The Healthcare Exchange: A Distraction from Our Broken System

The launch of the healthcare exchange site was a disaster.  I admit I was surprised it was such a flop.  The dismal start has fueled the fires of the many Republicans to increase the rhetoric against the new healthcare law. A rhetoric that distracts from the fact that our healthcare system is broken and not fixable with Band-Aids.  It needs a complete overhaul.  I know because as a patient advocate and healthcare navigator, I have to deal with the ever-increasing dysfunction of the system.

I have watched as Senator Cruz has yelled and rallied his forces against the new law.  Once again, through all the continuing noise since the onset of the passing of the law, I have heard no viable alternatives.  The only argument I have heard is that the USA has the best system in the world.  Yes, we have good, smart doctors and researchers. However, the system of obtaining the services of these professionals is broken, impossible to navigate and if uninsured, expensive.

One of the many Republican plans is to allow the buying of insurance across state lines.  I have to say it makes me laugh out loud.  It shows me exactly how little understanding of the system there is.  I have clients that have out of state insurance policies and it is an absolute nightmare.  It is difficult to get reimbursement, prior approvals, many doctors are not in network, and often are limited in services.

Here is a common scenario.  The policy is Blue Cross Blue Shield of RI, but the residence is Massachusetts.  The reimbursement policy is that it has to go through the BCBS MA before it gets sent to RI for final determination.  Why? Because the even though both are BCBS, each BCBS is regionally owned and controlled and not by the same organization.  Essentially, it is a franchise.

My experience has been that reimbursements get lost all the time.  It takes hours to track down.  Meanwhile providers and facilities are going to the client for payment at the usual above normal costs.  I am strongly against this as an option because it doesn’t work.

Another problem with out of state policies is, unless there is a doctor’s central credentialing system, where all doctors are certified, it will be impossible for offices to accept so many insurances.   It would take a new law to mandate a central credentialing system in order for insurance companies to accept one standard form.  I just don’t think that is going to happen.

Another experience with an out of state policy is the plans are so limited.  One plan (and most people don’t read the details) allowed for only doctor visit while in the hospital.  If someone has a complex problem and sees multiple specialties, then only one will be paid for.  It should be illegal.  How can Department of Insurances allow these policies to be sold?

As the weeks go on, the problems continue to surface.  People are loosing their policies and left with nothing.  It is still hard to get on the federal website.  Policies are expensive and in some states without much choice.  I am dismayed and sad that this is happening.  I don’t want to go back to insurance companies placing so many limits on care.  Everyone deserves healthcare.  We need this law to work.