Anyone dealing in the convoluted world of medical insurance billing knows how confusing and complicated even the simplest of procedures can be.
Insurance companies rule your medical care rarely based on the needs of the patient or the recommendations of the doctor but rather the costs involved. It’s the least favorite and, not coincidentally, most frustrating part of any medical professional’s practice.
Arizona has the opportunity to reduce sizeable headaches for doctors and patients, and in the process, ensure doctors can continue to provide the proper care.
Some insurance company customers opt to see doctors and other medical professionals outside their coverage network. This can be for a variety of reasons, including comfort with a particular doctor or proximity to a particular specialist. On top of the regular insurance costs, those customers pay a premium to see out-of-network medical professionals.
For most claims, insurance companies pay medical providers directly. Much of the bill, beyond a co-pay, goes to the insurance company, which pays the provider.
That’s the way it normally works. The system allows insurance companies and medical providers to deal with the labyrinth of regulations. Patients rarely see the behind the scenes battles and negotiations.
But out-of-network patients often face a different process. And the current practice is a way for insurance companies to keep more money and make life difficult for patients and doctors.
Under state law, insurance companies are allowed to send payments for medical services to the patients. In turn, they are supposed to remit the payment to the doctor for the services.
However, sometimes patients fail to realize they are supposed to send that money off to the doctor’s office. That can create an adversarial relationship between the doctor and the patient for no good reason.
Worse, sometimes, patients receive the money and send it off to the doctor. Months later, insurance companies come back to their customers demanding the payment be returned. Oftentimes, insurance companies like Blue Cross/Blue Shield, question the medical necessity of the procedure long after it is completed. Now the patient is forced to find hundreds, if not thousands, of dollars out of their own pocket to repay the insurance company. Failure to pay results in a hit to their credit and constant calls from a collections agency.
But there is a solution in the works now. HB2135, sponsored by Rep. Regina Cobb, mandates that any payments for out-of-network medical services must be signed by both the patient and the medical provider. It’s not a perfect solution and it still allows insurance companies to attack their customers by alleging a previously approved medical procedure was not necessary. Both sides have agreed to work with Rep. Cobb to fix this problem without future legislation.
The medical community will be watching insurance companies to ensure a compromise is implemented before moving forward with other legislation in the future. It is time to even the playing field and allow doctors and their patients to focus on important health issues and eliminate the financial worries.
Dr. Eric Church practices in Phoenix and Peoria.