For Her Head Cold, Insurer Coughed Up $25,865

If you think the health care cost problem is insurance, think again. The political rhetoric is misplaced and yet we freely criticize health insurance for questioning what they are asked to pay🤔

Then the bill came. Patient: Alexa Kasdan, 40, a public policy consultant in New York City, insured by Blue Cross and Blue Shield of Minnesota through her partner’s employer. Total Bill: $28,395.50 for an out-of-network throat swab. Her insurer cut a check for $25,865.24.

Source: For Her Head Cold, Insurer Coughed Up $25,865 | Kaiser Health News

8 comments

  1. Wow, Mr. Quinn! You actually “managed a group of 40,000 lives”?? Why, you’re almost a Deity!

    Okay, so now that you’ve insulted my intelligence as well as my own experience with that claim, and I’ve returned with an insult, shall we proceed with an intelligent discussion? Or would you prefer I just comment elsewhere?

    Your Blog – your call.

    And I’ll respect your call.

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      1. I’m afraid that anyone asserting that they “managed a group of 40,000 lives”, insults my intelligence.

        I’ll just write that off to my own over-sensitivity, and be on my way. Be well, Mr. Quinn.

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  2. There’s no arguing that the Health Care PROVIDERS are the origin of this problem, Mr. Quinn.

    But there’s also no arguing that Health Care INSURERS, (as well as some Patients), are also complicit and willing accomplices. Note that, towards the middle of the article, the medical billing attorney (Marting) consulting for this article states:

    “… this is a common problem for insurance companies. Most claims processing is completely automated, she said. ‘There’s never a human set of eyes that look at the bill and decide whether or not it gets paid.’ ”

    I can readily understand why it would be both costly and inefficient to have “human eyes” examine and render judgement on ALL claims. But WHY NOT submit (especially) Out-of-Network claims – as THIS example was – to “human scrutiny”, as a matter-of-course? The answer to that question is also addressed in the article …

    Shortly after that passage, within the sub-heading “Resolution:”, there’s THIS note that it was only ….

    “After a REPORTER started asking questions about the bill, BCBS [Blue Cross Blue Shield] of Minnesota stopped payment on the check it issued and is now investigating.” – [Emphasis and Insert, mine.]

    And just prior to those rather telling passages, there is THIS eminently telling statement : “Insurance companies base premiums on their expenses, and the more those rise the more participants have to pay.”

    In short, the REASON Insurer claims processing is “automated”, and “human eyes” don’t examine Health Care Provider billing, and this sort of exorbitant Health Care Provider bill just gets paid by default, and nothing is either questioned or investigated until a REPORTER starts asking questions, is because Insurers have NO INCENTIVE to either hold down OR even attempt to control Health Care Provider charges! Indeed, the INCENTIVE for Health Insurers is to “just pay the bill” no matter how large or exorbitant – by default! Again, “Insurance companies base premiums on their EXPENSES, and the more those rise the more participants have to pay” – in ever-escalating insurance premiums!

    Health Insurers are not the only “Bad Guys” in this mess, but they sure as dickens aren’t the “Good Guys” either!

    By the way, Kudos to “Bill of the Month”, Kaiser Health News and NPR for bringing this sort of thing to light.

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    1. A couple of points. Insurers do care about costs because they need to keep premiums competitive. Equally important in most cases where employer coverage is involved they act as administrators not insurers even though it appears otherwise. I can assure you employers care very much about what is spent. Finally, insurers do considerable pre-authorization unlike Medicare which is prevented from doing so by law and hence high levels of fraud undetected for years. Ask doctors (and patients) and they complain insurers are too invasive, question too much, deny too much.

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      1. I do take your points, Mr. Quinn. Insurers do have to compete with each other, at least partially on premium cost/price – especially for contracts with large and medium employers. I’ve been an employer myself in the past, albeit with smaller firms, so I’m familiar with the concept.

        However, Insurers don’t compete SOLELY, or even primarily on cost/price. They compete to a far greater degree on the extent and capabilities of their pre-approved “Network” of Health Care Providers. I suspect that, in your former position as HR Director of a major firm, you would reject my bid as a prospective Health Insurer if my pre-approved “Network” consisted only of that 80 year-old Sri Lankan General Practitioner, whose “office/clinic” is the quonset hut in the parking lot of the local tire store – even if my premiums prices were one-third those of my “competitors” for your contract.

        As for whether Insurers are getting an undeserved “bad rap” from doctors/patients/et.al., for being TOO invasive, asking TOO MANY questions, and denying TOO much, you may be right. But this article seems to indicate just the opposite. THIS Insurer wasn’t nearly “invasive” enough, didn’t ask nearly enough questions (until prompted to do so by a REPORTER), and didn’t deny an obviously unjustified, exorbitant bill.
        So, evidently in this case at least, Insurers are often earning the “bad rap” they seem to be getting.

        But I suspect you’re not taking MY point – I don’t consider the Health Insurers the only “Bad Guys” in this mess.
        But there is absolutely no evidence they are in any way the “Good Guys” either!

        They are in no way even INCENTIVIZED, let alone compelled, to reduce Health Care prices/costs.

        The problem in our system is NOT one of Insurers, per se. The problem is one of defective, mal-aligned INCENTIVES for both Insurers and Providers!

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      2. Insurers or as administrators of self-insured plans have the challenge of a managing costs while keeping providers, employers and patients happy. No easy task. In fact, probably impossible because of competing demands. I managed a group of 40,000 lives and when we selected a insurance company the size of the network was a major consideration. But more important was our total cost. We evaluated the actual fees negotiated for the various networks and matched it all to where our employees lived. The point being insurers do have an incentive regarding costs and spending.

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