Greater transparency needed in how insurers account for care costs

Regarding "Finding the right floor: How much should insurers spend on medical care?" (Article, Nov. 24, 2008): A broad view of the costs of providing medical care certainly should include the administrative costs of the insurers, at the least as a prominent sidebar.

But that doesn't go far enough. Bill-review companies working for insurers in California are frequently separate companies, located out of state. Their money comes out of what otherwise should be spent on patient care.

Now there is yet another layer to this administrative morass in the form of the companies that generate databanks, which distort medical research results allegedly to promote the practice of evidence-based medicine. I don't need coaching from some bureaucrat relying on a table about how to properly treat the straightforward, classical case of some disease.

Multiple-diagnosis patients and those instances of patients with multiple risk factors don't fit within cookie-cutter algorithms. We all know that those tables primarily are intended as tools to make profits for insurers, not help ensure the best care.

We should include in the figures about overhead the salaries of all health professionals who cost me unbillable time and stress, because they have the right to demand telephone conversations and/or lengthy reports (also nonbillable) with and from me, explaining to them my complicated cases, which are numerous.

I would be interested if these additional "administrative costs" are included in the medical-loss ratio figures that you provided in your provocative article. I would bet not. At the least, we need full transparency from these companies that are dealing with what should be a basic human right, i.e., health care. I would be glad to pay the price of transparency in my own bookkeeping.

Clifford J. Straehley III, MD, Fair Oaks, Calif.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2009/01/12/edlt0112.htm.