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Thread: Obama discusses deathbed measures

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    Re: Obama discusses deathbed measures

    Quote Originally Posted by RightinNYC View Post
    Right.
    Glad you agree.

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    Re: Obama discusses deathbed measures

    Quote Originally Posted by RightinNYC View Post
    This is a fairly unfounded assumption.
    Why?

    There are plenty of people who want UHC because they are tired of jumping through the hoops of insurance companies, and being denied coverage arbitrarily. I have never seen such corruption before as I have in the U.S. private insurance sector.

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    Re: Obama discusses deathbed measures

    Quote Originally Posted by Scarecrow Akhbar View Post
    You should read "We The Living", since "1984" is too complex for you.
    You should try actual debate. Oh wait, that is far too complex and taxing for you.

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    Re: Obama discusses deathbed measures

    Quote Originally Posted by Scarecrow Akhbar View Post
    You should read "We The Living", since "1984" is too complex for you.
    Quote Originally Posted by Redress View Post
    You should try actual debate. Oh wait, that is far too complex and taxing for you.
    Moderator's Warning:
    Obama discusses deathbed measuresBoth of you stop it or there will be further consequences.
    "Never fear. Him is here" - Captain Chaos (Dom DeLuise), Cannonball Run

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    Quote Originally Posted by Wiseone View Post
    This is what I hate about politics the most, it turns people in snobbish egotistical self righteous dicks who allow their political beliefs, partisan attitudes, and 'us vs. them' mentality, to force them to deny reality.

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    You can't paint everone with the same brush.......It does not work tht way.


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    See with you around Captain we don't even have to make arguments, as you already know everything .
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    Had you been born elsewhere or at a different time you may very well have chosen a different belief system.
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    It a person has faith they dont need to convince another of it, and when a non believer is not interested in listening to the word of the lord, " you shake the dust from your sandels and move on"

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    Re: Obama discusses deathbed measures

    Quote Originally Posted by RightinNYC View Post
    Are they proposing to require all doctors to work within the plan?



    "Single Payer"


    I would say this is by definition a "yes"....


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    Re: Obama discusses deathbed measures

    Quote Originally Posted by RightinNYC View Post
    Serious question: Link? I hadn't heard this.
    H.R. 676

    IN GENERAL.—It is unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act.

    Page 8, Lines 4-7.

    http://www.pnhp.org/nhibill/nhi_bill_final.pdf

    Quote Originally Posted by Orius View Post
    That law is the same in all nations with UHC, including Canada. The point is to make it so that the private sector is supplementary to the UHC system instead of it taking the full burden.
    Exactly. They want to marginalize the private health care industry and assume the lion's share of the market AKA a monopoly - those always work well.

    In the U.S. this would mean a downsizing of the private sector, but insurance companies have already proven they cannot be trusted so I say this is their loss.
    Of course, nothing wrong with putting thousands of people out of business because a few leftists find it politically advantageous to whine about how evil they are.

    People wouldn't be advocating for UHC if there weren't foul play happening.
    Be more specific. What's this "foul play" you speak of?

    The law makes private insurance more useful and less redundant. People will still rely on private insurance for some of the things UHC doesn't cover. It will make insurance plans cheaper and less bureaucratic.
    Well, the stated purpose of H.R. 676 is:

    To provide for comprehensive health insurance coverage for all United States residents, and for other purposes [1].

    Which makes me wonder, if they're providing comprehensive health insurance coverage, what's left for the private sector?

    [1] - http://www.pnhp.org/nhibill/nhi_bill_final.pdf

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    Re: Obama discusses deathbed measures

    Although I agree somewhat, how would you feel as a doctor in turning somebody off?


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    Re: Obama discusses deathbed measures

    Quote Originally Posted by Orius View Post
    Why?

    There are plenty of people who want UHC because they are tired of jumping through the hoops of insurance companies, and being denied coverage arbitrarily.
    Completely untrue.

    Quote Originally Posted by Solidus View Post
    1) How often do insurance companies "arbitrarily" deny claims?
    This figure doesn't seem to be popular, even amongst groups or lawyers who help you appeal insurance denial claims. For example, "healthclaimappeals.org" only quotes a percentage for Medicare (10%, non-sourced) but declines to give one for private insurers.[1] Office of Health and Human Services sampled Medicaid in 8 states in 2000, finding "On average, about 15 percent of claims submitted for payment contain fatal
    errors."[2] Maryland passed "clean claims" legislation in an effort to reduce the various clerical errors that result in denied claims. They now track claim denial rates to guage the success of the legislation. Using a Base Group of both private insurers and HMOs they find that in 2007 15.7% of all claims were denied.[3] Assuming Maryland is average, then both public and private insurance have effectively the same denial rate.

    Answer: Both public and private insurers deny claims roughly 15% of the time.

    2) What are the "arbitrary" reasons to deny claims?

    "healthclaimappeals.org" suggests three:

    Quote Originally Posted by healthclaimappeals.org
    " * It is a duplicate or inauthentic claim. This happens more than you might think. Sometimes individuals or their health insurance provider will accidentally submit the same claim more than one once for payment. Insurance plans are also on the lookout for health insurance fraud, which is a major problem confronting the system.
    * The policy that was purchased by you or your employer or established by the public program doesn’t cover the service or product in the claim. As an example, some plans don’t cover dental services or elective procedures.
    * The claim is for a service or product that the medical community considers to be experimental because it has not been proven to be safe and effective. Most plans purchased by employers and individuals do not cover experimental treatment."
    [1]

    Office of Health and Human Servies suggests:

    Quote Originally Posted by OHHS
    "The most common fatal errors include missing or erroneous:
    * provider and patient identification numbers,
    * birth dates,
    * diagnostic information, and
    * prior authorization information."
    [2]

    Maryland Insurance Administration reports the most common reasons are:

    Quote Originally Posted by MIA
    "* Duplicate claim submission (31.7 percent)
    * A pre-treatment authorization or referral for services was not obtained or unauthorized services performed were not covered by plan (19.8 percent)
    * The patient was not covered or eligible for benefits at the time services occurred (9 percent)
    * The patient had met the maximum benefit at the time services occurred (9 percent)"
    [3]

    Answer: The most common reasons are either insufficient information (for Medicare), or the claim is a duplicate (for private insurers). Procedure not covered or procedure considered unsafe or ineffective are secondary.

    3) Of the reasons given for denying claims, what impact do doctors employed by insurance companies have?

    If we assume that Maryland's "clean claims" represent those claims that are free of clerical errors, and that the only remaining reason for denial was the influence of an "in house" doctor (this is a generous assumption); then the percentage of clean claims denied can work as a proxy for "claim denied due to insurance doctor influence". For 2007 5.3% of "clean claims" were denied. For 2004 - 2006 the average was 1.5%.[3] Possible reasons for the increase in 2007 are provided in the report, "The most significant change in 2007 from the previous three years is the nearly four-fold increase in the number of claims denied because a pre-treatment authorization or referral for services was not obtained or unauthorized services performed." [3]

    Answer: Insurance company doctors are responsible for between 1.5% and 5.3% of claims being denied (probably closer to former given both the lax assumptions and the anomaly of 2007 data).

    Conclusion: Roughly 15% of claims are denied, and almost a third of those are denied because they are duplicates. Medical doctors employed by insurance companies have very little impact on the rate of claim denials, accounting for 5% or less of denials. Further, this assumes that all "in house" doctors act contrary to overall medical "best practices"; which has yet to be demonstrated. Banning doctors from being employed by insurance agencies will have little impact on reducing claim denials.

    J

    [1] Frequently Asked Questions - HealthClaimAppeals.org
    [2] http://www.oig.hhs.gov/oei/reports/oei-05-99-00071.pdf
    [3] http://www.mdinsurance.state.md.us/s...final01-09.pdf

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    Re: Obama discusses deathbed measures

    Quote Originally Posted by OxymoronP View Post
    Although I agree somewhat, how would you feel as a doctor in turning somebody off?
    1. What do you agree with?

    2. What do you mean by "a doctor turning somebody off"?

    3. To whom are you posing this question?

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    Re: Obama discusses deathbed measures

    Quote Originally Posted by danarhea View Post
    What bothers me is that the government gets the final decision on what treatment is acceptable. Of course, as it stands today, the insurance company is frequently the final decider. Whatever happened to the belief that the doctor is the most qualified to make these decisions?
    They are, but if they err they get sued.
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