Skip to comments.Deny This: Guess Who Has the Highest Medical Claim Rejection Rate?
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 AMAs own 2008 National Health Insurer Report Card (fairly large PDF).
I'm curious. Was it Aetna? Humana?
(Excerpt) Read more at newsbusters.org ...
No surprise at all.
We need to get rid of Medicare all together.
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.
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.
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.
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.
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!
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.
" “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.
dont’ worry - we can pray to Obama for our health care, just like these folks:
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.
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.
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.