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

Kasz216 said:
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.

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.

Something being necessary or unnecessary for a patient isn't clear.  Also, you can't expect doctors to know the nuances of medical billing.  Why not bill if you aren't sure?  Why not bill for more if they are going to pay a percentage of what you ask?  Why not bill them for things you didn't do to make up for what they wont pay?  On top of that, many Medicare patients dont pay their bills.  My hospital doesn't even send a due date with the bills they send out because they dont expect people to pay them.  If the patient you just saw isn't going to pay for anything, why not bill Medicare and recoup some of your loses?

Medical Billing is horrible, if they put more people on salary less people would see Medicare and other insurance providers as a cash cow.



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Kasz216 said:
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.

I just googled that, so you should look for better sources if you want to know their position in detail.



ManusJustus said:
Kasz216 said:
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.

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.

Something being necessary or unnecessary for a patient isn't clear.  Also, you can't expect doctors to know the nuances of medical billing.  Why not bill if you aren't sure?  Why not bill for more if they are going to pay a percentage of what you ask?  Why not bill them for things you didn't do to make up for what they wont pay?  On top of that, many Medicare patients dont pay their bills.  My hospital doesn't even send a due date with the bills they send out because they dont expect people to pay them.  If the patient you just saw isn't going to pay for anything, why not bill Medicare and recoup some of your loses?

Medical Billing is horrible, if they put more people on salary less people would see Medicare and other insurance providers as a cash cow.

I can't expect doctors to know the nuances of medical billing.

I CAN expect the doctors to know the nuances of Medicare billing.  The LARGEST insurance provider in the country... which you need to adopt in to and is supposed to have one of the most straight foward billings and claims process out there.  If your a medicare doctor... chances are medicare is a large amount of your buisness.

Your arguement is that they make more claims on the system that is most used, they come across the most and is supposed to be one of the most straight foward.

That defies common sense.



ManusJustus said:
Kasz216 said:
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.

I just googled that, so you should look for better sources if you want to know their position in detail.

Yeah there homepage is actually quite good on the issue. 

They basically want a Public option that works just like private insurance that you would pay for yourself that competes "fairly" with private insurance.

Nothing wrong with that.  It would just be a government run company.  Which is something I actually think the government should do a lot more of. 

I really don't understand the point of it though.  I guess an attempt at a "non-profit" insurance company.  They basically support a public option that isn't really a public option.

They want an equivlent to the government run banks like Freddie Mae.

All we really need is more standardization in the insruance industry, and a solution for people with prexisting conditions.

The standarization is never going to come though because neither party wants it.



Kasz216 said:

Yeah there homepage is actually quite good on the issue.  They basically want a Public option that works just like private insurance that you would pay for yourself that competes "fairly" with private insurance.

Nothing wrong with that.  It would just be a government run company.  Which is something I actually think the government should do a lot more of. 

You now know more about AMA's stance than I do.  And I agree with you on government 'non-profit' insurance.

...

My argument is that doctors use Medicare as a cash cow, billing for things they may or may not have done that may or may not be necessary to recoup losses they made from patients who they know will not pay for it.

Medicare is not synonymous with Public Healthcare, so just because Medicare doesnt pay doctors enough or isnt set up to cover its expenses doesnt mean that every public option will do the same.



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ManusJustus said:
Kasz216 said:

Yeah there homepage is actually quite good on the issue.  They basically want a Public option that works just like private insurance that you would pay for yourself that competes "fairly" with private insurance.

Nothing wrong with that.  It would just be a government run company.  Which is something I actually think the government should do a lot more of. 

You now know more about AMA's stance than I do.  And I agree with you on government 'non-profit' insurance.

...

My argument is that doctors use Medicare as a cash cow, billing for things they may or may not have done that may or may not be necessary to recoup losses they made from patients who they know will not pay for it.

Medicare is not synonymous with Public Healthcare, so just because Medicare doesnt pay doctors enough or isnt set up to cover its expenses doesnt mean that every public option will do the same.

Your point is that doctors use medicare as a cash cow... however aren't paying doctors enough....

and are caliming extesnive fraud... but only with medicare.

Even if true.  This would once again show the weakness with medicare and large isnurers in general... and espiecally large public options.

Fraud is more prevelant and more likely to happen.

No matter how you look at these numbers they indicate their is something wrong with Medicare.

If there is a public option it would have to be VERY different from conventional government medical plans to work.

Personally i liked the idea of a "Doctor Draft" but the AMA would hate that.




Did you read the fine print? Denied means unwilling to pay the full amount billed, it doesn't deny the procedure. Medicare is showing it is the most fiscally challenging of those listed.

Also double all the other carriers combined would be double 27.2, 54.4% of claims denied.


Just thought I'd jump in with a little fact check for you. See you around.

 


Get your Portable ID!

 

My pokemon brings all the nerds to the yard. And they're like, "You wanna trade cards?" Damn right, I wanna trade cards. I'll trade this, but not my charizard.

jjseth said:

Did you read the fine print? Denied means unwilling to pay the full amount billed, it doesn't deny the procedure. Medicare is showing it is the most fiscally challenging of those listed.

Also double all the other carriers combined would be double 27.2, 54.4% of claims denied.


Just thought I'd jump in with a little fact check for you. See you around.

I'm guessing your fact check missed the "Payment = 0" part of that fineprint.

Your entire post is wrong.

It doesn't count being unwilling to pay the full amount.

 



Kasz216 said:
jjseth said:

Did you read the fine print? Denied means unwilling to pay the full amount billed, it doesn't deny the procedure. Medicare is showing it is the most fiscally challenging of those listed.

Also double all the other carriers combined would be double 27.2, 54.4% of claims denied.


Just thought I'd jump in with a little fact check for you. See you around.

I'm guessing your fact check missed the "Payment = 0" part of that fineprint.

Your entire post is wrong.

It doesn't count being unwilling to pay the full amount.

Still, its a horrible way to compare.  If a private insurance company only pays 2% of the claim, that isnt included.  Thats not to mention that many insurance companies only pay a certain percentage of whatever the claim is.



Kasz216 said:
ManusJustus said:
Kasz216 said:

Yeah there homepage is actually quite good on the issue.  They basically want a Public option that works just like private insurance that you would pay for yourself that competes "fairly" with private insurance.

Nothing wrong with that.  It would just be a government run company.  Which is something I actually think the government should do a lot more of. 

You now know more about AMA's stance than I do.  And I agree with you on government 'non-profit' insurance.

...

My argument is that doctors use Medicare as a cash cow, billing for things they may or may not have done that may or may not be necessary to recoup losses they made from patients who they know will not pay for it.

Medicare is not synonymous with Public Healthcare, so just because Medicare doesnt pay doctors enough or isnt set up to cover its expenses doesnt mean that every public option will do the same.

Your point is that doctors use medicare as a cash cow... however aren't paying doctors enough....

and are caliming extesnive fraud... but only with medicare.

Even if true.  This would once again show the weakness with medicare and large isnurers in general... and espiecally large public options.

Fraud is more prevelant and more likely to happen.

No matter how you look at these numbers they indicate their is something wrong with Medicare.

If there is a public option it would have to be VERY different from conventional government medical plans to work.

Personally i liked the idea of a "Doctor Draft" but the AMA would hate that.

I'm not saying that private insurance companies aren't abused, I'm saying that Medicare is abused more.

The AMA is a special interest group and only have doctor's interests in mind.