Denied: Medicare's Smoking Gun

[leistb]

October 08, 2009
Denied

Joseph Ashby
Investors Business Daily has put out an editorial expanding on the recently publicized report by the American Medical Association on Medicare claim denial.

From investors.com:


As for denial of care, Medicare, which we've described as the government's public option for senior citizens, has the highest denial rate in the country, according to the American Medical Association's 2008 National Health Insurer Report Card.

From March 1, 2007, to March 10 of last year, Medicare rejected 475,566 of 6.94 million claims for a rate of 6.85%.

Aetna was the only private insurer that had a similar number, denying 43,317 of 637,239 claims for a rate of 6.8%. But the average of seven carriers was 4.05% including Aetna. Dropping Aetna as an outlier takes the denial rate down to 3.08%.

[Snip]

The lesson here is that a government program, even one as beloved as Medicare, is no more efficient, no more caring, no more morally superior than private coverage.


Medicare even denies claims due to [gasp] pre-existing conditions.

Now I know there are people out there who cannot be swayed by all the evidence in the world (and the world is full of evidence against socialist health care). I know there are politicians who want to pass a health care bill to consolidate political power. But at some point don’t facts have to convince a majority of congressmen and constituents alike that any federalization of health care is a bad idea?

Reality is screaming “stop!” on the health care overhaul. Will America listen?

http://www.americanthinker.com/blog/2009/10/denied.html

[Fiddlerdave]

42% of the denials were for things like a missing diagnosis, billing the wrong provider, or no medical information at all.

The Conservatives jumping on this bandwagon like to ignore that the over-80 fairly ill set of customers may be a wee bit more difficult to deal with than the young healthier people cherry-picked by private insurers. The government handles the hardest cases of all, so the private insurers can lay back and get the gravy, complaining the whole time.

This editorial is a piece of BS. Medicare is factually more efficient, certainly more caring (no one gets a bonus for finding ways to screw an old person out of coverage), and is vastly morally superior to most (not all) private insurers.

[Ought Six]

Fd:

"42% of the denials were for things like a missing diagnosis, billing the wrong provider, or no medical information at all."

And private insurers do not deny claims for the very same reasons?

[Fiddlerdave]

Originally Posted by Ought Six

Fd:And private insurers do not deny claims for the very same reasons?

Certainly. But you have no answer to my point.

It is obvious that incomplete and often very complicated claims from many of the 80 YO crowd may well, on average, be more poorly done than by 30 YO (we hope).

Private insurers leave the very old and very sick (even if younger) to be handled by Medicare. Claims will suffer errors much more often. Note the charts are showing kicked back individual claim forms, NOT measuring how many claims were outright and permanently denied.

[Ought Six]

Fd:

"Private insurers leave the very old and very sick (even if younger) to be handled by Medicare."

So the government takes over just about the entire elderly health care market with the freebe Medicare 'entitlement', and the evil insurance companies are 'leaving the old and sick to Medicare'? Pretzel logic; as twisted as it comes.

BTW, where have you been for the last week or so?

[leistb]

Originally Posted by Fiddlerdave

42% of the denials were for things like a missing diagnosis, billing the wrong provider, or no medical information at all.

The Conservatives jumping on this bandwagon like to ignore that the over-80 fairly ill set of customers may be a wee bit more difficult to deal with than the young healthier people cherry-picked by private insurers. The government handles the hardest cases of all, so the private insurers can lay back and get the gravy, complaining the whole time.

This editorial is a piece of BS. Medicare is factually more efficient, certainly more caring (no one gets a bonus for finding ways to screw an old person out of coverage), and is vastly morally superior to most (not all) private insurers.

So for all its wonderful benevolence, Medicare has missed the one point of simplifying the process so even a senile octogenarian can master a claim? Isn't this one of the top selling points the uber-benevolent administration is touting -simplicity? And we want to expand this POS? I find it difficult to believe you can simply sweep the premise of the post under the rug because everyone over 80 is a "wee bit difficult". Not everyone over 80 has lost all their marbles.

[BoneDaddy]

Originally Posted by Fiddlerdave

This editorial is a piece of BS. Medicare is factually more efficient, certainly more caring (no one gets a bonus for finding ways to screw an old person out of coverage), and is vastly morally superior to most (not all) private insurers.

64% of Medicare outlays go to the fiscal intermediaries (private insurance companies). I don't see that as being efficient.