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

  1. #31
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by apdst View Post
    Is that really the best argument you can come up with? I mean, no ****, really?
    Are you or are you not claiming that there are no circumstances where the government should deny claims? If so, I just provided you with one.

    Quote Originally Posted by apdst
    It's very, very, very relevant to the subject at hand. All we've heard, to date, from the Libbos is how government insurance won't deny claims. Obviously that's not true.
    You have heard no such thing, and you know it. However, a government plan would be less likely to deny you claims for silly pretexts like an unrelated preexisting condition from ten years prior.
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by Kandahar View Post
    If you have more sick people, of course it's more likely that more claims will be denied.
    475,000 sick people rejected and your ok with this???!!!
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by Agent Ferris View Post
    Obviously if you make a medical insurance claim you are sick or injured
    That's obvious? I file a claim with my insurance company every time I have a routine checkup. I would imagine that such claims are a larger proportion of a private insurer's total claims than the government's, since private insurers try to avoid covering the old and sick whereas the government specializes in it.

    And if insurers are not likely to deny a claim for a routine checkup...well, you do the math.

    Quote Originally Posted by Agent Ferris
    and if you're elderly you're probably more likely to be really sick and/or injured thus one should come to the conclusion that they should have less of a claim rejection %
    Why? If high cost procedures are most likely to be denied, then the insurer with the highest proportion of high cost claims is the one most likely to deny claims.
    Last edited by Kandahar; 10-07-09 at 10:20 PM.
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by Kandahar View Post
    Are you or are you not claiming that there are no circumstances where the government should deny claims? If so, I just provided you with one.
    You provided a rediculous example. The point is, all we've heard from the Libbos is how claim denials won't happen under government health care. That's an obvious lie.



    You have heard no such thing, and you know it. However, a government plan would be less likely to deny you claims for silly pretexts like an unrelated preexisting condition from ten years prior.

    You're full of **** and your middle name is doo-doo and you know it. That's exactly what your boy has been saying for months now.
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    At least Bill saved his transgressions for grown women. Not suggesting what he did was OK. But he didn't chase 14 year olds.

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

    Quote Originally Posted by Kandahar View Post
    Because Medicare bureaucrats, unlike private insurance bureaucrats, don't have to worry about maximizing profits.
    Um I would think that maximizing profits would entail denying MORE claims.

    I can think of several explanations, none of which have anything to do with the big evil government wanting to pull the plug on grandma:

    1. More fraudulent claims are filed with Medicare then private insurers.
    I'm guessing that people 65 and older are more likely to be in need of medical treatment.

    2. Certain claims are specifically excluded from Medicare, but not from private insurers. (In which case it's silly to argue against the effectiveness of Medicare based on these denials, as the easy fix would be to end the exclusion.)
    Which such claims? And even if that's true that would be a check in the negative box arguing for medicare versus private insurance.

    3. If high cost medical claims are uniformly more likely to be denied, then it makes sense that the insurer with the most old and sick people would have the most denials.
    I'm not aware that you are allowed to deny treatment based on cost. I mean if you have cancer and it's treatable by kemo, should an insurance provider be allowed to deny treatment because it would be cost prohibitive?

    Unless you have some evidence that the circumstances of these claims and denials are all identical, you can't draw any meaningful conclusion from the data.
    Starting on pg. 11 it gives the reasons why the claim was rejected for medicare and the % of times that reason was given. Cost for the treatment is not listed.

    http://www.ama-assn.org/ama1/pub/upl...reportcard.pdf

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

    Kinda, creepy that my insurance company is third highest on that list.
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by Kandahar View Post
    That's obvious? I file a claim with my insurance company every time I have a routine checkup. I would imagine that such claims are a larger proportion of a private insurer's total claims than the government's, since private insurers try to avoid covering the old and sick whereas the government specializes in it.
    Actually according to pages 10 and 11 on this PDF claim rejections based on routine examination is higher for medicare than for United HealthCare 3.9% versus 2.5% respectively.

    http://www.ama-assn.org/ama1/pub/upl...reportcard.pdf

    And if insurers are not likely to deny a claim for a routine checkup...well, you do the math.
    Routine checkup claims are rejected.

    Why? If high cost procedures are most likely to be denied, then the insurer with the highest proportion of high cost claims is the one most likely to deny claims.
    Again I'm not aware of cost of treatment being a disqualifier in and of itself rather experimental treatment can be rejected and would fall under "type of treatment not covered" category of the list of disqualifiers provided on the PDF.

  8. #38
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by Agent Ferris View Post
    That's right folks, medicare denies more sick people coverage then every single private insurance company combined. But hay by all means let's crush those evil insurance companies and vest our healthcare in the state. Obama, Reid, Pelosi you are sick ****ing jokes.
    None of what you posted means much unless we know the reason for rejection. For example we ( we as when I was in the corporate world of insurance) would reject a claim becasue the provider sent us the claim but we may not be the primary for that coverage. It very well could be that Medicare is the primary.

    There is also dupliucate and double billing which "we" are very good at detecting so that is not a vaild factor to show as a reject.

    Your stats show lines of rejection not sure if the comparisons between the companies and Medicare are based on comparibale "lines".
    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 Kandahar View Post
    You have heard no such thing, and you know it. However, a government plan would be less likely to deny you claims for silly pretexts like an unrelated preexisting condition from ten years prior.
    Steven Israel just made that very claim and I quote:

    "the days of insurance companies dropping your coverage because you get sick will be over."

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

    Quote Originally Posted by F107HyperSabr View Post
    None of what you posted means much unless we know the reason for rejection.
    Starts on pg. 7 of this pdf:

    http://www.ama-assn.org/ama1/pub/upl...reportcard.pdf

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