We are wondering what Edward S. Kornreich and Herschel Goldfield think now after reading our post “Which health insurance carrier denies the most claims?” You see these gentlemen posted an op ed “Medicare’s lesson for health insurance reform” at The Hill.com in September. Here is a quote from the piece, “ Missing from the healthcare debate is any serious discussion about a critical flaw built into our system: Insurers have an incentive to deny claims, because the more they pay out, the less they profit. Patients and doctors have the opposite incentive…….There is an alternative. In fact, it is already in place for the millions covered by Medicare.”
Kornreich and Goldfield should be pleased. Denials are no longer missing from the debate. You’re welcome.
Medicare denied coverage for ambulance rides, which had been pre-approved, for a 90-year-old double amputee. After multiple resubmissions of paperwork, trips to the hospital patient services department, and two-hour-long phone calls (reaching different Medicare representatives each time), this elderly man has not been able to resolve his nightmare.
Last month, Congressman Dennis Kucinich grilled private insurance carriers about the insurance claims they denied in an attempt to demonize them. Meanwhile, it turns out that Medicare actually denies a larger percentage of claims than any of the private insurers. See the report here.
According to page 5 of the 2008 Health Insurance Report Card released by the American Medical Association, the “carrier” with the highest percentage of denials is…..Medicare. Does it still sound like we need to put the government in control of (or develop a public option to compete with) health insurance companies to prevent them from denying claims?
Metric 12—Percentages of claim lines (i.e., records) denied Description: What percentage of records submitted are denied by the payer for reasons other than a claim edit? A denial
is defined as: allowed amount equal to the billed charge and the payment equals $0.
The eligibility rules for COBRA subsidy say “an employee who is terminated involuntarily (unless for gross misconduct)” is eligible. A client called to inform me that their company had two people who walked off the job who haven’t come back for days. Basically, “take this job and….” My client asked me if the company would have to offer COBRA and if these employees would receive the subsidy. When I called the Department of Labor office today to clarify what they meant by “gross misconduct” and “involuntary,” I was told that an employee would have to commit a felony to be considered gross misconduct and that an employee walking off the job and not coming back for days is not involuntary termination since the employer would have to make the decision to “take him off the books” for this behavior. So our tax payer dollars are going to subsidize COBRA premiums for pretty much everyone, not just those who were laid off due to the economy, as we were told.