Who Denies Medical Claims The Most?
Tom Enright
stephenJ
> http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsurer2008.jpg
>
> -Tom Enright
nice job. :)
--
There are so many posts in government service that
it is frightening just to think about them.
- F. Dostoyevsky
Jon Enslin
> http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsurer...
>
You do realize that's because Medicare has to official deny a claim in
order for Medicare supplemental insurance to cover it right?
Jon
xyzzy
d'oh! Jaros, you still think he did a good job?
Tom Enright
No, that's why I didn't offer any commentary on the chart. However,
you to must realize that millions of people have access to more than
one insurance carrier, so if Aetna says no, Cigna may say yes.
-Tom Enright
> Jon
xyzzy
How many Americans do you really think have access to more than one
insurance carrier? I know my employer only offers one, how many does
your employer offer?
The BorgMan
news:f7a7b744-627f-4961...@m18g2000vbs.googlegroups.com:
> http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsurer20
> 08.jpg
Show me the average value of a denied claim, and how many of those claims
were incorrectly denied - and it might mean something.
1% incorrectly denied claims is much worse than 10% correctly denied
claims.
--
Aaron
Tom Enright
My wife gets insurance through her employer, I get it through mine.
-Tom Enright
Tom Enright
> Tom Enright <freddy_ha...@yahoo.com> wrote innews:f7a7b744-627f-4961...@m18g2000vbs.googlegroups.com:
>
> >http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsurer20
> > 08.jpg
> Show me the average value of a denied claim, and how many of those claims
> were incorrectly denied - and it might mean something.
>
> 1% incorrectly denied claims is much worse than 10% correctly denied
> claims.
ODL, you can't be serious.
-Tom Enright
> --
> Aaron
TimV
They also aren't going to pay for a claim after you already have it, and
if you switch providers, are not going to cover ongoing claims as they
were "pre-existing".
T
Chris Bellomy
> http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsurer2008.jpg
Note: NHXS has significant skin in this game. This is worth
trying to corroborate.
cb
The BorgMan
> On Oct 7, 11:29�am, The BorgMan <m...@me.net> wrote:
>> Tom Enright <freddy_ha...@yahoo.com> wrote
>> innews:f7a7b744-627f-4961-9e21
> -908e1a...@m18g2000vbs.googlegroups.com:
>>
>> >http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsurer
>> >20
>> > 08.jpg
>
>> Show me the average value of a denied claim, and how many of those
>> claims were incorrectly denied - and it might mean something.
>>
>> 1% incorrectly denied claims is much worse than 10% correctly denied
>> claims.
>
> ODL, you can't be serious.
Yes, I am.
I have no doubt that the percentage of fraudulent claims submitted to
medicare exceeds those submitted to private insurers.
--
Aaron
The Ghost of Edward M. Kennedy
>>> >http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsurer
>>> >20
>>> > 08.jpg
>>
>>> Show me the average value of a denied claim, and how many of those
>>> claims were incorrectly denied - and it might mean something.
>>>
>>> 1% incorrectly denied claims is much worse than 10% correctly denied
>>> claims.
>>
>> ODL, you can't be serious.
>
> Yes, I am.
>
> I have no doubt that the percentage of fraudulent claims submitted to
> medicare exceeds those submitted to private insurers.
UNC hospitals say hi to the tune of hundreds of millions.
--Tedward
Tom Enright
> Tom Enright <freddy_ha...@yahoo.com> wrote innews:742f5023-855a-4720...@g23g2000vbr.googlegroups.com:
>
>
>
>
>
> > On Oct 7, 11:29 am, The BorgMan <m...@me.net> wrote:
> >> Tom Enright <freddy_ha...@yahoo.com> wrote
> >> innews:f7a7b744-627f-4961-9e21
>
> >> >http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsurer
> >> >20
> >> > 08.jpg
>
> >> Show me the average value of a denied claim, and how many of those
> >> claims were incorrectly denied - and it might mean something.
>
> >> 1% incorrectly denied claims is much worse than 10% correctly denied
> >> claims.
>
> > ODL, you can't be serious.
> Yes, I am.
>
> I have no doubt that the percentage of fraudulent claims submitted to
> medicare exceeds those submitted to private insurers.
OTOH...
Persons utilizing Medicare are generally older and/or poorer and will
likely be less healthy and more in need of medical care. Furthermore,
you are supporting the case that a government-run system will be far
more likely to see fraudulent claims.
-Tom Enright
> --
> Aaron
rich hammett
olisi pit�nyt tiet�� KUKA SIN� OLET, Tom Enright:
And, of course, business favors the one who says yes to more
and more expensive treatments.
rich
--
-to reply, it's hot not warm
+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+-+
\ Rich Hammett http://home.hiwaay.net/~rhammett
/
\ "rational romantic mystic cynical idealist"
Kyle T. Jones
Are you covered under hers as well? Is she covered under yours, too?
Otherwise, you make no sense with this reply.
Cheers.
The BorgMan
> On Oct 7, 11:55�am, The BorgMan <m...@me.net> wrote:
>> Tom Enright <freddy_ha...@yahoo.com> wrote
>> innews:742f5023-855a-4720-8a10
> -8e6c07...@g23g2000vbr.googlegroups.com:
>>
>>
>>
>>
>>
>> > On Oct 7, 11:29�am, The BorgMan <m...@me.net> wrote:
>> >> Tom Enright <freddy_ha...@yahoo.com> wrote
>> >> innews:f7a7b744-627f-4961-9e21
>> > -908e1ac95...@m18g2000vbs.googlegroups.com:
>>
>> >> >http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsu
>> >> >rer 20
>> >> > 08.jpg
>>
>> >> Show me the average value of a denied claim, and how many of those
>> >> claims were incorrectly denied - and it might mean something.
>>
>> >> 1% incorrectly denied claims is much worse than 10% correctly
>> >> denied claims.
>>
>> > ODL, you can't be serious.
>
>> Yes, I am.
>>
>> I have no doubt that the percentage of fraudulent claims submitted to
>> medicare exceeds those submitted to private insurers.
>
> OTOH...
>
> Persons utilizing Medicare are generally older and/or poorer and will
> likely be less healthy and more in need of medical care.
...and your point is?
I'm not interested in how often claims get denied - I'm interested in how
often claims get WRONGLY denied, and how often that denial is driven by
the cost of approval.
> Furthermore,
> you are supporting the case that a government-run system will be far
> more likely to see fraudulent claims.
No, I'm supporting the case that the current government run system is
more likely to see fraudulent claims. Many of the reasons for that change
under different government run systems.
--
Aaron
Tom Enright
> Tom Enright <freddy_ha...@yahoo.com> wrote innews:029b5227-c55d-4115...@p36g2000vbn.googlegroups.com:
> > OTOH...
>
> > Persons utilizing Medicare are generally older and/or poorer and will
> > likely be less healthy and more in need of medical care.
> ...and your point is?
>
> I'm not interested in how often claims get denied - I'm interested in how
> often claims get WRONGLY denied, and how often that denial is driven by
> the cost of approval.
No kidding.
> > Furthermore,
> > you are supporting the case that a government-run system will be far
> > more likely to see fraudulent claims.
> No, I'm supporting the case that the current government run system is
> more likely to see fraudulent claims. Many of the reasons for that change
> under different government run systems.
I see, you are disputing the validity of the table with a completely
subjective comment with absolutely no supporting data. Your
assumptions are stronger than actual numbers.
Hell, at least *I* had a picture.
-Tom Enright
"Obama’s rhetorical method in international contexts -- given supreme
expression at the United Nations this week -- is a moral dialectic.
The thesis: pre-Obama America is a nation of many flaws and failures.
The antithesis: The world responds with understandable but misguided
prejudice. The synthesis: Me. Me, at all costs; me, in spite of all
terrors; me, however long and hard the road may be. How great a world
we all should see, if only all were more like…me."
-Michael Gerson
> --
> Aaron
xyzzy
> Tom Enright <freddy_ha...@yahoo.com> wrote innews:029b5227-c55d-4115...@p36g2000vbn.googlegroups.com:
>
>
>
>
>
> > On Oct 7, 11:55 am, The BorgMan <m...@me.net> wrote:
> >> Tom Enright <freddy_ha...@yahoo.com> wrote
> >> innews:742f5023-855a-4720-8a10
or maybe that, as Jon Enslin tried to point out, many claims are
submitted to Medicare with an expectation of denial, so they can then
be passed on a medicare supplement plan.
The BorgMan
> On Oct 7, 12:55�pm, The BorgMan <m...@me.net> wrote:
>> Tom Enright <freddy_ha...@yahoo.com> wrote
>> innews:029b5227-c55d-4115-8fc6
> -d94346...@p36g2000vbn.googlegroups.com:
>
>> > OTOH...
>>
>> > Persons utilizing Medicare are generally older and/or poorer and
>> > will likely be less healthy and more in need of medical care.
>
>> ...and your point is?
>>
>> I'm not interested in how often claims get denied - I'm interested in
>> how often claims get WRONGLY denied, and how often that denial is
>> driven by the cost of approval.
>
> No kidding.
>
>> > Furthermore,
>> > you are supporting the case that a government-run system will be
>> > far more likely to see fraudulent claims.
>
>> No, I'm supporting the case that the current government run system is
>> more likely to see fraudulent claims. Many of the reasons for that
>> change under different government run systems.
>
> I see, you are disputing the validity of the table with a completely
> subjective comment with absolutely no supporting data. Your
> assumptions are stronger than actual numbers.
>
> Hell, at least *I* had a picture.
I'm not disputing the validity of the data, I'm disputing the usefulness
of it.
It's a bunch of data that is meaningless. I don't care, at all, who has
the most denials. All I care about is who has the most incorrect denials.
--
Aaron
honkifyoulovejustice
I don't. If it don't choose Amthem Blue Cross, I get kicked to the
kerb.
stephenJ
Yes, fantastic.
--
Duty largely consists of pretending that the trivial is critical.
- J. Fowles
lein
What happens if you don't have Medicare supplemental insurance?
lein
Do you have any medical expense coverage with your car insurance?
lein
> Tom Enright <freddy_ha...@yahoo.com> wrote innews:742f5023-855a-4720...@g23g2000vbr.googlegroups.com:
>
>
>
> > On Oct 7, 11:29 am, The BorgMan <m...@me.net> wrote:
> >> Tom Enright <freddy_ha...@yahoo.com> wrote
> >> innews:f7a7b744-627f-4961-9e21
>
> >> >http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsurer
> >> >20
> >> > 08.jpg
>
> >> Show me the average value of a denied claim, and how many of those
> >> claims were incorrectly denied - and it might mean something.
>
> >> 1% incorrectly denied claims is much worse than 10% correctly denied
> >> claims.
>
> > ODL, you can't be serious.
>
> Yes, I am.
>
> I have no doubt that the percentage of fraudulent claims submitted to
> medicare exceeds those submitted to private insurers.
>
So in the end, we'll spend substantially more for insurance coverage
if we are all put on the government plan.
The BorgMan
news:0dd049c4-945a-48e9...@x25g2000prf.googlegroups.com:
> On Oct 7, 8:55�am, The BorgMan <m...@me.net> wrote:
>> Tom Enright <freddy_ha...@yahoo.com> wrote
>> innews:742f5023-855a-4720-8a10
> -8e6c07...@g23g2000vbr.googlegroups.com:
>>
>>
>>
>> > On Oct 7, 11:29�am, The BorgMan <m...@me.net> wrote:
>> >> Tom Enright <freddy_ha...@yahoo.com> wrote
>> >> innews:f7a7b744-627f-4961-9e21
>> > -908e1ac95...@m18g2000vbs.googlegroups.com:
>>
>> >> >http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsu
>> >> >rer 20
>> >> > 08.jpg
>>
>> >> Show me the average value of a denied claim, and how many of those
>> >> claims were incorrectly denied - and it might mean something.
>>
>> >> 1% incorrectly denied claims is much worse than 10% correctly
>> >> denied claims.
>>
>> > ODL, you can't be serious.
>>
>> Yes, I am.
>>
>> I have no doubt that the percentage of fraudulent claims submitted to
>> medicare exceeds those submitted to private insurers.
>>
>
> So in the end, we'll spend substantially more for insurance coverage
> if we are all put on the government plan.
>
>
Not necessarily - no.
More fraudulent claims submitted != more fraudulent claims paid.
..and a large part of the reason for higher rates of fraudulent claims is
realted to who they service, not because they are a government agency.
--
Aaron
xyzzy
What's that got to do with anything? That only pays for medical
expenses I cause by my negligent operation of my car.
lein
> lein <boomer_the_...@my-deja.com> wrote innews:0dd049c4-945a-48e9...@x25g2000prf.googlegroups.com:
>
>
>
> > On Oct 7, 8:55 am, The BorgMan <m...@me.net> wrote:
> >> Tom Enright <freddy_ha...@yahoo.com> wrote
> >> innews:742f5023-855a-4720-8a10
>
> >> > On Oct 7, 11:29 am, The BorgMan <m...@me.net> wrote:
> >> >> Tom Enright <freddy_ha...@yahoo.com> wrote
> >> >> innews:f7a7b744-627f-4961-9e21
> >> > -908e1ac95...@m18g2000vbs.googlegroups.com:
>
> >> >> >http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsu
> >> >> >rer 20
> >> >> > 08.jpg
>
> >> >> Show me the average value of a denied claim, and how many of those
> >> >> claims were incorrectly denied - and it might mean something.
>
> >> >> 1% incorrectly denied claims is much worse than 10% correctly
> >> >> denied claims.
>
> >> > ODL, you can't be serious.
>
> >> Yes, I am.
>
> >> I have no doubt that the percentage of fraudulent claims submitted to
> >> medicare exceeds those submitted to private insurers.
>
> > So in the end, we'll spend substantially more for insurance coverage
> > if we are all put on the government plan.
>
> Not necessarily - no.
>
> More fraudulent claims submitted != more fraudulent claims paid.
true, but compared to private plans, Medicare fares poorly with
regards to stopping waste, fraud, and abuse.
>
> ..and a large part of the reason for higher rates of fraudulent claims is
> realted to who they service, not because they are a government agency.
It could also be a product that Medicare reimbursement rates are
lower.
The BorgMan
news:66472362-20b6-4ecd...@q40g2000prh.googlegroups.com:
> On Oct 7, 12:59�pm, The BorgMan <m...@me.net> wrote:
>> lein <boomer_the_...@my-deja.com> wrote
>> innews:0dd049c4-945a-48e9-a29d-8e
> f1f8a...@x25g2000prf.googlegroups.com:
>>
>>
>>
>> > On Oct 7, 8:55�am, The BorgMan <m...@me.net> wrote:
>> >> Tom Enright <freddy_ha...@yahoo.com> wrote
>> >> innews:742f5023-855a-4720-8a10
>> > -8e6c076f5...@g23g2000vbr.googlegroups.com:
>>
>> >> > On Oct 7, 11:29�am, The BorgMan <m...@me.net> wrote:
>> >> >> Tom Enright <freddy_ha...@yahoo.com> wrote
>> >> >> innews:f7a7b744-627f-4961-9e21
>> >> > -908e1ac95...@m18g2000vbs.googlegroups.com:
>>
>> >> >> >http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByI
>> >> >> >nsu rer 20
>> >> >> > 08.jpg
>>
>> >> >> Show me the average value of a denied claim, and how many of
>> >> >> those claims were incorrectly denied - and it might mean
>> >> >> something.
>>
>> >> >> 1% incorrectly denied claims is much worse than 10% correctly
>> >> >> denied claims.
>>
>> >> > ODL, you can't be serious.
>>
>> >> Yes, I am.
>>
>> >> I have no doubt that the percentage of fraudulent claims submitted
>> >> to medicare exceeds those submitted to private insurers.
>>
>> > So in the end, we'll spend substantially more for insurance
>> > coverage if we are all put on the government plan.
>>
>> Not necessarily - no.
>>
>> More fraudulent claims submitted != more fraudulent claims paid.
>
> true, but compared to private plans, Medicare fares poorly with
> regards to stopping waste, fraud, and abuse.
I've seen zero evidence of that outside incidences of fraud and abuse,
and those are more related to the population in question.
>> ..and a large part of the reason for higher rates of fraudulent
>> claims is realted to who they service, not because they are a
>> government agency.
>
> It could also be a product that Medicare reimbursement rates are
> lower.
No, most fraudulent claims made to medicare aren't because medicare
reimbursement is lower.
--
Aaron
James Schrumpf
> On Oct 7, 7:59 am, Tom Enright <freddy_ha...@yahoo.com> wrote:
>> http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsurer...
>>
>
>
> You do realize that's because Medicare has to official deny a claim in
> order for Medicare supplemental insurance to cover it right?
>
> Jon
>
"We had to deny Medicare in order to allow Medicare."
--
------------------------------------------------------------------------
James Schrumpf http://www.hilltopper.net
lein
<jaspammenotschru...@gmail.nospamnet> wrote:
> Quiet, Jon Enslin <jens...@charter.net> -- I'm transmitting rage.
>
> > On Oct 7, 7:59 am, Tom Enright <freddy_ha...@yahoo.com> wrote:
> >>http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsurer...
>
> > You do realize that's because Medicare has to official deny a claim in
> > order for Medicare supplemental insurance to cover it right?
>
> > Jon
>
> "We had to deny Medicare in order to allow Medicare."
Welcome to government run healthcare, oh, and you won't be able to sue
us when we fuck up.
lein
> lein <boomer_the_...@my-deja.com> wrote innews:66472362-20b6-4ecd...@q40g2000prh.googlegroups.com:
>
>
>
> > On Oct 7, 12:59 pm, The BorgMan <m...@me.net> wrote:
> >> lein <boomer_the_...@my-deja.com> wrote
> >> innews:0dd049c4-945a-48e9-a29d-8e
They are made because the government really doesn't give a rats ass
who they necessarily pay and how much. Now, a private insurance plan
uses their "excess" admin costs to significantly reduce fraud.
Jaybyrd
In reality Medicare has tougher standards than other insurers I've
seen (for hospital based reimbursement). MUE's and other edits just
say no. Other insurers base their reimbursement rules on
Medicare.
BillyZoom
> http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsurer...
>
I could be totally missing the point here - what sample is this based
on? One thing to consider is that Humana, et al, have agreements in
place that kind of prevent outright denials. This is especially true
for self-insured institutions that use Humana only as an
administrative function. I know my doctor knows what not to even try
submitting. Medicare is more of a "let's see what happens" thing. Of
course that's a point in and of itself, I guess.
I guess the only thing that matters to me (and I have GREAT healthcare
of my own since I work for a hospital), is that every American should
have access to decent healthcare. Do I think we're going to fuck it
up? Absolutely. Is it going to make me poorer? Absolutely. I still
think it's the right thing to do. I stopped judging the "rightness" of
things based on my own economic wellbeing when I was about 15.
lein
<crickets>
Plaidmoon
<freddy...@yahoo.com> wrote:
>http://i5.photobucket.com/albums/y164/wteach/Another/DenialsByInsurer2008.jpg
It's not surprising. Have you ever tried to get Pete Townsend to pay
up for anything?
Plaidmoon
The BorgMan
news:8375482e-0402-4fd7...@d9g2000prh.googlegroups.com:
> On Oct 7, 1:51�pm, The BorgMan <m...@me.net> wrote:
>> lein <boomer_the_...@my-deja.com> wrote
>> innews:66472362-20b6-4ecd-96cc-78
> 90d0d...@q40g2000prh.googlegroups.com:
>>
>>
>>
>> > On Oct 7, 12:59�pm, The BorgMan <m...@me.net> wrote:
>> >> lein <boomer_the_...@my-deja.com> wrote
>> >> innews:0dd049c4-945a-48e9-a29d-8e
>> > f1f8a6c...@x25g2000prf.googlegroups.com:
>>
>> >> > On Oct 7, 8:55�am, The BorgMan <m...@me.net> wrote:
>> >> >> Tom Enright <freddy_ha...@yahoo.com> wrote
>> >> >> innews:742f5023-855a-4720-8a10
>> >> > -8e6c076f5...@g23g2000vbr.googlegroups.com:
>>
>> >> >> > On Oct 7, 11:29�am, The BorgMan <m...@me.net> wrote:
>> >> >> >> Tom Enright <freddy_ha...@yahoo.com> wrote
>> >> >> >> innews:f7a7b744-627f-4961-9e21
>> >> >> > -908e1ac95...@m18g2000vbs.googlegroups.com:
>>
>> >> >> >> >http://i5.photobucket.com/albums/y164/wteach/Another/Denials
>> >> >> >> >ByI nsu rer 20
Yet they generally pay less, and deny more claims....
--
Aaron