Is there any truth to Medicare being the biggest denier of claims, and if so, does anyone know why?

[secondwind]

I've been hearing this a lot lately, but cannot find any information about this on Google.

anyone??

[LiberalFighter]

1. I haven't heard any complaints about Medicare from my parents.

[theoldman]

2. I have never had a problem over 13 years.

Probably just more fear mongering.

[mzmolly]

3. Are they the largest single hci provider?

If so that would translate into more denials.

[Jeff In Milwaukee]

6. If they're not the largest, they're one of THE largest

And you're right, that would make absolute sense.


Just checked - It looks like just under 30% of the country is under some type of government program. About 60% are covered by private insurance. I can't imagine there's a private provider with a more than 50% of the available market.

[Jane Austin]

4. It may be that the claims Medicare denies are for those heavily-advertised things

like walk-in bathtubs, scooters for tooling around your retirement community, and Craftmatic beds.

I wouldn't mind having one of those tubs, and a hospital bed is a necessity for invalids. I've also used a scooter to get around the Dallas Market Center when I'd fallen and hurt my knee.

One time my feet were killing me, and I used one of those motorized things Target has at the front of their store.

But - most people don't need those and the people who advertise them make you think you can get Medicare to pay for them.

Having said all this, I have no idea if Medicare denies more claims or not, but for most people those expensive scooters, tubs and beds are luxuries that Medicare probably shouldn't be paying for.

[clu]

5. I work for a claims processing software company

in the long-term care industry. If they don't submit the claims right, then they get rejections. There are probably a handful of groups who I would trust to analyze these statistics without a bias.

[Cleita]

7. Absolutely none. Apparently it's another disinformation campaign

started by insurance company publicists. I have been on Medicare for five years and never had a claim denied. I have had cataract surgery, colonoscopies, regular physical checkups and this weekend I had to make a trip to the ER for an infected cut. The ER whisked me right through because I had a Medicare card and then got paperwork and signatures after I had been treated. I never had this before Medicare where either the money or the insurance paperwork had to be completed before you saw a doctor even if you were dripping blood all over the floor.

Also, many doctors in my area, who are no longer accepting insurance, will still accept Medicare. A patient of my doctor who works in an MRI center also told me that even though Medicare paid less, they were happy to take it because they knew they would be paid every time and in a timely manner. So would they be doing this if they weren't getting paid?

[eridani]

15. My husband is on Medicare with no problems. I'm not, and wish I could say the same n/t

[Cleita]

17. Hopefully, we will get Medicare for All sooner and not later.

Don't give up.

[4lbs]

8. It could be a YES and a NO answer that are both valid.

For example.

Let's say 60 million are on MediCare. In any year, say you get 80 million claims for reimbursement filed with MediCare. MediCare denies 10 percent of them, or 8 million claims.

Now, let's say most of the private insurers each insure about 10 million people, and get 20 million claims filed each. However, let's say they each deny 5 million claims, or 25 percent of them.

So, you can say that MediCare denies more claims than any private insurer as an absolute number (8 million versus 5 million).

However, you can also say that MediCare denies a lower PERCENTAGE of claims (10% versus 25%) than any private insurer.

I suspect it's a GOP talking point that plays with the actual numbers. They aren't wrong, but they aren't being 100% truthful either.

[Bitwit1234]

9. The only thing they told me they would not pay for is a wig.

I had chemo and someone had said that is you put cranial prothesis on the prescription they would pay for it. No they won't, altho my secondary insurance BC/BS told he they would. Just file complete paperwork.

[katmondoo]

10. I have never had a problem, on Medicare for 15 yrs

Had pneumonia and bladder cancer. The bladder cancer is to be treatments for life.

[Frances]

11. I've only been on Medicare for 4 years, but NO problems

Can't say the same for some of the private health insurance companies before I was eligible for Medicare

[secondwind]

12. Thanks everyone, it's another distorition of truth put out by The Heritage Foundation apparently.

[newblewtoo]

13. I found this using google

I offer it as found...

Oh, the establishment press will just loooooove this -- not.

From BigGovernment.com (HT Mark Levin over the airwaves this evening):

Beverly Gossage, Research Fellow for Show-Me Institute and founder of HSA Benefits Consulting wondered which insurance companies rejected the most claims. She found her answer in the AMA’s own 2008 National Health Insurer Report Card (fairly large PDF).

I'm curious. Was it Aetna? Humana?

A chart showing the major carriers and how Medicare compared to them in the study follows:



Well, well.

The Medicare denial rate found in the study was, on a weighted average basis, roughly 1.7 times that of all of the private carriers combined (99,025 divided by 2,447,216 is 4.05%; 6.85% divided by 4.05% =1.69).

You would think Medicare's sheer size might enable it to have smoother procedures with its providers that would enable it to turn down a lower percentage of claims. But no, this is the government we're talking about.

So who's the most "heartless" now? And why should Americans accept the idea of gradually being forced into a government-run system when, based on documented government experience, they will be more likely to see their claims denied?

And I didn't even get to the idea of refusals to treat in the first place, something that is present to some degree in virtually every state-run system, but is currently against the law in hospital emergency rooms in the U.S.



Read more: http://newsbusters.org/blogs/tom-blumer/2009/10/06/deny-guess-who-has-highest-medical-claim-rejection-rate#ixzz0kGgifszT

Aetna isn't far behind but I bet that fact didn't make the talking point memo.

[Festivito]

16. Well done. Do people think they can hoodwink government more easily?

Not far in front of a private company.

Also, do they count huge numbers of a single type of claim as separate attempts?

[Hamlette]

20. I'm very suspicious of that chart, not blaming the poster, but look at source document

The document compares those insurance companies to medicare (and each other) several ways. This right wing blog picked one that matched its argument but look at this:

Metric 5—Contracted payment rate adherence
Description: On what percentage of records does the payer’s allowed amount equal the contracted payment rate? Source: MITSI

(Since this is a PDF and chart, I can't seem to cut and paste the results but

Medicare adhered to its contract 98.12% while private carriers adhered to their contract (what they said they would pay under their contract) between 61% and 86% of the time. What that means is you have a contract with UHC and they are only going to pay 61% of the stuff they say they will pay in their contract with you. They are going to break their contract with you 39% of the time.

Talk about cherry picking (the web site, not the DU poster).

Also, the chart is talking about "claim lines" what the hell is that? I'm not sure its really a claim if you read the source document. The document does not support the argument that Medicare is worse and may support the argument Medicare is much, much better than any other insurance company. But the right wing blog posts the one thing that might make Medicare look bad.

Assholes (not the DU who posted the link! The wing nut at the link who manipulated the study for propaganda purposes.)

[Hatchling]

14. I only had one procedure denied.

My eye doctor told me that they would pay for removing some lumps from my eyes. He took some pictures and told me they had pre approved it. Of course they didn't becasue they considered it comestic surgery. The doctor then tried to bill me for the surgery when Medicare denied his claim, but Medicare told me not to pay it, that obviously I was a victim of fraud by the doctor.

[LetsgoWings13]

18. just more lies

[golfguru]

19. I am on Medicare.................

and they have not denied me anything legitimate.
Had a colonoscopy (a preventive step) last year and Medicare paid their share.

The only thing I see with Medicare is they pay much smaller amounts than the bill.
Usually around 40% of the billed amount. So, many doctors will not accept new
Medicare patients.

[andym]

21. Look here for some useful into

http://www.dailykos.com/story/2009/10/6/05110/6076

[cliffordu]

22. They have NEVER turned down or refused to pay for anything

I've needed.

[old mark]

23. My wife has medicare for disability that she uses as a backup to private insurance.

She has had many more problems with the private insurance than with medicare, and the problems with medicare are usually resolved with a phone call.


mark

[Sgent]

24. Yes and no

I worked for a physician's office in the billing department, so I have a pretty good knowledge of Medicare vs others.

Medicare has some pretty specific billing requirements that differ from most of the rest of the world, so especially with doctor's/billers that don't keep up on their requirements, Medicare can have an outsized number of denials.

That being said, if the claim is submitted properly, I never once had an unexpected denial -- they publish their guidelines unlike many private insurers.

Medicare advantage is a different deal, and they are basically the same as private insurance companies, some are better than others.

[dionysus]

25. i think there is sometimes a problem with medicare reimbursing the doctors, but not

denying patient claims