In some cases, she said, insurers are simply trying to ensure that doctors treat patients consistently and in accordance with the highest medical standards -- that they're not wasting premium dollars by overusing costly treatments or ordering unnecessary tests.
"Utilization review is coming back," she said, referring to heightened scrutiny of doctors and hospitals. "You can't run a health plan today without using some of these tools and techniques" to control costs.
But Ignagni acknowledged that billing processes were inordinately complex. She said insurers were aware of providers' complaints and were trying to streamline billing systems.
"No question that administrative simplicity has to be job one," she said.
Reading the fine print in policies
Arcane and ever-changing coverage rules are a leading cause of fee disputes. Patients and physicians are compelled to pay special attention to the fine print in healthcare policies.
Dotti Smith, office manager for a group of surgeons affiliated with St. Mary's Hospital in Long Beach, recently billed a major insurance company for a gallbladder operation. The insurer had preauthorized the surgery and the surgeon was a member of the insurer's network of preferred physicians, Smith said. But the company refused to pay the $3,100 bill.
Why? The patient was enrolled in a subcategory of coverage with a smaller network of doctors that did not include the Long Beach surgeon.
The surgeon's office contacted the patient, who replied that the bill should be her insurer's responsibility.
Smith said the time she spends on billing issues has doubled over the last six years.
"It used to be a breeze," she said. "You'd bill Blue Cross or Blue Shield, and you'd get paid. Now you have to constantly stay ahead of the ball."
Doctors, nurses and other staff members are spending more and more time haggling with insurers over claims or obtaining advance approval for treatments.
Dr. John A. Glaspy, a UCLA oncologist, said that nurses who used to care for patients full time "now spend 40% of their 60- to 70-hour workweeks filling out forms and phoning for authorizations."
Walking through his office suite at UCLA Medical Plaza, Glaspy pointed to offices of clerks and medical assistants busy securing insurance approvals for even routine procedures.
