An Insurance System Choked by Red Tape
An astronomical number of Americans lack health insurance. In the frenzy of finding or creating coverage for them, another important issue has been overlooked: the arduous process of accessing healthcare.
I began a new job recently and had to enroll in an insurance plan and choose a new physician. I have a master’s degree in health administration and several years of experience in the healthcare industry, so I figured this shouldn’t be difficult.
First, I had to select a provider from a huge book that simply listed names and addresses and did not include any important information, such as ratings based on performance. How could anyone make an informed choice from such a list? So I spoke with fellow employees and finally decided on a doctor.
After I received my new insurance card, I called the physician’s office to make an appointment for a routine physical so that I could be sure to receive a new prescription for my medication before my current supply ran out. After making the appointment, the secretary said, “You don’t have the HMO, do you?” When I explained that I did, she politely noted that the physician no longer accepted patients with the HMO coverage.
I called my insurance company and asked the representative if he could tell me which physicians on the list accepted the HMO so I would not have to waste my time again. He said that he could not tell me because “if the physicians don’t tell us they aren’t accepting patients, then we don’t know.” He suggested I go to the company website for the most current listings.
I spent about an hour on the website trying to get the appropriate list to come up. When I dialed the number for the first physician I had chosen, I was greeted by an answering machine and left a message. I then called a second office and was placed on hold for what seemed like an eternity. The receptionist told me that the doctor did accept my HMO but I could not have an appointment for six weeks -- at which point I would be out of the medication I need. I explained my situation and was transferred to another person, who said I would have to see a different doctor in the group. After being placed on hold several more times, my appointment was finally confirmed for two weeks later. If a person like me has such trouble, how could an uneducated person or a person less familiar with the current healthcare infrastructure possibly navigate the system?
How can access to physicians continue to be so difficult in this day and age? The Joint Commission of Accreditation for Healthcare Organizations has repeatedly reminded the industry that access is crucial for effective and timely care. With limited access, continuity of care can easily be disrupted, and people are often in much later stages of disease by the time they can be seen and treated. This puts an even bigger burden on the already strained healthcare system.
Perhaps one of the most worrisome issues I pondered was how physicians can be so unethical. How can physicians accept regular, preset payments for each patient on the premise that they will treat the patient and then not be willing to see the patient? Essentially, this is a violation of the basic agreement made between the physicians and the insurance companies.
Although it is apparent that physicians are often being forced to increase revenue in any way they can because of low reimbursements, it is outrageous that the people we trust to care for our lives are allowed to act so dishonorably. By the same token, how can healthcare insurance companies accept this and ignore it?
We often hear of insurance companies cutting costs in ways that directly affect patient care. Perhaps such companies should consider how much money and time they and their insured could save if they had up-to-date information regarding their services and the people providing them. These companies also would probably save money if their patients weren’t bogged down in red tape and could see physicians early, rather than having to wait until their illnesses progress and become more costly.
It is time that healthcare insurance companies and physicians are held accountable and are called on to revamp their systems so that the public can use the services it pays for.
It is important to continue to work toward decreasing the number of the uninsured, but it is also important that we work to make sure the healthcare insurance programs we are so desperately trying to expand are effective and will allow for adequate access to healthcare.
