Insurance providers, including Medicare and Medicaid, are pushing more and more of the cost of services onto the consumer. People across the country are experiencing higher premiums, higher deductibles, higher co-pays, and less overall coverage. Hospitals are stuck in the middle, trying to provide quality services for patients while fighting for proper reimbursements on the other end. Meanwhile, Medicare and Medicaid actually reimburse less than the cost of the services provided, so healthcare organizations are losing money on the patient population with the most needs.
Our healthcare system is very different from the simple version from 100 years ago. Back then, all of the services and charges could be listed on a piece of paper and patients paid before they left. By the 1990s, patients bills were almost always sent to insurance before any money was requested, and hospitals and patients knew how much they could rely on insurance to cover.
Today, the entire system is so much more complex that hospitals have no idea how much insurance will reimbursement, when they will be reimbursed, or if it will happen at all. In many cases, good claims are rejected outright, hoping the hospital doesn't have time to resubmit the claim before the deadline. At the end of the day, insurance providers do not make money by reimbursing for claims; they make money by not reimbursing claims. Increasingly, insurance providers are working hard to avoid losing money, which leaves hospitals with large bills that patients cannot afford to pay.
Mario Burnette, Perry's Business Office Director, and Zac Heward, Perry's Business Office Coordinator, joined the Pulse to share their experience with the complicated process on our latest episode.