In response to the Blue Cross Blue Shield of Michigan CEO’s op-ed regarding the causes of rising health care costs and the need to reform the system, she makes many good points, but ignores some other important causes, mainly insurance providers themselves.
As a health care provider myself, dealing with prior authorizations for drugs and procedures is cumbersome. Prior authorizations, in practice, amount to medical decision making by non-providers.
BCBSM CEO pens op-ed: Health care costs are rising. We need to reform the system.
They add onerous paperwork, consume a lot of the provider’s time and delay care for patients. It should be noted that studies peg the rate of approval of prior authorizations between 83% and 99%, depending upon the specialty and procedure. Prior authorizations consume a lot of resources, frustrate patients and providers, and should be a much simpler process, if it is needed at all. Delays in health care are consistently associated with increased overall costs of care, as demonstrated in multiple analyses.
Pharmacy benefit managers (PBMs) are also not mentioned. The use of PBMs has been shown to increase out-of-pocket expenses for patients who pay deductibles and coinsurance. Personally, I was quoted a price for a medication (with insurance) for a family member that was four times the cash price with no insurance. The pharmacy was the preferred provider, and not coincidentally, my insurance provider owns the PBM that prices the drugs.
It is obvious that health insurance companies are part of the problem of the skyrocketing cost of health care. Reform should include insurance providers, too.
Martin Seta, PA-C
Dearborn
A Blue Cross Blue Shield of Michigan office in Detroit.
As big three health care players point fingers, Americans struggle
Will the health care system blame game ever end?
This is a question I ask myself weekly, as I try to navigate the labyrinth that is the American health care system. The navigation I do on a daily basis is for patients requiring care from their pharmacies. I have worked in many pharmacy settings, and it seems the battle between providers and insurance companies is never-ending. Upon reading the latest opinion piece calling for reform, I couldn’t help but notice the blame being directed at providers and pharmaceutical companies, and the lack of self reflection from insurance companies.
Yes — pharmaceutical costs and healthcare costs in both inpatient and outpatient settings are rising, however, so is insurance costs. Patients are spending large sums of money each year to meet their deductibles and max out-of-pocket, as well as paying monthly premiums or deductions being taken out of their paychecks.
All the while, insurance companies are denying claims, reimbursing at lower rates and taking back payments and expecting the patient to pay out-of-pocket for services their insurance plan claimed was a covered benefit. Yes — there have been providers that have ordered certain services that may not be medically necessary, but why punish the patients? Why not focus on going after the individual providers and practices? Maybe the repercussions need to be stricter in order to deter such practices?
And, of course, there are the costs of these medications, which patients are willing to forgo taking due to being unable to afford them. The three big players — insurance, providers and pharmaceuticals — will point their fingers at one another, all the while the patient suffers. Health care is no longer about providing patients with proper care and has turned into a profit-focused industry.
Alyssa Morrison
Madison Heights
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This article originally appeared on Detroit Free Press: BCBSM missed 1 health care reform prob: Insurance companies | Letters
