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Thread: Guess Who Has the Highest Medical Claim Rejection Rate?

  1. #91
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    [quote]
    Quote Originally Posted by PeteEU View Post

    I see. So what is an immediate health concern.. blood pouring from the face? Looking like you have the plague, chicken pox and worse all at the same time?
    So when does acne or a facelift affect health? Since you brought it up?
    How about a deflated breast implant that is seeping into the body.. is that "immediate" enough or because it is part of a cosmetic surgery then it is a "pre-existing" condition.?
    Look, your own article doesn't get it right, not my problem, a leaky breast implant that contains silicone IS covered, because that would be an immediate health risk, septic acne would be as well, now, what the story gets wrong is that the person would have coverage, just not for pre-existing conditions, EXCEPT for things that provably could cause death or disfigurement, they might even not cover something or reduce coverage, but then again NOT all insurance companies have the same policies, practices, or coverage models. See, it's easy to use a source that says blindly what you want it to, the problem is it doesn't stand up to scrutiny.


    So you are telling me that in a standard basic healthcare insurance coverage there is no pregnancy coverage for women? So insurance companies dont expect women to have babies... I see.
    There is no "standard" coverage, there are state requirements, there are policy minimums, and there are in fact many companies that offer a low priced rider instead of just covering pregnancy as a blanket condition....you know.....cause not everyone will get pregnant like, men, infertile women, women who don't plan to have children, young children............



    Read the article.
    I did, it was crap, first paragraph started out with bad info, it only got worse from there.



    And you expect the companies to some how miraculous change their spots over a decade and especially when it is not illegal in those 8 states? If it was not a problem, then why the hell did the other 42 states put bans in place? Because they had nothing better to do?
    Companies that use that practice don't often retain customers, and chances are they will be answering to an insurance commissioner for something in the future anyway.



    In other words you are defending the companies yet again for being able to screw over American's.. nice to know the conservative mindset rules again.
    I see, so you throw an insult because you are uninformed about the argument, and can't mind your own countries business. Gotcha, again, MYOB.



    LOL you accuse me of using a blanket statement and then you throw out one of your own.
    You DO know what a blanket statement means right?
    Neither side in an argument can find the truth when both make an absolute claim on it.

    LMR

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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    lol @ the way this thread has turned into a slaughter fest.

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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by Glinda View Post
    You're right on this point. The fact is, insurance companies are profit driven, and are more interested in denying treatment than they are in providing it. They HAVE to be or they can't pay their greedy CEOs hundreds of millions, can't pay dividends to their shameless stockholders, who all get their compensation on the backs of the ill and dying.



    If you can understand this, why would you be against a public option which is NOT profit driven? Because you might lose your job?
    First off, the CBO is estimating based on current cost, major economists have already said that this is going to change, which I think the CBO has readily admitted, secondly, you do know that the B at the end of public healthcare is astronomically bigger than the M from the private sector right? If not, get a stopwatch and count to the two numbers. Next, I don't lose my job, I am independent, which means I can sell whatever I want and am basically my own boss, I'm not firing myself, but many agents will lose their jobs and everyone will suffer the consequences of public healthcare, if it gets passed and fails, I will expect an apology from all of the pro-subsidized healthcare people on this forum, I'll even make a thread to make it easier.
    Neither side in an argument can find the truth when both make an absolute claim on it.

    LMR

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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by Objective Voice View Post
    But Medicare also has over 6.3 million more clients than Aenta. Not a reasonable comparasion by any stretch considering that percentage wise, both have an equal amount of rejected claims (6.80% and 6.85%, Aenta to Medicare).

    It's really not a fair comparison. I could see if all insurance agencies listed had roughly the same amount of cases and Medicare had a higher reject rate, but when the agency you're trying to knock has well over 6 million more clients that the "competition", it's really not a fair comparison.
    And United Health Group insures 70 million people and has less of a % of claim denials.

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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by PeteEU View Post
    Does Medicare deny coverage due to pre-existing conditions like being in an abusive relationship, having had a broken bone once long ago and not reporting it, or having acne?
    "Believe it or don't" - There actually may a a corrrelation between acne and certain deseases such a thyroid cancer and /or typer thyroidism. "being in an abusive relationship" is not a pre-existing condition it is probably more of a life style.

    Familiar to disclose is a though call since failure to disclose is important if that failure to disclose is material. Also there are conditionns that people have may not appear to be a long term impact upon health to them.

    Who would have expected that having acne may impact a cancer ? Severe sunburn asa child or teen is also listed as a possible cause of Thyroid canacer in later years. I am not sure that we even thought it would casue skin cancer.
    Last edited by F107HyperSabr; 10-08-09 at 11:18 PM.
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by Glinda View Post
    You're right on this point. The fact is, insurance companies are profit driven, and are more interested in denying treatment than they are in providing it. They HAVE to be or they can't pay their greedy CEOs hundreds of millions, can't pay dividends to their shameless stockholders, who all get their compensation on the backs of the ill and dying.



    If you can understand this, why would you be against a public option which is NOT profit driven? Because you might lose your job?
    There is really nothing wrong with making a profit. All companies are profit driven.

    I thought that he isue was insurance companies but most of the comp[anies you listed are DRUG companies and one I think is a hi-tech bio research commpany.

    Is the compensation paid to these guys in line with other industries ?
    Last edited by F107HyperSabr; 10-08-09 at 11:25 PM.
    I do not recall the Viet Cong asking me if I was a natural born or Naturalized American before they shot at me, they just shot at all of us f107HyperSabr

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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by rivrrat View Post
    I can give you examples of "not medically necessary" from my own experience in the healthcare field as an EMT.

    Taking an ambulance to the hospital for a sprained thumb = not medically necessary.

    Taking an ambulance to the hospital because you don't "feel well" = not medically necessary.

    ER treatment for a headache = not medically necessary
    Show me everything the state deems not medically necessary, because I seriously doubt that considering that more than 20% of their claim denials are from treatment which they deem not medically necessary that even half would fall into those above categories.

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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by Agent Ferris View Post
    Show me everything the state deems not medically necessary, because I seriously doubt that considering that more than 20% of their claim denials are from treatment which they deem not medically necessary that even half would fall into those above categories.
    I gave you only a couple of examples. And what was "medically necessary" as far as the ambulance went was determined by US... the medical professionals operating the ambulance. We either said it was medically necessary, or we didn't. Ditto for the docs in the ER. Easily 90% of the medicare/medicaid recipients I picked up fell into the NOT medically necessary category. If not more. I'm being kind with that estimate. The only medically necessary medicare/medicaid folks I picked up in the ambulance were either heart attacks or car accidents. The rest of them were hypochondriac, attention seeking ****ers using the ambulance as a taxi service. I applaud Medicare for letting the medical professionals decide what was actually medically necessary and what wasn't (about the ONLY thing I will applaud them for) and I am glad they deny a ****load of claims because of it. However, it's too easy to get around... it was too easy for ambulance personnel to just simply lie and state that it WAS medically necessary.

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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by rivrrat View Post
    I gave you only a couple of examples. And what was "medically necessary" as far as the ambulance went was determined by US... the medical professionals operating the ambulance. We either said it was medically necessary, or we didn't. Ditto for the docs in the ER. Easily 90% of the medicare/medicaid recipients I picked up fell into the NOT medically necessary category. If not more. I'm being kind with that estimate. The only medically necessary medicare/medicaid folks I picked up in the ambulance were either heart attacks or car accidents. The rest of them were hypochondriac, attention seeking ****ers using the ambulance as a taxi service. I applaud Medicare for letting the medical professionals decide what was actually medically necessary and what wasn't (about the ONLY thing I will applaud them for) and I am glad they deny a ****load of claims because of it. However, it's too easy to get around... it was too easy for ambulance personnel to just simply lie and state that it WAS medically necessary.
    From my understanding of Title 18 it's the Secretary of Health and Human Services and consultation boards which make the determination of benefits one will be entitled to:

    Sec. 1804. [42 U.S.C. 1395b-2] of the Social Security Act of 1965: (a) The Secretary shall prepare (in consultation with groups representing the elderly and with health insurers) and provide for distribution of a notice containing—

    (1) a clear, simple explanation of the benefits available under this title and the major categories of health care for which benefits are not available under this title,

    (2) the limitations on payment (including deductibles and coinsurance amounts) that are imposed under this title, and

    (3) a description of the limited benefits for long-term care services available under this title and generally available under State plans approved under title XIX.


    But are you seriously suggesting that elderly people who are far more likely to actually be sick are actually the ones coming in more often for treatment that is not medically necessary? I highly highly doubt it and in fact I'd be willing to bet my bottom dollar that they are being denied quality of life, and life extending treatment which will be exactly what happens to the rest of us once the fascist statist bastards in power take our healthcare out of hands of the private sector and into their own iron fists.

    And furthermore; why in the hell would ambulance drivers be more willing to lie for people with medicare insurance than they would for people with private insurance? Your statements do nothing to diminish the point made in the OP and that is that all private insurance companies combined deny less claims than medicare when the Dem statists continually make opposite assertions about those evil private insurance companies.
    Last edited by Agent Ferris; 10-09-09 at 01:39 AM.

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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by Agent Ferris View Post
    But are you seriously suggesting that elderly people who are far more likely to actually be sick are actually the ones coming in more often for treatment that is not medically necessary?
    In my experience, yes. Medicaid AND Medicare folks.


    And furthermore; why in the hell would ambulance drivers be more willing to lie for people with medicare insurance than they would for people with private insurance?
    I wasn't willing to lie for any of them. Which is why I stopped working there. I was required by my employer to lie in order to keep my job, so I quit.

    As for why they did it more for Medicaid/Medicare than private insurance... I'll give you a couple reasons. The main reason being that very, VERY few private insurance or self-pay folks ever abused emergency services. Those actions were almost exclusively Medicaid and Medicare ****tards. Because, well, you know... it was "free" for them.

    Second reason is that it was easier to fool Medicaid and Medicare with simple terminology differences. Private insurance wasn't as gullible.

    Last, Medicaid/Medicare denied more claims in general and were harder to get their money from in general. So anything the company could do to ensure that Medicaid/Medicare would actually pay, they would do.

    Not to mention the fact that the vast majority of our passengers were Medicaid/Medicare recipients.


    Your statements do nothing to diminish the point made in the OP and that is that all private insurance companies combined deny less claims than medicare when the Dem statists continually make opposite assertions about those evil private insurance companies.
    I wasn't trying to diminish that point. Someone asked what could be deemed medically unnecessary and I provided answers. I am NO advocate of Medicaid/Medicare.

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