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

  1. #101
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by American View Post
    And government is burocracy-driven, and therefore artifically drives-up cost by adding levels of unneeded administration. Eventually it becomes the mission of this burocracy to sustain itself, instead of the public service.
    Interestingly enough, all of this is true of the health insurance industry as it exists today.


  2. #102
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by LaMidRighter View Post
    So how long have you been in the insurance business? I'd really like to know since you can undoubtedly say what a company's motivations are, or can assign which points I am right on, you know, since I actually DO work in the Life/Health insurance industry.
    Ho-hum. Another one of those "If you're not up to your neck in the middle of it, you can't possibly know the truth" arguments. *yawn*

    Here's the thing. From where I stand I can see the health insurance ripoff forest for what it is - a greed fest at the expense of others' lives. You are blinded by the trees you hide behind - those massive trees owned by the insurance companies, whose ugly bidding you do and to whom you are beholden.

    I don't have to be a health insurance paper-pusher to know that people are regularly denied life-saving treatment (Hint: It's what this whole thread is about) from the very people who are compensating themselves to the tune of hundreds of millions of dollars every year. Nor do I have to be an insurance company tic sucking the life out of the public hide to know that 45,000 people die every year because they simply can't afford to pay the blood money the insurance companies demand for their [sarcasm] invaluable services [/sarcasm].

    It's disgusting and unconscionable.


    Quote Originally Posted by LaMidRighter View Post
    many agents will lose their jobs
    It's high time the poor health insurance make-work paper-pushers join the rest of us in the 21st Century, where we have the highest unemployment rate in 26 years. And, you know, if you had no job and no health insurance, you might actually start to see that forest the rest of us are looking at.

    Quote Originally Posted by LaMidRighter View Post
    and everyone will suffer the consequences of public healthcare,
    People are DYING RIGHT NOW because they're being denied treatment by their insurance companies. People are DYING RIGHT NOW because they have no coverage at all. People are DYING RIGHT NOW while insurance company salespeople continue pushing little pieces of paper around, desperately inventing new and more insidious ways to deny coverage.

    Bottom line, I'd rather take my chances with a not-for-profit option ANY day than be forced to live and die by an insurance company's greed margin.

    Quote Originally Posted by LaMidRighter View Post
    if it gets passed and fails, I will expect an apology from all of the pro-subsidized healthcare people on this forum
    I sincerely hope you'll be holding your breath in anticipation of that.

  3. #103
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by Agent Ferris View Post
    A) Those are number of claims not number of those insured.

    B) Those are the seven major insurers.

    C) Do you know what a % is? Even as a % of claims denied medicare still rejects more people.

    D) 200 million people are covered by private insurance, only 35 million are covered by medicare.

    E) Aetna provides insurance to 21 million people.

    Aetna - Wikipedia, the free encyclopedia


    F) Anthem provides insurance to 11.6 million people.

    Business Partners

    G) CIGNA provides insurance to 46 million people.

    CIGNA Newsroom: As Employee Benefit Enrollment Season Begins, CIGNA Suggests a ?Spring-Cleaning? Approach to Putting the Family Financial House in Order

    H) Coventry provides insurance for 4.6 million people.

    Coventry Health Insurance

    I) Healthnet provides insurance to 7.3 million people.

    Health Net - Wikipedia, the free encyclopedia

    J) Humana provides insurance to 11.5 million people.

    Humana - Wikipedia, the free encyclopedia


    K) UnitedHealth group provides insurance to 70 million people.

    UnitedHealth Group - Wikipedia, the free encyclopedia


    L) That's a grand total of 172 million people.
    Care to explain why Medicare has more claims even though it insures less people?

  4. #104
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by TacticalEvilDan View Post
    Their denial percentage is comparable to each of those other insurance companies, especially Aetna.

    Misrepresentation FTW!
    I think he may be trying to dispel the myth that UHC is somehow the perfect solution. Also, UHC isn't made to support old people for decades. There aren't enough funds for that. More claims from the elderly and terminally ill will be rejected because of the costs. I'm sure that's true for any insurance company or government system.

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

    Quote Originally Posted by Glinda View Post
    Ho-hum. Another one of those "If you're not up to your neck in the middle of it, you can't possibly know the truth" arguments. *yawn*
    Oh, I get it, a politician who wants the bill says something is so, Michael Moore says it's so, and a bunch of left leaning pundits say it's so, so it's so. Nevermind the fact that people in the medical and insurance fields are telling you it's smoke and mirrors and an overblown and overrepresented occurance, what would we know, we only WORK, in the industry.
    Here's the thing. From where I stand I can see the health insurance ripoff forest for what it is - a greed fest at the expense of others' lives. You are blinded by the trees you hide behind - those massive trees owned by the insurance companies, whose ugly bidding you do and to whom you are beholden.
    Yeah, okay, care to bring facts instead of demonizing people who do.
    I
    don't have to be a health insurance paper-pusher to know that people are regularly denied life-saving treatment (Hint: It's what this whole thread is about) from the very people who are compensating themselves to the tune of hundreds of millions of dollars every year. Nor do I have to be an insurance company tic sucking the life out of the public hide to know that 45,000 people die every year because they simply can't afford to pay the blood money the insurance companies demand for their [sarcasm] invaluable services [/sarcasm].
    But you DO need to bring credibility, which you seem to have a problem understanding, I am telling you what is and what I've seen, you are using faulty sources and using empty rhetorical emotionalizations which do not prove your point.







    People are DYING RIGHT NOW because they're being denied treatment by their insurance companies.
    Right, so do you care to bring facts, like percentages, proof that it was a necessary procedure, proof that the doctor wasn't ordering an unnecessary procedure, etc. etc. It's easy to blame insurers, it's hard to actually tell both sides.
    People are DYING RIGHT NOW because they have no coverage at all. People are DYING RIGHT NOW while insurance company salespeople continue pushing little pieces of paper around, desperately inventing new and more insidious ways to deny coverage.
    And yet.....with all of this.....the government programs have the highest denial percentage.........hmmmm......kind of takes the wind out of your "people are dying because of denials" rant doesn't it?


    I sincerely hope you'll be holding your breath in anticipation of that.
    Ah, I see, so if you get your way, and when it fails miserably, you won't admit you were wrong.....fine, have it your way.
    Neither side in an argument can find the truth when both make an absolute claim on it.

    LMR

  6. #106
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by LaMidRighter View Post
    Nevermind the fact that people in the medical and insurance fields are telling you it's smoke and mirrors and an overblown and overrepresented occurance, what would we know, we only WORK, in the industry.
    1. You don't work in the medical field.

    1a. Those in the medical field (you know, the people who actually PROVIDE HEALTHCARE SERVICES?) overwhelmingly support a public option.

    Poll Finds Most Doctors Support Public Option

    When polled, "nearly three-quarters of physicians supported some form of a public option, either alone or in combination with private insurance options."

    Most doctors — 63 percent — say they favor giving patients a choice that would include both public and private insurance. That's the position of President Obama and of many congressional Democrats. In addition, another 10 percent of doctors say they favor a public option only; they'd like to see a single-payer health care system. Together, the two groups add up to 73 percent.

    When the American public is polled, anywhere from 50 to 70 percent favor a public option. So that means that when compared to their patients, doctors are bigger supporters of a public option.
    Here's ANOTHER poll on the same topic, with similar results:

    Doctors Support the Public Option

    That's the conclusion of a national poll conducted by the Robert Woods Johnson Foundation. The survey included more than 5,000 doctors spread across an array of specialties, and asked two sets of questions. The first gauged support for a public health-care system, a system with public and private options, and a solely private system. The second measured attitudes towards Medicare. The results should be generally cheering to reformers.

    Doctors overwhelmingly support either a public option or a public system. Indeed, when you add the two groups together, it's more than 70 percent of respondents. There were some differences across specialties, but not a lot: about 75 percent of primary care doctors favored a public option or public system, while about 67 percent of surgeons felt similarly.

    Next, the survey asked about opening Medicare up to individuals between 55 and 64. Support overwhelmed opposition by more than 2 to 1.
    Oh, look! The AMA also supports a public option!

    AMA President Says House Bill Is a Good Start Toward Health Reform

    CHICAGO – The American Medical Association offers its support of the U.S. House bill on health reform and reiterates its commitment to effective, comprehensive health-care reform in a new video message from AMA President J. James Rohack, M.D.

    “The status quo is unacceptable,” says Rohack in the video message posted to YouTube and the AMA’s Web site. “Let me be clear: Without a bill that can pass the House, there is no health reform this year. The debate is far from over, and the AMA is going to be at the table to improve the final legislation.”

    “As physicians and healers, we’re at the heart of the health-care system,” says Rohack. “We know our position at the center of the health-reform debate is both an honor and a serious responsibility.”

    The House bill includes provisions key to effective, comprehensive health reform, including:

    * Coverage to all Americans through health insurance market reforms
    * A choice of plans through a health insurance exchange
    * An end to coverage denials based on pre-existing conditions
    * Fundamental Medicare reform, including repeal of the flawed sustainable growth rate (SGR) formula
    * Additional funding for primary care services, without reductions on specialty care
    * Individual responsibility for health insurance, including premium assistance to those who need it
    * Prevention and wellness initiatives to help keep Americans healthy
    * Initiatives to address physician workforce concerns
    And we can't ignore the New England Journal of Medicine, can we?

    In April 2009, we obtained data on a random sample of 6000 physicians from the American Medical Association (AMA) Physician Masterfile, which includes current data on all U.S. physicians. We excluded physicians from U.S. territories because health care reform may not be as relevant to them, and we excluded physicians in training because of their limited experience with insurance; a sample of 5157 physicians remained. We categorized physicians into four groups: primary care physicians (in internal medicine, pediatrics, or family practice); medical subspecialists, neurologists, and psychiatrists; surgical specialists and subspecialists; and other specialties. The survey instrument we used was developed with the input of an expert panel, and we conducted cognitive testing and pilot testing to ensure its clarity and relevance. (More detailed information about our methods can be found in the Supplementary Appendix, available with the full text of this article at NEJM.org.)

    Survey respondents were asked to indicate which of three options for expanding health insurance coverage they would most strongly support: public and private options, providing people younger than 65 years of age the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans; private options only, providing people with tax credits or subsidies, if they have low income, to buy private insurance coverage, without creating a new public plan; or a public option only, eliminating private insurance and covering everyone through a single public plan like Medicare. We also assessed the level of physician support for a proposal that would enable adults between the ages of 55 and 64 years to buy into the current Medicare program — a strategy that the Senate Finance Committee has proposed.

    Data were also collected on additional variables that might be associated with preferences for different expansion options, such as time spent on clinical duties each week, whether physicians owned their own practice, salary status, and type of practice. The survey has been in the field for approximately 2 months (June 25, 2009, to September 3, 2009). All available data were analyzed on September 4, 2009. A third survey wave was initiated on August 27, 2009.

    Overall, a majority of physicians (62.9%) supported public and private options. Only 27.3% supported offering private options only. Respondents — across all demographic subgroups, specialties, practice locations, and practice types — showed majority support (>57.4%) for the inclusion of a public option. Primary care providers were the most likely to support a public option (65.2%); among the other specialty groups, the “other” physicians — those in fields that generally have less regular direct contact with patients, such as radiology, anesthesiology, and nuclear medicine — were the least likely to support a public option, though 57.4% did so.

    Physicians in every census region showed majority support for a public option, with percentages in favor ranging from 58.9% in the South to 69.7% in the Northeast. Practice owners were less likely than nonowners to support a public option (59.7% vs. 67.1%, P<0.001), but a majority still supported it. Finally, there was also majority support for a public option among AMA members (62.2%)

    2. Of COURSE the health insurance paper pushers are telling me it's smoke and mirrors. They're worried their literal stranglehold on the American public is in danger of loosening.

    Quote Originally Posted by LaMidRighter View Post
    Yeah, okay, care to bring facts
    1. This has already been done.

    Study: 45,000 Americans die each year for lack of insurance

    2. For more facts, scroll up and click the links...

    Quote Originally Posted by LaMidRighter View Post
    instead of demonizing people who do.
    You, personally, and all your insurance make-work, paper-pusher colleagues are a major part of the problem. Why shouldn't I demonize you?

    Quote Originally Posted by LaMidRighter View Post
    I am telling you what is and what I've seen
    Why would I believe a guy who pushes paper for the health insurance industry? Your career is at stake; of course you're going to try to sell me a lot of indignant "I know the truth and you do not" hot air.

    Quote Originally Posted by LaMidRighter View Post
    you are using faulty sources
    Let's see, the sources I've supplied include the Mount Sinai School of Medicine, the American Journal of Public Health, Harvard, the Robert Woods Johnson Foundation, the AMA, and the New England Journal of Medicine. Please provide us with valid documentation that these sources are "faulty."

    Quote Originally Posted by LaMidRighter View Post
    Right, so do you care to bring facts, like percentages, proof that it was a necessary procedure, proof that the doctor wasn't ordering an unnecessary procedure, etc. etc.
    Without the ability to research the specifics of each of the 45,000 annual cases where individuals died because they did not have healthcare insurance, such a request is as impossible as it is pointless.

    But hey! YOU'RE in the health insurance industry! Why don't YOU provide us with those intimate details from each and every case, which you seem to think are so readily available? If you're unable to do this, I recommend you contact Harvard and the American Journal of Public Health. Perhaps they can straighten you out.


  7. #107
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    baucus, nelson, nelson, lincoln, carper, landrieu, conrad, dorgan, pryor, bayh, the united bluedog coalition and most democrat freshmen oppose the PO

    indeed, just wednesday 30 dem senators refused to sign a letter to reid demading the govt designation

    demonize them

    they matter

    we'll watch

  8. #108
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Wouldn't it be easier to just expand medicaid and include more people with higher incomes?

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

    wouldn't it be easier to cut NOW the half trillion dollars of waste, fraud and abuse in medicare and medicaid which the president banks on?

    what's he waiting for?

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

    Quote Originally Posted by Glinda View Post
    1. You don't work in the medical field.
    No, but my mother, godfather, cousin, and other relatives and friends do, and they are on MY side. Sorry, you lose.

    1a. Those in the medical field (you know, the people who actually PROVIDE HEALTHCARE SERVICES?) overwhelmingly support a public option.
    HAHAHAHA, good one, the fact is many physicians have already said they will leave that field of practice under Obamacare, they already HATE medicare.



    Oh, look! The AMA also supports a public option!
    And? The AMA is an association of some physicians, again, many even in it's membership are opposed.



    And we can't ignore the New England Journal of Medicine, can we?
    Sure can, considering it's not the end game in medicine, it's a trade journal, much like I have trade journals related to my field that are based on opinions as well as advice(based on opinion) etc.








    And again, the numbers have been exposed, so bring the right ones.





    You, personally, and all your insurance make-work, paper-pusher colleagues are a major part of the problem. Why shouldn't I demonize you?
    Because you have nothing else. I understand, you want to get your way, why let facts and fair debate get in the way.



    Why would I believe a guy who pushes paper for the health insurance industry? Your career is at stake; of course you're going to try to sell me a lot of indignant "I know the truth and you do not" hot air.
    I personally don't give a **** what you believe, and frankly, if you can't trust people who provide services based on clients needs then that's too bad, hope you have one hell of a gameplan, and frankly, I will say that you wouldn't be one of my clients, by my choice, because I don't deal with people who "know it all".


    Without the ability to research the specifics of each of the 45,000 annual cases where individuals died because they did not have healthcare insurance, such a request is as impossible as it is pointless.
    It's been done in explicit detail, the numbers don't say what you want them to, and the breakdown is less than 5% of the American populace.

    But hey! YOU'RE in the health insurance industry! Why don't YOU provide us with those intimate details from each and every case, which you seem to think are so readily available? If you're unable to do this, I recommend you contact Harvard and the American Journal of Public Health. Perhaps they can straighten you out.
    Wow, you used biased sources, incomplete info, and talking points from the hard left, you really showed me. Maybe since you made a bunch of generalized attacks on an industry with no working knowledge of it you could burden yourself to back it up, again, I'm not bringing numbers since I'm not the one attacking 1/6th of the American economy because free healthcare isn't my goal. I called you on bringing out the bull**** sources and rhetoric, it's not my job to back your claims.
    Neither side in an argument can find the truth when both make an absolute claim on it.

    LMR

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