First, my bona fides: I worked 15 years in a hospital business office. While I only provided support to those folks who were actually talking with patients, insurance companies, and other third parties, I did pick up on how things are done. My department had over 100 people in it (and that was just for the hospital side; the physician business office had closer to 200 people).
Normally, you’d think of a business office handling things like billing and collecting. But the health care industry is different.
The vast majority of the time, the person receiving the service isn’t the one paying for the service (or at least paying for all of the service). When you go to the hospital, chances are you don’t pay anything up front. After you’re discharged, a claim form is generated by the hospital and sent to your insurance company.
The insurance company looks at the charges, then looks at the contract they have with the hospital. They decide how much they’re going to pay for the services, and then sends the hospital a payment. The guarantor (the person actually responsible for paying the patient’s hospital bill (usually the patient or a spouse or parent)), then gets an Explanation of Benefits from the insurance company that explains what they’ve paid and how much the guarantor is going to have to pay “out of pocket”.
Then the guarantor gets a bill from the hospital for the remaining charges that weren’t covered by insurance.
So, what’s the problem? Where’s the crisis? Notice in all of this I didn’t say anything about the actual care of the patient. I think overall, actual health care in America is the best in the world. So is there a crisis with health care or with health care costs? I contend that while there may be a problem with health care costs, it’s certainly not urgent enough to PASS LEGISLATION RIGHT NOW!
Does health care cost too much? Maybe yes, maybe no. How much is it worth to you to be cured of cancer? How much is it worth to you to live?
They say that at least part of the crisis is that 20 25 30 40 45 million people are uninsured and that something needs to be done to get them insured so they can have access to health care. Well, I was one of those folks who were uninsured at one time.When I needed surgery, I got it. The hospital didn’t refuse to treat me because I couldn’t pay. They ultimately wrote off the costs of the hospital stay to charity.
So it’s false to say that people aren’t getting health care because they can’t pay. The hospital I worked at wrote off a LOT of charges to charity (they do more charity work in Middle Tennessee than the other hospitals).
