"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?
A chart showing the major carriers and how Medicare compared to them in the study follows:
Well, well.
The Medicare denial rate found in the study was, on a weighted average basis, roughly 1.7 times that of all of the private carriers combined (99,025 divided by 2,447,216 is 4.05%; 6.85% divided by 4.05% =1.69).
You would think Medicare's sheer size might enable it to have smoother procedures with its providers that would enable it to turn down a lower percentage of claims. But no, this is the government we're talking about.
So who's the most "heartless" now? And why should Americans accept the idea of gradually being forced into a government-run system when, based on documented government experience, they will be more likely to see their claims denied?
And I didn't even get to the idea of refusals to treat in the first place, something that is present to some degree in virtually every state-run system, but is currently against the law in hospital emergency rooms in the U.S."(Source)
Funny how President Obama, Nancy Pelosi, Barney Frank and others have demonized insurance companies and claimed that unisured individuals are dying because they don't have health insurance. But they don't discuss how the Gov't's existing public option is at the top of the list for denying claims. Oh.....the irony of it all.
15 comments:
You've nailed it. Great post.
Great post CBW.
People who don't recognize, choose not to.
Oh no...I've got that insurance! Hopefully I won't get sick......
This is a very good post. Unfortunately, many people are under the illusion that government can somehow magically solve all the problems in our health care system. They are just setting themselves up for a rude awakening.
Well doesn't this refute the claims of the Public Option will Bankrupt America?
Is there a Health Care problem in America. Yes.
Is it big. Yes. That is why people are supposed to run for Office right. To tackle the Big Issues no matter what the naysayers have to say.
Unless you feel public officals serve a different purpose?
I personally believe that the REJECTION RATE is a flawed argument in the first place.
I DON'T CARE WHAT SCHEME THEY ULTIMATELY COME UP WITH!!! It is IMPOSSIBLE to offer EVERYTHING TO EVERYBODY!!!
If this is the case - I need to ride my bike up the street and drive a Caddy or Lexus off of the lot.
Health Care = ECONOMICS.
There is no getting away from it.
The only way they are going to "reduce system costs" is to eliminate what everyone has access to in the first place.
THINK ABOUT IT - What if they took your data and say "OK we will approve 100% of Government Medicare claims?". This would only expand the money that the Government spends.
This government that has an $1,800 billion deficit and a $12,000 billion DEBT.
Excellent post CBW! Insurance means nothing if the claim is denied.
All those people that left comments, did you even read the source of the information to see why the claims were denied:
Did you compare the reasons denied to the other insurance companies reasons. The large majority of the claims were denied because of paper work errors, and not because of pre-existing conditions, termination of coverage, or high deductibles. Which means if they re-submit the paperwork with the proper procedures, the claims will be accepted.
Errors do to filing has been a big problem, and the reason why the health care reform wants to streamline Medicare and Medicaid is to make them more of an electronic system; a lot like what the other insurance companies have.
In all the other metric, Medicare works pretty well, and is ranked fairly high.
Medicare processes more than 3 times all of the insurance companies combined on that list, so it makes sense that the amount of claims do to "errors" would increase incrementally, especially if the technology isn't there to handle the load.
So yes Medicare is number 1 for denial, but not because of pre-existing conditions, termination of service, or because high deductible payments have not been met.
If the premise is that the current system works okay then that is a chasm that cannot be crossed. Only those of us working Americans who have healrh issues and use the current system can understand how messed up it is. And I speak as one married to a woman with a chronic confition (RA) and both of us with better than average employer provided coverage.
All the rhetoric about self reliance and conservatism doesn't mean a thing when your co-pay adds up to ten grand and you don't have it and you can't appeal to your insurance company for fair treatment. When it happens to you you will cross to this side of the debate.
Crossing over; Conchscooter. In the system and a co-pay for 10gs is something i don't understand. Well, yes i do. You're getting hosed. but why can't it be on a monthly pay-what-you-can-afford?
I quit all of it. Used nothing for insurance. I was healthy but down the road things nose-dived and i ended up on the table.
Emergency case, thru and thru. I had no money. Would have died had they not fixed me. If their work was successful, I intended to pay.
From nothing i made monthlys. They were small payments. Fifty here, ten, ten, a couple more for less. It's all i had - they were thrilled. Me? I'm still thrilled.
And no insurance to date. Fifteen years ago.
Different circumstances, different case?
I just can't get my head around "better than average employer provided coverage" for 10 grand co-pay. That's not better anything. that's lousey. Where's all the money, in the third party?
Ms. Grape,
You seem to have an excuse for everything that doesn't fit your agenda; so why is it that fewer and fewer M.D.s are accepting Medicare these days if it is such a wonderful plan, albeit on the verge of bankruptcy?
Could it be that lower and lower reimbursement for professional services coupled with the burdensome bureaucracy makes it cost prohibitive for most ethical M.D.s?
Why are the scooter type businesses thriving while American doctors are quitting the practice of medicine in larger and larger numbers each year?
Why does patient noncompliance go unchecked?
Who is stopping fraud and abuse? The government?
Until responsible behavior becomes part of the equation the delivery of care will continue to be financially inefficient and more and more rationed. What degree of health care that remains available will be essentially outsourced to 3rd world M.D.s from Pakistan, India, Cuba and the like---let's see how you and Michael Moore like that!
If the Public Option were to pass, inefficiency and rationed care would go into turbo drive and American M.D.s would take early retirement in droves.
"...why is it that fewer and fewer M.D.s are accepting Medicare these days if it is such a wonderful plan, albeit on the verge of bankruptcy?..." (BI)
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That's a fine point, the part of the American healthcare system that's currently failing is the existing "public option," so the liberal answer, of course, is "expanding the public option."
Only makes sense to liberal "emotional logic."
Medicare IS on the verge of bankruptcy, but Medicaid is ALREADY hopelessly insolvent! It's some $7 BILLION in the whole already.
In Medicaid's defense (and it's no defense at all) some of its overuns are due to elderly middle class Americans "gaming the system" to divest themselves of their accrued assetts (houses, savings, etc.) within a "lookback period" and then declaring themselves "indigent" to get Medicaid paid healthcare and nursing home care, much of its other cost overruns are due to outright fraud.
I've said from the beginning, the primary reason for the crisis in American healthcare is due to the fact we give away too much advanced care for free.
We do NEED to ration healthcare, BUT we NEED to target that rationing and those restrictions to those who haven't paid into any of the programs they benefit from.
Medicaid should exist but as a tightly restricted and strictly rationed program, maybe 4 visits per year and a maximum expenditure of, say, $8,000 per patient per year.
Each individual would have to find a way to pay for private supplemental insurance to circumvent those restrictions. Hell, lots of people on Medicaid find ways to buy $200 sneakers, so they could probably also find the $400 to $600 per month for the needed supplemental inurance.
Medicare recipients pay into that program all their lives, just as employers pay into unemployment insurance, money that would've gone into that worker's paycheck, so those porgrams should be the last one rationed, while Medicaid and other such programs should be targeted for the most severe rationing.
This is EXCELLENT
I just found your post tonight and it is refreshing to know that I am not the only one who believes that conditions and denials exist in government systems....the same thing the administration is using as an excuse for to take over healthcare. The other thing they use is the UN Stats of infant mortality rates and life expectancy....does not into account the diverse genetics in the USA compared to the other socialist countries in their report. Thank you for being you!
October 7, 2009 9:26 PM
MrsGrapevine said...
"Did you compare the reasons denied to the other insurance companies reasons. The large majority of the claims were denied because of paper work errors, and not because of pre-existing conditions, termination of coverage, or high deductibles. Which means if they re-submit the paperwork with the proper procedures, the claims will be accepted."
Why should we even HOPE the government CHANGE to health care will not also have high rates of rejection for paperwork/processing errors? Government red-tape and inefficient bureaucracies can only degrade service and its quality.
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