[Music] DAN: What role to health insurance companies play in our health care system? Today, I'm with Shara McClure our Vice President for Health Care Delivery here at Blue Cross Shara, tell me a little bit about our role in this health care insurance industry

Why are we important? SHARA: We're important because we help make health care affordable So health care is expensive and the sicker you are and the more intense your condition, the more the prices go up and so I've seen prices for cancer treatment reach $30,000 I've seen prices for emergency room visits reach an average of you know two thousand to five thousand dollars and your average Texan it might be hard for them to pay for that if they are injured or have a condition that's really expensive DAN: So it's a bank, kind of helps prevent bankruptcy to some degree, right? SHARA: Absolutely, yes DAN: One trip on a healthcare event could lead to a bankruptcy event

SHARA: And as a matter of fact I think that if you look at the cause of bankruptcies health care expenses are a big part of it DAN: So if the absolute bare minimum is kind of what our company does in the whole industry health insurance industry does, is we manage transactions between consumers, in this case patients, and providers which are hospitals and doctors and we kind of managed that market back-and-forth, but we also negotiate on behalf of our consumers, talk a little bit about that SHARA: So we do So prices aren't necessarily published by hospitals If I go to a physician I probably won't get a price list or if I go to a hospital I won't get a price list but the insurance company negotiates a price for every service and that's what my department and I do and we look at every time we go to the table to negotiate a price we look at a lot of different pieces of information

We look at what Medicare pays, we look at other prices in the market, and we represent our members and our employer groups to make sure that we negotiate a fair price that helps health care coverage become affordable DAN: So if you think about it in some respects if then the average patient or consumer tried to go into the healthcare system without the help of an insurance company they would be inundated with a bunch of different things 1 prices that they didn't pre-negotiate so they could be egregious prices but also you negotiate other things too like how to bill right so that you group or put things in certain billing categories so that patients don't get pummeled with a little bit of line item nickeled and dimed items is that fair to say too? SHARA: It is and so hospitals there really… there are limited rules for what hospitals and physicians can bill and so we look at those rules and we apply them, we apply medical policy, and we also apply claim policy to make sure that some of those extraneous services aren't paid when they shouldn't be DAN: Well great Well, Shara, thanks for being here today and shedding a little light on this idea of health insurance and thanks for joining us for this episode of Blue Promise


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