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

  1. #41
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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.
    When I worked for the Aetna we administered one of the major regions of Medicare coverage so are the MEDICARE reject stats included inthe Aetna's totals ?
    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 F107HyperSabr View Post
    When I worked for the Aetna we administered one of the major regions of Medicare coverage so are the MEDICARE reject stats included inthe Aetna's totals ?
    Not sure but even if they were that would make Aetna's actual totals even lower wouldn't it?

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

    Hold your horse ferris : NHXS is a company that has an axe to grind. They work and are paid by providers to try and squuees more payment out of "us" the insurance companies. This is from their own website " healthcare providers the advantages they need to recover more revenue and appeal denials more successfully "

    See all these people are after "us" insurance companies and want "us" to pay out more.

    Therefore they will go and post so called reject rates that are not based on sound principles or most likely skewed against "us" insurance companies.

    I was supicious when I saw your initial post now I see that you are quoting a company that is not playing fair since they are playing the game for the provider gainst the insurance companies.
    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?

    Just going to vouch for medicare and the public healthcare that we have.

    National Journal Online - Who's Afraid Of Public Insurance?

    People tend to be more satisfied with their public healthcare

    (slightly)

    OMG %0.5 THOSE STOOPID NAZIS THEY ARE WHOLLY A FARCE!

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

    Quote Originally Posted by F107HyperSabr View Post
    Hold your horse ferris : NHXS is a company that has an axe to grind. They work and are paid by providers to try and squuees more payment out of "us" the insurance companies. This is from their own website " healthcare providers the advantages they need to recover more revenue and appeal denials more successfully "

    See all these people are after "us" insurance companies and want "us" to pay out more.

    Therefore they will go and post so called reject rates that are not based on sound principles or most likely skewed against "us" insurance companies.

    I was supicious when I saw your initial post now I see that you are quoting a company that is not playing fair since they are playing the game for the provider gainst the insurance companies.
    Um the statistics are based on the AMA's National Health Insurance Report Card which is based on datapulled from the nationally mandated Health Insurance Portability and Accountability Act of 1996. Do you have contradictory statistics or just an ad-hominem logical fallacy?

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

    I already questioned the veracity of your source regarding denial rates of medical claims. There is also another factor to consider and the so called stats that you provided do not show why "we" deny a cliam.

    You people out here also need to understand that "we" insurance companies have valid reasons to deny claims and that "we" may deny a claim when first submitted but pay it later when it is sumitted coreectly.

    Why do we deny claims?

    1- submitted with invalid place of service address such as a PO box for service address. Do people think that "we" the insurance companies are stupid and beleive that a doctor can see patients and perform opeartions in a Post Office Box. - that is a fraud alert
    2- wrong tax id of provider submitted
    3- claim submitted for DOS date of service not within the policy period
    4- submitted with wrong or miss-matched member name
    5- submitted with invalid, nonexistent or missing memeber ID number
    6- services or drugs are not covered by the members plan
    7- provider not in our network
    8- provider lost his lisence
    9- duplicate claim
    10- overlapping billing for claim
    11- duplicate line item
    12- duplicate procedure billed
    13- procedure was billed within another procedure
    14- mememer not insured by us
    15- claim is for an accident but submitted as a health claim
    16- claim is a Workers Comp claim but memeber submitted as health claim
    17- claim submitted as a Hospital Claim but procedure is not a hospital procedure
    18- clam submitted on wrong form
    19- claim is for a nom covered procedure
    20- claim submitted for wrong memeber
    21- claim submitted for wrong gender e.g hitorectomy charges for a male, or prostate scan for a female
    22- claim submitted for an ugly person but we do not process ugly claims on Tuesdays - just joking but who reads such a long list anyways

    I was a corporate auditor and now perform auditing as a private consultant so I can keep writing and writing there are almost coountless legitimate reasons to reject a claim.
    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 Agent Ferris View Post
    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."
    I have no idea who Steven Israel is. At any rate, as soon as you show me some evidence that Medicare IS dropping people because they get sick, this might actually make sense.
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by Agent Ferris View Post
    OK, let's take a look at the reasons why Medicare claims were denied. Most of them basically boil down to:

    - The procedures simply are not covered under Medicare at all.
    - The person is not actually enrolled in Medicare, or was not enrolled at the time of the procedure.

    If you're arguing that more procedures need to be covered under Medicare and/or that coverage needs to be expanded so more people are enrolled (which would address both of those reasons for claim denial), I'm certainly willing to hear you out. But something tells me that is NOT what you arguing at all.
    Last edited by Kandahar; 10-07-09 at 11:56 PM.
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    Re: Guess Who Has the Highest Medical Claim Rejection Rate?

    Quote Originally Posted by Agent Ferris View Post
    Um the statistics are based on the AMA's National Health Insurance Report Card which is based on datapulled from the nationally mandated Health Insurance Portability and Accountability Act of 1996. Do you have contradictory statistics or just an ad-hominem logical fallacy?
    There is no ad hominen or falacy on my part. If your stats are from the AMA you need to understand that they represent the provider and the provider is tring to get us to pay for all that they submitt. If we reject a claim they are not happy. I have not seen the the details of what the stats you posted are from. Are legitimate denials included ?

    Just need to vett the accuracy.
    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
    I have no idea who Steven Israel is. At any rate, as soon as you show me some evidence that Medicare IS dropping people because they get sick, this might actually make sense.
    FROM STICKI WIKI
    Congressman NY 2ND DISTRICT :

    DEMOCRATIC PARTY
    After Rick Lazio left his House seat to run for the United States Senate in 2000, Israel was elected to the House of Representatives as a Democrat. Israel received 48% of the vote, defeating Republican Joan Jonhson, who received 34%, and three independent candidates who received 6% of the vote each
    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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