An interesting study before health reform
Since our foundation was having so much contact with so many uninsured Americans, Stanford and The Wharton Business School were interested in doing a study on the impact of our site on the uninsured. They simply wanted to take 5k uninsured who knew about us and 5k who didn't and see how many actually got signed up. Our advisory board thought it was a good idea, but like any good litigator we should have an idea of the answer before we ask the question. So we asked a prominent hospital system if they would ask all of the folks coming into the emergency room uninsured the eligibility quiz to discover who should have been liable for the bills experienced by the patient. Over two months the hospitals asked over 4000 uninsured patients. The results were astounding. 99% were eligible for either a private program or a highly subsidized State or Federal program. 75% were eligible for a State program that would be free or highly subsidized. About 22% were eligible for MediCal which is California's Medicaid program.
What most people do not know is that the hospital and doctors are eligible to collect payment if they can show that at the time of service the patient was eligible for MediCal they can collect retroactively. It used to be acceptable for the provider to collect up to one year after the service. This gave them time to work through the system. As the budget got tighter and tighter they lowered the time from 1 year to six months and now 90 days. So while they are supposed to be able to collect, if the bureaucratic delay is greater than 90 days there is no payment. In almost all cases the delay was greater than 90 days so it has become impossible for the servicers to collect from MediCal. They simply treat and release the non-admitted patients, and try as hard as they can to collect on the patients who are admitted, but it is terribly difficult. In the next chapter find out how the service was when we called MediCal 50 times over two weeks during working hours.
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Re: An interesting study before health reform
I think Kafka wrote a story about this: you're entitled to repayment within 90 days, but the bureaucracy (which gets larger every year) ensures that the process takes 90+ days.
This seems to suggest that a huge part of our health insurance problems are paperwork in nature, the result of a sclerotic bureaucracy.
Thank God Obamacare is going to sort that out!