By: Mick Raich, President, RCM Consulting
It’s 1982 all over again!
Recently, the Biden Administration offered up a plan to have commercial insurance plans pay for at-home COVID tests. This is a radical idea of realism from our government. The concept is simple: you get an at-home COVID test, pay for it, take the test, and then send in the cost to your insurance plan for reimbursement. This is exactly what healthcare used to be.
Before HMOs and managed care, the patient was responsible for getting the insurance plan to pay for the cost of treatment and the patient then sent the payment to the provider. Well, there is one major flaw with this plan. It seems insurance plans do not like to send denials to their end users. If this happens, patients will complain to their employers about the insurance and then change would have to take place.
You see, it is much easier to deny the claim from a provider so the patient never has to see the drama of medical billing. The current process allows payers to deny claims after the provider has committed cost into the healing process.
This will never pass as a mandate or a bill as the insurance industry won’t let this type of control of their denial process be held by the patient.