Tag: multi-payer system

How Much Are We Paying For a Choice of Insurers?

A number of years ago, a family doc friend of mine took me on a tour of his small group practice.   He proudly showed me the exam rooms, his medical equipment, and other parts of the facility that related to patient care.  Then we came to a large room with a bunch of desks piled high with paper.  He explained, bitterly, that this part of his office was for the people he had to keep on the payroll to do nothing but deal with insurers.  This administrative expense was cutting his margins to the bone and did not help him take better care of his patients.  He eventually left practice, to pursue a second career as a physician executive – a job that was, for him, more remunerative and more satisfying.

Part of the problem is that physicians in the US have to deal with multiple health plans – each with its own set of managed care rules, formularies (or list of approved drugs), requirements for prior authorization, rules for billing, submission of claims, and adjudication.  Until recently, almost all of this administrative work was done by phone or fax.  Picture this:  rooms full of practice-based nurses talking to insurance company nurses about the details of a case that may or may not lead to payment for medical care.

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