By Yaël Ossowski | Pittsburgh Post-Gazette
It is an unfortunate fact that most everyone has a health care insurance horror story.
In our overly complex and convoluted health care system, even routine checkups and minor appointments sometimes snowball into bureaucratic exercises of patience and will. While we thought health insurance would solve these issues, for some it has been made worse.
Whether at the primary care doctor, the dentist or the eye doctor, our reliance on insurance means that a simple transaction between patient and provider can often become complicated. For those without stellar plans, they must pay for care, then submit a claim to the insurer, negotiate the costs, wait for reimbursement and forward that payment to the provider. And that’s assuming the insurance company accepts the claim.
And while reform has been attempted at all levels of government, however well-intended, these have often served to further complicate the issues that come with being a patient in the American health care system, all the while giving more power to insurers.
At least one measure of progress can be found in a bill being pushed through the Pennsylvania Senate that would radically simplify the insurance process for dental patients.
State Sen. Judy Ward, R-Blair, and others have introduced a bill, SB850, that would enact what is known as assignment of benefits reform, requiring insurers to follow enrolled patients’ requests that the insurer directly pay a patient’s health care provider. There would be no additional forms, no additional waiting, and it would simplify the process so that patients could focus on getting what they need, rather than chasing an insurance claim.
This sounds intuitive, but at present, many dental insurance reimbursements must be vetted by the insurance company and then routed to the patients to pay their dentists. Not to mention any clauses found in insurance contracts that add additional steps.
If we were to simplify this process and empower patients, it would do wonders to improve care in this state — and perhaps free up at least one part of our health care system.
Critics of these reforms say they would put pressure on insurers, who would need to simplify and quickly pay health practitioners when patients tell them.
But conceding that point would mean allowing health insurers — who already have a dominant role in the health care industry — to complicate the process of reimbursing patients and providers with burdensome clauses and exemptions in their contracts.
After the Affordable Care Act and several Medicare reforms, assignment of benefits is a standard practice in general health care but so far does not exist across all medical categories. Passing this bill and getting it to Gov. Tom Wolf’s desk would be a strong measure of support for consumers and patients.
Of course, this level of legislation is far from the large-scale reform needed. An eventual decoupling of insurance from dental and primary care for a more direct-to-consumer model altogether would be a radical way to improve our system, but this bill is a step in the right direction.
These laws have already been passed in states such as South Dakota, Colorado and West Virginia and are trending across the country, but more will be needed.
Indeed, there are plenty of easy reforms state legislatures could enact that would help improve care: fostering innovation, reducing bureaucracy, giving incentives to patients to use direct-to-consumer options and more.
Tax-saving accounts for education have been widely successful, and we could do more with health savings accounts even at a state level. Here, there is a role for government.
If we can continue to promote competition and transparency to provide better care, then patients and consumers will benefit. There are many patients and consumers with great plans that serve their needs. Nevertheless, there are still millions of Americans who want a better process.
Let us hope the Legislature understands this key point and helps make our health care easier, more affordable and pain-free.
Yaël Ossowski is deputy director at the Consumer Choice Center, an international consumer advocacy group.
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