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Deny This: Guess Who Has the Highest Medical Claim Rejection Rate?
News Busters ^ | October 6, 2009 | Tom Blumer

Posted on 10/05/2009 10:20:05 PM PDT by Lorianne

Oh, the establishment press will just loooooove this -- not.

From BigGovernment.com (HT Mark Levin over the airwaves this evening):

Beverly Gossage, Research Fellow for Show-Me Institute and founder of HSA Benefits Consulting wondered which insurance companies rejected the most claims. She found her answer in the AMA’s own 2008 National Health Insurer Report Card (fairly large PDF).

I'm curious. Was it Aetna? Humana?

(Excerpt) Read more at newsbusters.org ...


TOPICS: Business/Economy; Government
KEYWORDS:
Lots of embedded links within source article.
1 posted on 10/05/2009 10:20:06 PM PDT by Lorianne
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To: Lorianne

No surprise at all.

We need to get rid of Medicare all together.


2 posted on 10/05/2009 10:22:11 PM PDT by trumandogz (The Democrats are driving us to Socialism at 100 MPH -The GOP is driving us to Socialism at 97.5 MPH)
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To: Lorianne

Bump!


3 posted on 10/05/2009 10:26:22 PM PDT by ellery (It's a free country.)
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To: Lorianne

Iffy. percentage wise not much difference in Medicare and Aetna. Looks like the bigger the company the higher percentage. Long ago when I was in the business, biggest reason for Medicare reject was diagnosis which was easily corrected and rebilled electronically. Paid in a week.


4 posted on 10/05/2009 10:30:40 PM PDT by libbylu ( Palin begins from Wasilla not only a campaign, an Iditarod of a crusade ....YEAH!)
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To: trumandogz
We need to get rid of Medicare all together.

We need to get rid of the waste and fraud in Medicare - maybe it should be turned over to a private company.

But 'get rid of'? What could it be replaced with? What do the people who pre-paid for the insurance for decades then use for insurance?

What is needed, along with cleaning up the waste and fraud is to stop giving Medicaid money/coverage to the millions of people who paid little or none into it but get it because they're a drug addict or alcoholic or 'bi-polar' etc.

For example, there's a couple down the street 0 both in their 30's, that get medicaid - recovering druggie/alcoholic and bi-polar...they get all medical, drugs and counseling paid in full - no co-pay, no deductible - and about $200 each for food stamps - and a monthly disability check out of our social security funds...that we retired folk pre-paid into from the time we were 15.

That all comes out or medicare money that they didn't contribute to.

THEY should be taken off medicaid and if the gov't wants to molly coddle them, find other funding.

Don't rob medicare.

And again, if you stop medicare, what do the people who pre-paid for decades and continue to pay about $100 a month for it (taken out of their social security) do for insurance. (that's another thing the druggies et al don't pay - the $100 a month.

5 posted on 10/05/2009 10:45:27 PM PDT by maine-iac7 ("He has the right to criticize who has the heart to help" LINCOLN)
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To: maine-iac7

That’s the truly vile thing about programs like this (Medicare, Social Security, and whatever government healthcare takeover they pass):

You get a bunch of people dependent on it as they’re heavily subsidized by future payers. Then when it goes broke you have no way to end it because everyone cause say they’re owed.

The only way to unwind them is to declare a cutoff age, have people quit paying into from that point forward, and continue to pay out benefits to everyone above the cutoff age until it’s gradually eliminated.

It turns a large, endless, and ever-increasing money pit into a very large but finite red number.


6 posted on 10/05/2009 11:06:14 PM PDT by BobbyT
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To: maine-iac7
But 'get rid of'? What could it be replaced with? What do the people who pre-paid for the insurance for decades then use for insurance?

Yes, get rid of Socialized Medicine, abolish Medicare and Medicaid.

As for those people who are now on Medicare, the feds should refund the money each person paid into Medicare, minus the amount of money that has been paid out for their care by Medicare.

And then those people who were on Medicare can go into the private market place and purchase private insurance.

7 posted on 10/05/2009 11:18:19 PM PDT by trumandogz (The Democrats are driving us to Socialism at 100 MPH -The GOP is driving us to Socialism at 97.5 MPH)
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To: Lorianne
And that's not the whole story. Medicare & Medicaid are the worst to pay AT ALL. You may wait MONTHS to get your money. And if they decide they are low on money guess who gets put on the back burner by claiming you didn't fill out something properly (LIES).

The insurance companies are by far better at paying their claims than government run Medicare & Medicaid! They are like dealing with the IRS and 'cash for clunkers' all rolled into one!

8 posted on 10/05/2009 11:30:26 PM PDT by kcvl
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To: kcvl

I am in a Medicare morass right now. I was supposed to get a corrected card and waited over a month - in the meantime I wasn’t in the Medicare computers and all my doctors were sending me bills and even collection letters.

When I called Medicare (several times) they got testy with me, and one guy even told me I needed to cool off and let it “work its way through the system”. That was in June. Still not straighted out.

It’s a classic government giant system. Don’t let anyone tell you different. There’s reason experienced seniors don’t want it expanding.


9 posted on 10/06/2009 2:11:29 AM PDT by I still care (A Republic - if you can keep it. - Ben Franklin)
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To: BobbyT
"The only way to unwind them is to declare a cutoff age, have people quit paying into from that point forward, and continue to pay out benefits to everyone above the cutoff age until it’s gradually eliminated.

" “Withering it on the vine” was a great idea but it interfered with the Democrat/Socialist movement and we were accused of wanting to kill of granny. Now we argue against a government option/socialized medicine and we are accused of wanting to kill off granny.

You have to hand it to leftists they ARE consistent.

10 posted on 10/06/2009 3:14:18 AM PDT by poobear
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To: Lorianne

dont’ worry - we can pray to Obama for our health care, just like these folks:

http://www.youtube.com/watch?v=CnXbuoOiuk8


11 posted on 10/06/2009 3:17:43 AM PDT by blueplum
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To: maine-iac7
Medicare and Social Security need to be phased out quickly, if at all possible. They are a cancer. Folks may have "prepaid" but what they prepaid for was a Madoff level Ponzi scheme. Crying that one has been "taken" doesn't help much just becasue one was "taken" by politicians. Gummint should do ONLY what ONLY gummint CAN do. The rest should be leftup to the folks.

Μολὼν λάβε


12 posted on 10/06/2009 3:33:59 AM PDT by wastoute (translation of tag "Come and get them (bastards)" or "come get some")
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To: Lorianne

Uh, well, wait a minute. This is something I know about from my work. Medicare rejects tons of claims, but a lot of them are rejected for coding errors. The claims are sent back for correction and resubmission. Sometimes that process goes around and around for months because the provider’s staff can’t figure out what the error was and the Medicare intermediary doesn’t explain it to them. So this makes the numbers look very much worse than they are.

In other words, Medicare isn’t rejecting the claims because they don’t cover a procedure; providers’ staff already know what’s not covered and don’t submit a claim for a noncovered procedure in the first place. The rejection is technical and may well be corrected.


13 posted on 10/06/2009 4:16:57 AM PDT by ottbmare (I could agree with you, but then we'd both be wrong.)
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To: ottbmare

Thanks for that info.

According to your description though, the bureaucracy is paperwork heavy and byzantine to figure out, or else there would not be so many ‘code’ errors.

It would be good to get some true numbers on this though.


14 posted on 10/06/2009 9:48:33 AM PDT by Lorianne
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To: Lorianne
According to your description though, the bureaucracy is paperwork heavy and byzantine to figure out, or else there would not be so many ‘code’ errors.

Most claims are submitted electronically. Most doctors and all hospitals have personnel who are trained to submit the claims and have to fight with the system. They contact Medicare (CMS, the dread "Centers for Medicare and Medicaid Services" in Rockville, MD) through various Medicare intermediary companies that are supposed to assist them and actually handle the claims. Some of these intermediaries are horrible and others do a good job. It's monstrously frustrating because there is often no explanation for the reason a claim has been kicked back, and it times out while the office is trying to get an explanation of how to submit it correctly. That is, the final denial is because too much time has elapsed since the event/procdure took place. So the doctor doesn't even get paid the miserable sum Medicare is willing to pay him for his time. This is why some doctors don't want to accept Medicare patients.

The adminstrator of a large hospital told me during a conference call that this sort of problem had cost them $750000 in lost claims despite the fact that they had full time, dedicated staff doing nothing else except working on it. I have heard other, similar horror stories all over the US. It's a nightmare. And this is what we can anticipate if Obamacare goes through.

15 posted on 10/06/2009 10:09:15 AM PDT by ottbmare (I could agree with you, but then we'd both be wrong.)
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To: poobear
Ayn Rand:
"In any conflict between two groups who hold the same basic principles, it is the more consistent who wins."

This summarizes what's wrong with the RINOs. When Rs try to be Ds, the choice is between some handouts and tons of handouts, and of course the more consistent socialists win the deadbeat vote while honest productive voters are just disgusted.

"In any collaboration between two groups who hold different basic principles, it is the more evil or irrational one who wins."

This is the basis for "bipartisanship" (and the UN, and appeasement) and every other food-and-poison mix where "compromise" is used to grant legitimacy to criminals and drag the honest down to their level.

"When opposite basic principles are clearly and openly defined, it works to the advantage of the rational side; when they are not clearly defined, but are hidden or evaded, it works to the advantage of the irrational side."

In other words, just keep calling it "reform" and claiming a government takeover will somehow decrease costs. Don't discuss the actual facts behind it (like how you could take something, add a bunch of non-paying consumers, and not run a shortage), just keep the discussion in lofty ideals so that you're either pro-"reform" or anti-"reform".
16 posted on 10/06/2009 12:40:28 PM PDT by BobbyT
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