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The “Fix” that isn’t

November 15, 2013

It behooves a CEO to know something about their company’s product or service or at least to have people in place that can explain it in detail. Apparently America’s CEO still doesn’t quite understand the product he’s selling.

This so-called Obamacare fix, namely allowing insurance companies to fix cancelled plans by  reinstating plans that Obamacare says don’t meet the statutory standard, doesn’t work at any level. Writing new, similar plans is a procedural impossibility. Under a best case scenario, plans that cancel on Dec. 31, 2013 could have the cancellation date changed to Dec. 31, 2014. The ones that are actually gone as of Oct or Nov. 1, 2013, are  just gone.

Americans personally will see this fix fall apart first in their healthcare provider’s office. Medical billing is a quagmire to decipher at any time. Long before you ever walk in and present your insurance card the accounting/receivables/billing department has to know whether your insurance even covers the health services you need.

A damn short synopsis of how provider reimbursement works

If your provider is an in-network provider they have a contract between the insurance company and the practice. That contract typically includes certain plan numbers and diagnostic and treatment codes the plan covers, along with the reimbursement rate. All that goes into the computer. Larger providers typically have one or more people that do nothing but research which plans cover what, determine the reimbursement rate, and enter that information into their billing software. That’s how the admissions desk can tell you how much you need to pay when you leave.

If they don’t have the information on file, or they are out-of-network, they will contact the insurance company either through a provider portal on the insurance company’s website, or directly via phone. With all the waffling, backtracking and just plain lack of process knowledge evident in the rollout of Obamacare, there isn’t going to be anyone at the insurance company that can accurately answer those provider questions. In other words, your provider won’t know for sure that they can get paid.

With this fix, there won’t be time to get provider contracts in place, even assuming that (a) the insurance company did manage to change all of their backend software to reflect the fix, and (b) the state insurance commission approves the reinstatement or new plan. Just that part can take up to a year, after which this supposed fix expires. Simply in terms of the physical steps needed to accomplish the supposed goal, this fix just doesn’t work.

What does that mean to you?

In the meantime, you are signing a form that says you know you are personally responsible for the bill. Even if your provider still accepts insurance, this fix will create massive confusion at both the provider and patient level. It is easy to foresee a situation where most providers are simply going to require cash upfront and leave it to you to forward the bill to your insurance company. Any business has to have cash flow, and no business can wait months to get paid. At best, after you pay they will still bill the insurance and refund or credit any amount the insurance pays them. It could be months before that happens.

Somebody knew this would happen.

No one expects any president to understand the nuts and bolts of every industry in the world. But someone in the chain of command has to, and apparently in the case of Obamacare, no one does. If they did, they were and are either afraid to push their knowledge up the chain of command, or at some point that flow of information was deliberately disregarded.

If the dog ate your homework, it’s still your fault.

Good CEO’s put people in charge to make processes work, but they also expect to be told when something is simply not viable. They hold their subordinates responsible for failures. Bad CEO’s stick their heads in the sand, claim ignorance when the whole thing collapses, and blame outside influences over which they supposedly have no control. They call that plausible deniability, also known as the “dog ate my homework” excuse.

This fix not only doesn’t fix anything, it puts the performance capability of the whole Obamacare team on display. It’s their homework, and their dog. Even if the dog did eat your homework, it was your responsibility to put your homework where the dog couldn’t reach it. You still get an “F”  on the assignment.

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