Posted on 04/15/2019 5:55:35 AM PDT by Pontiac
As many as one out of five in-network claims made for Ohio patients with Obamacare are denied, according to research by the Kaiser Family Foundation.
Obamacare marketplace plans are typically purchased by those who are not insured through work, Medicaid or Medicare
Insurers nationwide denied about 19% of all Obamacare claims, just below Ohio’s average, according to the Kaiser study, which analyzed data from The Centers for Medicare and Medicaid Services for Obamacare providers in 2017. Denial rates across the country ranged from a high of 41% in Kentucky to a low of under 8% in Oregon.
In Ohio, denial rates peaked at 33% for Molina Healthcare of Ohio and were as low as 10% for AultCare Insurance Co. and Summa Insurance Co. in 2017, the last year data was collected at the national level.
(Excerpt) Read more at cleveland.com ...
The reasons claims are denied are many. Insurers can deny claims for services that aren’t covered by a patient’s policy, were coded incorrectly, had clerical errors, didn’t have the required pre-authorization or were not considered a medical necessity.
...
A lot of these denials are probably corrected. Or it could be something like they cover 3 days in the hospital instead of 4.
Their argument now (and has always intended to be this way) is -
Greedy Corporate Insurance companies put profit before people, therefore it is a perfect segue for NATIONAL Medicare-for-All.
What frosts me is because I pay by check (bank next door, they can clear it immediately if they want) on the day of the visit. Even though I cost them NOTHING in billing and filing expenses and they don't have to wait for my payment, they charge me more! And what's their answer to my voicing concern about that? That I should by their insurance policy! And then they'd decide what care I need by the dictates of that policy.
It's insane. Prices have gotten so out of control.
ObamaCare Law made it illegal for insurance companies to deny policies for ‘PRE-existing conditions’.
It said nothing about ‘POST-Existing conditions’....................
What frosts me is because I pay by check (bank next door, they can clear it immediately if they want) on the day of the visit. Even though I cost them NOTHING in billing and filing expenses and they don’t have to wait for my payment, they charge me more!
...
Maybe it would cost you less to get the cheapest insurance just so you can get the insurance prices.
The last time I needed dental work of size was estimated at $6400.
I asked if they would give a discount for green cash. Not check, green cash.
I paid $4800.
“The reasons claims are denied are many. Insurers can deny claims for services that aren’t covered by a patient’s policy, were coded incorrectly, had clerical errors, didn’t have the required pre-authorization or were not considered a medical necessity.”
not covered means the patient dint read their policy
incorrect coding and clerical errors WILL be paid with a corrected claim
no pre-authorization or not medically necessary is solely the fault of the practice
I pay cash at the Dentist office and get a 20% discount from the "list price". This seems to be common practice around here. I have to ask for the discount to get it.
If I get their dental insurance (or anyone’s), they control what services I get, and how often I get them.
Yeah that’s why I’m more than a little frosted. Either they or I could walk to the bank a few hundred yards away and cash the check.
I usually get the discount on medical. Meanwhile, this is the first excellent dentist I’ve encountered our here. They’re few and far between; most aren’t accepting new patients.
Story once again makes the private insurance company the bad guy. This is just more of the building propaganda crescendo for single payer.
Ohio Ping
I have no doubts that you’re right.
After all it is a Plaindealer article.
I have good retiree insurance, and I’ve seen my insurance company deny claims from hospitals and doctors who treated me.
In each case it was because the claim was badly screwed up. In one case, I visited the ER with bradycardia. The ER doc I dealt with billed insurance for everything the hospital did, more than $8,000 for 90 minutes. The Insurance company made him charge for his own work only, and the hospital had to charge seperatly for its work.
The ER transferred me to a hospital with a cardiac specialist clinic. The screwed the claims up, too. Double billing only scratches the surface of what they did wrong. Insurance eventually paid hospital over $45,000.
You are a very lucky man.
I thought that was a thing of the past, at least in the private sector.
My company dumped their retirees about a decade ago.
I plan on retiring in about 2 years when I am 60. My wife will pick up my insurance on her company’s insurance.
Who knows what that will cost?
Don't I know it. I worked for GTE. They had some of the best benefits in the business. When GTE sold my division to General Dynamics in 2000, part of the deal was that they had to maintain the retirement benefits for former GTE employees. It would be difficult for General Dynamics to squirrel out of it.
I continued to work for GD for 12 years after the acquisition, so I have the best of both worlds. Thanks to GTE, I even have a real pension.
OHIO PING!
Thanks to FREEPER Pontiac for bringing this in for the Ohio PING list.
“Business Ohio insurers deny 20% of Obamacare claims”
http://freerepublic.com/focus/f-chat/3742078/posts
Please let me know if you want on or off the Ohio Ping list.
Is there anything good about ObamaCare at all? Even one tiny little thing?
I’ve not seen it if there is
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.