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dpibel

(3,439 posts)

12. So some insurers are targeted by the scammers?

Thu Dec 12, 2024, 08:54 PM

Dec 12

Since all the denials are legitimate, the fact that one company denies claims at double the rate of the next closest entrant in the race must mean that that company simply receives more bogus claims.

Would that about get it?

Or is it just that all the claims adjudicators at the other companies are just too stupid to catch all the bogus bills?

I hope you can agree that there must be some clear explanation for the difference in claim denial rates.

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Meowmee

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If you suddenly found yourself working for an insurance company and received a claim that looks like this for MRI-- [View all] Silent Type Dec 12 OP

Thanks. This post (and this point of view) is long overdue here. stopdiggin Dec 12 #1

Why do they have to deny it just to ask for more information? Iggo Dec 12 #2

Exactly, lol Meowmee Dec 12 #3

It's not denied in the sense they will never pay. It's denied because they ain't gonna cut a check until they get Silent Type Dec 12 #5

There are also denials regarding valid claims and treatment approvals with delay tactics Meowmee Dec 12 #16

But they leave the customer responsible Diraven Dec 12 #58

In my opinion it's the doc's office responsibility. They have all the information, they under codes, Silent Type Dec 12 #59

That's like a claims adjuster for houses. My 1999 MRI was $500.00. bucolic_frolic Dec 12 #4

Kudos for the diversion!! dpibel Dec 12 #6

They've gotten care in most "claim" denials. Preauthorization is much the same. For example, Medicare's policy on MRIs Silent Type Dec 12 #8

So some insurers are targeted by the scammers? dpibel Dec 12 #12

You know who gets scammed the most -- MEDICARE. Silent Type Dec 12 #19

Objection. Nonresponsive. dpibel Dec 12 #22

You need to understand something. I have been for Medicare/caid-for-All since 1982. If I were to dig through my addict Silent Type Dec 12 #24

Haven't missed 80% at all dpibel Dec 12 #34

She has recieved threats from the Luigi cult. Silent Type Dec 12 #35

Just curious choie Dec 14 #78

I'm saying insurance companies are not worse than other aspects of our healthcare system -- doctors, hospitals, big drug Silent Type Dec 14 #82

Are you sure about the Medicare policy? rog Dec 13 #68

Medicare wouldn't ask you, they'd ask providers if claim wasn't coded well enough, Silent Type Dec 13 #71

This involves a huge teaching hospital in Wisconsin, and ... rog Dec 13 #72

I'm all for something like in other countries. I just don't see any Congress person with guts to tell millions of people Silent Type Dec 13 #74

If we're talking about Canada ... rog Dec 14 #75

I have had the same satisfactory experience with just plain Medicare, no supplemental no advantage Walleye Dec 14 #77

Hospitals and insurance companies work hand-in-hand on thousands of claims a week.... Think. Again. Dec 12 #7

Yeah sure. That's how Medicare or private insurers end up paying claims to providers who don't even exist. Silent Type Dec 12 #9

I just don't believe mistakes or fraud could total 30% of claims. Think. Again. Dec 12 #11

One more time. Those are INITIAL denials -- similar to examples above -- that are overturned in over 80% of cases Silent Type Dec 12 #13

Oh, okay, so this doesn't even address the 34% of final claims denied by UHC. Think. Again. Dec 12 #15

Because 80+% of initial claim denials are reversed exactly as outlined in the OP. Have a good night. Silent Type Dec 12 #25

It happens with Medicaid because the government hires unscrupulous people to deny claims questionseverything Dec 12 #36

Good point, it ain't just private insurance. Medicaid and Medicare are government programs and likely model Silent Type Dec 12 #37

Bullshit. I helped care for a lady moniss Dec 12 #42

I'd have to see the bills. He might have been submitting improper bills, that were changed Silent Type Dec 12 #43

No changes I went through stacks of paperwork moniss Dec 12 #47

Like Wendell Potter, got rich supporting denying claims and felt guilty. Ask him if anyone died from his Silent Type Dec 12 #48

Not talking about Potter. moniss Dec 12 #51

Was that for just one MRI? Eko Dec 12 #10

Yes. The actual claim form submitted electronically has a Units column. But, good example of claims not always making Silent Type Dec 12 #14

An MRI can cost up to $12,000. Eko Dec 12 #17

Example in OP includes meds. The type sedation -- xanax or something -- is pretty cheap. Well, unless provider cheats. Silent Type Dec 12 #20

This is what I found. Eko Dec 12 #27

If you are uninsured, someone might charge you $50 K. Insurance will not approve $12K, including Medicare. Silent Type Dec 12 #31

Let's say $12 K is going rate. Should insurer, including Medicare, pay $17K, or deny and ask for additional . . . . . . Silent Type Dec 12 #32

Who was shot in the back for an insurance claim denial? Eko Dec 12 #28

Give me a break. You know who Luigi shot and his rationale. Heard tonight Luigi was apparently never insured by UHC. Silent Type Dec 12 #30

So if he was never insured by them he certianly wasnt denied a payment claim by them. Eko Dec 12 #40

I know enough to not join the Luigi cult. Silent Type Dec 12 #41

Same here. Eko Dec 12 #45

OK, guess his manifesto said nothing about denials, claims, pre authorization. And UHC never insured him Silent Type Dec 12 #46

Here is his manifesto. Eko Dec 12 #50

That is not a claim. n/t vanessa_ca Dec 12 #18

Read the last paragraph. I explain that. But very few here are going to understand what an electronic claims looks like. Silent Type Dec 12 #21

"few here are going to understand what an electronic claims looks like" vanessa_ca Dec 12 #39

I answered your question since you didn't read the note in OP. Have a good evening. Silent Type Dec 12 #44

I didn't ask you any questions. Your notes in the OP are inadequate. Good night. eom. vanessa_ca Dec 12 #49

won't somebody please think of the claims??? WhiskeyGrinder Dec 12 #23

Got a good laugh out of that, actually. I do care about shooting someone in the back while being misinformed. Silent Type Dec 12 #26

Funny FirefighterJo Dec 12 #29

Get it and envious. But lot of the blame is on greedy providers for prices. I've never seen Medicare or private insurers Silent Type Dec 12 #33

That "form" looks sketchy. moniss Dec 12 #38

Fun fact: UHC employees have been ordered to defend their murders. N/t Hellbound Hellhound Dec 12 #52

Considering the misinformation, Luigi cult, etc., don't blame them too. When people catch on government programs Silent Type Dec 12 #54

Try English next time Vlad. N/t Hellbound Hellhound Dec 12 #55

OK, Timothy McVeigh, or is it ghost of Unabomber? Silent Type Dec 12 #57

First of all - Ms. Toad Dec 12 #53

So what do think a typical insurer might pay? Three times Medicare, 1.5, even less than Medicare by requiring Silent Type Dec 12 #56

So, is it your job to Bettie Dec 12 #60

Not "defending" anyone. Trying to point out not just insurance. It's also Congress, Medicare, Providers, Silent Type Dec 12 #61

Will no one think of the insurance companies???? dpibel Dec 13 #62

Think we ought to put blame where it belongs, Congress primarily for failing us. Silent Type Dec 13 #63

They can't help themselves! dpibel Dec 13 #64

Insurance companies exist because of Congress' inaction. Silent Type Dec 13 #65

Exist? dpibel Dec 13 #66

No, not in insurance business. There are federal guidelines too, not just state insurance laws. In fact Silent Type Dec 13 #70

Approximately the same as Medicare. Ms. Toad Dec 13 #69

Insurance employees seem like they're as nervous as school children Scrivener7 Dec 13 #67

You pay the allowed (customary) amount LeftInTX Dec 13 #73

You can look up the cost some procedures on the Medicare site (example for MRI below). rog Dec 14 #76

Medicare determines a set rate that healthcare Emile Dec 14 #79

Yes, Medicare has set rates. Jacson6 Dec 14 #81

If a hospital charges $1800 for an MRI that is what the insurance company should pay Autumn Dec 14 #80

Yeah right, Medicare did pay hospitals and doctors based on bills in early years. Both started inflating charges to Silent Type Dec 14 #83

Maybe Congress should step up and end the scams. Autumn Dec 14 #84

Most definitely, when do you think they will do that? Silent Type Dec 14 #85

When we voters no longer allow it. nt Autumn Dec 14 #86

No looking good right now, unfortunately. Silent Type Dec 14 #87