We all have different insurance policies outside of health insurance...car, home owners, etc. When you need to have routine maintenance work done on your car like an oil change, do you have your oil change billed to your car insurance company? The answer is of course a resounding no. We actually go out of our way to avoid “using” our other insurances because we understand that every time we use it, we will have to pay higher premium next year, and just so it sinks in, for several next years!
So why do we think that using health insurance product should be any different? And in most instances, if you have car or home work done, you submit the bill to your insurance company for reimbursement--this allows you to make sure that the work being done is best (an intersection of cost and quality) possible. Of course there are instances where businesses are following the practice of medical offices….to create a sense of ease and peace of mind, medical offices started to bill the insurance company directly on behalf of the patient, and so started the slippery slope. Once the patient didn’t know/care about the amount being billed, insurance company started to create regulations and requirements to get paid and the whole thing has snowballed into the current mess of price opaqueness and unnecessary documentation. We would have been better off if the medical practice gave you a bill so you paid and knew exactly what you were being billed for your visit, and then you submitted it to insurance company; and when your insurance company was going to give you a hard time about getting the money--you know how they make your doctor’s office run around for the money, the insurance company would have known that since you are their direct client, you may potentially leave them and thus may have created a better incentive for customer retention.
Regardless, we have walked down this path too far and the only way to gain some control is to control the money. So doctor offices need to start being paid from their customer (the patient) at the time of visit, not inflated costs but true costs which is what they are collecting even now minus all the hassle and delay in payments. You as the patient should have transparency and control over what you are going to pay for your care, and the right to obtain care where and when you need it.
In our next blog, we will explore a group which is also responsible for this mess, and has been in a Stockholm syndrome type relationship with the insurance carriers for far too long...you guessed it...the employers!!
Dr. Arshad is a practicing physician with extensive administrative experience, who has firsthand knowledge of running a medical practice and working in employed models. WoW Health aligns incentives for the healthcare ecosystem so all stakeholders benefit from transparent and direct relationship between patients and medical service providers.