Health care biller, physician lament ‘the system’
Since leaving the Chico Breast Care Center business office last August, Dawn Wright has gotten a broader perspective on health care. She now works for a billing company with clients nationwide; her accounts include two radiology practices in Alaska and one in the Bay Area.
The California fight over 3-D mammography mirrors insurance issues “all over the United States,” she said. “One of the Alaska groups I deal with chooses not to bill for it because they don’t want to deal with the problems.” This sense of resignation echoed in a number of California clinics, Wright added, even after CBCC helped pave the way for a quicker appeals process.
“They didn’t want to have to deal with the patient complaints or the denials or having to submit appeals,” she explained, “which, in all honesty, hinders the whole movement.”
Such deterrents fit into the bigger picture described by Henry Abrons. A retired physician and professor living in Berkeley, Abrons serves on the national board and as president of the California chapter of Physicians for a National Health Program, an organization advocating for single-payer insurance.
“The system is set up to not do a good job of doing the very thing the system exists for in the first place,” he said by phone. “While there is a market in health insurance, there is no market in health care services.”
By that, Abrons means “the classic economic definition of how a market operates”: where sides “transact for the sale and purchase of a product, and each party has adequate information for a decision. They can walk away from the sale. That’s a free market.”
Can patients always “walk away”? How often do they know prices and insurance payments before getting a statement?
“Health care is not a commodity like cellphones and cabbage, where if you like the product and can afford it you go to the market and buy it,” Abrons said. “Health care isn’t that way.”