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Forums - General - Medicare denies more claims than all private insurance combined

Kasz216 said:
NJ5 said:
Kasz216 said:
NJ5 said:
For there to be a denial there has to be a request in the first place. Maybe people who use Medicare do more requests than others?

Statistics can often be misleading, in very weird and sometimes hard to see ways.

That's why there is a percentage their NJ5.  Medicare denies the most claims on average.

At best you could argue that for some reason people on Medicare put it more frivelous claims then other people.

However that's a fairly untenable arguement and one that if proven correctly would still be a negative indictment on public run healthcare since it still costs the same to process a successful claim.

 

^ bolded (that's what I meant, maybe I didn't explain myself well)

I'm not saying it's necessarily the case but maybe the people who have other insurers know the rules better for some reason. I mean if you had an extremely stingy insurer, at some point you'd stop bothering. Maybe it would help to see the data for several years to see if there's such a trend.

 

How would serveral years help?  I mean new insurees enter the market every year and old customers leave every year. 

A several year study would show no difference even if that was your contention.

Information spreads, I guess... but I see your point, the new and leaving customers could distort the data quite a lot.

 



My Mario Kart Wii friend code: 2707-1866-0957

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Kasz216 said:
highwaystar101 said:

"Private healthcare companies use every trick they can to deny you healthcare coverage"... Oooh, goody, I really want to go on private healthcare please. J/k I think you meant to phrase that differently Kasz

I think maybe things are a bit different here in Britain, because we have a hybrid system covered largely by the NHS, the only private system are usually very high quality so they can compete with the national system. Maybe this leads them to attempt to accommodate the customers needs more. 

Come to think of it, because the USA has low national coverage then the private systems can have much wider quality gradations in comparison to Britain. So yeah, you're right, I'm using the British system as a model which is a flawed comparison.

No, i actually don't want to phrase it differently.

That's the arguement used against them.  That doesn't mean it's true.

In reality our public system as you can see... denies more people.

 

Out of interest because I just don't know, what is included in a Medicare coverage plan? Is it like other insurnace companies that only cover certain things like accidents or general medical care (obviously for a price, more you pay more you get)? Or does it cover everything but bases the decisions on if you get the care person by person?

If so, what's to say the figures are scewed by this? If a person has insurance but it's only for general injuries and stuff, yet they get a desease that isn't covered, would they class that as they are denied or that they weren't covered so can't get the care anyway?

 

My friend recently moved to the US and before he could get his VISA he had to prove he had medical insurance, this took months. He has 2 health issues already and no one policy covered both of them and even then he could only get a general injuries insurance which didn't really cover care for the health issues the way the NHS does. Example being he has nerve damage in his leg which means he cannot bend it and causes him pain. With a procedure, he can make it so he can use that leg, here in the UK he can get it once every 6 months (it usually lasts 10-14 weeks for him) and for free on the NHS (he did get it once privately but had to pay £300, it used to be thousands when it first started) but in the US he has to pay $1000 for it as his insurance plan doesn't even cover it so does that count as a denial?



Hmm, pie.

Here is where the 2009 report card is by the way.

In general everybody improved. Aetna must of been worried about some negative action that's for sure.

http://www.ama-assn.org/ama1/pub/upload/mm/368/2009-nhirc-long.pdf



The Fury said:
Kasz216 said:
highwaystar101 said:

"Private healthcare companies use every trick they can to deny you healthcare coverage"... Oooh, goody, I really want to go on private healthcare please. J/k I think you meant to phrase that differently Kasz

I think maybe things are a bit different here in Britain, because we have a hybrid system covered largely by the NHS, the only private system are usually very high quality so they can compete with the national system. Maybe this leads them to attempt to accommodate the customers needs more. 

Come to think of it, because the USA has low national coverage then the private systems can have much wider quality gradations in comparison to Britain. So yeah, you're right, I'm using the British system as a model which is a flawed comparison.

No, i actually don't want to phrase it differently.

That's the arguement used against them.  That doesn't mean it's true.

In reality our public system as you can see... denies more people.

 

Out of interest because I just don't know, what is included in a Medicare coverage plan? Is it like other insurnace companies that only cover certain things like accidents or general medical care (obviously for a price, more you pay more you get)? Or does it cover everything but bases the decisions on if you get the care person by person?

If so, what's to say the figures are scewed by this? If a person has insurance but it's only for general injuries and stuff, yet they get a desease that isn't covered, would they class that as they are denied or that they weren't covered so can't get the care anyway?

 

My friend recently moved to the US and before he could get his VISA he had to prove he had medical insurance, this took months. He has 2 health issues already and no one policy covered both of them and even then he could only get a general injuries insurance which didn't really cover care for the health issues the way the NHS does. Example being he has nerve damage in his leg which means he cannot bend it and causes him pain. With a procedure, he can make it so he can use that leg, here in the UK he can get it once every 6 months (it usually lasts 10-14 weeks for him) and for free on the NHS (he did get it once privately but had to pay £300, it used to be thousands when it first started) but in the US he has to pay $1000 for it as his insurance plan doesn't even cover it so does that count as a denial?

Medicare works like every other insurance company.

Well actually they're supposed to be more upfront... since they know an unpaid medical bill is somethng you definitly can't afford.

Which is why the denial rate is surprisng.



Kasz216 said:

So the report is accurate.  Though the title is misleading. This is done by the AMA afterall.  They can't afford to doctor reports.  Right now they're actually the group without a political backer.  Also I think it would be illegal.

They'd like to see an end to the governments helping of insurnce companies but they also don't want government run healthcare.

Wrong.  AMA supports a public option.



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ManusJustus said:
Kasz216 said:

So the report is accurate.  Though the title is misleading. This is done by the AMA afterall.  They can't afford to doctor reports.  Right now they're actually the group without a political backer.  Also I think it would be illegal.

They'd like to see an end to the governments helping of insurnce companies but they also don't want government run healthcare.

Wrong.  AMA supports a public option.

This has changed since June?

 

“The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage andlower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”

If private insurers are pushed out of the market, the group said, “the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.”

http://www.nytimes.com/2009/06/11/us/politics/11health.html

I mean if you've got a later source... then feel free to show it.  But as of June they saw a public option as exploding healthcare costs.



IRT, this topic is horribly ignorant, and its obvious that the aritcle and topic creator have no idea how health insurance works in America. Private insurance companies are very clear about how much they can pay, for instance the doctor knows that they will pay 80% of the operation after a deductible of $500, so thats how much you bill for. Medicare will pay for almost anything, which is why doctors bill them for everything and even scooter salemen will file a claim on a patients behalf.

Private insurance company - no scooters, no use to bill them

Medicare - maybe scooters, bill em



Kasz216 said:
ManusJustus said:

Wrong.  AMA supports a public option.

This has changed since June?

“The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage andlower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”

If private insurers are pushed out of the market, the group said, “the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.”

http://www.nytimes.com/2009/06/11/us/politics/11health.html

I mean if you've got a later source... then feel free to show it.  But as of June they saw a public option as exploding healthcare costs.

The new president of the American Medical Association, which represents the interests of the nation's doctors, said Wednesday the group is open to a government-funded health insurance option for people without coverage.

http://www.cnn.com/2009/HEALTH/07/01/AMA.health.care.reform/

I just googled that, so you should look for better sources if you want to know their position in detail.  AMA sent a brochure supporting the public option with the JAMA they send to my roommate.



ManusJustus said:
IRT, this topic is horribly ignorant, and its obvious that the aritcle and topic creator have no idea how health insurance works in America. Private insurance companies are very clear about how much they can pay, for instance the doctor knows that they will pay 80% of the operation after a deductible of $500, so thats how much you bill for. Medicare will pay for almost anything, which is why doctors bill them for everything and even scooter saleman will file a claim on a patients behalf.

 

Medicare doesn't "Pay for anything". 

They only pay for nessesary services... and what they pay for and don't is clearly laid out.

 

http://www.cms.hhs.gov/mcd/overview.asp

These claims are "after service" claims.


Which is actually what those "scooter" guys do.  They look at the info you've provided and the medicare standards... and see if you qualify.  The only reason they only do it for medicare is that medicare is by far the largest provider.



ManusJustus said:
Kasz216 said:
ManusJustus said:

Wrong.  AMA supports a public option.

This has changed since June?

“The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage andlower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”

If private insurers are pushed out of the market, the group said, “the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.”

http://www.nytimes.com/2009/06/11/us/politics/11health.html

I mean if you've got a later source... then feel free to show it.  But as of June they saw a public option as exploding healthcare costs.

The new president of the American Medical Association, which represents the interests of the nation's doctors, said Wednesday the group is open to a government-funded health insurance option for people without coverage.

http://www.cnn.com/2009/HEALTH/07/01/AMA.health.care.reform/

I just googled that, so you should look for better sources if you want to know their position in detail.  AMA sent a brochure supporting the public option with the JAMA they send to my roommate.

Funny since said article defeats the point you were trying to make in this thread about Medicare... calling it a program that's going broke and doesn't even pay doctors costs.