Page 9 of 12 FirstFirst ... 7891011 ... LastLast
Results 81 to 90 of 119

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

  1. #81
    Klattu Verata Nicto
    LaMidRighter's Avatar
    Join Date
    May 2005
    Location
    Louisiana
    Last Seen
    07-21-17 @ 02:42 PM
    Gender
    Lean
    Libertarian - Right
    Posts
    30,534

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

    Quote Originally Posted by Kandahar View Post
    "My side"? I love that phrase. Which side would that be?
    Which side? Really? How about big government side, or if you prefer, for this debate, taxpayer subsidized healthcare.

    I would not bitch about it if insurers denied a claim for some of the reasons listed here, such as the patient is not actually a policy holder with the insurance company or they filled the form out wrong.
    What makes you think this isn't the case? For instance, the insurance commissioner of my state just asked for agents to contribute anything they may have on double billing, and other less than ethical extra procedures charged to various companies and insurances, but these aren't the stories you hear on the news, you hear about companies "denying legitimate procedures", oh, and by the way, if a doctor proves medical necessity to satisfy requirements, your better companies DO in fact pay out.
    My problem is when insurers look for a pretext to deny a high cost procedure, such as combing through the patient's medical files for an unrelated preexisting condition from 10 years prior.
    And you have experienced this personally or had a client complain to you of this? Cause I've been in the business for a while and haven't seen it, but then again what do I know, I'm just an insurance professional, not a clueless journalist.


    And unless you can show that Medicare's denials are for illegitimate reasons, this statistic is meaningless.
    But you would assign a different standard to private health insurers? Nice, so government can deny no questions asked, but private is guilty until proven innocent, gotcha.
    I've already identified several possible explanations for this, none of which involve a sinister government wanting to pull the plug on grandma:
    I'll take these one at a time.
    1) Perhaps Medicare receives more fraudulent claims than private insurers.
    And why would that be? Could it be that government programs don't have a very good loss prevention mechanism, since the programs are not accountable to anyone outside of their own beauracracies, or maybe because losing money rewards bigger budgets in the upcoming fiscal year. How would this improve under a taxpayer subsidized plan?
    2) Perhaps Medicare receives more claims that aren't covered because the law doesn't cover certain procedures.
    Uh, okay, medicare benefits are stated in writing, just like private plans, the denials are worded in a way in which scope of coverage is void because of a loophole.
    3) Perhaps people are more likely to think they're Medicare members when they aren't, than they are to think they're Cigna members when they aren't.
    You get a card with Medicare, same with any coverage, it's kind of hard to think you are covered when you are clearly NOT. This point is very weak.
    4) Perhaps high-cost procedures universally receive more scrutiny among ALL insurers, so the insurer with the highest proportion of high-cost procedures will inevitably deny more claims.
    It doesn't work that way under private, if it's in contract and meets the standard of necessity it gets paid.
    5) Perhaps Medicare patients are more likely to fill out the claim form incorrectly than private insurance patients.
    ????? You present a card to the doctor, he fills out the forms as necessary, the charge nurse takes care of her part, you sign.





    Then don't get the public option.
    You really don't get it do you? The "public option" is designed to eventually be the only "option" read the laws, they are tailor made to drive insurers out of the market, the one's that do survive will be prohibitively expensive.







    I think taxes will go up to subsidize health insurance for those who can't afford it...but that's true whether or not there is actually a government-run insurance plan. As for the public option itself, I see no reason why taxes would need to go up (except maybe for the first year the plan is operational), since it would be covered by premiums just like private insurance plans are.
    Read the CBO numbers, then get back to me.
    Neither side in an argument can find the truth when both make an absolute claim on it.

    LMR

  2. #82
    You kids get off my lawn!
    Glinda's Avatar
    Join Date
    May 2009
    Last Seen
    06-11-11 @ 02:01 AM
    Lean
    Undisclosed
    Posts
    1,716

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

    Quote Originally Posted by Strucky View Post
    475,000 sick people rejected and your ok with this???!!!
    Upwards of 30,000,000 with NO medical coverage of any kind and you're ok with this???!!!


  3. #83
    Klattu Verata Nicto
    LaMidRighter's Avatar
    Join Date
    May 2005
    Location
    Louisiana
    Last Seen
    07-21-17 @ 02:42 PM
    Gender
    Lean
    Libertarian - Right
    Posts
    30,534

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

    Quote Originally Posted by Glinda View Post
    Upwards of 30,000,000 with NO medical coverage of any kind and you're ok with this???!!!

    Wait a sec.! I thought the current arbitrary estimate was 40m, not 30. But actual breakdowns put the insurance poor(no access) at a little over 6m, a very small percentage of the population. The biggest demographic are voluntary non-participants(trade off insurance for more money), the second biggest......illegal aliens.
    Neither side in an argument can find the truth when both make an absolute claim on it.

    LMR

  4. #84
    Klattu Verata Nicto
    LaMidRighter's Avatar
    Join Date
    May 2005
    Location
    Louisiana
    Last Seen
    07-21-17 @ 02:42 PM
    Gender
    Lean
    Libertarian - Right
    Posts
    30,534

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

    [quote]
    Quote Originally Posted by PeteEU View Post
    Oh they are? Maybe you should learn a bit about your own country first.
    Right, cause you've demonstrated SUCH a great understanding of that which is American over the years.

    Oh where to start with an op-ed? 'Kay, let me 'splain something, first, most insurance contracts will NOT cover cosmetic necessity UNLESS it is a matter of immediate health concern, second, pregnancy riders are offered with initial contracting, IF you don't sign for it and it is specified that it is NOT IN INITIAL COVERAGE, then NO the insurer WON'T pay, this is why it is an insurance contract. This "whoa is me" reporting really needs to stop.


    And then you bring McClatchy, too rich. Okay, I'll bite.........the states allow it, what is the actual breakdown of companies that exclude as a pre-existing that operate IN THOSE STATES?

    I have worked for companies that had tricky writing, this is something to watch out for, while a broken wrist may entail a pre-existing condition, most companies allow for a doctor's clearance for prior injuries, this becomes a non-pre-existing condition after a doctor clears it, not hard to do, and I have had prior injuries cleared for clients before. Next, what was the organizational model: There are traditional plans, fee-for-service plans, OPO's, PPO's, indemnity companies, HMO's, and there are HSA's, without the coverage model, the reporting is incomplete.

    So again, do you deny that private insurance companies use any and all excuses to deny coverage? Things like.. wanting to adopt to being a police officer?
    Yes I do, because you are using a blanket statement to make your case, there is good coverage and bad coverage, but with government there is one coverage, and it's bad more often than not.
    Neither side in an argument can find the truth when both make an absolute claim on it.

    LMR

  5. #85
    You kids get off my lawn!
    Glinda's Avatar
    Join Date
    May 2009
    Last Seen
    06-11-11 @ 02:01 AM
    Lean
    Undisclosed
    Posts
    1,716

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

    Quote Originally Posted by LaMidRighter View Post
    Wait a sec.! I thought the current arbitrary estimate was 40m, not 30. But actual breakdowns put the insurance poor(no access) at a little over 6m, a very small percentage of the population. The biggest demographic are voluntary non-participants(trade off insurance for more money), the second biggest......illegal aliens.
    The actual number is difficult to pin down. Regardless, I think we can all rest easy tonight knowing that certain people are more outraged that 475,000 were denied healthcare treatment than that tens of millions have no healthcare whatsoever.

    Number of uninsured crucial in health debate
    Obama frequently cites last yearís Census Bureau number of 46 million people with no health insurance. Some specialists, however, argue that figure is off by tens of millions.

    The recessionís continuing toll on jobs, a tendency to undercount people on Medicaid, and other factors make it hard to come up with an exact number. And the most widely accepted range - 40 million to 50 million - includes some 10 million noncitizens, a detail thatís generally overlooked.

    Even if there are fewer uninsured than now estimated, health analysts emphasize that itís still a lot of people, and being uninsured has consequences. The Institute of Medicine has found that uninsured people are more likely to succumb to illness and suffer premature death.

    The 45.7 million uninsured cited by Obama and others comes from the Census Bureauís annual Current Population Survey for 2007. Itís the consensus figure, but some researchers believe the survey undercounted how many people are covered by Medicaid, the federal-state program for the poor.

    Another government survey done by the Department of Health and Human Services says that about 40 million people were uninsured for all of 2007, and about 70 million were uninsured for part of the year.

    But taking into account the effects of the recession, with more than 5 million jobs lost since last August cutting into employer-provided healthcare, researchers at the Urban Institute and elsewhere estimate that the present-day number of uninsured is closer to 50 million.
    That is the number used by the Congressional Budget Office.

  6. #86
    Klattu Verata Nicto
    LaMidRighter's Avatar
    Join Date
    May 2005
    Location
    Louisiana
    Last Seen
    07-21-17 @ 02:42 PM
    Gender
    Lean
    Libertarian - Right
    Posts
    30,534

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

    Quote Originally Posted by Glinda View Post
    The actual number is difficult to pin down. Regardless, I think we can all rest easy tonight knowing that certain people are more outraged that 475,000 were denied healthcare treatment than that tens of millions have no healthcare whatsoever.
    You have conveniently left out the qualifying data, I work in the insurance industry as an agent, so I see these numbers. 475k denied means absolutely zero to me without a numbers breakdown, I know non-industry people have a problem with grasping that sometimes doctors and insureds cheat, but it happens, which is why things are under such scrutiny by the companies who contract, denials don't happen because of greed for the most part.......are there bad companies, sure, but most denials happen for very legitimate reasons, and it all comes down to cost management.
    Neither side in an argument can find the truth when both make an absolute claim on it.

    LMR

  7. #87
    You kids get off my lawn!
    Glinda's Avatar
    Join Date
    May 2009
    Last Seen
    06-11-11 @ 02:01 AM
    Lean
    Undisclosed
    Posts
    1,716

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

    Quote Originally Posted by LaMidRighter View Post
    it all comes down to cost management.
    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.

    CEO Compensation: Who Said Health Care is in a Financial Crisis?

    Those of you who are struggling to pay for your generic medicines or wondering why the doctor is charging you a $5.00 co-pay, give some thought to these facts about how our health care dollars are allocated. At the end of this post, there is a list of 23 health companies I found on Forbes.com, what the CEO was paid in 2005, and the average paid to the CEO in the past five years.

    Imagine adding vice presidents, Board of Directors, stock holders and the other 200-300 other companies all cashing in on your health to that total at the bottom.

    Based on this, the next time you want to argue with your Primary Care doctor's front desk about a $5.00 co-pay, remember that he makes an average of $149,000.00 per year. On the other hand -- using United Healthcare as an example -- your insurance company paid their CEO -- one man -- $324,000,000 over a recent five year period.

    BTW: 10% of 14.9 billion is 1.4 billion. If basic insurance costs $8,000/year for a family then taking 10% from just these CEO salaries would insure 35,000 Americans a year for five years. That is a lot of people that can be helped just by 23 men. Looking at the companies as a whole that profit from health care, we can probably pay for every uninsured person in this country for decades to come.

    The numbers are numbing, which is why we should do something about this.

    * United Health Group
    CEO: William W McGuire
    2005: 124.8 mil
    5-year: 342 mil

    * Forest Labs
    CEO: Howard Solomon
    2005: 92.1 mil
    5-year: 295 mil

    * Caremark Rx
    CEO: Edwin M Crawford
    2005: 77.9 mil
    5-year: 93.6 mil

    * Abbott Lab
    CEO: Miles White
    2005: 26.2 mil
    5-year: 25.8 mil

    * Aetna
    CEO: John Rowe
    2005: 22.1 mil
    5-year:57.8 mil

    * Amgen
    CEO: Kevin Sharer
    2005:5.7 mil
    5-year:59.5 mil

    * Bectin-Dickinson
    CEO: Edwin Ludwig
    2005: 10 mil
    5-year:18 mil

    * Boston Scientific
    CEO:
    2005:38.1 mil
    5-year:45 mil

    * Cardinal Health
    CEO: James Tobin
    2005:1.1 mil
    5-year:33.5 mil

    * Cigna
    CEO: H. Edward Hanway
    2005:13.3 mil
    5-year:62.8 mil

    * Genzyme
    CEO: Henri Termeer
    2005: 19 mil
    5-year:60.7 mil

    * Humana
    CEO: Michael McAllister
    2005:2.3 mil
    5-year:12.9 mil

    * Johnson & Johnson
    CEO: William Weldon
    2005:6.1 mil
    5-year:19.7 mil

    * Laboratory Corp America
    CEO: Thomas MacMahon
    2005:7.9 mil
    5-year:41.8 mil

    * Eli Lilly
    CEO: Sidney Taurel
    2005:7.2 mil
    5-year:37.9 mil

    * McKesson
    CEO: John Hammergen
    2005: 13.4 mil
    5-year:31.2 mil

    * Medtronic
    CEO: Arthur Collins
    2005: 4.7 mil
    5-year:39 mil

    * Merck Raymond Gilmartin
    CEO:
    2005: 37.8 mil
    5-year:49.6 mil

    * PacifiCare Health
    CEO: Howard Phanstiel
    2005: 3.4 mil
    5-year: 8.5 mil

    * Pfizer
    CEO: Henry McKinnell
    2005: 14 mil
    5-year: 74 mil

    * Well Choice
    CEO: Michael Stocker
    2005: 3.2 mil
    5-year: 10.7 mil

    * WellPoint
    CEO: Larry Glasscock
    2005: 23 mil
    5-year: 46.8 mil

    * Wyeth
    CEO: Robert Essner
    2005:6.5 mil
    5-year: 28.9 mil


    TOTAL 2005: 559.8 mil

    TOTAL 5-Year: 14.9 billion
    If you can understand this, why would you be against a public option which is NOT profit driven? Because you might lose your job?

  8. #88
    Sage
    PeteEU's Avatar
    Join Date
    Mar 2006
    Location
    Denmark
    Last Seen
    Yesterday @ 04:49 PM
    Gender
    Lean
    Centrist
    Posts
    29,090

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

    [quote=LaMidRighter;1058297244]
    Oh where to start with an op-ed? 'Kay, let me 'splain something, first, most insurance contracts will NOT cover cosmetic necessity UNLESS it is a matter of immediate health concern,
    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? 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.?

    second, pregnancy riders are offered with initial contracting, IF you don't sign for it and it is specified that it is NOT IN INITIAL COVERAGE, then NO the insurer WON'T pay, this is why it is an insurance contract. This "whoa is me" reporting really needs to stop.
    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.

    And then you bring McClatchy, too rich. Okay, I'll bite.........the states allow it, what is the actual breakdown of companies that exclude as a pre-existing that operate IN THOSE STATES?
    Read the article.

    An informal survey by the House Judiciary Committee in 1994 found that half of the 16 largest insurers in the country considered domestic violence in deciding whether to approve health coverage. The Pennsylvania insurance Department reported a year or so later that nearly one out of four insurance companies factored in domestic violence when deciding whether to issue or renew policies.
    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?

    I have worked for companies that had tricky writing, this is something to watch out for, while a broken wrist may entail a pre-existing condition, most companies allow for a doctor's clearance for prior injuries, this becomes a non-pre-existing condition after a doctor clears it, not hard to do, and I have had prior injuries cleared for clients before. Next, what was the organizational model: There are traditional plans, fee-for-service plans, OPO's, PPO's, indemnity companies, HMO's, and there are HSA's, without the coverage model, the reporting is incomplete.
    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.

    Yes I do, because you are using a blanket statement to make your case, there is good coverage and bad coverage, but with government there is one coverage, and it's bad more often than not.
    LOL you accuse me of using a blanket statement and then you throw out one of your own.
    PeteEU

  9. #89
    Tavern Bartender
    Constitutionalist
    American's Avatar
    Join Date
    Mar 2006
    Location
    Virginia
    Last Seen
    Yesterday @ 10:49 AM
    Gender
    Lean
    Conservative
    Posts
    76,323

    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?
    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.
    "He who does not think himself worth saving from poverty and ignorance by his own efforts, will hardly be thought worth the efforts of anybody else." -- Frederick Douglass, Self-Made Men (1872)
    "Fly-over" country voted, and The Donald is now POTUS.

  10. #90
    Klattu Verata Nicto
    LaMidRighter's Avatar
    Join Date
    May 2005
    Location
    Louisiana
    Last Seen
    07-21-17 @ 02:42 PM
    Gender
    Lean
    Libertarian - Right
    Posts
    30,534

    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?
    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.
    Neither side in an argument can find the truth when both make an absolute claim on it.

    LMR

Page 9 of 12 FirstFirst ... 7891011 ... LastLast

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •