Deny This: Guess Who Has the Highest Medical Claim Rejection Rate?

[Hyme Lipshitz]

Guess Who Has the Highest Medical Claim Rejection Rate?



By Tom Blumer
October 6, 2009





Beverly Gossage, Research Fellow for Show-Me Institute and founder of HSA Benefits Consulting wondered which insurance companies rejected the most claims. She found her answer in the AMA’s own 2008 National Health Insurer Report Card

I'm curious. Was it Aetna? Humana?

A chart showing the major carriers and how Medicare compared to them in the study.. : see chart below :






Well, well.

The Medicare denial rate found in the study was roughly double that of all of the private carriers combined.

You would think Medicare's sheer size might enable it to have smoother procedures with its providers that would enable it to turn down a lower percentage of claims. But no, this is the government we're talking about.

So who's the most "heartless" now? And why should Americans accept the idea of gradually being forced into a government-run system when, based on documented government experience, they will be more likely to see their claims denied?

And I didn't even get to the idea of refusals to treat in the first place, something that is present to some degree in virtually every state-run system, but is currently against the law in hospital emergency rooms in the U.S.



.

[barry49s]

http://news.yahoo.com/s/bloomberg/20...g/art21rgbyvra

Didn't W and the Repubs get slammed for schmoozing up to the drug companies during the negotiation of the prescription drugs benefit package?

[jazzbluescat]

Wonder if BlueCrossBlueShield is a subsidary or one of those or just isn't one of the top eight?

[Wonder Woman]

Originally Posted by jazzbluescat

Wonder if BlueCrossBlueShield is a subsidary or one of those or just isn't one of the top eight?

Anthem.

[Scrappy]

Originally Posted by Hyme Lipshitz

Guess Who Has the Highest Medical Claim Rejection Rate?



By Tom Blumer
October 6, 2009





Beverly Gossage, Research Fellow for Show-Me Institute and founder of HSA Benefits Consulting wondered which insurance companies rejected the most claims. She found her answer in the AMA’s own 2008 National Health Insurer Report Card

I'm curious. Was it Aetna? Humana?

A chart showing the major carriers and how Medicare compared to them in the study.. : see chart below :


Well, well.

The Medicare denial rate found in the study was roughly double that of all of the private carriers combined.

You would think Medicare's sheer size might enable it to have smoother procedures with its providers that would enable it to turn down a lower percentage of claims. But no, this is the government we're talking about.

So who's the most "heartless" now? And why should Americans accept the idea of gradually being forced into a government-run system when, based on documented government experience, they will be more likely to see their claims denied?

And I didn't even get to the idea of refusals to treat in the first place, something that is present to some degree in virtually every state-run system, but is currently against the law in hospital emergency rooms in the U.S..

Should we really be surprised by this? No.

[gridfaniker]

this can't be true. or there must be more to the story.

[Fro]

So wait...Hyme is now complaining that Medicare denied claims double the percentage of private companies? Geez, I dunno but I thought you'd be happy about your tax dollars not being spent into a socialist program.

[gridfaniker]

Originally Posted by Fro

So wait...Hyme is now complaining that Medicare denied claims double the percentage of private companies? Geez, I dunno but I thought you'd be happy about your tax dollars not being spent into a socialist program.

I think he was trying to point out that the govt.-run program (medicare) is more likely to perpetrate the vile act of claims denial than private insurance companies. which runs contrary to claims made by Obama HC reform supporters.

Buit again, I can't help but be skeptical of the chart Hyme posted. Why on earth would Obama and all his cohorts in the HC reform battle deride private insurance companies as being heartless when Medicare is even more so? doesn't make sense.

[weavervegas]

Originally Posted by Hyme Lipshitz

Guess Who Has the Highest Medical Claim Rejection Rate?
http://www.thisboardrocks.com/forum/...1&d=1254819857

why just the first week in march (a new program could of started that week and the billers needed time to adjust to the new coding standards?)

why claim Lines, why not claims? A claim line would be one service performed during the visit, and there are many reasons to deny it, the very simple one would be wrong CPT or ICD9 code used - which goes back to the vendor they are using for Practice management allowing such typos - and again it could be that medicare wanted a new code starting March 1 for some common service



Also a Zero dollar payment does not mean a true denial, true denials come in usually with a claim status of 4 (electronic remit), Zero dollar payments could happen on a refile

1st file, they may of paid claim lines 1/3/5, 2nd filing, they paid lines 2/4 and Zero dollar payments would be on 1/3/5

so for the most part I would dis regard this chart as utter trash

Also remember that some states use normal insurance companies to handle their medicare payments processing (u know farm it out to 3rd parties per repubs needs so they can make money on it, let the Gov't process their own claims and stop over paying for a 3rd party to process and pay them / cut the !@#$ing middle man out)

[gridfaniker]

Originally Posted by weavervegas

so for the most part I would dis regard this chart as utter trash

there's a stunner

[chipshot]

why just the first week in march (a new program could of started that week and the billers needed time to adjust to the new coding standards?)

you might want to look at the chart again, it's from 3-1-07 to 3-10-08

[VA49er]

Originally Posted by chipshot

you might want to look at the chart again, it's from 3-1-07 to 3-10-08

lol

[Superfluous_Nut]

that chart doesn't include "edits" that take the number down to $0.

aetna adjusts 3.75% of their claims down to $0
anthem 3.4%
cigna 7.33%
coventry 0.31%
humana 3.17%
uhc 9.15%
medicare 1.4%

looks like rather than saying "yes, we WOULD pay that but we aren't paying it for you" they're saying "great, let's just rework a couple things and there -- here's you $0 for that service".

honestly, i'm kind of surprised that there seem to only be 2.5 million non-medicare claims made over the course of a year. particularly given that you get multiple claims fired off from a single event.

[Fro]

Originally Posted by gridfaniker

I think he was trying to point out that the govt.-run program (medicare) is more likely to perpetrate the vile act of claims denial than private insurance companies.

yeah yeah yeah i got that part

[weavervegas]

Originally Posted by chipshot

you might want to look at the chart again, it's from 3-1-07 to 3-10-08

oh - but they should still be looking at the claim status and not the Zero pay amount

more info http://en.wikipedia.org/wiki/Medicar...ical_Insurance