Wednesday, July 22, 2009


So, in the attempt to derail health care reform, GOP chairman Michale Steele had this to say,

"You're journalists. You scrutinize this stuff. You mean you're sitting here and telling me that this is not unprecedented? That even you aren't shocked at the degree to which this Administration is bringing the government not just into our lives, but into the very relationship between the doctor and the patient?

Between the patient and his insurance company?

Between the insurance company and the market?

This is unprecedented government intrusion into the private sector. Period."
The relationship between the patient and his insurance company? Really? I mean isn't that like fretting about putting government paid law enforcement between a victim and his mugger?

It brought to mind something discussed here at the Playground about a year and a half ago.

Based on purely anecdotal evidence, it seems to me that an unexpectedly large number of claims are wrongly rejected because of problems with the paperwork, whether its a wrong code, the wrong person listed as the policy holder, a data entry error or any number of other missteps somewhere between the doctors office and the insurance company.

The rejections are often the result of a human error somewhere along the way and if one is diligent in working through the intimidating looking form full of seemingly meaningless numerical codes, the mistake can be found. Then, if you have the time, patience, and sheer force of will to negotiate the phone tree and call back a couple of times until you get someone at the insurance company who will work with you and not merely dismiss you, you can get it sorted out. TheWife has become an expert in negotiating these shark infested waters.
The question was whether the complexity of the health insurance system was being used by health care insurerers to bilk customers out of more money by not paying claims, fully or at all, that they are obligated to pay because virtually no customer could understand what was happening or have the stamina or spare time to get it appropriately resolved.

Is there anyone who has not had this happen to them? In light of that, is it really a good strategy to raise the relation of a patient and his insurance company? Am I mistaken or is that relationship not universally seen as adversarial?