Wednesday, August 15, 2001
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Wednesday, August 15, 2001 |
| When insurance
won't pay, who do we see about that?
I just finished reading Dr. Günther Rückl's commentary on the health care system in America. I have to agree with Dr. Rückl. I wanted to add to his commentary. My issues with health care is the control that the insurance carriers have over the health care systems. I deal daily in pediatrics at a major university hospital system. I cannot list all of the issues I deal with daily related to nonpayment of services. These denials are from the major health insurance companies: BCBS, Aetna, Cigna, Kaiser, Prucare and numerous other carriers. I am upset. If you are not riding the system via Medicaid, Social Security or Peachcare, your doctor bills are not being paid. My middle-income families are struggling to buy formula for their children that must have it to live. The insurance companies are getting away with charging employers large sums for coverage for their workers. Patients pay their monthly part and then an office co-payment. The patient assumes that the doctor will be paid. The health care providers are not receiving reimbursement and are forced to charge the patient or, even worse, write off the charges. An example of a typical lab charge is $185 for a basic blood workup. Payment from the major companies is $25 total. That is its! I understand the concept of lab charges being too high, but to only reimburse $25, the glass tubes and the salary of the lab worker taking the blood is the only fee covered. We will not even mention the possibility of sending blood-work out for a specialized test. People in America expect coverage, and it is not happening. If you are not angry, then you are obviously healthy. Therefore, you do not have a past due bill hovering on a doctor's spreadsheet. The worse case scenario is that the bill is now on your credit report. We as Americans need to wake up. This system is not working. I suggest stronger legislation to force the insurance companies to pay, but our attempts have been useless. We cannot fight lobbyists that are backed by these major insurance carriers. Unfortunately, Dr. Rückl is being attacked because he is not an American. If he were American, would we listen to him? No, I don't think we would because we don't want to admit that America is not perfect. Our health care system is the best in the world. Best doctors, best research and various other aspects are the highest standards in the world. However, if providers do not receive payment for services, we won't be here. Doctors, hospitals and clinics cannot survive without the insurance support that we pay high rates just to say we have coverage. Most people I speak with regarding these issues say, "Get money from the state." Exactly which department would that be? With the nationwide cutbacks in the federal and state health care monies, where are the providers getting this assistance? Yes, I have personal insurance coverage, but I have to fight and scream to have my carrier pay for my basic checkup. So, what happens if I have to go into the hospital? I will be welcomed into the hospital. My insurance carrier will deny my coverage, and I will be billed continuously until I either sue the carrier or the hospital writes the bill off. I am currently in this situation. Wake up, folks: This system is not working. B. L. Jones
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