The Real Death Panels: Insurers Deny 22% of Claims

[Susan43]

The Real Death Panels: Insurers Deny 22% of Claims

For the first half of 2009, as the national debate over healthcare reform was escalating, the rejection rates are even more striking.

Claims denial rates by leading California insurers, first six months of 2009:
• PacifiCare -- 39.6 percent
• Cigna -- 32.7 percent
• HealthNet -- 30 percent
• Kaiser Permanente -- 28.3 percent
• Blue Cross -- 27.9 percent
• Aetna -- 6.4 percent

http://tpmcafe.talkingpointsmemo.com/talk/blogs/national_nurses_movement/2009/09/the-real-death-panels-insurers.php

[fiver]

:confused: How is a claim adjuster a "death panel".

Oh that's right, it's NOT.

Califorina, huh. Well that's no surprise as jacked up as that state is.

How about this headline:

Medicare more likely to deny claims than commerical health insurers

http://healthcare-economist.com/2008/06/30/medicare-more-likely-to-deny-claims-than-commerical-health-insurers/

[fiver]

"The state government Medicaid plan known as MassHealth, which covers low-income patients who can’t afford insurance, was the slowest payer of health claims to Massachusetts doctors last year, averaging 56 days, and denied the highest share of claims, 23.8 percent, according to rankings set to be released today. …"


http://www.patientpowernow.org/2009/06/23/masshealth-denies-claims-commercial-insurers/

wow, they have a totally different % of denials for commercial health insurance companies.

[Grayson]

Alright the Death Panel urban legend is just pathetic, I mean this is 200and NINE-Death Panel seriously...

[Susan43]

:confused: How is a claim adjuster a "death panel".

Oh that's right, it's NOT.

Califorina, huh. Well that's no surprise as jacked up as that state is.

How about this headline:

Medicare more likely to deny claims than commerical health insurers

http://healthcare-economist.com/2008/06/30/medicare-more-likely-to-deny-claims-than-commerical-health-insurers/

I don't believe it. I have been looking for any other info on medicare denials and if the number was that high I'm sure I'd be able to find some other info or studies.

This is a AP article so I can't paste any of it. But maybe they meant the private medicare policies.

http://www.latimes.com/business/nationworld/wire/sns-ap-us-medicare-advantage,0,3056520,full.story

So far I haven't found much but I'm still looking.

[orangetaffy]

Medicare claims are processed by (or used to be anyway) bluecross/blueshied, Aetna and Cigna. So they decide what is denied. It was set up this way to avoid undue government interference in medical practice.

Govt feels they are approving too many procedures, so encourage them to reduce the number of procedures approved to cut down on expenses.

ie. Joe goes to the doc complaining of burning pain in his chest. Doc decides echocardiography is needed. If the results show COPD, the procedure is covered, if the results show acid reflux, the procedure would not be covered. problem is, doc can't be sure without the test. If he doesnt order the test, and Joe ends up in serious medical trouble, doc gets sued. If he orders the test, and Joe just has indigestion, doc doesnt get paid.

[bkwits]

Medicare claims are processed by (or used to be anyway) bluecross/blueshied, Aetna and Cigna. So they decide what is denied. It was set up this way to avoid undue government interference in medical practice.

Govt feels they are approving too many procedures, so encourage them to reduce the number of procedures approved to cut down on expenses.

ie. Joe goes to the doc complaining of burning pain in his chest. Doc decides echocardiography is needed. If the results show COPD, the procedure is covered, if the results show acid reflux, the procedure would not be covered. problem is, doc can't be sure without the test. If he doesnt order the test, and Joe ends up in serious medical trouble, doc gets sued. If he orders the test, and Joe just has indigestion, doc doesnt get paid.

Where does your information come from? WPS administers Medicare Part A and Part B throughout the Midwest. WPS is Wiconsin Physicians Service.

How do you know that the test is not covered when it shows acid reflux? I've certainly not heard of this. So you are saying the doc has to pay if there is not a serious condition as a result of the test? Please point me in the direction of securing this information for myself.

Thank you.

[IaNsSyAlNuE]

Medicare more likely to deny claims than commerical health insurers

http://healthcare-economist.com/2008/06/30/medicare-more-likely-to-deny-claims-than-commerical-health-insurers/

AND

MassHealth has higher claim denial rate than commercial insurers

http://www.patientpowernow.org/2009/06/23/masshealth-denies-claims-commercial-insurers/


So we should consider Medicare and MassHealth as death panels too when they deny more claims than private insurers?

[IaNsSyAlNuE]

I saw a man on a financial show today. He said that although the phrase "death panels" was a bit over the top, the fact is that people are being untruthful about the effects the currently discussed bills will have on medicare. He said that there is already a structure where more and more claims are going to be denied. He said that is what should be focused on in any reform discussion, but there is no way they can add so much and not start to ration.

I am unsure how anyone could claim otherwise. Do you recall what show? I would love to ee it or read the transcript. Feel free to PM me if you like.