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Just because a claim was denied initially by an insurance company doesn't mean it was not refiled and paid. Many claims filed by doctors are filed incorrectly, are coded improperly, and have to be refiled. Happens every day.
Yeah, blame everybody... the patients, the uncovered, and the doctors BUT let us protect the health insurance companies. Wonderful!
Having said that, there is no harm in looking at the other side of the story... Dr. Jason Dees, a family doctor in a private practice based in New Albany, Miss., said his office often resubmits claims that have been "magically denied." "That adds to our administrative fees, extends the payment cycle and hurts our cash flow," he said. Dees also spends a lot of time getting "pre-certification" from insurers to approve higher-priced procedures such as MRIs. "We're already operating on paper-thin margins and this takes times away from our patients," he said. Link
Yeah, blame everybody... the patients, the uncovered, and the doctors BUT let us protect the health insurance companies. Wonderful!
Having said that, there is no harm in looking at the other side of the story... Dr. Jason Dees, a family doctor in a private practice based in New Albany, Miss., said his office often resubmits claims that have been "magically denied." "That adds to our administrative fees, extends the payment cycle and hurts our cash flow," he said. Dees also spends a lot of time getting "pre-certification" from insurers to approve higher-priced procedures such as MRIs. "We're already operating on paper-thin margins and this takes times away from our patients," he said. Link
Fortunately, I have a son who is a doctor, and the main problem seems to be with MEDICARE,...not private insurance companies. Guess that problem with government-run healthcare will be eliminated with the new healthcare bill.
Ya know, I've seen things like this when I worked for the Army (30 year civilian). We have a "training form" (Form DD1556) that was one page, but it was extremely detailed. A lady in our Personnel shop got so tired of sending them back for correction/re-doing that she wrote a 22-page booklet to explain to the rank and file how to fill out the damned form. I saw that booklet and laughed my ass off. The point is that if you need a small book in order to fill out a 1-page form, FIX THE DAMNED FORM, as the problem is the form itself. Same with the medical claims / coding biz; automating the claims process with standard codes for procedures obviously needs fixing if the people can't file a claim correctly. The SYSTEM is the problem, REFORM the system, and that's what we want to do, rather than keep the status quo with all it's ills.
These weren't issues of complexity, they were issues of negligence in very simple matters. That is why she called them idiots as if they simplified the form anymore, they would need a purple dinosaur to show up and sing a song on how to do it. While I agree in some fields and even in this one, forms may be a bit overly complicated, but we can not discount the "stupid" factor and to be honest, I have seen a lot of that regardless of the field.
Here's an article that reminds us how insurance companies NOW determine who lives and who doesn't. Read the article....
Health care is ALREADY rationed by nameless, faceless bureaucrats whose only interest is making a PROFIT for their employer. Anyone who went to see the movie SICKO saw the interviews with doctors who work FOR the insurance companies in which the docs talked about how they weaseled out on paying claims and denying medical services to people. DENIAL OF CARE has been an industry practice for years. Obama's reforms want to STOP this abuse, not implement it.
Excerpt from the article:
- A study by the AMA found the biggest insurance companies in the country denied 2-5% of claims put in by doctors last year ... There is no national database of insurance claim denials, though, because private insurance companies aren't required to disclose such stats. ... just three insurance companies kicked at least 20,000 people off their rolls between 2003 and 2007 for such reasons as typos on their application paperwork, a preexisting condition or a family member's medical history. People who buy insurance under individual policies, about 6 percent of adults, may be especially vulnerable ...
I know for a fact this is true because it happened to me. These people are really slick and are experts at denying claims and strong arming YOUR DOCTOR.
They do not care about you at all, money is all that matters.
How very,very strange - this Salon article nowhere mentions that Medicare lead the pack in claim denials last year at 6.85%? ? ?
(This year they were second behind Anthem BCBS)
Yeah, blame everybody... the patients, the uncovered, and the doctors BUT let us protect the health insurance companies. Wonderful!
Having said that, there is no harm in looking at the other side of the story... Dr. Jason Dees, a family doctor in a private practice based in New Albany, Miss., said his office often resubmits claims that have been "magically denied." "That adds to our administrative fees, extends the payment cycle and hurts our cash flow," he said. Dees also spends a lot of time getting "pre-certification" from insurers to approve higher-priced procedures such as MRIs. "We're already operating on paper-thin margins and this takes times away from our patients," he said. Link
Yet he didn't mention the fact that the insurance company had been dealing with him several times on the same issue, each time pointing to the glaring error in the form filed and pointing out that it clearly defines what the field should contain and in the proper format. He also didn't mention the likelihood of his hire who was doing the forms had absolutely no experience in medical forms and kept making stupid mistakes over and over while blaming the insurance company for the issue only to have a representative escalate the issue until finally the doctor is on the line and gets to hear how stupid his hire is.
But... never mind that, I mean its those "evil" insurance companies. /boggle
To me it seems ridiculous when those against healthcare reform point their fingers and are (or pretend to be) outraged at the report of suffering under the healthcare of another nation. It's a bit pretentious and phony.
That people without healthcare in America suffer or die is of little concern to them. That's the Status Quo they want to preserve.
Beyond the 50 million without any insurance, there are those of us who have a really good insurance plan, like me. I'm in a good spot right now. But I'm not stupid enough not to be able to see that if my husband loses his job (he's been layed off twice in 5 years as it is) or if he wants to progress in his career by taking a new job, both of us take the chance of losing everything, since we both have back issues that would be deemed pre-existing conditions.
Does this seem acceptable to anyone? ALL of us WILL , at some time or another, develop some sort of health condition - either us or one of our children. And when that happens, all you can do is pray that your current job lasts forever. What are the odds of that? Let's face it, the odds of that are NOT GOOD. And forget about trying to better yourself by taking a new position. The risk of financial ruin due to uncovered medical issues are all too real.
This level of vulnerability is truly wrong. It is ruining countless families and prohibiting people from being able to get ahead. Too many people are choosing to put their head in the sand and are pretending that they will never be caught in a predicament where one medical issue could bankrupt them. I wish people would wake up.
I know for a fact this is true because it happened to me. These people are really slick and are experts at denying claims and strong arming YOUR DOCTOR.
They do not care about you at all, money is all that matters.
Not a surprise, really. We all know the US is all about the almighty buck, don't we? We've all said it before pertaining to other things we've seen in our lifetime in the US with companies buying out others in-mass, creating less competition. Millions of jobs outsourced and opened borders with millions crossing over, private prisons replacing manufacturing jobs for local residents. And local and Federal jobs growing, providing health insurance for its employees at taxpayer expense, all for the almighty buck. Now the insurance healthcare delivery scheme now is becoming too pricey and greedy with many hands in the till that it has become so glaringly obvious.
Beyond the 50 million without any insurance, there are those of us who have a really good insurance plan, like me. I'm in a good spot right now. But I'm not stupid enough not to be able to see that if my husband loses his job (he's been layed off twice in 5 years as it is) or if he wants to progress in his career by taking a new job, both of us take the chance of losing everything, since we both have back issues that would be deemed pre-existing conditions.
Does this seem acceptable to anyone? ALL of us WILL , at some time or another, develop some sort of health condition - either us or one of our children. And when that happens, all you can do is pray that your current job lasts forever. What are the odds of that? Let's face it, the odds of that are NOT GOOD. And forget about trying to better yourself by taking a new position. The risk of financial ruin due to uncovered medical issues are all too real.
This level of vulnerability is truly wrong. It is ruining countless families and prohibiting people from being able to get ahead. Too many people are choosing to put their head in the sand and are pretending that they will never be caught in a predicament where one medical issue could bankrupt them. I wish people would wake up.
All true. The naysayers are actually smart enough to understand that, but are more intent on denying others the same thing and/or are more intent on making the President and his party fail. Most of the GOP health care debate is about divisive politics and winning back the White House, nothing more, and those people do NOT care one single bit how many of us die from lack of insurance.
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The fact that opponents of this bill are lying about its purpose is absolutely infuriating. The fact that stupid people in this country believe the lies without stopping to say, "hmmm, something doesn't sound right about that," is truly terrifying.
The fact that you are willing to hand over healthcare to the government is what is terrifying.
Besides the military (which thank God is not run by bureaucrats) what government run entity do you receive high quality services from? The IRS? The DMV?
I get my neighbor's mail all the time and sometimes I have to walk several blocks to deliver it to them myself.
My neighbor from 2 doors down had my tax rebate check. The City inspector's department sent me a letter threatening $15,000/day for every day that my roof drains were hooked up to the city sewer system. Never mind that they were disconnected over 50 years ago. I could go on and on about government waste, fraud, sloth, rudeness, and inefficiency. Point is, I do not trust the government's ability to do anything right.
It doesn't matter what the bill says in a strict sense, it matters how the government is going to implement everything in the bill. In five years, if the bill passes, there will be very few similarities between what the bill says and what is actually happening in practice. The abuse will be legendary.
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Insurance Carriers are cruel
