General Discussion

LeftInTX

(30,625 posts)

73. You pay the allowed (customary) amount

Fri Dec 13, 2024, 10:10 PM

Dec 13

The provider writes the rest off.
Happens all the time.

I don't know why it's that way. I used to freak out. Then I found put the provider writes the whole thing off. It's very strange.

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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