Now, they've said they're concerned about 'overwhelming' the surrounding medical community. What does that mean? As someone who has worked in medical billing in the past, I'm gonna tell you.
The Broken American Healthcare System
When I was a student at BYU, part of how I afforded my tuition was working for an LDS family I knew who had a private physical therapy practice in the suburbs of Baltimore. Their patients were primarily blue collar workman's compensation patients from factories and industrial settings.
The structure of their practice (which will become relevant in a second) is that they partnered with a couple of doctors who pulled in most of these patients. These doctors would then refer the patients to physical therapy, which was in the practice where I worked right across the hall. Anyone in private practice will tell you this is a dream situation. The physical therapist I worked for never had to think about where his patients were coming from. As long as the demands of capitalism kept hurting working class workers doing manual labor, they would never run out of patients.
So, let's talk about how medical bills work. When you go to see a medical professional, everything they do for you the second they start to treat you has a billing code. Each code is associated with a reimbursement rate that insurance companies have to/agree to pay. These reimbursement rates are set by something called fee schedules. Each state has their own fee schedule that control the maximum a medical professional can be paid for their services.
There are multiple billing codes for everything. If this is a game about making money, the billing codes are the pieces. How you use them will determine what the insurance company will pay for and how much you get. So, the physical therapists see a patient. They treat the patients and lay out the services they provided. There was someone whose job it was to draft the bill and submit it to the insurance company the first time.
At this point, it hadn't even reached my desk.
In an ideal world, when you submit a bill to an insurance company, they would pay what they owe in a timely fashion. They would do it without any hassle because we live in civilized society and it's the right thing to do, right?
Nope.
Insurance companies don't pay for anything the first time a provider submit a bill. Or the second time. Or the third time. They don't pay for anything until you have hassled someone every other day for at least two weeks. That was my job. I sat on the phone calling insurance companies for outstanding cases. Mostly talking to voicemail. Their job was to hold onto the insurance company's money for as long as possible. Mine was to annoy them until they finally relented and paid what they owed us.
If you talk to any medical professional who has ever touched their own billing (which is mostly private practice people because hospitals have entire departments who do this for their doctors, who have often never even touched a bill) this the most aggravating part of what they do. For every hour they spend treating patients, they spend at least 2-3 hours trying to get paid. Paying additional staff to make sure they get paid. Hiring idiots like me to relieve their qualified staff, so they end up spending even more money trying to get paid.
Here's where Medicaid comes in
Not every service provider can just take in Medicaid patients. You have to see a Medicaid-approved physician. To become approved, it's an expensive, largely bureaucratic process that I won't pretend to understand.
Here's what you need to know.
Medicaid patients, through no fault of their own because they are pawns in a broken system, are a loss to most of the physicians who see them. That practice I worked at was losing money when they saw Medicaid (and to some extent, Medicare) patients. This is because Medicaid functions on a completely different fee schedule than private insurance companies. They reimburse very little money to the physicians for the care they provide. Far below anything that would cover operational costs, let alone be considered fair market value.
The physical therapist I worked for would had to have seen three or four of Medicaid patients simultaneously to make what he would've gotten by seeing one private insurance patient. That's why many private practice doctors don't bother to accept Medicaid patients. The physical therapist I worked for expressed to me that the practice only took Medicaid patients because it was a form of charity and giving back. The income they got from private insurance patients subsidized the care of their Medicaid patients. Without enough private insurance patients, they wouldn't have been able to do this financially. The reimbursement from Medicaid wouldn't have been enough to operate their practice.
THIS problem is why BYU-I is refusing to recognize Medicaid as an insurance provider for its students.
Here are my questions...
Why are the financial insolvencies of accepting Medicaid patients in private practice in the surrounding communities of eastern Idaho any of BYU-Idaho's problem?Why do they think putting that cost back on poor students is the solution?
Off the top of my head, here's what they could be doing instead:
- Advocate for updating the Medicaid fee schedule in Idaho so treating these patients isn't a financial loss anymore.
- Make their student health insurance ACA compliant so it qualifies for subsidies.
It's worth noting that Medicaid insolvency in the first scenario goes away under a single payer system because healthy and/or wealthy people pay for sick people. Sure, this happens already. But it removes the bloated tick that is private insurance from the equation, freeing up the money being spent on making them pay their claims and do their jobs. But BYU-Idaho isn't going to support single payer healthcare because socialism? And of course, the requirements ACA compliance for their own health care plans would necessitate including comprehensive reproductive health coverage. Namely, contraception and abortion care. So BYU-Idaho doesn't want to do that either.
I don't know who the health care administrators are who are setting health care policy at BYU-Idaho, Deseret Mutual Benefit Administrators, or the Church Education System in general. But those are the people we should be looking for. Those are the people who are in control of this situation.
This policy reeks of the bureaucratic, paper-pushing, "please resubmit" (even though your claim is sitting on my desk), inhumane, callous indifference I dealt with on a daily basis until my head nearly exploded with rage and fear for the future.
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