BY: Rodger A. Bayne
President, Benefit Indemnity Corporation
Phone: 443-275-7412
Email: rodger.bayne@benefitindemnity.co
Achieving efficiency in an ecosystem absent of standards presents an insurmountable task. When each provider charges what they will but charges each patient according to the rules of responsible party paying on behalf of each patient's health plan or absence thereof, we find only chaos. This chaos costs us hundreds of billions of dollars each year in bloated administrative waste and continued financial abuse of the system. According to the JAMA, this number is estimated to reflect "...$760 billion to $935 billion, of the $3.6 trillion the US spends on health care annually" ... "is potentially wasteful."
Consider the contributing factors to this waste:
- Absence of health care pricing standards -- This means we have to navigate an infinite number of pricing schemes which may vary by provider, location, patient, health plan, provider network, carrier, care setting, and more.
- Absence of health plan payment standards -- This means that we are subject to another potentially infinite set of combinations of reimbursements which may vary by patient, location, setting, health plan selection, carrier or provider network, utilization review and pre-certification, provider, setting of care, and more.
- This infinite set of scenarios, now must be placed alongside the above infinite set of scenarios and must be reconciled in a way to resolve the cost to the patient and to the health plan, and the reimbursement to the provider in relation to patient share and health plan share of the expense or reimbursement.
- Adding to these costs, is the extensive and costly network of vendors associated with these processes and charges, and you'll see that we have fees for utilization review and Pre-certification, PPO re-pricing, Data exchanges (IT), cost containment, wrap networks, audits, apps, value-based pricing vendors, independent claim review, and more.
- Consumerism is made to be impossible -- Not only is it unreasonable to expect the everyday routine health care consumer to be able to understand and navigate this labyrinth; it is rather made impossible by hidden fee schedules, reimbursement schedules, and general ignorance. Many if not most provider offices can't tell you what a service or procedure will cost. And the some that try will do so while qualifying their answer to insurance, plan, network or other variable considerations.
- Imagine the accounting -- Each and every health care provider needs to manage their billing, accounting and receivables in a way that manages to navigate and control these infinitely variable reimbursement scenarios. And this, only after the insurance companies, and patients find their way through the maze to a final bill or responsibility.
We could go on and on here, but I ask you simply to consider:
- In this zipcode,
- Procedure "X" has a standard price of "THIS Much",
- Your Insurance will pay "THIS much -- minus your copay"
- This selected doctor/facility will charge "That Much" so you'll pay the difference between "THIS much and THAT much" if you so choose to see this doctor/facility (hopefully based upon some true value proposition.)
Save billions on PPO fees, save billions on accounting, save billions on staffing, save billions upon billions of dollars while enhancing the consumers' true ability to be a health care consumer rather than a health care victim.
 | Rodger A. Bayne President, Benefit Indemnity Corporation Phone: 443-275-7412 Email: rodger.bayne@benefitindemnity.co |
