Healthcare, Bureaucracy and Process

I have heard people in the healthcare business say that they don’t have a bureaucracy problem.  The dictionary defines bureaucracy as administration characterized by excessive red tape and routine.

Let’s look at an example.

This is a simple process that takes place daily.

  • You go to see your doctor for a check up
  • Your doctor performs the check up
  • The doctor provides a form explaining what they are billing for
  • Their book-keeper determines:
    • The amount billed to insurance
    • The amount billed to the individual
  • The book-keeper sends out bills

The bureaucracy comes in when the book-keeper looks up who gets billed and for how much.

There is a list of things that can be billed for during a check up.  There are things that can be billed only on a separate visit.  Amounts are predetermined.  Deviations are not allowed.

Who decides what can be billed during a check up?  Who decides the amounts that can be billed?  How would a doctor go about changing these?

If you don’t believe this is happening, look at your bill.  You will see some outrageous amount being billed by the doctor.  You will see that the insurance company only recognizes a fraction of the billing amount.  You will see that the doctor will forgive most of the difference, leaving you with some small amount to pay.

Does this make sense to anyone?  Why can’t the doctor just bill for the approved amount?  Or better yet, why don’t they?

The bureaucracy exists in the billing.  Who or what organization determines the amount that gets billed?   How does it get determined?  How would you go about getting the amount changed?

My Thoughts…

The doctors show the higher amount on the bill because they don’t want the insurance companies to forget that they are underpaying.  I am thinking that this is their pitch to increase the billed amount.

Your Thoughts?

Bureaucracy or not?

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