Monday, September 04, 2006

Is This Waste?


Let's say you are insured through one health insurance company, but for one reason or another (a change of employer; a decision to change plans during "open enrollment", expiration of COBRA eligibility, etc.) switch to another plan. You have commenced treatment for a medical condition with the first plan, which requires that they invest in medical equipment. You buy the equipment, or "rent to buy" over a relatively short period of months, with the insurance company paying the significant majority of its cost.

The new insurer requires that you switch doctors, which means that you also need a new evaluation, perhaps new testing, and at the end of the day a prescription for new medical equipment which is slightly (but significantly) different from that you (and your former insurance company) recently bought.

Or perhaps you're under treatment for a condition which, although generously covered under your former plan, is covered more stingily under your new plan. That may not be immediately apparent - that is, the coverage may look the same on paper, but each insurer interprets the terms of the policy and bounds of medical necessity differently. So instead of getting continuous coverage you spend hours on the phone with the new insurance company, and bounce between doctors who are included in the plan trying to get authorization for treatments they don't normally cover, for doctors who don't participate in the plan but who offer a treatment unavailable from doctors "in the network", or both.

Meanwhile, behind the scenes, there's a mad scramble to try to get medical records transmitted from the old doctors to the new, with an alarming frequency of medical records being somehow lost in transmission. A doctor may apologetically tell you that although he is not certain that the records were transmitted to his clinic, they may have been misplaced, and thus you need to again try to secure copies.

Does all of this count toward the 20% of U.S. health care dollars lost to waste?

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