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Friday Night Lights and Healthcare

When Insurance and Football Collide

Football in Houston

As Sheldon Cooper (The Big Bang Theory) would say, "Football is ubiquitous in Texas. Pro football, college football, high school football, Pee-Wee football." I recently worked with a hospital in Houston. Every Friday night in the fall, young athletes are injured and a doctor issues an order for an MRI. Every Saturday morning, these kids and their parents show up at the local hospital to get their MRI.

The Collision - Who Gets Hurt?

Unfortunately, most insurance companies aren't open on Saturday, so the hospital cannot get the preauthorization required to get paid for the MRI until Monday. But what parent wants to take time off from work and pull their kid out of school to come back for the MRI? None.

Could the doctor get preauthorization when they issue the order on Friday? Not my job.
Could the doctor advise the parent that they should wait until Monday because of insurance delays?
Hospitals can do the MRI and hope to get paid.
Could the hospital work around the system by delivering the service, but not booking it until Monday?
Parents can take their child to the emergency room but incur the copay expense.
Could the insurance companies be open when healthcare is open (24/7/365)?
Could the hospital get concessions on the contract so that they can provide care and get paid when the insurance company isn't open?

The same sort of problem occurs when discharging a patient from the hospital. Does the patient qualify for home healthcare that will prevent a readmission? The list goes on and on. The promise of affordable healthcare is unlikely to be achieved under these conditions.

The Patient is a Customer

Some systems are so screwed up that it's difficult, but not impossible, to arrive at a root cause or a solution. Everyone from the doctor issuing the order to the MRI provider to the insurance company needs to be involved in figuring out how to best serve the patient. Until we remember who the customer is and how to deliver on their needs, healthcare will still feel broken and disjointed. My 91-year-old mother says that when she goes to the doctor, she "feels like a can of corn run over a scanner."

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