I have been temping for the last year in the patient accounts department of a prominent neurosurgery group. I deal with insurance and billing from the specialists end of things. Our surgeons range from those that will send patients to a collection agency in a heartbeat, to those who will almost always take a personal hit to write off a patient's bill. What bothers me most, though, is observing how patients are treated, both by us in patient accounts and the insurance companies.
When patients claim they don't have the money to pay us (they have thirty days from when the insurance pays to pay the remainder or set up an payment plan, which can take no longer than one year), we don't take their word for it. We have them fill out a monthly budget, go to the county auditors website to find out the value of their homes, and push back at every turn - often nearly forcing them to pick up a medical only credit card, called CareCredit. If they qualify for CareCredit but choose not to use it, we have no mercy. We use a lot of black humor when talking about patients because otherwise I don't think we'd be able to look ourselves in the mirror, sometimes.
Insurance companies can be no better. There is no limit on how far back they can go to do what we call a take-back, which is basically what it sounds like. They've paid for a service, then later determine (for whatever reason) that they shouldn't have paid — so they take that money back from us, putting the financial burden on the patient. It's a bit like rescission, in how arbitrary it seems, but if it happens three years later and the policy isn't actually dissolved, surprise!
All this, of course, is complicated by the fact that patients aren't all angels, either. I get to overhear the really ugly side - patients who make no effort to pay or understand their benefits (if they have them at all), who flat out lie to us when they promise to pay, who believe that their treatment is a right (that "center of healing" view about hospitals) and that it's illegal to deny them office visits or treatment if they don't pay us (it's not, most of the time). Basically, unless you have good insurance through your employer, you are having a mainstream procedure, and everyone involved (the patient, office staff, and physicians) remembers to dot every i and cross every t, it could get very ugly very easily.
All of this has convinced me of two things: One, some kind of health care reform is absolutely necessary, though I am not informed enough to offer any real suggestions on how to make that happen. Two: I don't want to have any part in this system, because it has exposed me to some of the absolute dregs of human behavior. I'll be leaving this job at the end of the month by my own choice.