Medicare: Largest Denier Of Health Care Claims
Posted October 6th, 2009 at 1:10pm in Health Care, Ongoing Priorities 
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According to AMA’s National Health Insurance Report Card, Medicare denies 6.85 percent of its claims, higher than any private insurer (Aetna was second, denying 6.80 percent of its claims), and more than double any private insurer’s average.
What’s fascinating is that The American Medical Association (AMA) has endorsed a public option, despite the fact that “some member physicians at the group’s annual meeting [in June] likened the notion to communism.”
The Obama administration repeats ad nauseum that we need a government option to “keep insurance companies honest” and to make sure they don’t deny anyone coverage. Well what does one say about the fact that Medicare denies more claims than private insurers?
President Obama has promised that if we like our health insurance we can keep it. But will those who are forced into the public option–which has been estimated to be minimum of tens of millions of currently insured Americans in addition to those “46 million” currently uninsured–be satisfied with their care given that the government program Medicare’s denial of claims outranks any private insurer’s?
AMA is effectively endorsing a public plan that is the largest denier of claims. How the public option would provide health care to patients is hard to understand.
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11 Responses to “Medicare: Largest Denier Of Health Care Claims”
Joe on October 6th, 2009 at 1:10pm said:
Mr. Weinberger needs a lesson in math.
“Medicare denies 6.85 percent of its claims, higher than any private insurer (Aetna was second, denying 6.80 percent of its claims), and more than double any private insurer’s average.”
6.85% is not double 6.8%
Furthermore, most of Medicare’s denials were from the provider sending the form to the wrong place or not providing the proper information. How is that Medicare’s fault?
Mike Pennsylvania on October 6th, 2009 at 1:10pm said:
Joe tries to absolve Medicare from blame because he says that most Medicare denials were from the provider sending in the wrong forms.
Typical deceptive liberal argument.
A- He doesn’t provide proof.
B- He doesn’t apply the same standard to private insurers. Notice he didn’t say why most of Aetna’s claims were denied.
Mike Pennsylvania on October 6th, 2009 at 1:10pm said:
Also Joe can’t read too well. Weinberger didn’t say Medicare was double Aetna he said it was double the private insurer’s average.
Bill on October 6th, 2009 at 1:10pm said:
This is also a bit misleading. I would expect Medicare claim denials to be higher.
Here’s why: health insurers who do managed care require pre-approval or require following a protocol, so in effect there is pre-screening.
Medicare does not pre-screen and or pre approve. It is a post approval process.
And, don’t forget, Medicare payment process is managed by the same carriers who bid to serve as the administrator, most often Blue Cross plans, so you can’t say it is ineptitude.
We should have more denials, in my opinion, not fewer.
Dexter, San Francisco on October 6th, 2009 at 1:10pm said:
It would seem more likely, Joe, you need more than what the current political class has to ofer for your survival. It is sad to see ignorant people in pain even when they bring it on themselves. Empathy from any of us will not save you, as what it takes to just live in this world is being squandered by the idle (meddling) rich we call ‘our government.’
When the fiat money is gone, they can eat each other; since that is the only way they can feed themselves.
Wallace Hoffman on October 6th, 2009 at 1:10pm said:
Medicare denies rationing of health care, but my checkbook testifies otherwise. Rationing began in February 2009, when Medicare refused to pay for certain essential lab tests and medicines that our physician says are absolutely necessary because of my wife’s damaged immune system. Appeals to Medicare were not even answered. Tricare for Life for military retirees also does not pay anything when Medicare refuses a claim. Because of paying full price out of pocket for health care Medicare previously provided, I ran out of money and credit by September 2009.
Steve on October 6th, 2009 at 1:10pm said:
“Bill writes: This is also a bit misleading. I would expect Medicare claim denials to be higher.”
I agree Bill…I had the same thought.
We’ve all seen the numbers which show how much more we spend for health care per capita – twice most others; but if you just look at how much government spends per capita for all the nations, we still spend more.
I don’t think those trying to fix the problem really understand the problem.
Rick, Utah on October 6th, 2009 at 1:10pm said:
How about checking out the source for this info before commenting? The link is;
http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf (there is a comma between the ama and assn).
Notice that the link is to an AMA site. This report is part of their effort to reduce claim processing complexity and if you check the denial codes you will see that Medicare denies claims most often due to coding issues. To me it proves that the Medicare claim process is so complex that even when trained/experienced filers submit claims they can’t get payment.
Joe – find out what average means.
Bill – pre-approval only verifies that the person is covered under the carriers plan, it has nothing to do with filing a claim for payment and therefore has nothing to do with the point of the study or the story.
Jim, Maryland on October 6th, 2009 at 1:10pm said:
Mike Pennsylvania writes:
Also Joe can’t read too well. Weinberger didn’t say Medicare was double Aetna he said it was double the private insurer’s average.
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He reads a lot better than you do. To quote from the article: ..”and more than double any private insurer’s average.” See the word “any”. That doesn’t mean industry average it means any of the insurers [which would be Aetna].
Nor did he say the they filled out the wrong form as you claim. He said there was a mistake on the form or it was sent to the wrong place.
He uses the same source that the article did, i.e., AMA’s National Health Insurance Report Card. Why you couldn’t figure that out is a question? There’s even a link to the report on the page.
Perhaps the difference between liberal [him] and conservative [that would be YOU], is he can read and is willing to look through the report while you are not. Perhaps you should just turn the tele on to Glenn Beck and drink your beverage of choice; nod your head like a bobble head and repeat “It’s just common sense.”
You catch this one in the “article”:
“What’s fascinating is that The American Medical Association (AMA) has endorsed a public option, despite the fact that “some member physicians at the group’s annual meeting [in June] likened the notion to communism.””
So what? If you had two member physicians liken it to “communism” that would be “some members”.
The odds the you caught that one Mike is some where between zero and nada.
Jim, Maryland on October 6th, 2009 at 1:10pm said:
I’m really disappointed in the Heritage Foundation on this one. I often refer to their Federal Budget and Spending section which is generally very good. But this one on health care is a rather poor effort in data mining and language trickery. Maybe I should rethink their.
Neil, Bogotá on October 6th, 2009 at 1:10pm said:
PÑlease, folks, don’t get so wound up.
This is the Heritage Foundation website, after all.
And we know they like to twist facts a bit, don’t we?
And Joe reads pretty well.
And Jim is pretty smart.