Access to Care and Transportation
The list of problems with the American health care system is long and complicated. Access to care is defined as being able to see a provider for the care needed. That does not mean that it is the patient’s preferred provider who may not be in network. It may be a network provider. It is linked to transportation in the sense that if they can’t get to the provider, they don’t have access to care be it their provider of choice or not. Insurance company networks limit the providers the patients can see. A shortage of specialists in an area makes it difficult to see those specialists when they live hours away even if the patient drives.
Networks have allowed the insurance companies to sell their services by having a large network of desired providers. Most networks have a limit on the number and type of providers that can participate. This makes it difficult for those finishing their residency and starting practice to get onto networks. The graduating residents have been taught the most recent techniques in their respective fields. By locking them out, we deny the American people the best care that is available.
Credentialing is done by the health care insurance companies. It is a time-consuming process that is done at different lengths of time for each insurance company. When I first went into practice, I applied to the insurance companies to be a provider so that I could bill them for services that I rendered to patients that had their insurance. That process involved a statement typed on my letterhead that I wanted to be able to bill them for services I provided to their patients. At that time, the patients paid my fee, and I would submit my bill to the insurance company. The insurance company would then reimburse the patient. Attached to the letter I attached a copy of my license, my residency certificate and my malpractice cover sheet. That was it. Now the applications run from 12 to 16 pages plus the copies already mentioned as well as board certification certificate. All of this is because the insurance companies have networks and are responsible for the doctors in their network. This is a very time-consuming process for both the insurance company and the providers. The credentialing process is not just once to get on the panel. It must be done every couple of years for most insurance companies.
By eliminating networks, you help solve the access to care problem and cut down on the administrative burden at both ends. The insurance company pays providers by CPT-4 code. The reimbursement varies by the geographic area. If there were no networks, then the patient is responsible for their choice of providers and not the insurance company. In most cases, if not all, being able to select the provider themselves is preferred by the patients. It would also be one facet to reintroducing competition back into health care as the patient would be aware of the fee structure of the provider they select and what their cost would be.
To help end the confusion with reimbursement, it makes the most sense that the insurance company reimburse the same fee per geographic area for a CPT-4 code, regardless of who provides that care. After all, the risk, the amount of work performed, and the documentation doesn’t change by the provider’s degree so why should the reimbursement?
Considering full transparency in billing which is presently in front of Congress, providers’ fees and insurance companies’ reimbursement rates should be posted on their websites. This would encourage competition and bring down the cost of health care too. In this way, the patient can look up the doctor’s fee and the insurance company’s reimbursement for let’s say an initial visit. By knowing that, the patient would know exactly what their responsibility to the provider would be if any. The doctor can choose to accept assignment from the insurance company, so the patient doesn’t have to put the money out up front. The provider would know what the patient’s responsibility is at the time of the service provided and would collect that amount. This would cut down on the administrative burden of billing patients after the fact.