Tag: Claim Denial

There is a bit of a Cold War of sorts, raging between Private Insurance “providers” and your neighborhood Health Care professionals (and it’s NOT the Govt getting in between the two.)

It’s the battle over Claim Denials. It’s an “arms race” that just keeps escalating …

DMI: Denial Management, Inc — The Claims Solution People

The Problem:

One in seven claims are denied by insurance companies. This can cost your clinic or practice thousands of dollars every year.

http://www.claimsmgt.com/produ…

That’s about 15% of Claims, Insurers choose NOT to pay. So, Doctors need all the help they can get, to stay focused on Healing, NOT Bill Collecting!

Denial Management Services

Problem: Most Health Systems lose between 3% and 5% of net revenues as a result of payment denials.

Solution: Outsource your denied claims to DMI, the foremost industry leader in capturing additional revenue.

http://www.claimsmgt.com/compa…

We learned last week from LA Times reporting, and from Congressional Hearings, that Insurance companies routinely try to drop your Insurance policy, if you happen to get one of their “Hot List” illnesses.

Getting any of these illnesses, can Trigger the Insurance Company’s “Cancellation Police”, into action.

Denial Specialists scour your medical history, and cross-check that against your application, looking for any reason to Cancel, or rescind, your Insurance policy, thus saving the Insurance Company untold thousands in future payments for your expected Care. Denial Specialists, of course, earn bonuses for each Policy they cancel. What a system!

Those 4 illnesses (out of the 1000+ such Triggers) previously disclosed are:

breast cancer, high blood pressure, lymphoma and pregnancy

Well thanks to the tough questioning of the Oversight and Investigations Sub Committee, at least 2 more Triggering Illnesses have been disclosed, as indicated in the video and transcript of the Hearing:

The 2 other newly disclosed “Drop List” illnesses, include:

ovarian cancer, and brain cancer

cross-posted on the kos

About.com — Health Insurance

Question: What is a pre-existing condition exclusion period?

Answer: Insurance companies try to discourage people from waiting until they get sick in order to purchase health insurance. One way in which they do this is to impose pre-existing condition exclusion periods. This means that if you have a medical problem which exists at the time you enroll in or purchase your health insurance, the insurance company will deny all claims pertaining to this medical problem for a certain period of time.

(emphasis added)

http://healthinsurance.about.c…

So there IS Hope —

Just Stay at that Job Forever —

Or NEVER get Sick —

And NO Problem!!!

They got you covered!  (as long as you can live with “Job Lock”)

Rockefeller on Health Insurance Industry Practices

Mar 27 2009

PRESS RELEASE — SENATOR JAY ROCKEFELLER.

WASHINGTON, DC – Senator John (Jay) Rockefeller, Chairman of the Senate Committee on Commerce, Science, and Transportation, held a full committee hearing this week entitled, “Deceptive Health Insurance Industry Practices – Are Consumers Getting What They Paid For?”

[…]

A recent investigation conducted by the Attorney General of New York concluded that for a number of years, the insurance industry has systematically under-estimated the out-of-network reimbursement rates it pays its policy holders, costing consumers billions of dollars in excessive out-of-pocket costs. The victims of this deceptive practice – more than 100 million Americans who pay for health insurance coverage that allows them to go outside of their provider network for medical care.

(Emphasis Added)

Press Release

In case you haven’t noticed, there is a Talking Point War, developing around the “validity” of the Public Option.

There is very much at stake in this inevitable War of Words — not least of which is YOUR Future Health, Wealth, and peace of mind.

Of course, the forces of the Status Quo, will do everything within their Financial Power, to convince you that a non-profit “Public Option” in Health Care — is against your best interests!  That it is anti-American! … That a Public Option is somehow an “inferior” product.  (says who, btw?)

Just don’t buy what their selling, because really it’s someone else’s “best interests” that those Talking Point warriors, really have in mind:

Beware of Big Business’ next “Bait and Switch”!  

(Whether it be some amorphous “co-op” idea, or some other shiny object, like promising to finally “play nicely now”.)