Could Your Health Insurer Run “Cash For Clunkers?”

August 21, 2009 RSS Feed Print
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People opposed to healthcare reform have a new mantra: If the government can’t run the “cash for clunkers” program, do you really want them managing your healthcare?

Catchy. Timely. And probably as misleading as “death panels” and “euthanasia.”

The problem with the government’s Clunkers program is that car dealers had to spot their customers those government rebates—up to $4,500—then wait for the feds to reimburse them. Since late July, dealers have sent the government about 457,000 applications for nearly $2 billion in rebates. Through the first three weeks of the program, only about 7 percent of those claims had been paid, totaling about $140 million in rebates.

Disaster!

Or is it?

[See the industries hurt most by soaring healthcare costs.]

The government hasn’t provided exact figures, but it has said that many of the rebate claims were sent back to dealers because of paperwork problems. The biggest problems were things like unsigned sales agreements, mismatched serial numbers, and forms that failed to include the make, model, and year of the clunker being traded in. Such sticklers, those government bureaucrats.

Now if a superefficient insurance company like Aetna, Cigna or MetLife were running the Clunkers program, they probably wouldn’t get all bent out of shape about a few paperwork snafus, would they? The money would just go flying out the door, with no worries about technicalities. If it turned out that a bunch of those rebate applications were fraudulent or bogus, the extra money paid to the swindlers would just get tacked onto next year’s insurance premiums and nobody would complain. Right?

[See the trouble with healthcare reform, in numbers.]

Funny, most people submitting a reimbursement application to their insurance company would be thrilled if the check arrived within three weeks. But obviously our expectations aren’t that high. I haven’t been able to find reliable data on average national wait times for health insurance reimbursements (if you know of any such data, please email me at flowchart@usnews.com), but we all have experience with this. If I’m submitting a claim that is unambiguously reimbursable, it seems reasonable to expect a check within 4 to 6 weeks. If I don’t fill out my forms right, I’m 99.7 percent certain the insurance company will send them back to me and my check will get delayed. And if I’m trying to get the insurance company to pay for something it doesn’t feel it should pay for, I fully expect it to take 3 months, 6 months or forever to get paid back.

That’s all inside a system that has been in place for years. Let’s say some omnipotent third party suddenly declared there would be 25-percent rebates on healthcare for certain people, provided they met certain conditions. Similar to Clunkers. There was a fixed pot of money to cover the rebates, and the deal would end once the money was exhausted. That would doubtless produce a surge of patients rushing to medical offices and hospitals once the rebate period began. Yet you gave the insurance companies processing the payments just a few weeks to prepare for the deluge. Oh, and they weren’t allowed to hire any new workers—they had to manage it all with staff on hand.

[See 5 downsides to the “cash for clunkers” program.]

What would happen? There would be all kinds of confusion about who qualifies. The paperwork would be a nightmare. Payments would get held up for weeks or months. Yet critics deem the Clunkers program a failure because it’s performing on a par with, or better than, the typical health insurer. And it’s not even consumers who are complaining about Clunkers. They’re pretty happy, since the burden for getting the paperwork right and obtaining the government rebates doesn’t fall on them. It’s the car dealers who are grousing, even though it’s a safe bet that every legitimate Clunker claim will be paid, because failing to do so would be political suicide by the Obama administration.

If the government ran a healthcare plan that offered major discounts, worked through existing providers, minimized the paperwork burden on consumers and paid every legitimate claim, would that be considered a failure? I guess it would depend on our expectations, which seem to be higher on government than on a private sector that routinely delays payments to consumers—without any controversy whatsoever.

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One of the points you fail to recognize is if the private sector is providing a service and you are not satisfied then you can fire them and replace them with a different company assuming you have good competition in place (hence the need for competing across state lines). With a government service you have no choice other than to take it or leave it. Have you ever tried to file a complaint regarding a government service you were not happy with? There are some old sayings which are for the most part true, for example "don't fight City hall". We are slowly marching down the path where eventually the only choice you will have is no choice - I guess that's what being a progressive means.

Stan of GA 2:34PM December 24, 2009

Health insurers are typically required contractually to meet certain turnaround times for manual claims processing and reimbursement. A typical standard would be all "clean" claims (i.e., claims with no missing information) processed and paid withing ten days, while all "exception" claims (i.e., claims with some problems or missing info) within 20-30 days. Actual performance is usually much faster than this, about 100% all claims, clean and exception, within 10-14 days.

Electronic and partly electronic claims processing can be much faster. A good mail order pharmacy can take faxed prescriptions, convert the data to electronic form, process and ship a clean script within one day, while exception scripts that require follow up with the physician take two to three days.

A better example for your article would be pharmaceutical manufacturer rebates to PBM/healthplans/payors. Pharma manufacturers scrub, process and pay the bulk of rebate claims submissions (95%) within 180 days of receipt of data, as these can be fairly complex data and financial transactions involving numerous contractual payment schedules, data formats, third-party involvement, etc. These rebate payments typically are made starting 30 days after receipt of data, and continue until the full amount is processed and paid. About 5% of all claims are scrubbed out due to incomplete/missing data and/or claims fraud.

Medicaid rebates, on the other hand, which are based on standardized formulas, require payment within 38 days (formerly 31 days).

I'm not as skeptical as you are that the healthcare industry would fare as badly as the government did in managing the Cash for Clunkers program. Certainly it has its problems and weaknesses, but it also can be very good and efficient at what it does.

P.S. Advice on plan for writing future articles:

Step 1: Gather data

Step 2: Analyze problem

Step 3: Present conclusions

Dave Lister of CO 5:28PM September 09, 2009

You can't compare projections for Cash for Clunkers, where demand couldn't be known so an arbitrary (in fact pared-back) number was picked, to the projections for health care, where population trends and actuarial tables do in fact give pretty good guidance regarding future needs. Thanks, Rick, for a piece I'll be sending around; should be in the mag.

Randi of NY 9:27PM August 22, 2009

Rick Newman

Rick Newman

The global economy is mysterious, even scary. Chief Business Correspondent Rick Newman connects the dots. In addition to his writing for U.S. News, Rick is the co-author of two books: Firefight: Inside the Battle to Save the Pentagon on 9/11, and Bury Us Upside Down: The Misty Pilots and the Secret Battle for the Ho Chi Minh Trail.


Read Rick's latest blog entries here.

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