This is about right. I am on the board of small business that provides health insurance for our employees. When we were lookin at OB coverages the insurance companies were absolutely not competitive. It would have cost us about $900/year/female employee for "reproductive health/maternity" coverage. As our board is philosophically opposed to paying for voluntary terminations, and "reproductive health" invariably included VT, we were left with a choice of no maternity coverage at all or self-insuring. Most of our female employees are of reproductive age. We figured that it would be cheaper to pay up front costs than buy insurance for everyone.
We called several ob's in the area and told them our plan. We wanted to know what it would cost to cover an uncomplicated pregnancy start to finish with NSVD/term. The prices were in that range. What was surprising to us was how difficult it was to actually pay the ob's.
We told our employees to see if the obs would bill the company directly for the services. Most agreed and then started asking us for claim forms, and all manner of paperwork. We told 'em we don't do doctoring and they don't do manufacturing. If they thought a service was medically justified, send us a bill and we'd pay it on our next check writing schedule. Just don't try to tell us how to run our production schedules.
After three pregnancies, they finally got it. We told 'em we trust their medical judgement, please don't rip us off. They all liked the idea that a.) we didn't want E&M codes, CPT codes, service justification or any other paper, b.) we just wanted to know how much they wanted to be paid and c.) we generally paid the bill within the week of getting it. One guy reduced his fee. He told me, you guys pay more than the insurance company, you don't cost anything to us to get paid and you pay within a week. One of our HMOs takes 5-6 months to pay, they want $500 worth of paperwork and they always find something wrong with it and want pre-approval on nearly everything.
The company ended up getting the exact coverages it needed. We do pay for a surgical policy that covers anesthesia, emergent/elective (rpt)/ indicated c-sections. Our major medical policy covers most but not all of the services required of high risk pregnancy, so if we had one of these, we'd be dinged, but we're willing to take that chance.
Maybe MSA/HSAs will help make everything better. Fast payment, getting multi-million dollar insurance executives siphoning off health care dollars out of the loop, better compensation for docs. It's time to make the patient the first party payer with full say in her care, not the fifth party payer who goes to and does what somebody else tells her. Musings for a slow call day.
