I just saw California Representative Maxine Waters speak about one health insurance problem in her state. On the Keith Olbermann show, she stated 25% of health claims in her state were denied by health insurance companies.
This means: of all medical bills sent to the insurance companies following a service that was already provided, 25% of the time, payment was denied. Maxine Waters went on to say that this is precisely why Americans are going broke. Olbermann and Waters stated they were speaking of HMOs. What both don¹t seem to understand is that the doctors are the ones who don¹t get paid by the HMOs when a claim is rejected, and, according to regulations passed in the 1980¹s and 1990¹s, it is illegal for the doctors to go after the patients for the money. The patients are unaffected in this specific instance. I would expect that 90% of individuals reading this know this to be true. Why doesn't Maxine Waters or Keith Olbermann?
Are they terribly ignorant or deceitful? You decide.
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9 comments:
Back when I had a job and health insurance, the doctors and hospitals would send out "$0.00" bills stating that the charges had been sent to my insurance company. After the company paid (or didn't), the remaining sum was billed back to me; usually on the third month. PRMC would sometimes send the collection threat along with it.
I had a certain annual out of pocket deductible to attain before they would start paying part.
Ignorant would be a compliment. I can't believe that there are people that watch Keith Overbite. He is a pathetic puppet of the left wing radicals. I can't wait for the day when these elite ,silver spoon fed, hypocrites are crushed and deported along with their corrupt congressional counterparts.
deceitful
so everything's okay as long as it's patients getting screwed but not doctors? more conservative elitism.
Anon, 12:01. Care to explain? How are patients getting screwed? I well try to stoop to your level and explain something to you.
Patients get sick and go to the Doctor. The patient presents his/her insurance card to the receptionist. Please understand that this is the patients insurance, not the Doctors. Now lets say the patient has uncontrolled diabetes, high blood pressure and heart disease. He/She continues to smoke and has a cough and fever. Pneumonia is diagnosed and antibiotics are chosen with particular consideration given towards that fact that the patient has diabetes,heart disease and is a chimney. The doctor reviews the patient's medications to make sure there will be no serious medication interactions. Labs and a CXR were ordered and the results will be reviewed when available. The patient thanks the doctor and leaves. Yes, without paying the bill. Ok, so what expenses were involved with the encounter? Real quick, there are the expenses of having and office, rent, utilities, etc. There is Malpractice insurance, commercial liability, injured workers and a couple others. There needs to be staff right?- receptionist and a nurses aide, billing clerk which is essentially the bare minimum. Lets stop there however, I could go on and on. Now assuming your Doctor bills you what he should bill you which is a Level IV visit around $130. All too often, your doctor likely down codes to a Level III, around $89 because he feels sorry for your ass. Not to fear you say, you have good insurance, you have Blue Cross. Your doctor smirks because he knows he is only going to get around 65% of his charge from your lousy insurance. He will eat the other 35%. Now this is the important part, the doctor does not get to pocket the money he gets from your insurance company. That is right, there are those pesky bills and staff that want to be paid. You did not forget did you? There really is no need to go on is there? The patient is getting quality healthcare, the health insurance gets to collect those big premiums and the doctor gets to pocket a cool $10 to $15. Now who is getting screwed?
Well, 5:52, I used to do construction projects for a certain Florida businessman. He was never happy with my bids until he talked me down 10%. So, as a matter of form, I would add a "talk down charge" to all my bids, fought and argued through each one, and "settled" on the lower price! It was a great business relationship! Your doctor's first mistake was to reduce it to a level 3 visit. Make it a level 5, and say, "NEXT!"
Orsonwells, you are a smart man. However, if you increase your bid the worst thing that could happen is you lose the bid. Now I am all for upcoding however the only problem is this little thing called fraud, particularly Medicare Fraud. Last I checked I believe the fine was $10,000 per offense with some jail time for good measure. Somehow, the extra $50 from upcoding just not enough for me to take the chance.
So wheres the protection for those with non-HMO health plans? Its a slap in the face to pay over $100 a week for insurance,pay your copays and then get a whopping bill a month later from the doctor because your health insurer denied coverage on some BS technicality and then you have to appeal the decision.You almost need a damn law degree to get the insurance YOU pay dearly for to cover what they say they will.The doctors are stuck in the middle of this.
The guaranteed payment by the third party payor IS the root of this problem. The ins. companies need NOT to tell Dr.s how to practice medicine. When they screw up, monetary recovery ought NOT be limited. IMO
Fix that.
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