You know how you go to the Dr., you pay you co-pay, and then there just always seems to be more to pay? When you're a member f a PPO, particularly, it goes something like this: for reasons completely unknown to the patient a doctor charges XX;, the carrier only agrees to pay YY; they both agree to write off ZZ, and somehow the consumer is left to pay $$, and we just pay it, shaking our heads, having no way to check whether it's right or wrong.
I can understand it more in the above situation because each doctor has his/her own charges, and just as the carrier may not know in advance what doctor you're going to and how much the charge will be, the doctor may not know what your particular plan covers or does not cover, or where you are in meeting your deductible.
But I belong to Kaiser now. Kaiser, where the carrier and the service provider are under one roof/umbrella. Kaiser where the Member Office where I go to check on my deductible status is right down the hall from the lab. Kaiser where one would imagine (hope) the computer system the member services consultant uses is the same that the doctor's assistant uses.
So why do I show up, dutifully pay whatever I'm told to pay, and then still get a bill for more? Why can't the person asking for my co-pay check look me up in the Kaiser computer, see my Kaiser status, know how much the Kaiser service costs, and charge me the delta I rightfully owe?
It seems so inefficient. What a waste of paper, of stamps, of administrative effort. Multiply that by the thousands and you begin to understand why tort reform is not the biggest part of increases in health care costs, administrative costs and overhead are.
And this at an all-in-one HMO-type facility.
it's stupid, right?
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