Several major health insurance carriers got a surprise this week when the AMA released a report card that rates the insurers from a doctor’s point of view. Included in the ratings are Aetna, Anthem Blue Cross Blue Shield, Cigna, Coventry, Health Net, Humana, United Healthcare, and Medicare. In the individual health insurance market in Colorado, we deal extensively with Aetna, Anthem Blue Cross Blue Shield, Humana, and United Healthcare, so I was especially curious to see how those carriers rated.
When I saw the report card, the first thing that stood out for me was how well Medicare did. I know that their reimbursement rates are much lower than private health insurance companies, but at least they do what they say they will. 98% of their claims were paid at the contracted rate – the next closest was Coventry with 87%, and United Healthcare only paid according to the contracted rate schedule 62% of the time. So at least with Medicare, doctors know what they’re going to get. In the transparency and accuracy categories, Medicare was by far the best insurer. To me, these are the categories that matter most. Denials might not be the fault of the insurer – perhaps the patient went in for a service that’s not covered by their policy (as is the case for nearly 60% of United Healthcare’s denials), or maybe the physician made a billing error. These are things that are out of the insurer’s control to a large extent. But every health insurance company should be making allowable amounts readily available to physicians, and should be honoring the contracted amounts when claims are being paid. Otherwise, what’s the point of having a contracted amount in the first place? We’re big fans of transparency in health care, and we know what a drag it is to be thwarted in your efforts to obtain accurate billing information. So while the opponents of a universal health care system love to bash Medicare, it looks like a national system for all Americans based on the Medicare model would at least be a lot more transparent than the system we currently have. Doctors might get paid less overall, but they wouldn’t have to spend so much time dealing with several different insurance billing systems, or wonder how much they are going to get paid for a particular service.
Another thing that caught my attention was the number of denial codes that simply had to do with incomplete claim forms. Things like missing or incomplete patient, treatment, or provider information. How is this happening in the age of electronic medical records and Web 2.0? I remember when we used to use paper applications with our clients. We would have to proofread the apps before we submitted them to the health insurance companies, but every once in a while something would get through with missing information. In general it was a slow and error-prone process. But several years ago insurance carriers started making applications available online, and removed nearly all of the human error issues. The online applications don’t allow you to move forward if information is missing, and since everything is typed, nobody has to decipher someone else’s handwriting.
If health insurance billing could be set up with a universal computer-run system, used by all physicians and all health insurance carriers, the denials because of errors would surely decline. As it is now, every company has their own billing system (and based on the report card it looks like some of them even have proprietary codes) and doctors have to submit claims in a different way for each insurance company. Think how easy, transparent, and time-saving it would be if they were all on the same, simple system. But with our profit-driven, private health insurance system, a change like this would have to be pushed through from the doctor’s side, because it’s unlikely that the health insurance carriers are going to want to work together to develop a universal billing system. But it sure does make a good case for a government-run universal health care system.
