The View From Your Sick Bed

by Patrick Appel

A reader writes:

I'm a chiropractor, in private practice since 1999. Your reader's description of the convoluted insurance authorization process struck a chord for me. It will never be in the insurance companies' best interest to automate this process.

That 11 step approval process doesn't just apply to hospital outpatient procedures; it is also the same method by which all private practice physicians must attempt to verify benefits and coverage for every one of their office visits and procedures. At the end of that 11 step process, the insurance company has one final trump card: that entire process is hypothetical anyway. Without fail there is a disclaimer at the end of every one of these conversations, "Actual benefits may vary. Verification of patient's coverage does not guarantee payment." Can you imagine any other business operating with those uncertain payment conditions?

We are small business owners. We often have 5 or less employees. Verifying coverage and benefits for our patients can take 20 hours or more per week. Another way to think of it: every hour of patient treatment time will require 30 minutes or more interacting with an insurance company.

The current insurance market provides a clear incentive to keep that process as inefficient as possible.