health benefits (a lot don't). We then get sent somewhere else to find out co-pays, deductibles met, etc. It is a full time job for one employee. We get every patient pre-approved and yet we have claims denied as non-necessary treatment, file appeals and finally get paid after months of haggling. And don't get me started on the pathetic fee schedules by each insurance company.

Not all companies are this hard but most are all because mental health treatment is the stepchild of the insurance community. The parity bill that just passed Congress hopefully will make things much easier but we are afraid that instead of making mental health claims easier they will just make all medical claims harder. My understanding of the new law is as long as there is parity between the different medical services covered the insurance companies are in compliance. Hence, make it harder for everyone to get treatment, not just those needing mental health services and the insurance companies are good to go. Hope I'm wrong.

But pre-certs aren't the answer - just another delay in getting people treated. IMHO

[AllentownJake]

12. My opinion on Pre-Certs

If there isn't a universal health care and we still have a payment based for services Pre-Certs help combat fraud, waste and abuse as long as they are done efficiently and are not used as a way to combat paying for legitemate services.

I also have had some fraud background and there is a huge amount of insurance fraud taking place by providers. Most providers are good but the few that are bad really cost the consumer alot of money and in the case of medicare and medicaid the taxpayer.

I believe that by taking the pre-certification out of the hands of the insurance companies and into a third party that is independent it would speed up the process.

[AllentownJake]

10. AIG is an entirely different issue

I've worked in the Insurance industry for 10 years. AIG marketed an insurance product without having reserves for it and without calling it an insurance product. It was legal due to poor regulation.

AIG has very little to do with the Healthcare debate. AIG is primarily a Life, Annuity, Property, and has very limited Health Insurance programs.

[Mojorabbit]

11. How about letting the docs

decide how best to treat their patients like they used to..

[AllentownJake]

14. Fraud

I've worked on that side...as long as we have a fee for service system there will be docs and other providers (pharmacist, DME providers, imaging centers) that take companies and the taxpayers to the cleaners.

[Mojorabbit]

16. My husband is a family physician

and has never committed fraud. It irks him to no end to have bean counters decide how he will treat his patients. Better to do spot reviews on the payors end after the fact then waste so much time and money having people second quess a docs treatment plan.

[AllentownJake]

17. That's great

However, as a bean counter, I've seen the bad guys and Pre-certs help to combat them and they are more numerous than you'd believe.

It's cheaper to do pre-certs on procedures that are likley to be fraudulent than it is to do annual audits of every provider...plus some providers keep absolutley horrible records. This forces them to keep better records.

[HelenWheels]

18. Daschle no help

We will never get the insurance companies out of health care with Daschle as head of HSS. He is too lobby friendly.