Drudge Retort: Red Meat for Yellow Dogs

When she broke her wrist ice skating, Yogi Yogan was told by her insurer that it wasn't covered because it's a "pre-existing condition," a mistake she had to overcome with a ridiculous amount of work. CNN reports that insurers are keeping money from customers by making it difficult or even impossible to collect on valid claims. "There's a reason for this -- it's called money," she said.

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Sorry I don't watch CNN.

Damnit! I have no speakers at work. Is this headline right?

#1 | Posted by mysterytoy at 2009-10-01 10:25 AM | Reply | Flag:SHHHHHHHHHHHHHHHHHHHHHHHHHHHHH
HHHHHHHHHHHHHHHHHHHHHHHHHHHHHH
HHHHHHOCKING.

Is this headline right?
.....#2 | Posted by kanrei

....yes......the woman involved eventually got her money, but the article goes on to show how insurance companies go about ripping off both patients and doctors......

Is this thread supposed to be an argument for Obamacare? Try handling a disagreement with government bureaucracy sometime.

"Try handling a disagreement with government bureaucracy sometime."

Millions of people are covered by Medicare and most have no problems with it at all. It seems that when there is no profit motive to deny claims they don't get denied.

Ray is an imbecile.

The approval process for procedures is well established for medicare, and the fascists would be having a party if they could show otherwise.

Sorry I don't watch CNN.

#1 | Posted by mysterytoy

Don't post in this thread then mysterymoron.

I hope the Govt forces you to help subsidize your employees with their ins needs and your sub shop fails. Hehehehehehe

"Sorry I don't watch CNN."

Actually, from reading your posts I'm not surprised. It is pretty obvious where you get all your "news."

Sorry I don't watch CNN.

#1 | Posted by mysterytoy at 2009-10-01 10:25 AM | Reply | Flag: only watches the Cartoon Network

I got a denied claim in the mail yesterday, so I called the insurance company this morning and they said it was just coded incorrectly, so they fixed it. Human error, problem solved, less than 10 minutes invested. Try that with a government agency, like the DMV, sometime.

"Try that with a government agency, like the DMV, sometime."

Generally I don't submit insurance claims to the DMV. That's just dumb. Try to get your health insurance company to renew your driver's license.

Redman,

Insurance companies shouldn't be making decisions about peoples need for healthcare, they should only supply the insurance.

"Millions of people are covered by Medicare and most have no problems with it at all."

Define "most," and then let me know if it is any more than those who do not have problems with their private insurance.

Ray's point stands. Dealing with government is never any easier than the story described in this thread.


"Try that with a government agency, like the DMV, sometime."

Generally I don't submit insurance claims to the DMV. That's just dumb. Try to get your health insurance company to renew your driver's license.

#12 | Posted by danni

LOL. Ok, you got me, but you know that what I meant was problem resolution.

"Ray's point stands. Dealing with government is never any easier than the story described in this thread."

Baloney. That guy Potter, the former insurance executive testified before Congress, under oath, that insurance companies purposely deny claims specifically to increase profits. It happens all the time, even Redman's example of a happy outcome was very likely not a "mistake" but rather mis-coded on purpose because the insurance company knows many people won't contest it so if they do it enough times they increase profits.

Blue Cross praised employees who dropped sick policyholders, lawmaker says

Workers received high marks on performance reviews after policies were rescinded, documents show. The health insurer denies the practice is a factor in evaluations.

|June 17, 2009

Blue Cross of California encouraged employees through performance evaluations to cancel the health insurance policies of individuals with expensive illnesses, Rep. Bart Stupak (D-Mich.) charged at the start of a congressional hearing today on the controversial practice known as rescission.

The state's largest for-profit health insurer told The Times 18 months ago that it did not tie employee performance evaluations to rescission activity. And executives with Blue Cross parent company WellPoint Inc. reiterated that position today.

But documents obtained by the House Committee on Energy and Commerce and released today show that the company's employee performance evaluation program did include a review of rescission activity.

The documents show, for instance, that one Blue Cross employee earned a perfect score of "5" for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.

WellPoint's Blue Cross of California subsidiary and two other insurers saved more than $300 million in medical claims by canceling more than 20,000 sick policyholders over a five-year period, the House committee said.

"When times are good, the insurance company is happy to sign you up and take your money in the form of premiums," Stupak said. "But when times are bad, and you are afflicted with cancer or some other life-threatening disease, it is supposed to honor its commitments and stand by you in your time of need.

articles.latimes.com

#16 | Posted by danni at 2009-10-01 01:27 PM | Reply | Flag:

Nothing in your post refutes the basic fact that dealing with government, even when they aren't "acting purposefully to deny your claims," is routinely a time-consuming nightmare.

It appears the providing health care to all that is cheaper than the existing system is a concept that is just too f'n decent and righteous for the right to approve.


Yeah.... that must be why 94 percent of Medicare patients love their plan.

The 'right' in this case is too concerned with handing a 'defeat' to the Democrats and sticking it to the black president to care if they are also seriously hurting the American people.

If they defeat or seriously water down health care reform, they will pay dearly in 2010.

There won't be enough Rtards in Congress to field a basketball team for a game of 2 on 2.

"94 percent of Medicare patients love their plan."

Link?

Also, provide a link showing that less than 94% of those with private insurance do not like their plan.

I represented a woman who was smashed in the face with a softball, with emt's, ambulance, and everything, where the insurance co. refused to pay because they said her treatment (wiring her jaw shut) was somehow cosmetic surgery. Even though my involvement persuaded the co. to pay, the woman was out of pocket a few thousand for my bill and the ins co. just paid what they should have paid originally. Oh yeah, and they got to use the money for 9 months in the meantime. Insurance companies suck.

I got a denied claim in the mail yesterday, so I called the insurance company this morning and they said it was just coded incorrectly, so they fixed it. Human error, problem solved, less than 10 minutes invested. Try that with a government agency, like the DMV, sometime.

#11 | POSTED BY REDMAN AT 2009-10-01 12:49 PM | REPLY | FLAG:

Congratulations. This has happened many times to me and the answer from the insurance company was always the same:

"Have the Dr.s office resubmit using the correct coding."

The insurance company won't change the coding the Dr's use.

Damn lawyers are the crooks. Not only did she get rapped by the insurance company. you rapped her as well. Good job.

#23 | Posted by mOntecOre at 2009-10-01 01:51 PM

And how would this be different if it was the government that refused to pay?

red,

It has been shown that insurance companies routinely deny claims for spurious reasons, just to see if the patient will stand up for herself.

There are strict time limits for filing claims, lawsuits, anytime a human interacts with a Corporation. Corporations do not operate under the same constraints, thanks to political bribery, just like divorce lawyers.

Lawyers are the crooks who figured out how to play the game best. I don't know if I hate lawyer or envy their cunning.

The insurance company won't change the coding the Dr's use.

#24 | Posted by YAV

I think that would be illegal. Something to do with altering medical records.

They don't change the codes themselves, but they do pressure doctors to bill under this code instead of that code by denying all claims filed under a code they don't want. Codes are used to define illness and by changing the codes, you are changing the percent of people who suffer from problem A instead of B.


The point, Lil' Joe, is that the ebil gub'mint tends to provide better service to their patients than private plans do.... even when considering that Medicare services the older, less healthy people.


Who's Afraid Of Public Insurance?
Health Care Consumers Give Medicare Higher Marks Than Private Plans

seniorjournal.com

Senior Citizens Like Medicare More Than Younger People Like Private Health Insurance

Medicare's strong consumer satisfaction suggests that many under age 65 would choose a public health insurance option if it were offered, says Commonwealth Fund

www.nationaljournal.com

"Nothing in your post refutes the basic fact that dealing with government, even when they aren't "acting purposefully to deny your claims," is routinely a time-consuming nightmare."

That is a tired cliche. I don't have too many dealings with the federal government but the one's I have had were reasonable and the people I dealth with seemed very dedicated. On the other hand some of the nastiest people I have ever dealth with were insurance companies and the most unfair too, I might add.

www.cms.hhs.gov

that looks like a very quick and painless process...

www.cms.hhs.gov

That is a tired cliche. I don't have too many dealings with the federal government but the one's I have had were reasonable and the people I dealth with seemed very dedicated. On the other hand some of the nastiest people I have ever dealth with were insurance companies and the most unfair too, I might add.

#32 | Posted by danni
of course her word is gold, and can can not be refuted. Danni has spoken, argument is over.

Millions of people are covered by Medicare and most have no problems with it at all. It seems that when there is no profit motive to deny claims they don't get denied.

#6 | Posted by danni

No profit motive. But plenty of political motive. They can get away making Medicare appear to be cheaper than what it is. Medicare has an unfunded liability close to $80 Trillion. That Trillion with a T.

You always think you're getting something for nothing when the feds are printing money to pay deficits, producing a tax through inflation.

You're still young. When you are eligible, there'll be nothing for you. You'll be getting what you deserve. I'll be collecting until the money runs out. Ain't that the irony.

www.google.com

"Damn lawyers are the crooks. Not only did she get rapped by the insurance company. you rapped her as well. Good job.

#25 | Posted by freechoice"

You're right, I should have just worked for free. Then I could go out of business and not be able to help anyone. But I'm sure the insurance companies would then just choose to do the right thing. LOL. You get a naive flag for that one.

"And how would this be different if it was the government that refused to pay?

#26 | Posted by Redman"


Because it would be nonprofit, it would not have the same incentive.

Anyone who says Medicare is better to deal with than the insurance companies has never dealt with Medicare.

There would be no ins exec at the top making $33M salary, or junior execs making $10M, who would need that kind of grease to make the wheels turn.

You're right, I should have just worked for free. Then I could go out of business and not be able to help anyone. But I'm sure the insurance companies would then just choose to do the right thing. LOL. You get a naive flag for that one.

#37 | Posted by mOntecOre
Nope, my point is that it is fine for you to charge whatever the hell you want to make a profit, without goberment involvement. But it is not alright for healthcare providers to do the same. Huge hypocrit flag for you!


The studies showing the popularity of Medicare over private plans are about the experience individuals have with private and public plans, not administrators or doctors, which could be different.

Millions of people are covered by Medicare and most have no problems with it at all.
#6 | Posted by danni at 2009-10-01 12:10 PM | Reply | Flag:

Toking up early danni?

Results 1 - 10 of about 1,230,000 for medicare claim problems. (0.29 seconds)

www.google.com

Expert: LASHUNDA - 6/25/2009

Question
Hello,

My grandmother fell at my mom's home several months ago (she doesn't live there). As a result of the fall, her Dr. ordered a CAT Scan. The hospital is now saying that Medicare will not pay for the CAT Scan since she was at my
mother's residence. They are saying that my mother needs to turn the claim into her home owners insurance. Is this right? If my grandmother has medical coverage for herself, why would it matter where she fell? Thanks.


Keep thinking the government is there to help - what got is into most of the problems we experience as a country today.

Worst ten words you can ever hear: I am from the government and am here to help.

" without goberment involvement. "

Only goobers spell it "goberment".

#44 | Posted by nullifidian
lack of a responce turns you into a typical liberal troll, probably with a goberment edumacations.

"The hospital is now saying that Medicare will not pay for the CAT Scan since she was at my
mother's residence."

Private insurance company would tell her the same thing.

"I am from the government and am here to help."

Same guy who said that also used government health care. It was good enough for him but not for the rest of us.

when there is no profit motive to deny claims they don't get denied.

#6 | Posted by danni at 2009-10-01 12:10 PM | Reply | Flag:
Nor investigated fraud you half wit, sorry giving you credit for half a wit is half a wit too much...

"lack of a responce turns you into a typical liberal troll, probably with a goberment edumacations."

Where did you get your edumacation???

It's response, not responce.

- I am from the government and am here to help.


www.drudge.com

Science is a bitch, eh?

And reality is almost as bad.

Where did you get your edumacation???


It's response, not responce.

#48 | Posted by danni
again, typical, nothing good to say, so attack. That is the leberal way!

"Nope, my point is that it is fine for you to charge whatever the hell you want to make a profit, without goberment involvement. But it is not alright for healthcare providers to do the same. Huge hypocrit flag for you!

#41 | Posted by freechoice"


What the fuck? Where did you pull that out of? Please, tell me where I said the healthcare providers couldn't charge what it wanted to. I'll wait.

It is an very valid point that one day the government can step in a say "since we now pay for your health care, we are going to start passing laws to force you to do X,Y, and Z." It won't be Obama's administration, but, just as the right are learning now, the laws stay on the books long after your horse leaves the race and you may not trust the next horse.

#31 | Posted by Corky at 2009-10-01 02:06 PM | Reply | Flag:

Neither of those links prove your 94% number. Try again, or admit you made it up.

Today's determination by the Centers for Medicare and Medicaid Services (CMS) to not cover screening computed tomography colonography (CTC), also known as virtual colonoscopy, exams is not supported by the latest clinical evidence and may result in tens of thousands of unnecessary deaths each year from colorectal cancer, particularly among minority and underserved populations

Racist bastards at Medicare! They just hate minorities.

www.medicalnewstoday.com

#53 | Posted by JOE at 2009-10-01 02:32 PM | Reply | Flag: As a Pro Pettifogger, more concerned with stat source than proof that he is wrong about government run programs like Medicare being less responsive than private ones.... but it does help cloud the fact that he is wrong on point

themedicaredoc.com

This whole Health Care thing is unconstitutional.
We are entitled to Life, Liberty and the Pursuit of Happiness. So they can't let us die prematurely and if you have pain, you're not happy.
I just the founding fathers would have slipped in the word "High" before "Life"...

Millions of people are covered by Medicare and most have no problems with it at all. It seems that when there is no profit motive to deny claims they don't get denied.

#6 | Posted by danni

Many more millions are covered by insurance companies and have very little problem. What's your point?

Here you go, Joe. Took all of about 15 seconds:

"Seniors in the U.S. are overwhelmingly satisfied with their current Medicare coverage, according to a survey released today by Silverlink Communications and Suffolk University in Boston. Of the more than 2,600 Medicare beneficiaries surveyed, more than 94% indicate that they are satisfied with their coverage, with just 6% expressing dissatisfaction"
www.reuters.com

#51 | Posted by mOntecOre
Pro Medicare single payer system, means govt sets the price, means health care providers can't charge what they want. I know A = B, and B = C, then A = C is tough for you.


Thanks, Doc.

I was going to make him beg for a while, but your kindness saved him.

"#51 | Posted by mOntecOre
Pro Medicare single payer system, means govt sets the price, means health care providers can't charge what they want. I know A = B, and B = C, then A = C is tough for you.

#60 | Posted by freechoice"


And I said I was pro-Medicare single payer system where?

OK, I made a bit of a leap by your defense of the goverment healthcare. Was I wrong, do you not want a public options/ single payer system like medicare?

Come on Freechoice, you can do it! Show that you're not as ignorant as you appear!

#64 | Posted by mOntecOre
Did you not see 62?

"Did you not see 62?
#65 | Posted by freechoice"


Newsflash, Freechoice - I MADE post #62. Fuck, dude, I'm done with you. I can't stand debating retards (except Goatman - he's an entertaining retard.)

ok 63, damn, then you made 64

Dorky-

Is there a difference between "loving" your plan and being "satisfied" with your plan? A simple yes or no will do.


Lil' Joe, Pettifogger Extraordinaire.

Just admit you were wrong on the substance, Joe, and the details won't matter so much to you.

Just admit you were lying, and we can move on from there.

Generally I don't submit insurance claims to the DMV. That's just dumb. Try to get your health insurance company to renew your driver's license.

Okay, that was pretty funny.

Now Dorky is calling names. Must be hard getting all worked up when you are called out on your lies.


Corky is making a scientific observation about the sexuality of your twit-hood.

You have nothing to say about being proved wrong, you just want to deflect to semantics.... a pettifogger's MO.

"Anyone who says Medicare is better to deal with than the insurance companies has never dealt with Medicare." - Kanrei

My parents dealt with both. They had only few problems with Medicare. They had constant problems with their insurance company (Blue Cross).

The point people who argue against a government plan try to make is that dealing with the government is worse than with insurance companies. From listening to many people who have dealt with both, neither is noteworthy, but neither stands out from the other. So the core argument fails.

"Anyone who says Medicare is better to deal with than the insurance companies has never dealt with Medicare."

You're joking, right? I've served on health committees, dealing with private insurers for over a decade (probably closer to two). We seem to have to change providers every few years due to complaints. Conversely, my M-I-L is on Medicare. I'd choose the latter over the former any day.

I wonder what Yogi Bear would have to say about Yogi Yohan.

"Anyone who says Medicare is better to deal with than the insurance companies has never dealt with Medicare."

My parents said it was tremendously better. Of course, my father was getting the runaround on hernia repair for the last two years of his private insurance (knowing that he was 63 and would be on Medicare soon enough). Sure enough, he got his socialized surgery within 60 days of his 65th birthday. Thanks, America.

My mother worked in records for medical practices. They had six people working in insurance billing (and re-billing, re-billing, re-billing). One in Medicare billing, and she went home early.

I don't like either option. I personally deal with enough government red-tape (the DOT and OSHA). I have private insurance and haven't had ANY problems over the last 15 years with getting a claim paid. I've had 4 surgeries and 1 emergency C-Section and 2 ER visits. No questions about payouts.

The Dept of Transportation, on the other hand, has been nothing but hassle. Fill out 4 inches of crap and then they call asking questions. Sure hope the "health czar" isn't as big of an idiot as the Transportation Sec.

I was going to make him beg for a while, but your kindness saved him.
#61 | Posted by Corky

CORKY -

Poor lil' Joe was whining at a pitch that made by neighbor's dog yowl; it was the only way to try and get both of them stfu.

This is no big deal really. Quit whining.

Has anyone here gotten a tax bill that was wrong and had to fight with the IRS or their state?

This stuff happens all the time.

How about the bogus electric bill?

Incorrect cell phone bill?

Is this crap really news?

Get a life.

Is this thread supposed to be an argument for Obamacare? Try handling a disagreement with government bureaucracy sometime.

Ray, you've missed the point.

Obamacare would nix the whole "pre-existing condition" nonsense. It's about the one aspect of Obama's plan(s) which has never wavered. He even mentioned it in his speech to Congress a few weeks ago.

Simply ending denials and reduced coverage for "pre-existing conditions" would be a big step in the right direction.

How about the bogus electric bill?

I have one of those from the gas company. They can't understand why I don't want to pay them for months of service when my gas valve was closed. The valve is behind a locked door which only the gas company can open.

So far they've farmed it out to a "collections" agency which is really just a nag agency. They're not allowed to accept less than face value for the bill. I tell them to call me back when they can. All I want is a few bucks off, for service I was billed, but was undeliverable due to their closed valve.

Incorrect cell phone bill?

I got one of those from AT&T which is why I will not be their (Cingular now I guess) customer any more. After moving from one coast to the other I called AT&T and told them I've moved, set me up with a number in my new area code and let's talk about rate plans. I couldn't get the sweet government rate plan in my new region, which sucked.

For two years I continued using AT&T. Then one day I got a notice from a collections agency stating that my AT&T account was two years and hundreds of dollars past due.

AT&T at that time was broken up into for national billing regions which didn't talk to each other. So the region I left figured I had disappeared and sent me to collections. Despite the fact that I was an AT&T customer in good standing in my new region.

I asked AT&T what was up and they explained their regional billing systems had no insight into the other regions. I asked why, as a customer, that was my concern, or how I was even supposed to know that. I confirmed with the rep that I had given AT&T my new address upon relocation, and obviously they had my phone number since they were the provider. I also pointed out the hefty (sometimes up to a thousand dollars a month) cell phone bills I'd rung up since then, which had always been paid. Finally I told them that if the restaurant I'd been eating in every day found an old unpaid ticket from two years ago that had dropped behind the cash register, they might just consider that water under the bridge, or perhaps a lesson to them on how to better handle their accounts.

They didn't budge, I didn't budge. God Bless America!

I think that bill may finally have dropped off my credit report because I haven't heard about it in a while.

You know, I bet single payer systems are a good way around this sort of bureaucratic nonsense. :)

Insurance companies shouldn't be making decisions about peoples need for healthcare, they should only supply the insurance.

#13 | Posted by moneywar


This was the most important point made in the entire thread.

Is there a difference between "loving" your plan and being "satisfied" with your plan? A simple yes or no will do.

What a pathetic attempt at nitpicking. Stands out even more than freeflake's idiocy.

The headline was created by CNN... who needs speakers for that? I just saw the story on the late news... made me sick... now this is Rhetoric!

They don't change the codes themselves, but they do pressure doctors to bill under this code instead of that code by denying all claims filed under a code they don't want. Codes are used to define illness and by changing the codes, you are changing the percent of people who suffer from problem A instead of B.


I used to manage the insurance and patient billing for a large dermatology practice in NJ and some of the interactions I've had with insurance was frustrating. There were many instances of first time denials that required multiple attempts to get them to pay the claim correctly.

We'd eventually get them to pay the claim, but it usually took about 20-30 minutes time between multiple calls, rebilling, faxing proof or whatnot.

However, to change the code to something unrelated (people suffer from problem A instead of B) would be considered insurance fraud unless changing from A to B was more descriptive of the condition and not a different condition just to get payment.

Though, come to think of it, I've never been pressured to change a DX or CPT code, from an insurance company, in order for them to pay.

Seems kind of silly for them to place all those blocks to payment to have them tell you, let alone pressure you, to change it so that they will have to pay.

Maybe its just me. :)

Loh

My grandmother fell at my mom's home several months ago (she doesn't live there). As a result of the fall, her Dr. ordered a CAT Scan. The hospital is now saying that Medicare will not pay for the CAT Scan since she was at my
mother's residence. They are saying that my mother needs to turn the claim into her home owners insurance. Is this right? If my grandmother has medical coverage for herself, why would it matter where she fell? Thanks.

#43 | Posted by ELCIDCE90

The same thing will happen with private insurance and has happened to me with Blue Cross/Blue Shield. If you require medical treatment for certain injuries (over a certain $ amount) that are often the result of an injury, your insurance company will look for red flags (like MRI or CAT scans) and transfer your case to their subrogation department.

From there, they will contact the injured to find out if other insurance might be liable to pay (auto, homeowners, workman's comp, etc.) and go after them through arbitration.

The same thing would have happened if your grandmother was in an auto accident and went to the ER and instructed them to bill Medicare or if you hurt yourself at work and was pressured by your employer to use your own health insurance to pay for treatment.

One more piece of anecdotal evidence:

My mom is 81 and has had an ulcer repair and an elbow replacement in the last 3 years.

She has Blue Cross supplemental and Medicare.

No problems from Medicare but BC consistently refuses to pay. The doctors and hospital keep resubmitting until they do.

My mom just throws the bills in the trash until BC finally pays them six to nine months later.

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