L. Whitaker
Aug 8, 2017 · 2 min read

Agreed.

Insurance companies may need to streamline their processes. They should be more vigilant and it is time for a re-haul of procedure and diagnostic coding.

I would also like a serious discussion on a reset on what is the criteria for determining ‘medically necessary’ procedures. The example you gave on a previous response concerning your brother-in-law’s patient is a good example. I suspect that an insurer might decline the second round of tests due to the fact that the tests had been done within the same year and were not ‘medically necessary’. If the claim was denied then the physician’s office would have to submit documentation that would support the decision to have the second round of testing and I suspect that they might, at that point, be reviewed and the charges allowed depending on the urgency of the medical situation. That’s a lot of back and forth and simple ‘grunt’ work that can cause costs to skyrocket just from ‘pushing paper’ around.

I don’t believe throwing the baby out with the bath water — the private insurance companies being the baby — is a good solution and I completely agree that private insurers are much better and more likely to root out fraud than our government.

Let’s face it, if fraud affects your bottom line (and it does) common sense would dictate that you root it out. The government has a notorious reputation for side-eyeing fraud until it reaches epidemic proportions. At that point their standard mo has been to take ‘immediate and extreme’ steps to address the issue that usually entails appointing committees, allotting time, and more money.

The simple fact is taking care of unhealthy people is expensive. Someone has to foot the bill and if the government is involved then they will recoup by higher taxes. Insurance companies will recoup by raising premiums and deductibles. Integrated care is the most attractive, progressive and viable solution at this time.

HSA’s require an effort on the part of the insured to take some responsibility for their health. It sounds cruel but, frankly, if you don’t care enough about your health enough to make as much as an investment in it that you would a vacation or college education then I don’t believe our government should feel compelled to assume that responsibility either.

For the people that are currently living paycheck to paycheck an HSA might not be a possibility, if so, it may be a conversation would need to take place concerning raising the minimum wage…?

There is no perfect solution but there are better steps that can be taken they just need to see the light of day so that Americans have as many options to consider as possible.

    L. Whitaker

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