Insurance provider with most rejections?

[NathanS]

Deny This: Guess Who Has the Highest Medical Claim Rejection Rate? | NewsBusters.org

Medicare.

Medicare is also widely considered to have the highest level of fraud (>20%). This is interesting considering Progressivse often cry that private companies spending 10% of premiums largely stamping out fraud is a "market waste."

[davidra]

Originally Posted by NathanS

Deny This: Guess Who Has the Highest Medical Claim Rejection Rate? | NewsBusters.org

Medicare.

Medicare is also widely considered to have the highest level of fraud (>20%). This is interesting considering Progressivse often cry that private companies spending 10% of premiums largely stamping out fraud is a "market waste."

It's always nice to think about why. In fact, it's always nice to think:

Why is this? It could be the case that commercial health insurers have more efficient claims processing centers. While economists generally believe that the private sector is more efficient, in the case of health insurance claims firms make more money when they deny more claims. Thus, I am not sure that the profit motive is leading to more private-sector claims approvals.
Competition between insurers may increase claims approvals. Most physicians and hospitals must take Medicare because it represents so large a share of the helathcare spending. On the other hand, physicians may only accept patients whose insurance companies have prompt payment with fewer denials. This leads to some incentive for insurance companies to decrease claims denials.
Another reason for the differential claims denial rates is the demographics of Medicare and commercial insurance enrollees. Almost all Medicare enrollees are over 65, while commercial insurers have enrollees who are of varying ages. Since older individuals are more likely to demand high cost medical procedures, if high cost medical procedures are the ones that are more likely to be denied then Medicare’s higher denial rate may simply be due to the composition of its enrollees.
Whatever the reason, the fact that Medicare denies more claims than commercial insurers should dispel the myth that the government is simply a benevolent entity, while commercial insurers are ruthless, profit-hungry wolves. The truth–as always–lies not in the black nor the white but in the gray.

Healthcare Economist · Medicare more likely to deny claims than commerical health insurers

If you are really interested in health care financing issues, and not just republican talking points, you might spend some time on this website. It is written by actual health economists...not partisan sheep.

[NathanS]

Originally Posted by davidra

It's always nice to think about why. In fact, it's always nice to think:



Healthcare Economist · Medicare more likely to deny claims than commerical health insurers

If you are really interested in health care financing issues, and not just republican talking points, you might spend some time on this website. It is written by actual health economists...not partisan sheep.

Your post entirely agrees with my point. Medicare is a wasteful inefficient system with no competition and no incentives to serve it's customers. You just posted another "Republican talking point."

[davidra]

Originally Posted by NathanS

Your post entirely agrees with my point. Medicare is a wasteful inefficient system with no competition and no incentives to serve it's customers. You just posted another "Republican talking point."

Unlike you, I try and find thoughtful posts that are unbiased. This reference gives very cogent reasons why Medicare may deny more claims than most (but not all) private insurers. And a significant reason is that insurance companies cherry-pick the healthiest people in the country to insure. Is there something about that argument you don't comprehend? Additionally, if it saves money without decreasing the quality of care, is there something wrong with an appropriate denial? Do you think every procedure should be paid for no matter how inapproprate it is?

[NathanS]

Originally Posted by davidra

Unlike you, I try and find thoughtful posts that are unbiased. This reference gives very cogent reasons why Medicare may deny more claims than most (but not all) private insurers. And a significant reason is that insurance companies cherry-pick the healthiest people in the country to insure. Is there something about that argument you don't comprehend? Additionally, if it saves money without decreasing the quality of care, is there something wrong with an appropriate denial? Do you think every procedure should be paid for no matter how inapproprate it is?

I think we can have useful discussion on the profit motive in denying care. I think there are also solutions to such situations if people would do more than spit out the one size fits all "the government should do it" solution.

Personally I have an HSA with a 10,000 deductible and life insurance from the same company. Seems to eliminate most of the problems you keep making up about health insurance.

I have an incentive to shop around and save money for most procedures, and insurance only kicks in for truly catastrophic cases. Good luck denying my 20,000 operation, having me die, and paying out my million dollar life insurance policy.

[davidra]

Originally Posted by NathanS

I think we can have useful discussion on the profit motive in denying care. I think there are also solutions to such situations if people would do more than spit out the one size fits all "the government should do it" solution.

Personally I have an HSA with a 10,000 deductible and life insurance from the same company. Seems to eliminate most of the problems you keep making up about health insurance.

I have and incentive to shop around and save money for most procedures, and insurance only kicks in for truly catastrophic cases. Good luck denying my 20,000 operation, having me die, and paying out my million dollar life insurance policy.

A $10,000 deductible? You must be pretty young and healthy, not have a family that needs preventive care, and be a really careful driver. We've discussed HSA's at length. They are fine for some people...but the people that really need health insurance do not have access to them. They may solve your problem....but not the country's problem. But I suppose that's of less interest, right?

[NathanS]

Originally Posted by davidra

A $10,000 deductible? You must be pretty young and healthy, not have a family that needs preventive care, and be a really careful driver. We've discussed HSA's at length. They are fine for some people...but the people that really need health insurance do not have access to them. They may solve your problem....but not the country's problem. But I suppose that's of less interest, right?

They are being outlawed by the health care bill... god you are dumb if you really think closing off options is going to fix our problems.

[davidra]

Originally Posted by NathanS

They are being outlawed by the health care bill... god you are dumb if you really think closing off options is going to fix our problems.

If you or any republican had an idea that would fix our problems, that would be interesting. And unique as well.

[foosball]

Originally Posted by NathanS

They are being outlawed by the health care bill... god you are dumb if you really think closing off options is going to fix our problems.

Hey don't forget he's an MD!

All this proves is that it doesn't matter if you're an MD or a rocket scientist if you don't understand economics then all the training in the world won't be able to protect you from the law of unintended consequences.

The reality is most people would be better served to simply do what Nathan does and use an HSA. It was $800 a month for my family to get full "cadillac" coverage with no deductible. Instead I put the monthly difference in my HSA and its costs me $200 a month for my $10,000 deductible HSA. My family is better served that way than overpaying for health coverage we don't need.

After Obamacare kicks in my rates will skyrocket and insurance will be unaffordable for me and my family.

Why do socialists like Obama and Davidra hate people so much?

[mcmaster48]

Originally Posted by NathanS

For those who read this, notice the "thank" from mcmaster on the above post. Really. What a circle jerk. The guy made a completely useless post and you thanked him. Go jack off or something.

It would have been considered "useless" that Republicans had a well-considered, forward-thinking plan versus the blank sheets of paper they taunted Obama with during the SOTU address? That's a unique perspective.

[NathanS]

Originally Posted by mcmaster48

It would have been considered "useless" that Republicans had a well-considered, forward-thinking plan versus the blank sheets of paper they taunted Obama with during the SOTU address? That's a unique perspective.

Ugh. Are we back to this again. Doing something is better than nothing, except when something is worse than nothing.

[davidra]

Originally Posted by foosball

Hey don't forget he's an MD!

All this proves is that it doesn't matter if you're an MD or a rocket scientist if you don't understand economics then all the training in the world won't be able to protect you from the law of unintended consequences.

The reality is most people would be better served to simply do what Nathan does and use an HSA. It was $800 a month for my family to get full "cadillac" coverage with no deductible. Instead I put the monthly difference in my HSA and its costs me $200 a month for my $10,000 deductible HSA. My family is better served that way than overpaying for health coverage we don't need.

After Obamacare kicks in my rates will skyrocket and insurance will be unaffordable for me and my family.

Why do socialists like Obama and Davidra hate people so much?

Well, by all means, Dr. Economist, please explain to us how HSA's would help low income people who can't benefit from a tax break, yet are working and have no insurance. What do you mean by "most people"? People like you? I'll say again what I said before: HSA's may be fine for relatively young healthy people. They don't help those that need help. But that fits right into the republican playbook. They choose to ignore those that really need help. And you have no idea what your rates will be like. If you want them to be totally controlled, then you should support a single payor option....or tighter control on insurance companies. So tell us, which of these do you favor? The real question is why do republicans and their supporters care so little for people that don't have insurance? There's some hatred for you.

[NathanS]

Originally Posted by davidra

Well, by all means, Dr. Economist, please explain to us how HSA's would help low income people who can't benefit from a tax break, yet are working and have no insurance. What do you mean by "most people"? People like you? I'll say again what I said before: HSA's may be fine for relatively young healthy people. They don't help those that need help. But that fits right into the republican playbook. They choose to ignore those that really need help. And you have no idea what your rates will be like. If you want them to be totally controlled, then you should support a single payor option....or tighter control on insurance companies. So tell us, which of these do you favor? The real question is why do republicans and their supporters care so little for people that don't have insurance? There's some hatred for you.

So apart from young healthy people we have what? Old, sick people? Wait, I thought we had this thing called Medicare?

[davidra]

Originally Posted by NathanS

So apart from young healthy people we have what? Old, sick people? Wait, I thought we had this thing called Medicare?

Well, you see, it's like this. The vast majority of the uninsured are workers. However, most of them cannot afford insurance, and their income is not high enough for them to benefit from HSA's. Additionally, most insurance companies are opposed to HSA's because people will disenroll from standard insurance, which will take most of the healthy people away. Like every other way of providing insurance, there are some good things and some bad things about HSA's...but in the opinion of many with a global view of health care financing, it is not a solution to the health care problems of the country because it doesn't address the appropriate population.

You do get one point for recognizing that elderly people have Medicare, and I'm glad you support it, since many people consider it "socialist" or some crap like that. Congrats on that.

[foosball]

Originally Posted by davidra

Well, by all means, Dr. Economist, please explain to us how HSA's would help low income people who can't benefit from a tax break, yet are working and have no insurance. What do you mean by "most people"? People like you? I'll say again what I said before: HSA's may be fine for relatively young healthy people. They don't help those that need help. But that fits right into the republican playbook. They choose to ignore those that really need help. And you have no idea what your rates will be like. If you want them to be totally controlled, then you should support a single payor option....or tighter control on insurance companies. So tell us, which of these do you favor? The real question is why do republicans and their supporters care so little for people that don't have insurance? There's some hatred for you.

How HSA's help low income people:

They reduce the cost of healthcare by reducing over-utilization. Over-utilizaton directly contributes to higher prices leading to higher priced/unaffordable care for the poor. See the effects of overutilization in any standard health economics textbook.

What rates will be like:

They will inevitably be higher because an increase in demand with no corresponding increase in supply is not a Republican tactic, its otherwise known as the Law of Supply & Demand and no politician can repeal it.

Totallly controlled rates:

Rates will go down when there is less bureaucratic redtape, not more. Government cannot dictate prices, it is subject to supply and demand just like everybody else. Attempts to control prices are futile and even worse counterproductive. Did you live through the Jimmy Carter era? Misery index sound familiar?

Tighter control over insurance companies:

Those who bear the costs of over-regulation are those who can least afford it, the poor. Want to help the poor? Increase competition in the market place by offering companies incentives NOT dis-incentives to join the market. A healthy, vibrant, efficient insurance market would be one with portable insurance products offered that could be sold across state lines from a plethora of carriers. The best way to regulate companies it to make sure there is another company looking over their shoulder not some bureaucratic regulations that do nothing to make coverage more affordable.