Single payment by insurance

| Comments (4) | Misc
Like many employed Americans, I have had the dubious pleasure of experiencing a variety of health insurance plans over the years (whatever my employer thought was most attractive at the time.) I generally go for the PPO, and of course there's the usual thing where the insurance company only pays for a portion of your visit due to co-pay, partial coverage etc. My doctor doesn't take payment at the time of visit so a month or so after after you've seen them and gotten your prescription for 30 800mg tabs of ibuprofen you get a bill for $20 or whatever. Actually, you get two things: (1) a statement from {Blue Cross, Blue Shield, Aetna} explaining that your doctor billed them for $190, they paid $170, and your share is $20 and (2) a bill from your doctor for $20. And then of course I go to pick up my vitamin I and pay Safeway Pharmacy $10 (because it's generic) and AetnaCrossShield pays them $20 or whatever.

My question about this is why. Not why there's a co-pay, I understand about moral hazard, incentive alignment, etc. My question is why I'm getting two pieces of paper and why my doctor is getting two checks. It seems like it would be a lot easier if AetnaCrossShield just paid all the bills in full, then consolidated all the co-pays or whatever in the month, and sent me a single bill. That would be a lot more convenient for me, and certainly would be for the providers. That's doubly true if your employer does the high deductible plan/HSA thing, since you end up doing a lot of your payments out of the HSA. It would be a lot more convenient (again, for me) for the insurance company to just bill the HSA directly (perhaps billing me for any overage) than for me to have to dig out my HSA credit card every time I want anything.

The best answer I have is that the insurance company wants me to directly experience some annoyance every time I go for service as part of their general co-pay service deterrence strategy. It's not really working in my case, though, since I pay out for prescriptions with my credit card, which is easy, and pay my other co-pays weeks to months later, so it doesn't really affect my behavior.

4 Comments

The best answer I have is that the insurance company wants me to directly experience some annoyance

That's your best answer? Really? Why would the insurance company do this? It costs them money to print and ship out those notices. It costs them money to manage those multiple payments. If it was their position - they would do exactly what you advised. But they can't.

The simple fact is that these notifications are largely due to the complicated, cumbersome, and sometimes contradictory federal and state regulations on health care insurance. Some of those regulations were passed with the greatest intentions. Others - not so much. And guess what? Not going to get much better with the new health care regulations.

(works for a health care insurance company)

Well, the reason the insurance company wants people to experience annoyance is precisely the reason they charge co-pays: to disincentivize use of health care. This is the purpose of a fair amount of health insurance company activity.

But you say they cant... So, what regulation exactly prohibits them from fronting the money for my co-pays?

Someone in my family has an employer plan with UnitedHealthcare which has an HRA (Health Reimbursement Account). The insurance pays the copays from that HRA fund.

So, yes, it is possible.

Note that UnitedHealthcare is sometimes just the servicer of an employer-based self insurance plan. In the cases where the employee's company is actually also the "insurance company" much of the desire to annoy the employee/insured fades away. Some irritants go away as a result.

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