Marketplace Series: What Do 'Insurance Verifiers' Do?

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A new Marketplace series called "The Cure" will examine the costs - and potential savings - to the American health care system. The first installment aired yesterday and explored the obstacles to interacting with insurers - a costly activity that one study estimates costs doctors $31 billion a year. The report introduces Sharissa Dyke, an insurance verifier who "basically spends every day checking whether patients have insurance and what their plans cover."

To determine whether an MRI is covered for a patient who may need knee surgery, Dyke contacts Aetna, the insurer. Depending on the patient and their plan, it can take days or just minutes to get a response. In this case, it's minutes. The insurer tells Dyke the patients does not require pre-authorization.

Doctors wonder why they must cut through the red tape, since they've never had an insurer actually deny and MRI. A spokeswoman for America's Health Insurance Plans, an industry group, said the imaging is being overused by doctors, inflating costs. The pre-authorization requirement helps limit use. The insurers agree that all the different systems are extraneous (Keith, 8/10).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

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