Saturday, December 20, 2008

All I want for Christmas is a Hysterectomy

The hospitals are busting at their seams right now. The insurance companies business model is in full effect. Health insurers know that people will defer getting elective procedures done until their deductable is met. They also make sure that the deductables follow the calander year because most people take time off in December over the holidays and the hospitals and health providers will try to take time off as well so people will have a hard time getting things done. So, what happens? People generally meet their deductable about the end of November and then want all the medical care and procedures they can before the end of the year so that they don't have to pay another deductable. As a result, there is a huge rush at the hospitals. It seems that "all I want for Christmas" is that hysterectomy that I have been putting off, or hernia, or knee replacement, etc. It is amazing. The OR volume from Thanksgiving to New Years doubles! The hospitals are at limited staff because the staff wants to have time off or their elective surgeries as well! One good thing though, the insurace companies give their staff extra time off during this time of year so that all these elective procedures can not get pre-certified and they can still stick the patients with added expenses.

1 comment:

SeaSpray said...

I get mad when I read these things... how do you all stand it??? I guess it is the status quo with the insurance companies.

I definitely try to get in under the deductible. Unfortunately, I will still have to pay out at some point because I do require scans, etc. and have so many med bills...even with ins! And my doc has graciously opened a slot for me next week but I have a pre-existing appointment and so might get stuck with a January bill. :(

An interesting thing happened in my pCP's office today. No big deal but the way she said it was interesting. As I was checking out to leave, doing the co-pay, etc., the receptionist after looking at her computer screen...very seriously..yet a tad baffled said..."Your insurance pays quickly!" I said, "I know..they have a good turn around time "2 or 3 weeks.", to which she said.."Unless that is a payment from your last visit?" i told her no, because I hadn't been in since August and that they do pay quickly. They also compensate well in the doctor's office.

Anyway...what struck me is the way she said it...that it was almost surreal to her.

I have had this same insurance sine 1989 and so I don't have personal experience with other reimbursement plans.

But I have learned a lot through reading the medblogs.

Anyway... if one company can pay this quickly...why can't they all do that?

And why is it such a cat an mouse game?

Assuming all the info is submitted should just be logical and an automatic response resulting in payment of appropriate funds.