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  • Medicare: Largest Denier Of Health Care Claims

    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.

    Posted in Ongoing Priorities [slideshow_deploy]

    22 Responses to Medicare: Largest Denier Of Health Care Claims

    1. Joe says:

      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?

    2. Mike Pennsylvania says:

      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.

    3. Mike Pennsylvania says:

      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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    5. Bill says:

      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.

    6. Dexter, San Francisc says:

      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.

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    9. Wallace Hoffman says:

      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.

    10. Steve says:

      "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.

    11. Rick, Utah says:

      How about checking out the source for this info before commenting? The link is;
      http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcar... (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.

    12. Jim, Maryland says:

      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.

      ==============

      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.

    13. Jim, Maryland says:

      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.

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    19. Neil, Bogotá says:

      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.

    20. Aaron, South Dakota says:

      No, I'm afraid that Joe's missing the point and is misinterpreting what's being offered. If Medicare denies coverage more than any private insurer (including Aetna), why would we want to go to that system?

      Joe is using literalism in a sentence in order to mask his willful obtuseness over the basic point of the argument: Medicare denies claims more than anyone else. Period.

      Since one claim (among many others) is that we need a form of "universal" health care in order to not have these denials of claims by private insurers – which deny less than the (horrendously insolvent) Medicare, I don't see that it's such a hard argument to grasp.

      Jim is merely compounding it by expressing "sadness" at Heritage, when the only sadness he should be expressing is that he's not getting the point, either.

      Willful ignorance on display. And pride in it.

      Heritage was founded to combat just these sentiments, for thoughts they be not.

    21. BONNIE HARVEY says:

      I JUST DON'T UNDERSTAND WHY MEDICARE DOESN'T GIVE OUR DR'S OR HOSPITALS PRE APPROVAL OF PAYMENT FOR PROCEDURES TO BE DONE. OUR SECONDARY INSURANCE DOES! AND, WE "PAY" FOR MEDICARE SO WHATS THE DEAL WITH THEM?? IS IT BECAUSE IT'S A GOVERNMENT RUN INSURANCE AGENCY? IF SO THEN THAT MAKES IT EVEN WORSE.I (AS MANY OTHERS) WOULD LIKE TO KNOW BEFORE I HAVE A SURGICAL PROCEDURE DONE WHAT MY INSURANCES WILL BE PAYING FOR SAID PROCEDURE.THAT GOES FOR DOCTORS, ANESTHESIOLOGIST AND (INCLUDING) HOSPITAL.HOW HARD CAN THIS POSSIBLE BE???

      THANKS FOR LETTING ME VENT. I REALIZE THAT SINCE MEDICARE IS A GOVERNMENT RUN AGENCY MY COMPLAINT FALL ON DEAF EARS.HOW DEPRESSING IS THAT.

    22. lynn says:

      I am about to pull my hair out at the small optometrist office i work at. We have been trying for 2 years to get payment from medicare on claims and they deny them all I guess we like many others will have to stop accepting medicare because they unethically refuse claims they know they owe providers

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