Yes we do. Cause yo uneed to remember who they are comparing them to...the government. Want to take a stroll through the VA and see how the gov does healthcare. Granted it is like the difference between a dog with a puzzle and a monkey with a puzzle. Neither will get it done but the monkey may at least not eat the puzzle.

This system sux, but our government running things is not going to work either. I worked in medicare/medicaid IT systems before, you will not find a more crappy, error prone, inneficient, abused system on the planet.

In our experience my wife's claim was denied because she went to a doctor in NC instead of one "right on the corner of our street"..............errr we moved 2 years previously.

That was your fault. You are supposed to use a local doctor "in network". Others are considered "out of network" and you need pre-approval for that. The same happened to me and they finally did pay the "out of network rate. But it was my fault. It was on my paperwork that I failed to read. Did you read yours?

I worked in medicare/medicaid IT systems before, you will not find a more crappy, error prone, inneficient, abused system on the planet.

That's actually not true. A recent study of billing involving many private insurance and Medicare found Medicare to be the MOST accurate, while private healthcare (specifically Anthem Blue Cross) was FAR worse, with nearly 10 times as many mistakes.

Given the choice between a government 'death panel' and the private one we have now, I'll take the government's version every time. At least they won't put profits ahead of your survival.

LOL - Its your FAULT you didn't choose an in-plan doctor. WTF?! Why isn't a doctor is a doctor is a doctor? I can take my car to any repair facility I want for my car insurance, why can't I take my BODY anywhere I want?

I have been waiting 3 weeks for my private insurance to decide if I'm worthy of changing to a new medicine. They can't even deny it so I can apeal. so much for private insurance.

For those who are so against government health care, what about Tricare, the system we use for military dependants. Works pretty well in my experience. Are you folks saying that we give less then the best for our service people and their families?

Obxron

You are right this is a huge issue not just for the patient but also for the provider.

Getting approval to treat a patient is a long expensive process. It starts with secretaries trying to get through poorly written voice recognition software to speak with a human. The next step usually involves filling out paperwork and faxing records to the insurer. Most large provider offices have staff dedicated to this process.

Then it usually goes to a nurse to deal with the insurance company nurse or physician. Next step the "peer to peer" with the insurance company MD.

If care is denied, then comes the appeal process. The MD or nurse in the provider office usually writes up a case for the treatment with the appropriate medical literature cited. If the insurer really doesn't want to pay for this it really doesn't matter how well prepared your case is, it will go into the second level of internal insurance appeal. When we get to this level we suggest the patient contact the local media to see if they can get additional pressure put on the insurer.

Even if the insurer gives in they always do it with the clause "this does not guarantee payment". When a bill is submitted after treatment they can deny payment sending the entire process back to the beginning.

Gouranga, As part of a large specialty group in a large academic medical center we never have this problem with Medicare patients unless they are part of Medicare "Advantage" which is run by the private insurance industry.

The above process add nothing to patient care. The doctors and nurses at the provider offices must take time away from patient care to do this. The additional administrative staff dedicated to this process drives up provider costs and the cost of health care.

The main fact of our insurance driven healthcare system is that the insurance industry only makes money by NOT providing you with healthcare.

Fred Evil-

It's b/c they can't screw you that way.

USA USA USA

Of course we can trust private insurance more than we can trust government. Private insurance is much better at taking our money and redirecting it into the bank accounts of people who have already too much money and have never done an honest second's work in their lives.

Gouranga: You might want to talk to people who use the VA. With few exceptions they prefer the VA over any other medical provider. But I'm sure Glenn Beck didn't tell you that part of the story, just the few bad examples of what GWBush did to the VA system and I'm sure you blame those on Obama as well.

Why would anyone want the government handling their health care? I just don't understand. Ever been to the DMV, what a mess that is. And the post office is bleeding money.

Every one of us trusts private corporations with every other aspects of our lives. You buy a car from Ford or Toyota or whatever. Your computer comes from Dell, or Hewlett Packard, or Apple. Would anyone want to buy the government iPhone? Hell no. So if we can't trust them for that, why would we trust them to handle something infinitely more important like health care?

Ever been to the DMV, what a mess that is. And the post office is bleeding money.

Actually, the Virginia DMV is VERY efficient, they just have a huge customer base to service, and only so much money (which is what happens when people want government to spend LESS). And of course the PO is bleeding money, it's an anachronism of yesteryear. It didn't ALWAYS bleed money, just since the internet took away 80-90% of their traffic, and they have been slow to adjust (not to mention all the hillbillies who don't use the intarwebz yet don't want it to go away...the USPS ain't the only anachronism 'round these parts).

There is a fundamental problem with for profit medical insurance. Their entire profit depends on:

A) taking as much of your money as possible in premiums and

B) denying every claim that they can get away with denying.

Whatever problems there may be with government insurance, it does NOT have these basic problems. Virtually the entire rest of the civilized world understands this. Unfortunately, here in the United States of Republicans we still hold on to the silly idea that our medical insurance needs can be served by private companies that have no financial incentive to treat us fairly and EVERY incentive to cheat us at every turn.

This is the system Republicans want to protect, nice.

Hell I would be dead right now if not for Government Health Insurance (Medicare). If I had relied on FOR PROFIT health insurance they would have taken forever to approve anything or deny the care while I was lying in a hospital dying. I wouldn't trust FOR PROFIT health care to take care of ANYTHING properly. The government is far more efficient at doing the billing process and has almost no waste compared to private insurance companies because THEY ARE NOT FOR PROFIT.

You can blame ALL of our health insurance problems on the Republican Party. By law Health Insurance companies were NON-PROFIT. But the Republicans got a wild hair up their butt decades ago that it would be so much better if Health Insurance was free market. So they passed a law allowing Health Insurance companies to be FOR PROFIT. The rush was on as health insurance companies rapidly changed to a FOR PROFIT model and things have gone into the toilet from there.

Thanks Republican Party for absolutely NOTHING.

Private Insurance is totally horrible, and the Medicare/Medicaid systems for reimbursements is much easier to use. Less errors than private insurance which is really wierd. But what do you expect with these PROFIT seeking companys.

The Republicans are savvy to an Arab maixim to which you are apparently ignorant: The evil you know is better than the evil you don't know.

What we have is bad. What the liberals would shove on us is worse.

DAMN the GOP

DAMN the Insurance Companies

DAMN the US CHAMBER of COMMERCE

DAMN the Big Corporations

DAMN the decisions made by the Supreme Court

and Damn it...as an individual, I find that MY rights aren't as important as BIG MONEY.

Watch HBO's Documentary HOT COFFEE : Spilling Our Way to the ‘Evils’ of Tort Reform

http://abovethelaw.com/2011/06/hot-coffee-spilling-our-way-to-the-evils-of-tort-reform/

and you will see that your Constitutional Rights to a fair insurance settlement give you less than a 10% chance of success.

@ctviking

Why would anyone want the government handling their health care? I just don't understand. Ever been to the DMV, what a mess that is. And the post office is bleeding money.

What's wrong with DMV? As far as I know, renewing my license is far easier than getting an insurance claim fixed.

About USPS - does Fedex deliver letters at 44cents a piece? I don't think so. If anything, USPS is an example of how government run system is cost efficient. If they start charging $5 like Fedex does, they will have a surplus to.

As someone who worked for an insurance company for years, I can tell you how useless and money hungry they are. The people at the top don't give a damn about how well cared for you are, or how many benefits are on your plan. All they care about is the bottom line and that bonus in their pockets. The bottom half are a bunch of underpaid, under-trained, frustrated corporate cogs. I tried my best to "make a change" from inside the system (I was young and naive), but they did NOT appreciate that.

This article is right though... if you just do a little bit of research, and write a letter (try not to be nasty about it though, I know it's tempting, but that really only makes things worse) you will probably already know more than the billing/coding "specialist" trying to make sense of a stream of useless numbers. If your first appeal doesn't work, appeal again, and again, until you make them do it right. Persistence, patience, and politeness (no matter how frustrated you are) will get you a LONG way.

Every one of us trusts private corporations with every other aspects of our lives. You buy a car from Ford or Toyota or whatever. Your computer comes from Dell, or Hewlett Packard, or Apple. Would anyone want to buy the government iPhone? Hell no. So if we can't trust them for that, why would we trust them to handle something infinitely more important like health care?

I would buy an iPhone from the government if they made it. What difference does it make?

In every developed country in the world (except ours) the government runs health care and does so more efficiently. They spend far less money per person and people live longer. I am sure Faux News wouldn't tell you that.

In India government owns 50% share of the largest car company there. That company sells more cars than those made by private manufacturers.

Need more examples?

The article does not make it clear that denying claims is part of private insurance company strategy for improving the bottom line, which they have done a great job at. Kaiser Permanente has published study after study that show insurance companies make billions of dollars more year after year, while the co-pay as a percent of the cost increases, premiums increase, and fewer services are covered. And quality has deteriorated to the point where, globally, we are at the level of countries like Cuba. Yes folks, almost every industrialized country in the world is doing this better than the US.

This is billions of dollars - and not one cent of that goes for health care. All this is is a payment system. It all goes into the pockets of the C-level management of these companies. They could not care less about your problems - they are hanging out on their yachts in the Mediterranean.

The "government" does not provide health care, except maybe the Veteran's Administration to vets. What health reform does is focus on the private system, applying structures that incentivize it to work more efficiently and effectively. There is a focus on prevention, a focus on meeting specific quality measures, incentives for using the patient medical home model, etc.

The Republicans have disseminated huge amounts of pure propaganda about health reform.

For example, the whole "death panels" nonsense. Many state Medicaid plans pay for the doctor's time when they provide end of life counseling (i.e., when you have a terminal illness, a doctor will sit down with you and lay out your options for treatment and care). But many state Medicaid plans don't pay for it. If it is not a service that is paid for, it is not a service that is rendered.

So, the Obama administration proposed putting end of life counseling as a service that is reimbursed in the "essential benefits" package, the services that a state Medicaid/Medicare plan has to cover to qualify for Medicaid. That way, all state plans would have to cover it.

Add Palin and the Republican propaganda machine, and "voila" you have "death panels."

Thanks to these folks, most of what people think they know about health care reform is nothing but nonsense. Most people can't even name the enabling statute let alone describe what is in it.

And I love how neo-cons position themselves as victims in opposition to the "lamestream" media, when most of the media in this country is owned and controlled by conservatives.

Just wait 'till The Republicans Get In Control Of The White House In 2012 and Pass The Ryan Plan or Should I Say . . . . .

Welcome Seniors & Everyone Else To The New Republican Death Panels... Where we let private insurance companies decide whats best for their bottom line...either by denying any expensive treatement until the patient dies of their illnes or jacking the premiums so high to get the same effect. INSTEAD DECIDING WHATS GOOD FOR THE PATIENTS AND THEIR FAMILIES INTEREST.

Either way kiss your Golden Years GoodBye Seniors that you paid into and worked all your life for and replace them with Anxiety and Worries about the financial problems your going to have when your at the most vulnerable times in your life.

Who will benefit from this: The usual Republican suspects of course:
1)The rich with thier lower tax cuts
2)Big Business specifically Big insurance companies that can charge astronomical rates or refuse treatement.

Why Dont You Just Die ! ! ! (It would be the best thing for the bottom line)

Why would anyone want the government handling their health care?

Ever been to Canada?

The Canadian system isn't perfect, but they receive the care they need without losing their retirement accounts. Here, if you can even afford the monthly premiums on most health insurance, you'll STILL lose your life savings and be in for the fight of your life with your insurance company just because you got sick.

I'd rather have more taxes taken off my paycheck and know I'll be taken care of if I get sick, than the system we have now. The only people it benefits are the fatcats at the heads of insurance companies, and the politicians whose campaigns they fund.

Ever been to Canada?

It was good enough for Sarah Palin in her younger years, right?

FORGET that privacy crap you sign.

MOST Doctor Offices send their billing to be done in I N D I A.

http://www.hospitalbillingservices.com/Hospital_Billing_outsourcing.html

You get some kind of weird coding that is a jumble of Alphabet Soup and numbers.

De-coding that Insurance Bill is a consumer nightmare.

Go ask next time you visit the Doctor...there are hundreds of web-sites offering this service:

1. Cost efficiency of Hospital Billing Outsourcing in India - Significant cost saving can be achieved by Outsourcing Hospital Billing Services to India, owing to the wide gap between the personal costs in India and that of the developed countries. Offshore outsourcing to India offers considerable economical benefits for those who are prepared to exploit the advantages of outsourcing.

2. Standard quality that firms doing Outsourcing in India guarantee - The Indian companies involved in Hospital Billing Outsourcing provide high quality work, meeting international standards and complying with the ISO & Six Sigma standards.

3. The reliable communication facilities - India prides in the reliable satellite and submarine communication links that facilitate good band connectivity with the rest of the world. Thus companies engaged in Medical Billing, Hospital Billing Outsourcing to India, can be in touch with the vendors

Rimom,

So you are saying that people in India are looking and sorting thru all of the patients information (socials, tax ids, birth-dates, address, and m/p). isn't that against the privacy laws, to send sensitive info over seas?

Oh, I forget that these Corporations can do as they please.

1.24

Yes...that's what I'm saying.....

And the dems want us all to starve to death instead. None of these groups Dems or Reps want to fix the problem. If you want it fixed, work with other citizens. Vote these long term senators OUT of office. NONE of them will do anything to help you.

Vote them out, all of them, and maybe the next round will look to us ahead of the lobbiest. But keep voting them in and guess what they will continue to ignore us. Don't settle on the Dem/Rep tag. LOOK at what they do. None of them has ever voted for a sustainable healthcare plan. partly because none of them has ever proposed one. Obamacare will bankrupt us, the status quo will bankrupt us, oh all of us except for the Senators, they all get free healthcare for life after 2 years in office on us. Get them on private insurance and we will see the system change QUICK.

Sorry Gouranga, but the great Bush recovery already bankrupted us. We are now searching for a way out and bankrupcy so the rich can buy government assets is not the answer.

Yes we do. Cause yo uneed to remember who they are comparing them to...the government. Want to take a stroll through the VA and see how the gov does healthcare.

Yes Gour anga, Tell me how terrible the VA is. Cause the VA I go to is simply outstanding in ever respect!!! I am curious to know who\at kind of people complain about our government? I have had nothing but great service for all my needs with government employees from a host of agencies. IRS, SS, State Dept (Passport) recovering ducument I lost (DD214) and others.

So Gour anga, tell me your whine about our government that isn't a regurgitation of someone's taking point!

Thanks, izzybar, I am not myself employed by the government but I work with a lot of agencies and like any private company there are individuals who don't give 100%. But I have been continually impressed by how absolutely determined most people are to do the best job that they can, again and again going the extra mile. The way that Republicans malign these people who are working for us and doing a great job most of the time is really not right.

Government is not some blank monolith. It is people doing their job, and doing it well, in my personal and professional experience.

BTW, I work as a consultant and see both sides of the fence. There is absolutely nothing intrinsic to the for-profit center that makes them do better work. In fact, there are a lot of disincentives to do quality work. Federal employees do not have secure jobs, which a lot of people imagine they do. They can be fired anytime just like in the private sector, and I have seen it happen when parties change over.

When the administration changes, all of the agency heads submit their resignations, and many of them are replaced. If they are replaced with competent people, that's great. But if you don't believe in "big government" you don't keep the agency staffed and you appoint heads to return political favors instead of based on their competence, so you have cr*ppy leadership at the FDA, the SEC, FEMA, etc.

We saw what happened as a result under the Bush administration - case in point, Michael Brown at FEMA when Katrina / Rita hit. Under Obama, the Republicans are still holding up appointments to agencies, and this paralyzes government. People can't move forward until the leadership is in place.

Completely agreed, Justathought08 - and to add to that:

And that's why I have such a problem with the 2-party system as is.

Everything political has become so polarized, black-and-white, 'I automatically believe the opposite of what the other party says' - they block everything the other party suggests, and fight each other just to fight each other, not because they genuinely believe the policies (or appointments) are wrong. In fact, I don't even believe they think about most of the policies any more - they just knee-jerk that the other group must be wrong.

People complain that Obama hasn't done what he said he would - well, it isn't for lack of trying, it's because the Republicans have fought him at every turn. We are in this state of limbo where nothing can be done or fixed because it's more important that the other party doesn't win than what is right for the country.

If they would just put their mandate - the welfare of their constituents - first, we could start moving forward. Look at the policies, not who puts them forward. COMPROMISE!!! Meet in the middle. Agree to sacrifice some points in order to gain others. Realize that moving forward at all, even if it isn't your own way, is more beneficial to the country than being stuck where we are.

The fighting, blocking and therefore leaving important positions unfilled is hurting us far more than the other party's policies could. You are 100% correct:

People can't move forward until the leadership is in place

And if there's one thing we need right now more than anything else, it's the ability to move forward.

Sorry Wakehead, I could absolutely see a government program being worse. Scary as that thought is, I have seen government run healthcare. Look at the VA, look at how unbelievably cruddy the current Medicare/Medicaid program is.

I worked on those systems, and the number of fraudulent claims paid out was beyond belief. hundred of millions of dollars blown on things like a guy having his vagina worked on (yeah I said a GUY), someone having the same arm amputated twice in a month. All sorts of messed up stuff that a 12 yr old could program a denial for.

Their has no been any solution put forth yet that is effective AND sustainable over the long haul.

For every complaint we hear about the VA making mistakes we can find ten similar or worse stories in the so called free market. Which is actually scarier since those in the VA system are generally sicker. However, survey after survey finds those who use both the VA and other health care resources outside VA think that the VA is better. Oh the facilities might not be new and shiny but the care is better and there is less hassle.

As for medicare? There is not a separate system for medicare. You realize that I hope. It is just the mechanism for payment that is different. However, from what I have seen with my mom and dad who are on medicare they have received great care from their doctors. And while people complain about how much they do or do not pay out it seems all their doctors are fine to take as much medicare money as possible. In fact I think the payment by specific treatment or office visit or test has resulted in too many visits to too many doctors over the years "just to check." There should be changes to medicare payments to reduce those. They should not be seeing a doctor for a specific problem so often and certainly not the specialists. What happened to seeing a specialist to fix a problem and then returning to the internal medicine person for the check ups.

Gouranga, only someone who WORKS FOR private insurance companies or profits from them could say ANYTHING you have been saying. Those of us who have used both government and private health insurance know YOU ARE LYING THROUGH YOUR TEETH!

Oh he is definitely lying. I had a private insurance pay for a patient, the insurance all of a sudden decided to take all the money back due to "not being in network". We provided more than $10,000 in care, and the private insurance took it all back. We are in appeals with them now.

Another thing insurance companies do is hold back on paying doctors. I have a friend who is a cardiologist in private practice and she is ready to close her doors. They used to hold back 30 days, then it became 60, 90, and now it is 120 days before she gets reimbursed. She has had to take out loans to keep her business afloat, and the loans cost interest. The insurance companies keep her money and make interest on it, she has to borrow to pay her overhead and staff and pays interest on the loan.

She is getting ready to shut her doors before she loses everything she has worked for over the years.

I live in Canada, where the government runs our health care system, and I would not change it for the world. There are occasional waits, but we have never waited an obscene amount of time for anything, usually like an hour or two to get an xray or a prescription. Is it perfect? Heck no, but its a heck of a lot better than what Americans pay an arm and a leg for. It really upsets me when I see Americans condemning a system that they have never tried (I have recieved health care in the states while on vacation - I am super clumsy! ;) simply because politics dictates that the other side must be wrong. Come spend a few months here, go to the ER or urgent care centre and see what it is like. Its not nearly as bad as Americans make it out to be!

Amanda, you are correct. Canadian health care services are far better even though they aren't perfect. And for any Americans believing Fox News about 12 or 14 hour waits in an emergency room I will tell you this. The first person you see when you enter a Canadian hospital emergency department is a triage nurse, and if you do have to wait 12 hours, it's because you do not need to be in an emergency room and should have gone to a walk-in clinic. There is no excuse for the U.S. to not join the rest of the industrialized world and spend LESS while covering everyone, and as every other industrialized nation can tell you, it results in a net profit for the nation in the form of healthy people being able to work and pay taxes.

I am Canadian and quite familiar with our system and I have to say that yes I have seen 12-14 hours waiting in the emergency room. Thoses wait times ONLY happen to thoses who go to the ER with a little nothing that a bandaid would take care of. If it's an emergency or in any way serious you'll be seen and treated right away. The problem is more and more peoples go to the ER for a common cold or a little nothing. And yes of course they'll wait a long time and thoses are the ones that will complaint the loudest. Hence they will be taken as examples by the "governement can't do anything right" crowd.

And your car insurance company just pays claims or do they require proof also?

Nick, I think the opinion of a doctor is just a tad more respectable and reliable than that of an auto mechanic and the human body just a little bit more valuable than your average car. I have no problem with insurance companies verifying that a service needs to be provided, but once the doctor has given his opinion, that should be good enough. Private, for-profit insurance companies should not be second guessing doctor's recommendations.

I have seen how this works - some insurers will use these kinds of tactics as deliberate delaying strategies, in the hope that the patient will die before the procedure can be performed. The people supposedly looking at the evidence submitted and making the decisions about payments are not even medical doctors themselves. Their jobs often depend on them not approving beyond certain amounts that management don't publish but all the staff know about.

And after all, a police officer's testimony in court is prima facie evidence, often with high stakes involved. Why isn't a doctor's opinion considered good enough?

...denied because the treatment isn't appropriate -- a particular service isn't considered "medically necessary,"

That, to me, was the scariest part of the article.

If a medical doctor deems a treatment or service medically necessary, who are insurance companies to say they are wrong?

Unless they are true medical experts, more trained in diagnosing and treating patients than the doctors are, they cannot legitimately make this claim.

In fact, in court, it's not just a police officer's testimony that is considered prima facie evidence - a medical doctor's medical testimony is considered that of an "expert witness"... if it's good enough for the legal system - the pinnacle of "what's right" in our country - why not for insurance?

It's crazy that they are allowed to take money without providing service.

There is a very simple solution. Pay your own bills. One of my family members just was diagnosed with cancer. The initial hospital and treatment was $85,000 and there will be continual treatment for the rest of the year. That did not include doctor's fees. The insurance premiums will amount to about $6000. And you think you are getting screwed? I am amazed that someone thinks because they are not using the insurance they are being shafted. Or they don't follow the proper process and blame the insurance company for balking.

I'd LOVE to do without insurance but when a minor surgery can go into the tens of thousands, it's not a risk I'm willing to take. I believe in personal responsibility. I am not going to pass my health-care costs onto other people. I was a republican when they, a long time ago, also believed in personal responsibility. Now they believe in a person's right to have their 'freedom' to pass any health-care costs off onto other people.

Insurance companies take money, then fail to provide much of what they say they will. HOW can a baby, not yet born, seek prior approval when a hospitalization is needed after birth????? How do you follow the 'proper procedures' on that? If most industries took money then failed to provide the service, they would be guilty of fraud.

When my oldest niece was born, the doctor was not in the hospital -- he arrived hours later -- and my brother actually delivered her in the labor room.

Nonetheless, the hospital billed for the delivery room and the doctor billed for the delivery.

My brother and his wife spent a lot of time disputing those charges!

So Nick, based on your personal experience and this one anecdote, you think everything is just fine? Let me guess - you are an upper middle class white guy in a mid- level to upper management level job who are among the shrinking class in our country still getting something resembling health care.

Never mind the data and statistics. Never mind that most Americans can't even get insurance. Never mind that insurance premiums keep going up as a percent of costs, fewer services get covered, and fewer and fewer Americans can even qualify. Never mind that the quality of health care in the US has been deteriorating steadily for decades while every other civilized country has improved. You still have reasonably decent insurance, make enough to afford the premiums, and you got what you needed, so there's nothing wrong here, am I right?

What about your wife's insurance? Oh, she doesn't have any of her own? If something happened to you, or you lost your job, you know what she would be doing right now? Selling every asset she owns to pay for her health care, or dying from cancer without treatment.

Don't be too hard on Nick as he seems to have difficulty reading an entire contribution.

He blamed me early on that it was "my fault" for not getting a pre-approval form my wife's health care after we moved from VA to NC.............errr Nick46 look at my early post again and read the WHOLE thing next time.........We DID get a preapproval that was later denied by another arm of the insurance mafioso. The insurance industry thrives on denying claims regardless if they preapproved them or not.............BTW the claim was eventually approved when they miraculously realized that the provider in NC WAS on their approved provider list...........that they initially denied several times...........

So follow the guidance in this article and do not give up with the initial denial of coverage if you have done everything right and the insurers are wrong.

Insurance companies take money, then fail to provide much of what they say they will.

You can't listen to the embellished stories and belive that they are denying most of the claims. I don't know these people but I believe it's only those that have been denied something gather to whine. I have never been denied an insurance claim. I have been asked to have the doctor provide a better explanation but never denied.

ROFL!

LOL @ Steveo - Here, you forgot something

/sarcasm

There you go! (psst, if you don't actually know what socialism is (and it's obvious you do not) Don't use words you don't understand!)

Did anyone else notice the woman in the article named her child Nofi. Poor kid. Just a rant on stupid names people name their children.

Leslie, this is a multi-cultural country. Not everyone thinks "Mary" and "John" are regular names. Some kids have names that may sound a little odd to you, but fit right in with their particular race/ethnicity.

It doesn't help when Obama doesn't pitch it in a way for most people to understand. What they do understand are the words "socialism" and "fascism" that the right spews to try to demonize a system that has been proven time and time again to work. Its an ugly political system and we are the ones to suffer from it. Hopefully one day we will get a single payer or "medicare for all" type of system. Until then, we will continue to bend over and take it.

I have to agree. Obama screwed up the delivery on health care. No one understands what was passed, only that it was done in a rush and forced through.

When you don't fill the communication space, someone else will.

I'm also a medical billing manager. What sfilutze has said is right on the money.

People would be shocked to know how many decisions about their healthcare are made by $7.00 per hour clerks with little or no healthcare experience. Some of the insurers have even shipped their claim service centers overseas, and when you call for help you're often dealing with people that have a hard time speaking English.

Billions of what we spend on "healthcare" are actually spent on fighting with these profit mongers to get payment for legitimate claims, either due to incompetence or outright fraud.

You two are so correct. I have actually had a private insurance send me documentation/auth on which codes to use. When I did as they instructed me to, they still denied the claim due to "code invalid".

Stay away from these private insurance companys, have seen alot of people credit destroyed because of them:

UHC, BS, Humana, Cigna, Aetna.

I work in healthcare IT specializing in revenue cycle management. I agree with both of the billing managers above. I would like to add that consumers would be appalled at the time, money, software, and effort that providers and medical facilities have to utilize, in order to get paid for services that are clearly defined in their extensive contracts with the insurance companies.

More recently I have seen healthcare providers/entities billing patients for the denied claims that they once would have worked themselves. Two reasons for this are simply resource utilization and cost benefit. Another reason is because patients have more power with the insurance companies than the providers do. Ultimately it is your responsibility to make sure your doctor gets paid.

As a result of providers pushing the unpaid claims to the patients, I believe we are seeing articles and blogs like this one. Insurance companies ripping people off is old news to those of us in the business. It is, however, relatively new to the patient because the providers have not always passed the bill onto the patient.

It is my sincere hope that patients will become more educated and outraged with our current system. I don't proclaim to know the answer but what we have is bad broken and at its root is a conflict of interest. Yes, a single payer system such as Medicare is better than the cluster we have now. Sad but true.

Good info, thank you.

Love it.

If the claim is for any significant amount of money the insurance company has deep enough pockets to out wait you. Companies are immortal and you're not.

Yes, companies are immortal.

Thanks to the Supreme Court and our corrupted congress, in some act of perversion they have the equivalent in rights and legal status as a human being. Ridiculous.

Patients often don't feel compelled to pay for services their insurance company denies.

Most people I talk to believe, wrongly, that an insurance dispute is between the doctor and the insurance company. I know doctors that won't file insurance claims. You pay the doctor and then the insurance pays you.

You are right. Oftentimes, if only the patient would be proactive & contact their insurance carrier the problem is resolved. But when the doctor's office is doing the inquiring the insurance companies tend to not respond.

Slow pay or no pay by insurance has forced some docs to turn to a prepay system. Frequently it's with certain carriers who have a poor payment record.

My office has had this happen. It seems to occur most frequently when there are two insurance companies involved - as when mom and dad both work, and the kids have coverages through both of them. You'd think that would be great, but it's always just a headache. The insurance companies argue about who has to pay first, and delay payment until this is settled. All it takes is a quick phone call from the patient or parent, but they ignore the letters from us and the insurance companies, phone calls from us, etc. until they get a bill. Then they wonder what happened.

I had a patient once whose exam and cleaning (I'm a dentist) were denied because it hadn't been at least six months since her last exam. According to our records, it had been two years, and she said she hadn't been to another office since then. Turned out her twin sister, who lived with another family, had seen her dentist (another office) two months ago. Even though we provided records showing our patient had not been seen recently, the insurer continued to deny payment because someone with the same last name and date of birth (twins, duh) had seen a dentist less than six months before the date in question. Took months to straighten out.

You are 100% correct, unfortunately, it is completely unconstitutional.

Matt,

why is it unconstitutional. Please tell me where it is stated as so

Thanks

Your post is too logical and well-reasoned for Faux news viewers. They fail to understand that for-profit (not that there's anything wrong with that) insurance companies make money, not by paying claims but denying them. As a consumer advocate for almost two decades, the biggest complaint was insurance companies not paying bills. Of course, the industry with its 2million lawyers makes damn sure you don't fully understand the Schedule of Benefits which spells out the contractual obligations of the policy. All I can say is Read the SOB, read it and read it again".

In the US we've been sold a bill of goods. Told that 'private industry' is the best way to go, while 40 percent of people are abandoned.

I was a Katrina volunteer. One large, national insurer sent pick-up trucks into small impoverished communities and offered checks for 500-700 dollars. The people are poor in Western Alabama, and they took the money not realizing that this was a quick claim for the insurance company.

Then they would sit across the desk, and explain all of this to me. I'd point them to the state insurance commisioner, but other than that there was nothing that could be done.

Truly agree

Just wait 'till The Republicans Get In Control Of The White House In 2012 and Pass The Ryan Plan or Should I Say . . . . .

Welcome Seniors & Everyone Else To The New Republican Death Panels... Where we let private insurance companies decide whats best for their bottom line...either by denying any expensive treatement until the patient dies of their illnes or jacking the premiums so high to get the same effect. INSTEAD DECIDING WHATS GOOD FOR THE PATIENTS AND THEIR FAMILIES INTEREST.

Either way kiss your Golden Years GoodBye Seniors that you paid into and worked all your life for and replace them with Anxiety and Worries about the financial problems your going to have when your at the most vulnerable times in your life.

Who will benefit from this: The usual Republican suspects of course:
1)The rich with thier lower tax cuts
2)Big Business specifically Big insurance companies that can charge astronomical rates or refuse treatement.

Why Dont You Just Die ! ! ! (It would be the best thing for the bottom line)

Amen Drew!

Welcome Seniors & Everyone Else To The New Republican Death Panels... Where we let private insurance companies decide whats best for their bottom line...either by denying any expensive treatement until the patient dies of their illnes or jacking the premiums so high to get the same effect. INSTEAD DECIDING WHATS GOOD FOR THE PATIENTS AND THEIR FAMILIES INTEREST.

Either way kiss your Golden Years GoodBye Seniors that you paid into and worked all your life for and replace them with Anxiety and Worries about the financial problems your going to have when your at the most vulnerable times in your life.

Who will benefit from this: The usual Republican suspects of course:
1)The rich with thier lower tax cuts
2)Big Business specifically Big insurance companies that can charge astronomical rates or refuse treatement.

Why Dont You Just Die ! ! ! (It would be the best thing for the bottom line)

PS:I'd rather have more taxes taken off my paycheck and know I'll be taken care of if I get sick, than the system we have now. The only people it benefits are the fatcats at the heads of insurance companies, and the politicians whose campaigns they fund.