SPECIAL REPORT: Michael Moore, president of Graymatter Pharmacy Services Inc.
| Thursday, May 28 2009 06:11 PM
Last Updated Thursday, May 28 2009 06:11 PM
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Michael Moore
The issue of reforming health care always appears to be a topical issue no matter who holds the reins in Washington.
Insurance issues plague this industry. The entire process of dealing with insurance companies is daunting. There are in-network and out-of-network co-pays and deductibles. Then we have maximum allowables for what health-care providers can bill and drug formularies that limit the types of medications patients receive.
Patients, caregivers and providers all struggle with the complexities of this system. It distracts from the main task at hand: to take care of our patients.
Even more maddening is that providers charge insurers one price, but the insurers pay a very different price. This insurer’s “discount” is huge. However, when individuals try to negotiate cash rates similar to what the insurer receives, they rarely receive them. This appears to be pretty unfair to those without insurance.
If Washington should do anything, it might be to put some transparency into the whole process of pricing. Perhaps medical providers should be required to list the price ranges for the products and services they provide. Allow consumers to comparison shop for the best deal.
They should also require insurers to cover their own patients at one rate throughout their medical journey. Insurers can’t tell a patient to go to an “in-network” hospital and then have the patient receive a bill from a surgeon that was “out-of-network” for services received while being treated at the “in-network” hospital. This practice is particularly shameful.
I believe that insurance has a useful place in the provision of health-care services, but patients need to be better informed. Our government has the power to simplify the industry and make it easier for patients to make decisions.
