Healthcare Services: Why is our role as consumer being denied?
ByThe fact is we need to either ask the office manager, the plan administrator, the network provider, or the doctor how much it is for a particular health service. The reason is that prices for healthcare services are not easily accessible. They are difficult to compute, assess and manage. For this reason, we as consumers do not feel empowered to make good decisions with respect to our healthcare. The cards are stacked against us.
In recent times, it has come to light that many hospitals and providers charge special lower rates for services rendered to policy-holders of large insurance companies. Whereas, uninsured patients are charged the highest rates for the same services rendered. In addition, it is practically impossible to track and manage these costs. This is unfair and unjust.
Healthcare is not a transparent industry that caters to consumers. Most other industries that service consumers are focused on market conditions that drive their businesses. This means that promoting their prices is important. Imagine going to a gas station and not knowing how much they were charging for unleaded gasoline! Imagine attending a spa and just not knowing the cost of the services, but also later receiving the final bill that would be impossible to understand and that it would include items and services that you did not feel you received! There are not many businesses that could survive with this strategy.
As consumers, we are very disconnected from the healthcare services and costs that we receive. This is not a good model that entices good consumerism. Due to the fact that we are removed from the process of acting like a consumer, it is then easier to understand why we are not as focused on the costs. Yet, we complain and scream at our rising health insurance premiums. The truth is that it is not entirely our fault. We want to be better consumers, but the system doesn’t work to assist us. It is common practice to keep prices confusing to consumers and not to promote them.
All of us understand that healthcare is complex and includes many, many different goods and services, but it is definitely not as difficult as it is represented. American consumers are smart, intelligent, and able to make decisions with respect to their healthcare while also assessing a provider’s economic value for their goods and services. It is paramount that consumers are brought back into the healthcare model; they will drive up competition and quality service.
Like most of every other industry in the United States, pricing is an important gauge for goods and services. It is not acceptable that the healthcare industry does not provide its prices for goods and services to the users of those goods and services on a more formal and easier basis. As our healthcare industry matures, this will be a reform change that will come to the front of issues being raised.
As more and more health insurance plan designs incorporate consumer risk through high-deductible and health savings accounts, consumers will demand more transparency from their providers. It is only fair; it is only the right thing to do. There is no need to keep prices and costs behind locked doors where only a select group has readable access.
One may ask why government run businesses do not work, and they only need to look at our Medicare and Medicaid programs. In these cases, the consumer again has been removed from the equation therefore there are no checks and balances to guide the ship.
Question and Answer
Healthcare becomes universal then what happens to people like me that work in healthcare?
If healthcare gets revamped will I get CUT IN PAY? I am a X-ray tech. When everybody can afford healthcare, will I loose money?
I am confused if revamping healthcare is bad or good for me. I am for everybody getting great healthcare, but not for a pay cut that I worked hard for!
Rene Luis –
About the Author:
Rene Luis is the Founder of VitalOne Health and has worked in the Health Care and Health Insurance Industry for over 15 years. In 1991 he passed is certified public accounting examination in San Antonio, Texas.
18 Comments
April 18th, 2010 at 10:49 pm
If you are business saavy you may consider being on the administrative side of healthcare. Physicians are required to bill with special codes called CPT-4 codes that describe services that they provide to patients. There are also codes to describe every diagnosis.
In order for the physicians to obtain payment for services these codes must be submitted in a timely fashion to insurance companies and they must be within the scope of usual practices.
Insurance companies also deny payment to the physicians more often than not and they need people to fight for their money.
Administrators allow physicians to concentrate of helping patients without the nagging concern of redtape and paperwork.
There are also budgeting, managerial and operational issues in healthcare offices or other settings that are handled by these professionals.
You may consider obtaining a masters in heatlh administration. Please refer to http://www.ache.org.
April 18th, 2010 at 11:44 pm
1) No. Insurance may be offered through occupation, or you can get a private provider.
2)Depends on how badly I needed it.
3)78. 75 for men, 81 for women. From wiki
4)It has pros and cons. I'd like to see some reform.
5)I'd like to see more employers offer insurance, and private insurance be more affordable. I'd also like to see caps on the cost of healthcare.
6)Somewhat. If it stopped at universal healthcare, I would be okay with that. I'm afraid it may open a door allowing more socialist ideals to enter.
April 18th, 2010 at 11:49 pm
I don’t understant the bill still needs to pass the senate. doesn’t it?
April 19th, 2010 at 12:12 am
Yes, it does. But as everyone will tell you, the dumocrats are going to fall on the oblama sword. Come November, The American People (not illegal aliens) will show them how much we don’t want government run or mandated Health Care.
April 19th, 2010 at 7:34 am
Don't get sick!
April 19th, 2010 at 2:06 am
Congratulations to the American people for still dreaming and fighting to see some of their dreams come true……This man is saying the truth….There is still hope….Greetings from Greece
April 19th, 2010 at 3:29 am
Now the Federal Government has officially joined and legitimatized the fraudulent Ponzi health insurance scheme and the scamming of the American working public,like two mafia families joining forces.Beware celebrating it, for the devil is in the detail while the solution remains in the big picture, yet totally unrecognized.
Amend Medicare to allow anybody to buy in as a voluntary option.
**DURING TIMES OF DECEIT, TELLING THE TRUTH BECOMES A REVOLUTIONARY ACT**
April 19th, 2010 at 10:17 pm
Hospitals carry liability insurance for their nurses. It is unlikely that a nurse will get sued unless she/he does something very deliberate and intentional to harm a patient.
April 20th, 2010 at 7:56 am
empty suit!
April 20th, 2010 at 8:21 am
The Federal Government now has officially joined and legitimatized the fraudulent Ponzi health insurance scheme and the scamming of the American working public, like two mafia families joining forces.Beware celebrating it, for the devil is in the detail while the solution remains in the big picture, yet totally unrecognized.
Amend Medicare to allow anybody to buy in as a voluntary option.
**DURING TIMES OF DECEIT, TELLING THE TRUTH BECOMES A REVOLUTIONARY ACT**
April 20th, 2010 at 4:12 pm
Since the drug companies became privatized, there have been far, far less cures than when it was government controlled. Drug companies only want symptom relievers, since they will be reused over and over, whereas cures are not needed once the problem is gone. No money in cures. Drug companies are more interested in Marketing. Obscene amounts go into marketing. At least thousands if not millions are spent on just pens, clocks, notepads, lunches, clipboards, and a ton of little practically useless stuff they give away for the sole purpose of having the name all around the dr. You should go in a dr's office and just look at the amount of stuff with a drug name on it. That is only a small fraction. The government should really take back the pharmaceutical industry, that would definitely lower regular health insurance prices.
If universal health care is brought in, it doesn't mean you can't get regular health insurance. Considering how very little the health insurances pay out ($0.67 on a $10 charge) I highly doubt that the doctors income would be impacted negatively.
I think universal health care would be a great thing. And this is coming from someone who would probably have to find a new job. You don't see the people who come in who don't have to money to get seen. People who are already sick, dying, and still getting harassed about payments. There are already tons of people who die because they just didn't have the money for a doctor. What is a couple of days wait to that?
6 months is quite far fetched. I was in the military, and the same type of system ran. Health care was FREE and there were no massive wait times.
The only valid complaint that I have heard is that you would not always be able to see the same doctor. Not exactly a big deal.
It could very well be that some doctors could choose to take more regular health insurance patients, and then you could have one of those for your regular doctor.
As atrocious as regular health insurance is, most doctors take most of them. Why? To boost the number of patients. Universal health care could work the same way.
Universal health care will certainly not stop the advancement of medicine. With a little less fear involved, it may even enhance it. Besides, that sounds an awful lot like you want to believe the US is the only place in the world who has helped medicine. Nope.
Would you give up your career to keep universal health care from coming?
That's how strongly I support it.
April 20th, 2010 at 7:41 pm
I am English and now live in California. Like most people I thought that there was a huge tax burden in Britain, but after coming here I now think that's not the case.We pay two forms of tax from our wages:Income tax and National insurance. Your income tax is tax like everywhere else, national insurance pays for your pension and healthcare. I have lived in England all my life up till now and I will fiercely defend our healthcare system, the NHS (national health service). In thanks largely to the effort of our heroic doctors and nurses (and all other staff) the NHS survives….the healthcare is nothing like as bad as people make out, and there are no long waiting lists anymore (now if you're waiting more than six months for routine surgery they'll send you abroad to have it done, paid for of course). No-one pays anything for medical care and the one reason it's under stress (As a healthcare proffesional I know this from experience) is the fact that something built as a national health service is used as a world health service. People come to the UK from all over Europe to take advantage of the NHS and from all over the world. I would like to see treatment restricted to citizens/people who have paid at least 5 years national insurance contributions but at the same time I would never ever want to see anyone, citizen or not, turned away or denied medical care because of money. I'm fortunate enough to be able to afford health insurance in the US but the amount hospitals/doctors charge is disgusting and I don't really understand why people are so opposed to universal health care, can you really put a price on life?
By the way income tax is 20% of anything you earn over about 5 and a half thouse pounds ($11k) and national insurance is 11% of anything you earn over 84pounds a week ($160) And people have the option of private healthcare in england too if they want to pay for it
April 21st, 2010 at 6:01 pm
I am from Canada where medical coverage is free for everyone,regardless of whether you work or not.
April 21st, 2010 at 11:48 am
What the f.. do you know?
Stay in Greece and mind your own business unless you have some knowledge of what is going on.
April 21st, 2010 at 3:01 pm
JESUS would want every American to have health insurance, illness to be treated, sick people not be discriminated against, and not be bankrupt by lack of health care. Thank you JESUS. I LOVE U. PRAISE THE LORD!
April 22nd, 2010 at 1:04 am
An option to consider is traveling overseas for your dental work. I am originally from Los Angeles, but have been living in Monterrey, Mexico for about 2 years now. I have had regular dental visits and am VERY impressed with the quality of the facilities and the doctors. The best part is that dental work is about 50% less expensive here than it is in the U.S! Monterrey, Mexico is just two hours south of Texas, so it is very easy to get to wherever you are. And, you can always combine your visit with a vacation! If this is something that interests you, check out http://www.travelforcare.com a Medical Travel facilitator that will help you with all the details.
April 22nd, 2010 at 2:11 am
First, I doubt that healthcare will become universal.
Second, I see no reason why you as a X-ray technician should lose pay…ompare it to salaries in France & other places where they have universal health care.
April 22nd, 2010 at 7:05 am
Now the Federal Government has officially joined and legitimatized the fraudulent Ponzi health insurance scheme and the scamming of the American working public,like two mafia families joining forces.Beware celebrating it, for the devil is in the detail while the solution remains in the big picture, yet totally unrecognized.
Amend Medicare to allow anybody to buy in as a voluntary option.
**DURING TIMES OF DECEIT, TELLING THE TRUTH BECOMES A REVOLUTIONARY ACT**