Imagine if you really, really screwed everything up royally at work. Your boss talks to you, and a year later you are still really, really incompetent. You'd be fired, right? Handed a pink-colored sheet of paper, have your health insurance axed and told to get out, huh? Well, apparently health insurance companies don't have to do anything right -- and they still get to keep their rich rewards in the form of multi-billion dollar profits. From The Consumerist blog:
Last June, when the American Medical Association announced its finding that nearly one out of every five health insurance claims had been processed incorrectly, it had probably hoped it was giving the insurance biz a much needed kick in the pants. But one year and another AMA report card later, that statistic remains virtually unchanged.
United HealthCare, home of America's richest CEO, seems to be doing the best (I suppose when you make $111 million/year you can at least yell at your underpaid worker bees to file paper correctly), but Anthem Blue Cross Blue Shield -- owned by extreme-profits corporation WellPoint -- has practically an "F" grade in filing paper:
The company with the best rating for processing claims was UnitedHealth with 90.23% of claims processed accurately. The least accurate company is also the one garnering all the headlines for rate inflation, Anthem Blue Cross Blue Shield only processed 61.05% of its claims accurately.
You know, I totally understand why the most incompetent insurance company would be the one most prone to jacking up rates -- when you have to call the 1-800 number and spend hours on the phone arguing over a $15 co-pay, that's a huge freaking waste of time (for doctor, patient and insurer), and money. Repeat, repeat, repeat, repeat, repeat -- says one board member of the American Medical Association:
A 20 percent error rate among health insurers represents an intolerable level of inefficiency that wastes an estimated $17 billion annually... Health insurers must put more effort into paying claims correctly the first time to save precious health care dollars and reduce unnecessary administrative tasks that take time and resources away from patient care.
Hmmm..."paying claims correctly the first time"? What if there were a perverse incentive in the big-profit health insurance business for companies not to pay them correctly the first time? Just sayin'!
The Chicago Tribune helps out by paging Captain Obvious:
Improving claims processing could save patients money and improve medical care by reducing hassles physicians have when they are forced to haggle with health plans over payments or other issues. The AMA said the report is designed to hold insurance companies accountable.
You know, as much as these statistics represent tremendous pain and suffering for patients, frustration for doctors and probably a significant amount of blood on the hands of insurers, I am sympathetic to their plight.
Operating a for-profit, business-oriented health care non-system must be really, really hard work -- having to handle a claim for every little chunk of medical treatment just like a car insurer handling claims for different repairs to the old Toyota is incredibly tedious, mind-numbing and complicated work. Mistakes are bound to happen. Of course, this is why the rest of the world has simple single-payer (no private insurance companies for basic care), all-payer (all insurance companies pay the same rate for every single treatment) or other highly-regulated forms of financing health care.
What if insurance companies really can't do better than a near failing grade for doing exactly that which they exist to do? What if there's something inherently wrong with the entire model that makes this kind of performance be as "good as it gets" for private health insurance?
Think about it.
And next time some insurance company thug -- like Angela Braly from WellPoint -- claims that we need to "cut medical costs" and become "more efficient," through these statistics in said thug's face.
Is it time yet?
Share your horror stories in the comments. Me suspects there are some anecdotes to back up this data...
Oh, and in case anyone out there cares, Medicare, our government's single-payer program, is on track to reduce billing errors by 50 percent, and their error rate is already 50 percent lower -- at its worst -- than the "best" big-profit, bloodsucking private insurer.
Well, one more thing: the plans called Medicare Advantage that are run by the bloodsuckers actually have much higher error rates...