Practical Way To Cut Medical Costs

There are a lot of reasons for the high cost of medical care in the U.S., many of them having to do with the cost of evolving cures for formerly incurable illnesses, miraculous drug treatments and the fact that people are living longer these days.

We don’t want to suggest potential cures for these kinds of seemingly insoluble problems, but we do have some basic, common sense thoughts which could still save a lot of money while streamlining the medical system.

The idea came to us while we were reading a study by the Weill Cornell Medical College, the University of Toronto and the Medical Group Management Association, which concluded that U.S. physicians and their staffs spend almost four times more time dealing with health insurers and health payers, than do doctors in Canada. This additional administrative time is figured in the fees charged to patients and their insurers.

The study calculated that if U.S. doctors had administrative costs similar to their brethren in Canada, the savings in health dollars to the U.S. would about $27 billion. This might seem like a pittance when compared to the overall health costs in the U.S., but we have to start somewhere and this is an area which does not touch on the quality of treatment. It just makes sense.

Canada has a single payer health system. If we don’t want to have such a system in the U.S., there certainly should be no objection to uniform forms which document services and medical necessity and provide treatment summaries to minimize the administrative burden on the doctor’s office staff. Rather than having to “recreate the wheel” every time an insurer asks for information, the use of standardized formats by all carriers will make it easier for the doctor’s office to comply with the request and to comply in a timely, cost effective manner. Like anything else, when you repeat the same procedures over and over again, you become familiar with them and it becomes easier for you to fill in the information on a familiar form.

Insurance companies should be expected to jointly design a series of reporting forms for U.S. doctors which sets forth the information the insurers need while providing doctors and their staffs with a user-friendly, standard record to complete.

Such standardized forms, devised by the insurance companies themselves, should be used by every health insurer so that once doctors and their staffs become familiar with them, it will take less time and effort to complete them, and to do so correctly the first time.

Why is this important? Because the study found that doctor’s nurses and medical assistants spent more than 20 hours a week per doctor on tasks related to health insurance plans, more than 10 times that spent by the same staff in Canada.

Evaluation of the time spent by senior office administrators and clerical staff told the same story – substantially more time spent in U.S. offices than in Canada. If time is money, and it is, then it is easy to see that administrative waste is eating up a much larger chunk of the medical pie here than it is in Canada.

If health insurers, whose profits are soaring these days, would cooperate and spend the time and effort required to devise standardized reports, it would cut down on the heavy administrative costs doctors pay their staffs (and charge patients for), while streamlining the medical reimbursement system.

Such a move should save appreciable money and maybe a few bucks would fall off the table for patients. What a concept!

 

 

Do It While You Think Of It

 Whenevcr we think about writing a blog on life, health or long term care insurance, we think about how many policies may be lapsing at that very moment because the policyholder has the beginnings of some cognitive disorder which affects the ability to remember to pay premiums.

One would think that an insurance company which deals with older persons would be aware of the fact that advancing age sometimes brings on Alzheimers or some other functional disorder that affects a person’s ability to take care of their business. If the insurer were a friend, or even neutral, one would expect that the insurer would make inquiry about the failure to pay premiums before canceling a long term care or life policy.

However, the insurer is anything but a neutral, vis-à-vis the policyholder, and is plainly and simply, an adversary. So, when it comes time to pay premiums on the policy, the insurance company gains nothing by spending a lot of time and money trying to ascertain why the insured has stopped paying the premium after many years of payment. After all, if the company cancels the policy for nonpayment of premium it has the best of both worlds – it keeps the premiums it has and sheds the obligation of ever paying money out. What could be better?

That’s why every state should have a law requiring the insurance company to follow a specified procedure to try to make certain that the policyholder hasn’t defaulted because of cognitive failure. This procedure might involve absolutely requiring a check of Social Security’s
Master List of Deaths to see if the person has died. If the person has not, further inquiry requirements should be set forth before the policy could be legally canceled.
As an example of making a start on the problem, New Jersey has a statute, N.J.S.A. 17:29C-1-2, requiring that every senior citizen (a person over 62) be permitted to designate a third party who shall receive notices of cancellation, nonrenewal or conditional renewal before those policy changes can be effective. Although this statute doesn’t shut the door on cognitive policy loss, it should help to cut these losses.

But, let’s be real. No matter what the requirements of the law, insurance companies will do the minimum required to meet the law and that may not be enough. There will be nobody at the company working on the insured’s behalf when it decides to cancel the policy.

Every policyholder should protect against losing his or her insurance coverage because of a lapse caused by cognitive dysfunction, by making certain immediately that their policy requires at least a 30-day notice, not only to the owner, but to a close relative or friend, of the insurer’s right to cancel or substantially alter the terms of the policy.

In this way, a policyholder will have someone in his or her corner when the company decides to cancel because of nonpayment of premium or some other reason related to a cognitive failure.

If you are such a policyholder, and while you are thinking of it, just notify the company of the names and addresses of those besides yourself to whom you want notice of cancellation sent, so you will know you are protected if things start to go downhill mentally for you.

After all, when things start to go downhill for you after years of paying premiums, that’s the worst time for you to lose your coverage.

From the insurance company’s point of view, it’s the very best time.