For every two doctors in the US, there is one health insurance employee - over 470,000 in the U.S. - and you wonder why your insurance premiums keep going up?
If you take a minute to think what your interaction is like with your health insurance, you can easily understand why companies like Blue Cross Blue Shield have so many employees. When was the last time your doctor could order an MRI without having to get an official “OK” from an insurance company employee? When did you pick up your brand name medication at the pharmacy without it being denied by insurance the first time? How long did it take you to get through to the right “department” when you called to ask about coverage?
The red tape and multiple layers are there for a reason - to decrease utilization and lower costs. If doctors were able to use their clinical judgement and order your knee MRI because your injury requires it, then insurance companies would have to pay for every MRI that was ordered. By denying them the first time, many doctor’s offices are likely to say it isn’t covered and send you back to the drawing board. This means, your busy doctor doesn’t have time to work on the authorization, leaving you without the test he thought you needed. Who wins? It’s not the patient and I don’t think it’s the doctor. It’s the insurance company who successfully saved $1000s on the price of that MRI.
When the doctor does decide to call and try to get through to do an authorization, he waits on the phone for 20-30 minutes most times being sent from one “department” to another. Why? That same red tape decreases his chances of actually having time to complete it. Which in turn decreases his ability to get you the test HE has decided you need!
The administrative costs of healthcare in the United States are nearly $200 billion. Imagine if all insurances operated like healthshares - low staff, low administrative costs, your money goes from you to the patient on the other side in your co-op who needs those dollars to pay his medical bill. Simple. We could cut the wasted spending toward all those insurance employees and use it for medical and healthcare (and even wellness and prevention!). If you’re sick of your dollars being lost in the healthcare abys, consider paying your doctor directly. At Direct Doctors, patients pay an affordable monthly fee to get primary care when and where they need. If they need an authorization for a test, we have time to jump through the hoops! To find out how we practice primary care differently, check us out at www.directdoctors.org.
Lauren Hedde, DO and Mark Turshen, MD are Family Physicians and Founders of Direct Doctors, Inc. a Direct Primary Care Practice.