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View Diary: Dear Mr. President (339 comments)

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  •  Outstanding. One thing you missed... (8+ / 0-)

    Maximizing profit requires insurance companies to deny coverage for virtually all submitted claims.  Re-submitting  (whether by physician's office for their own billing or for the patient to be able to get the medication they ordered,  or by the patient) is time-consuming and complicated and therefore often not done, even though in most cases the insurance company is wrong and the claim should be paid.

    •  I'm sorry - hate to intrude reality, but (0+ / 0-)

      Maximizing profit requires insurance companies to deny coverage for virtually all submitted claims.

      is just not true.

      I am no defender of insurance company practices - but do you have any idea of how many claims are processed electronically and routinely every day?

      Claims are denied.  Charges are "re-bundled."  All kinds of things happen ...

      But really .... this is the reality based community.

      •  I'm in medicine (11+ / 0-)

        We send in bills. They are denied (even though pre-authorized).  We send them back. They sail through.  Many clinics at academic medical centers don't have anyone to send them back and they are just dropped.  My previous institution hired someone to just dog the billing and paid claims increased $1 million that year.

        There certainly are a lot of claims.  They don't often get confused if someone forgets to pay, though.  

        •  Oh - claims are denied. No denying. (2+ / 0-)
          Recommended by:
          historys mysteries, greenearth

          Just "virtually all"??

          Either you have some problems in the billing office or the world's worst group of insurance companies (after all, I would assume you see M-Care, M-caid, BCBS, and most other commercial payers).

          As to your comments about academic medical centers and their clinics and billing... most I know here in NC have gotten pretty good about the bottom line.  Sometimes too good - like sending off notices of intent to put liens on folks homes.

          •  That's better than UVa used to be. (2+ / 0-)
            Recommended by:
            SarahLee, Pinecone

            A friend of mine worked at the hospital there about 30 years ago, and they would send a first bill, a delinquent notice, and then a final notice.

            That last one was "final" because it was the last one they sent. After that they just wrote it off and stopped bothering.

            Listening to hdwh, it sounds like some hospitals have taken the same approach when billing insurance companies.

          •  depends on your field (3+ / 0-)
            Recommended by:
            SarahLee, churchylafemme, mamkotke

            although virtually all is certainly an excessive description

            but I would say most of the denials I see are "mistakes" and I don't so often see insurance companies forgetting to send a bill

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