Regardless of your job, your income, or where you live, we’ve all had at least one nightmare scenario when it comes to health insurance.
There are forms, claims, reimbursement requests, schedules, and negotiations. Doctors, dentists, and health practitioners understand the burden, and often have to face their own bureaucratic tests of will before focusing on their patients. The growth of healthcare administration costs emphasizes this. And that’s for people with private plans.
The price inflation that comes with the amping up of health insurance plans in our entire system — not to mention the role of government subsidies — is a well-known phenomenon. Insurance becomes involved in every rudimentary doctor visit or procedure, leading to bad incentives for health providers, employers, and insurance companies. This process involves a middleman in what should essentially be a simple medical contract between patient and practitioner.
The answer, however, is not in abandoning free exchange in healthcare, as Medicare For All proponents would have us believe, but rather it is in reckoning with insurance to make our system more competitive and fair.
In Pennsylvania, one particular bill is addressing the process of making insurance more accountable and lowering patient costs and headaches.
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This session, State Sen. Judy Ward has introduced SB850 that would enact assignment of benefits reform, compelling insurance companies to follow a patient’s wish to directly pay healthcare providers rather than leaving them with the paperwork and negotiation. This would simplify life for patients by requiring insurers to pay providers directly.
One would think this is standard practice, but especially for dental insurance, there are additional steps and vetting that often leave patients responsible for paying their dentists only after the insurance company has paid out the claim.
Though only a small reform, and leagues from where we need to be to have a truly free market in healthcare decoupled from our employers, this bill would make the entire process simpler and better empower patients and consumers.
Since the Affordable Care Act and large Medicare reforms at the federal level, assignment of benefits is recognized in most medical insurance markets, but not yet for dental patients.
These reforms are complicated by the often cumbersome terms of dental insurance contracts: only portions of care or procedures can be covered by insurance, there are caps on the amounts one can reimburse in a single year, and dentists must navigate these steps to accurately bill their patients without producing a shocking bill. This balanced billing approach is necessary for any medical professional who wants to stay in business.
The answer, however, is not in abandoning free exchange in healthcare … but rather it is in reckoning with insurance to make our system more competitive and fair.
But the status quo often makes it more complicated than it otherwise would be.
That is why price transparency remains an important principle for these debates, and why legislators should continue ensuring patients have choice and access to the information they need.
There are dozens of easy reforms state legislatures could follow that would help improve care: fostering innovation, reducing bureaucracy, giving incentives to patients to use direct-to-consumer options, and more.
By continuing to promote competition and transparency, patients and consumers can benefit from better care and lower costs. It is only a small degree of change we need, but it beats the alternative.
Yaël Ossowski is deputy director at the Consumer Choice Center, a global consumer advocacy group.
One thought on “Yaël Ossowski: Reckoning with insurance for better patient choice in healthcare”
In the state I live in (not PA), directly paying providers is limited to contracting providers. This provides an administrative incentive for providers to contract with insurance companies to get paid directly from the insurance company. Contacting with the insurance company provides additional benefits to consumers of negotiated fees and the requirement to only allow for covered services. The more you know, the less this sounds good for the consumer.