So What Was The Point of Obamacare Again?

[Flopper]

To collapse the American health insurance industry and usher in single-payer.

Obama said he wants to put 1,300 companies that pay $100 billion a year in Federal, state, local and property taxes on their buildings, etc. and at the same
time put 400,000 people out of work!
"I happen to be a proponent of a single payer universal health care program.”

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf
View attachment 34029
So those ignorant stupid people that think insurance companies ONLY want to reject claims are again DUMB!!
Average insurance companies pay 80% of the premiums out in claims!
Now the biggest cost driver and I've said this dozens of times is what the doctors report as their biggest cost driver..
Proof is 90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
Physicians estimate the cost of defensive medicine in US at $650 to $850 billion per year

Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

FEAR of being sued causes $850 billion a year in claims paid by insurance companies/Medicare wastefully all out of fear of lawyers suing!

And having a good deal of experience with that, I can say with complete confidence that many MANY unnecessary tests and medical procedures are done and many MANY insurance claims are paid that are not owed, purely because of threatened litigation and the costs of defending those cases would exceed paying the claim that is not owed. And that drives up the basic cost of healthcare for all of us and has driven insurance costs into the stratosphere.

And every time somebody suggests remedying that situation, the trial lawyers, aided and abetted by elected officials who themselves are mostly trial lawyers, will point to the very few cases that go to trial. What we are supposed to believe is that litigation is a tiny part of the medical costs overall. What they don't tell you are the fortunes they are raking in from their clients by just threatening the litigation.

With the onset of Medicare and Medicaid, the deep pockets of government covering those programs has sharply escalated that trend and Obamacare will only worsen it.

THANK YOU!!!!
I've been beating this drum constantly and it appears you are one of the very few that comprehend the magnitude of this gigantic cost driver.
$850 billion a year is what these 90% of physicians admit their reason is fear of lawsuits.
Further proof is this:
Up to 92% of US physicians practice defensive medicine.
76% of physicians report that defensive medicine decreases patient access to healthcare.
53% of physicians report delaying new techniques, procedures, and treatments due to fear of lawsuits.
Patients most affected by defensive medicine include those visiting emergency rooms and those requiring surgery.
Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
BUT NOTE this: "Physicians contracted by the federal government practice significantly less defensive medicine as they are protected
against lawsuits by the Federal Tort Claims Act.
Only 48% practice defensive medicine compared to 92% of non-government physicians.
89% of physicians support a patient’s right to be compensated fairly for true negligence.
SOURCE: Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

And so if government doctors won't be sued because of the Federal Tort Claims Act... why not expand that act to cover the rest of the physicians?
As a result this $850 billion cost would be reduced dramatically.
Then the insurance companies will NOT have claims to pay for these defensive measures and as a result and this is what most people are
grossly uninformed so I'm making it in bold letters!!!

STATE Insurance regulators approve premium increases.
IF insurance companies having to verify their claim costs have gone down, then the states WON"T approve RATE increases but MAY require reductions!

I have worked in both the medical and insurance industries so have some first hand experience. And my hubby is a 40-year experienced all lines general insurance adjuster who has worked hands on all that time and has sufficient credentials and experience that he has been used as an expert by the legal and insurance industries. During the course of this discussion on this thread I asked him his best guess of how many insurance claims are paid for claims the insurance company does not owe just to avoid the cost of litigation. He said he is aware of no hard statistics on that, but his best guess would be at least 50%. And it is an absolute certainty that those costs for products, services, and insurance coverage are passed on to us all.

So, unless the patient gets screwed by not being able to receive compensation for real negligence and injury as a result of it, what does it profit us for the government to assume the risk instead of the insurance companies? Now the government gets to decide who the winners and losers will be? I think most of us can see a real danger there.

The best solution except in the most hardship cases--and those could be judged on a case by case basis--is that if the plaintiff loses the case, he pays the court costs and attorney fees for the defendant or his/her insurance company. That would stop almost all opportunistic litigation in its tracks.

I don't know if you saw my last post...so here are the FACTS NOT guesses and it is BETTER far better then the "best guess of 50%" as there are hard statistics so please go to the below and check out the realities that insurance companies REJECT the FIRST time less then 5% NOT 50%

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf

View attachment 34034

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

 

[Foxfyre]

To collapse the American health insurance industry and usher in single-payer.

Obama said he wants to put 1,300 companies that pay $100 billion a year in Federal, state, local and property taxes on their buildings, etc. and at the same
time put 400,000 people out of work!
"I happen to be a proponent of a single payer universal health care program.”

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf
View attachment 34029
So those ignorant stupid people that think insurance companies ONLY want to reject claims are again DUMB!!
Average insurance companies pay 80% of the premiums out in claims!
Now the biggest cost driver and I've said this dozens of times is what the doctors report as their biggest cost driver..
Proof is 90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
Physicians estimate the cost of defensive medicine in US at $650 to $850 billion per year

Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

FEAR of being sued causes $850 billion a year in claims paid by insurance companies/Medicare wastefully all out of fear of lawyers suing!

And having a good deal of experience with that, I can say with complete confidence that many MANY unnecessary tests and medical procedures are done and many MANY insurance claims are paid that are not owed, purely because of threatened litigation and the costs of defending those cases would exceed paying the claim that is not owed. And that drives up the basic cost of healthcare for all of us and has driven insurance costs into the stratosphere.

And every time somebody suggests remedying that situation, the trial lawyers, aided and abetted by elected officials who themselves are mostly trial lawyers, will point to the very few cases that go to trial. What we are supposed to believe is that litigation is a tiny part of the medical costs overall. What they don't tell you are the fortunes they are raking in from their clients by just threatening the litigation.

With the onset of Medicare and Medicaid, the deep pockets of government covering those programs has sharply escalated that trend and Obamacare will only worsen it.

THANK YOU!!!!
I've been beating this drum constantly and it appears you are one of the very few that comprehend the magnitude of this gigantic cost driver.
$850 billion a year is what these 90% of physicians admit their reason is fear of lawsuits.
Further proof is this:
Up to 92% of US physicians practice defensive medicine.
76% of physicians report that defensive medicine decreases patient access to healthcare.
53% of physicians report delaying new techniques, procedures, and treatments due to fear of lawsuits.
Patients most affected by defensive medicine include those visiting emergency rooms and those requiring surgery.
Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
BUT NOTE this: "Physicians contracted by the federal government practice significantly less defensive medicine as they are protected
against lawsuits by the Federal Tort Claims Act.
Only 48% practice defensive medicine compared to 92% of non-government physicians.
89% of physicians support a patient’s right to be compensated fairly for true negligence.
SOURCE: Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

And so if government doctors won't be sued because of the Federal Tort Claims Act... why not expand that act to cover the rest of the physicians?
As a result this $850 billion cost would be reduced dramatically.
Then the insurance companies will NOT have claims to pay for these defensive measures and as a result and this is what most people are
grossly uninformed so I'm making it in bold letters!!!

STATE Insurance regulators approve premium increases.
IF insurance companies having to verify their claim costs have gone down, then the states WON"T approve RATE increases but MAY require reductions!

I have worked in both the medical and insurance industries so have some first hand experience. And my hubby is a 40-year experienced all lines general insurance adjuster who has worked hands on all that time and has sufficient credentials and experience that he has been used as an expert by the legal and insurance industries. During the course of this discussion on this thread I asked him his best guess of how many insurance claims are paid for claims the insurance company does not owe just to avoid the cost of litigation. He said he is aware of no hard statistics on that, but his best guess would be at least 50%. And it is an absolute certainty that those costs for products, services, and insurance coverage are passed on to us all.

So, unless the patient gets screwed by not being able to receive compensation for real negligence and injury as a result of it, what does it profit us for the government to assume the risk instead of the insurance companies? Now the government gets to decide who the winners and losers will be? I think most of us can see a real danger there.

The best solution except in the most hardship cases--and those could be judged on a case by case basis--is that if the plaintiff loses the case, he pays the court costs and attorney fees for the defendant or his/her insurance company. That would stop almost all opportunistic litigation in its tracks.

I don't know if you saw my last post...so here are the FACTS NOT guesses and it is BETTER far better then the "best guess of 50%" as there are hard statistics so please go to the below and check out the realities that insurance companies REJECT the FIRST time less then 5% NOT 50%

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf

View attachment 34034

I didn't say anything about rejecting claims. I am talking about paying claims. And I wasn't talking about just medical claims but all insurance claims in general. I am not talking about those claims that have involved actual threats of litigation but all claims that are paid just to avoid litigation. It is cheaper to pay it up front than it is after a lawyer is involved. Your statistics don't address that part of the equation.

I can assure you that without the fear of litigation hanging over their heads, insurance companies would be paying for a whole lot less stuff than they now pay for. And they should pay for a whole lot less stuff because they could make insurance affordable for the necessary stuff for everybody again.

 

[healthmyths]

Obama said he wants to put 1,300 companies that pay $100 billion a year in Federal, state, local and property taxes on their buildings, etc. and at the same
time put 400,000 people out of work!
"I happen to be a proponent of a single payer universal health care program.”

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf
View attachment 34029
So those ignorant stupid people that think insurance companies ONLY want to reject claims are again DUMB!!
Average insurance companies pay 80% of the premiums out in claims!
Now the biggest cost driver and I've said this dozens of times is what the doctors report as their biggest cost driver..
Proof is 90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
Physicians estimate the cost of defensive medicine in US at $650 to $850 billion per year

Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

FEAR of being sued causes $850 billion a year in claims paid by insurance companies/Medicare wastefully all out of fear of lawyers suing!

And having a good deal of experience with that, I can say with complete confidence that many MANY unnecessary tests and medical procedures are done and many MANY insurance claims are paid that are not owed, purely because of threatened litigation and the costs of defending those cases would exceed paying the claim that is not owed. And that drives up the basic cost of healthcare for all of us and has driven insurance costs into the stratosphere.

And every time somebody suggests remedying that situation, the trial lawyers, aided and abetted by elected officials who themselves are mostly trial lawyers, will point to the very few cases that go to trial. What we are supposed to believe is that litigation is a tiny part of the medical costs overall. What they don't tell you are the fortunes they are raking in from their clients by just threatening the litigation.

With the onset of Medicare and Medicaid, the deep pockets of government covering those programs has sharply escalated that trend and Obamacare will only worsen it.

THANK YOU!!!!
I've been beating this drum constantly and it appears you are one of the very few that comprehend the magnitude of this gigantic cost driver.
$850 billion a year is what these 90% of physicians admit their reason is fear of lawsuits.
Further proof is this:
Up to 92% of US physicians practice defensive medicine.
76% of physicians report that defensive medicine decreases patient access to healthcare.
53% of physicians report delaying new techniques, procedures, and treatments due to fear of lawsuits.
Patients most affected by defensive medicine include those visiting emergency rooms and those requiring surgery.
Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
BUT NOTE this: "Physicians contracted by the federal government practice significantly less defensive medicine as they are protected
against lawsuits by the Federal Tort Claims Act.
Only 48% practice defensive medicine compared to 92% of non-government physicians.
89% of physicians support a patient’s right to be compensated fairly for true negligence.
SOURCE: Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

And so if government doctors won't be sued because of the Federal Tort Claims Act... why not expand that act to cover the rest of the physicians?
As a result this $850 billion cost would be reduced dramatically.
Then the insurance companies will NOT have claims to pay for these defensive measures and as a result and this is what most people are
grossly uninformed so I'm making it in bold letters!!!

STATE Insurance regulators approve premium increases.
IF insurance companies having to verify their claim costs have gone down, then the states WON"T approve RATE increases but MAY require reductions!

I have worked in both the medical and insurance industries so have some first hand experience. And my hubby is a 40-year experienced all lines general insurance adjuster who has worked hands on all that time and has sufficient credentials and experience that he has been used as an expert by the legal and insurance industries. During the course of this discussion on this thread I asked him his best guess of how many insurance claims are paid for claims the insurance company does not owe just to avoid the cost of litigation. He said he is aware of no hard statistics on that, but his best guess would be at least 50%. And it is an absolute certainty that those costs for products, services, and insurance coverage are passed on to us all.

So, unless the patient gets screwed by not being able to receive compensation for real negligence and injury as a result of it, what does it profit us for the government to assume the risk instead of the insurance companies? Now the government gets to decide who the winners and losers will be? I think most of us can see a real danger there.

The best solution except in the most hardship cases--and those could be judged on a case by case basis--is that if the plaintiff loses the case, he pays the court costs and attorney fees for the defendant or his/her insurance company. That would stop almost all opportunistic litigation in its tracks.

I don't know if you saw my last post...so here are the FACTS NOT guesses and it is BETTER far better then the "best guess of 50%" as there are hard statistics so please go to the below and check out the realities that insurance companies REJECT the FIRST time less then 5% NOT 50%

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf

View attachment 34034

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

Absolutely right about the rejected claims. I know because my business helps providers get paid by Medicare so I'm very knowledgeable about it.
But the point of my comments was the insurance companies are NOT the evil guys the majority of people make them out to be!
99% of the people that work for insurance companies are like you and me. And most people portray insurance companies' executives as making huge
salaries and yes a small handful do! But idiots who have NO idea how health insurance or claims' submission or all the issues involved make these
idiotic comments about insurance companies when IN fact the blame should be place in a large part on the ambulance chasing lawyers that
have created this litigious environment that created the $850 billion in defensive medicine that creates the claims in turn are passed on in the form of
higher premiums. A very vicious cycle that proven by the fact because of the Federal Tort Claims Act has half the amount of doctors responding about
defensive medicine!

 

[Flopper]

And having a good deal of experience with that, I can say with complete confidence that many MANY unnecessary tests and medical procedures are done and many MANY insurance claims are paid that are not owed, purely because of threatened litigation and the costs of defending those cases would exceed paying the claim that is not owed. And that drives up the basic cost of healthcare for all of us and has driven insurance costs into the stratosphere.

And every time somebody suggests remedying that situation, the trial lawyers, aided and abetted by elected officials who themselves are mostly trial lawyers, will point to the very few cases that go to trial. What we are supposed to believe is that litigation is a tiny part of the medical costs overall. What they don't tell you are the fortunes they are raking in from their clients by just threatening the litigation.

With the onset of Medicare and Medicaid, the deep pockets of government covering those programs has sharply escalated that trend and Obamacare will only worsen it.

THANK YOU!!!!
I've been beating this drum constantly and it appears you are one of the very few that comprehend the magnitude of this gigantic cost driver.
$850 billion a year is what these 90% of physicians admit their reason is fear of lawsuits.
Further proof is this:
Up to 92% of US physicians practice defensive medicine.
76% of physicians report that defensive medicine decreases patient access to healthcare.
53% of physicians report delaying new techniques, procedures, and treatments due to fear of lawsuits.
Patients most affected by defensive medicine include those visiting emergency rooms and those requiring surgery.
Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
BUT NOTE this: "Physicians contracted by the federal government practice significantly less defensive medicine as they are protected
against lawsuits by the Federal Tort Claims Act.
Only 48% practice defensive medicine compared to 92% of non-government physicians.
89% of physicians support a patient’s right to be compensated fairly for true negligence.
SOURCE: Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

And so if government doctors won't be sued because of the Federal Tort Claims Act... why not expand that act to cover the rest of the physicians?
As a result this $850 billion cost would be reduced dramatically.
Then the insurance companies will NOT have claims to pay for these defensive measures and as a result and this is what most people are
grossly uninformed so I'm making it in bold letters!!!

STATE Insurance regulators approve premium increases.
IF insurance companies having to verify their claim costs have gone down, then the states WON"T approve RATE increases but MAY require reductions!

I have worked in both the medical and insurance industries so have some first hand experience. And my hubby is a 40-year experienced all lines general insurance adjuster who has worked hands on all that time and has sufficient credentials and experience that he has been used as an expert by the legal and insurance industries. During the course of this discussion on this thread I asked him his best guess of how many insurance claims are paid for claims the insurance company does not owe just to avoid the cost of litigation. He said he is aware of no hard statistics on that, but his best guess would be at least 50%. And it is an absolute certainty that those costs for products, services, and insurance coverage are passed on to us all.

So, unless the patient gets screwed by not being able to receive compensation for real negligence and injury as a result of it, what does it profit us for the government to assume the risk instead of the insurance companies? Now the government gets to decide who the winners and losers will be? I think most of us can see a real danger there.

The best solution except in the most hardship cases--and those could be judged on a case by case basis--is that if the plaintiff loses the case, he pays the court costs and attorney fees for the defendant or his/her insurance company. That would stop almost all opportunistic litigation in its tracks.

I don't know if you saw my last post...so here are the FACTS NOT guesses and it is BETTER far better then the "best guess of 50%" as there are hard statistics so please go to the below and check out the realities that insurance companies REJECT the FIRST time less then 5% NOT 50%

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf

View attachment 34034

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

Absolutely right about the rejected claims. I know because my business helps providers get paid by Medicare so I'm very knowledgeable about it.
But the point of my comments was the insurance companies are NOT the evil guys the majority of people make them out to be!
99% of the people that work for insurance companies are like you and me. And most people portray insurance companies' executives as making huge
salaries and yes a small handful do! But idiots who have NO idea how health insurance or claims' submission or all the issues involved make these
idiotic comments about insurance companies when IN fact the blame should be place in a large part on the ambulance chasing lawyers that
have created this litigious environment that created the $850 billion in defensive medicine that creates the claims in turn are passed on in the form of
higher premiums. A very vicious cycle that proven by the fact because of the Federal Tort Claims Act has half the amount of doctors responding about
defensive medicine!

Insurance companies like any private enterprise charge whatever the market will bear and will minimize their costs as much as the law and their customers will tolerate. They operate on the same principals as any business. There is nothing wrong with this. It's how our economy works. What is evil is not providing regulations to protect the public from abuses that market forces can not prevent.

 

[Foxfyre]

THANK YOU!!!!
I've been beating this drum constantly and it appears you are one of the very few that comprehend the magnitude of this gigantic cost driver.
$850 billion a year is what these 90% of physicians admit their reason is fear of lawsuits.
Further proof is this:
Up to 92% of US physicians practice defensive medicine.
76% of physicians report that defensive medicine decreases patient access to healthcare.
53% of physicians report delaying new techniques, procedures, and treatments due to fear of lawsuits.
Patients most affected by defensive medicine include those visiting emergency rooms and those requiring surgery.
Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
BUT NOTE this: "Physicians contracted by the federal government practice significantly less defensive medicine as they are protected
against lawsuits by the Federal Tort Claims Act.
Only 48% practice defensive medicine compared to 92% of non-government physicians.
89% of physicians support a patient’s right to be compensated fairly for true negligence.
SOURCE: Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

And so if government doctors won't be sued because of the Federal Tort Claims Act... why not expand that act to cover the rest of the physicians?
As a result this $850 billion cost would be reduced dramatically.
Then the insurance companies will NOT have claims to pay for these defensive measures and as a result and this is what most people are
grossly uninformed so I'm making it in bold letters!!!

STATE Insurance regulators approve premium increases.
IF insurance companies having to verify their claim costs have gone down, then the states WON"T approve RATE increases but MAY require reductions!

I have worked in both the medical and insurance industries so have some first hand experience. And my hubby is a 40-year experienced all lines general insurance adjuster who has worked hands on all that time and has sufficient credentials and experience that he has been used as an expert by the legal and insurance industries. During the course of this discussion on this thread I asked him his best guess of how many insurance claims are paid for claims the insurance company does not owe just to avoid the cost of litigation. He said he is aware of no hard statistics on that, but his best guess would be at least 50%. And it is an absolute certainty that those costs for products, services, and insurance coverage are passed on to us all.

So, unless the patient gets screwed by not being able to receive compensation for real negligence and injury as a result of it, what does it profit us for the government to assume the risk instead of the insurance companies? Now the government gets to decide who the winners and losers will be? I think most of us can see a real danger there.

The best solution except in the most hardship cases--and those could be judged on a case by case basis--is that if the plaintiff loses the case, he pays the court costs and attorney fees for the defendant or his/her insurance company. That would stop almost all opportunistic litigation in its tracks.

I don't know if you saw my last post...so here are the FACTS NOT guesses and it is BETTER far better then the "best guess of 50%" as there are hard statistics so please go to the below and check out the realities that insurance companies REJECT the FIRST time less then 5% NOT 50%

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf

View attachment 34034

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

Absolutely right about the rejected claims. I know because my business helps providers get paid by Medicare so I'm very knowledgeable about it.
But the point of my comments was the insurance companies are NOT the evil guys the majority of people make them out to be!
99% of the people that work for insurance companies are like you and me. And most people portray insurance companies' executives as making huge
salaries and yes a small handful do! But idiots who have NO idea how health insurance or claims' submission or all the issues involved make these
idiotic comments about insurance companies when IN fact the blame should be place in a large part on the ambulance chasing lawyers that
have created this litigious environment that created the $850 billion in defensive medicine that creates the claims in turn are passed on in the form of
higher premiums. A very vicious cycle that proven by the fact because of the Federal Tort Claims Act has half the amount of doctors responding about
defensive medicine!

Insurance companies like any private enterprise charge whatever the market will bear and will minimize their costs as much as the law and their customers will tolerate. They operate on the same principals as any business. There is nothing wrong with this. It's how our economy works. What is evil is not providing regulations to protect the public from abuses that market forces can not prevent.

I have no problem with regulation to prevent unethical business practices. But in this case, the problem is not with the insurance companies but a failure to prevent abuses by opportunistic trial lawyers sometimes working in tandem with opportunistic policy holders.

 

[Freewill]

I see ads for signing up for Obamacare. The biggest sales point is that YOU can be eligible for federal help. YOU can become dependent. YOU can have your healthcare dictated to you. It is all up to YOU.

 

[Freewill]

Obama said he wants to put 1,300 companies that pay $100 billion a year in Federal, state, local and property taxes on their buildings, etc. and at the same
time put 400,000 people out of work!
"I happen to be a proponent of a single payer universal health care program.”

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf
View attachment 34029
So those ignorant stupid people that think insurance companies ONLY want to reject claims are again DUMB!!
Average insurance companies pay 80% of the premiums out in claims!
Now the biggest cost driver and I've said this dozens of times is what the doctors report as their biggest cost driver..
Proof is 90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
Physicians estimate the cost of defensive medicine in US at $650 to $850 billion per year

Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

FEAR of being sued causes $850 billion a year in claims paid by insurance companies/Medicare wastefully all out of fear of lawyers suing!

And having a good deal of experience with that, I can say with complete confidence that many MANY unnecessary tests and medical procedures are done and many MANY insurance claims are paid that are not owed, purely because of threatened litigation and the costs of defending those cases would exceed paying the claim that is not owed. And that drives up the basic cost of healthcare for all of us and has driven insurance costs into the stratosphere.

And every time somebody suggests remedying that situation, the trial lawyers, aided and abetted by elected officials who themselves are mostly trial lawyers, will point to the very few cases that go to trial. What we are supposed to believe is that litigation is a tiny part of the medical costs overall. What they don't tell you are the fortunes they are raking in from their clients by just threatening the litigation.

With the onset of Medicare and Medicaid, the deep pockets of government covering those programs has sharply escalated that trend and Obamacare will only worsen it.

THANK YOU!!!!
I've been beating this drum constantly and it appears you are one of the very few that comprehend the magnitude of this gigantic cost driver.
$850 billion a year is what these 90% of physicians admit their reason is fear of lawsuits.
Further proof is this:
Up to 92% of US physicians practice defensive medicine.
76% of physicians report that defensive medicine decreases patient access to healthcare.
53% of physicians report delaying new techniques, procedures, and treatments due to fear of lawsuits.
Patients most affected by defensive medicine include those visiting emergency rooms and those requiring surgery.
Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
BUT NOTE this: "Physicians contracted by the federal government practice significantly less defensive medicine as they are protected
against lawsuits by the Federal Tort Claims Act.
Only 48% practice defensive medicine compared to 92% of non-government physicians.
89% of physicians support a patient’s right to be compensated fairly for true negligence.
SOURCE: Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

And so if government doctors won't be sued because of the Federal Tort Claims Act... why not expand that act to cover the rest of the physicians?
As a result this $850 billion cost would be reduced dramatically.
Then the insurance companies will NOT have claims to pay for these defensive measures and as a result and this is what most people are
grossly uninformed so I'm making it in bold letters!!!

STATE Insurance regulators approve premium increases.
IF insurance companies having to verify their claim costs have gone down, then the states WON"T approve RATE increases but MAY require reductions!

I have worked in both the medical and insurance industries so have some first hand experience. And my hubby is a 40-year experienced all lines general insurance adjuster who has worked hands on all that time and has sufficient credentials and experience that he has been used as an expert by the legal and insurance industries. During the course of this discussion on this thread I asked him his best guess of how many insurance claims are paid for claims the insurance company does not owe just to avoid the cost of litigation. He said he is aware of no hard statistics on that, but his best guess would be at least 50%. And it is an absolute certainty that those costs for products, services, and insurance coverage are passed on to us all.

So, unless the patient gets screwed by not being able to receive compensation for real negligence and injury as a result of it, what does it profit us for the government to assume the risk instead of the insurance companies? Now the government gets to decide who the winners and losers will be? I think most of us can see a real danger there.

The best solution except in the most hardship cases--and those could be judged on a case by case basis--is that if the plaintiff loses the case, he pays the court costs and attorney fees for the defendant or his/her insurance company. That would stop almost all opportunistic litigation in its tracks.

I don't know if you saw my last post...so here are the FACTS NOT guesses and it is BETTER far better then the "best guess of 50%" as there are hard statistics so please go to the below and check out the realities that insurance companies REJECT the FIRST time less then 5% NOT 50%

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf

View attachment 34034

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

I was called by my doctor to remind me of my yearly physical which is the only doctor's appointment I have. So I go in and present my new medical card. New because I was dropped from the old because, according to my company, Obamacare was more affordable, affordable to them. Anyway on the card it says prevenative office visits had a zero copay. The woman at the window says that will be 20 dollars. I point out that it says zero. She says that if the doctor codes it as preventive then I'll get a credit. I asked what else could it be?

So I come out and they charge me the 20 dollars. I say WTF? So they say, OK we will look into it and get back to you, if we coded it wrong we will let you know. Three days later they call and say that he doctor, who did nothing but check me out didn't code it as preventative thus I was charged correctly. They had some BS reasons but I said "HE DIDN'T do anything. Any way it is only 20 bucks but I didn't like their attitude so after 25 years I am going elsewhere.

So no, they are not sure of everyone's policy. I guess when the liberals get what they want and everyone is covered under one plan then they will know.

BTW the insurance company could not of cared less.

 

[asterism]

Obama said he wants to put 1,300 companies that pay $100 billion a year in Federal, state, local and property taxes on their buildings, etc. and at the same
time put 400,000 people out of work!
"I happen to be a proponent of a single payer universal health care program.”

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf
View attachment 34029
So those ignorant stupid people that think insurance companies ONLY want to reject claims are again DUMB!!
Average insurance companies pay 80% of the premiums out in claims!
Now the biggest cost driver and I've said this dozens of times is what the doctors report as their biggest cost driver..
Proof is 90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
Physicians estimate the cost of defensive medicine in US at $650 to $850 billion per year

Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

FEAR of being sued causes $850 billion a year in claims paid by insurance companies/Medicare wastefully all out of fear of lawyers suing!

And having a good deal of experience with that, I can say with complete confidence that many MANY unnecessary tests and medical procedures are done and many MANY insurance claims are paid that are not owed, purely because of threatened litigation and the costs of defending those cases would exceed paying the claim that is not owed. And that drives up the basic cost of healthcare for all of us and has driven insurance costs into the stratosphere.

And every time somebody suggests remedying that situation, the trial lawyers, aided and abetted by elected officials who themselves are mostly trial lawyers, will point to the very few cases that go to trial. What we are supposed to believe is that litigation is a tiny part of the medical costs overall. What they don't tell you are the fortunes they are raking in from their clients by just threatening the litigation.

With the onset of Medicare and Medicaid, the deep pockets of government covering those programs has sharply escalated that trend and Obamacare will only worsen it.

THANK YOU!!!!
I've been beating this drum constantly and it appears you are one of the very few that comprehend the magnitude of this gigantic cost driver.
$850 billion a year is what these 90% of physicians admit their reason is fear of lawsuits.
Further proof is this:
Up to 92% of US physicians practice defensive medicine.
76% of physicians report that defensive medicine decreases patient access to healthcare.
53% of physicians report delaying new techniques, procedures, and treatments due to fear of lawsuits.
Patients most affected by defensive medicine include those visiting emergency rooms and those requiring surgery.
Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
BUT NOTE this: "Physicians contracted by the federal government practice significantly less defensive medicine as they are protected
against lawsuits by the Federal Tort Claims Act.
Only 48% practice defensive medicine compared to 92% of non-government physicians.
89% of physicians support a patient’s right to be compensated fairly for true negligence.
SOURCE: Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

And so if government doctors won't be sued because of the Federal Tort Claims Act... why not expand that act to cover the rest of the physicians?
As a result this $850 billion cost would be reduced dramatically.
Then the insurance companies will NOT have claims to pay for these defensive measures and as a result and this is what most people are
grossly uninformed so I'm making it in bold letters!!!

STATE Insurance regulators approve premium increases.
IF insurance companies having to verify their claim costs have gone down, then the states WON"T approve RATE increases but MAY require reductions!

I have worked in both the medical and insurance industries so have some first hand experience. And my hubby is a 40-year experienced all lines general insurance adjuster who has worked hands on all that time and has sufficient credentials and experience that he has been used as an expert by the legal and insurance industries. During the course of this discussion on this thread I asked him his best guess of how many insurance claims are paid for claims the insurance company does not owe just to avoid the cost of litigation. He said he is aware of no hard statistics on that, but his best guess would be at least 50%. And it is an absolute certainty that those costs for products, services, and insurance coverage are passed on to us all.

So, unless the patient gets screwed by not being able to receive compensation for real negligence and injury as a result of it, what does it profit us for the government to assume the risk instead of the insurance companies? Now the government gets to decide who the winners and losers will be? I think most of us can see a real danger there.

The best solution except in the most hardship cases--and those could be judged on a case by case basis--is that if the plaintiff loses the case, he pays the court costs and attorney fees for the defendant or his/her insurance company. That would stop almost all opportunistic litigation in its tracks.

I don't know if you saw my last post...so here are the FACTS NOT guesses and it is BETTER far better then the "best guess of 50%" as there are hard statistics so please go to the below and check out the realities that insurance companies REJECT the FIRST time less then 5% NOT 50%

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf

View attachment 34034

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

"Should" is the operative term but when you're dealing with a massive government program the results just don't seem to materialize. They certainly haven't in this case.

 

[asterism]

THANK YOU!!!!
I've been beating this drum constantly and it appears you are one of the very few that comprehend the magnitude of this gigantic cost driver.
$850 billion a year is what these 90% of physicians admit their reason is fear of lawsuits.
Further proof is this:
Up to 92% of US physicians practice defensive medicine.
76% of physicians report that defensive medicine decreases patient access to healthcare.
53% of physicians report delaying new techniques, procedures, and treatments due to fear of lawsuits.
Patients most affected by defensive medicine include those visiting emergency rooms and those requiring surgery.
Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
BUT NOTE this: "Physicians contracted by the federal government practice significantly less defensive medicine as they are protected
against lawsuits by the Federal Tort Claims Act.
Only 48% practice defensive medicine compared to 92% of non-government physicians.
89% of physicians support a patient’s right to be compensated fairly for true negligence.
SOURCE: Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

And so if government doctors won't be sued because of the Federal Tort Claims Act... why not expand that act to cover the rest of the physicians?
As a result this $850 billion cost would be reduced dramatically.
Then the insurance companies will NOT have claims to pay for these defensive measures and as a result and this is what most people are
grossly uninformed so I'm making it in bold letters!!!

STATE Insurance regulators approve premium increases.
IF insurance companies having to verify their claim costs have gone down, then the states WON"T approve RATE increases but MAY require reductions!

I have worked in both the medical and insurance industries so have some first hand experience. And my hubby is a 40-year experienced all lines general insurance adjuster who has worked hands on all that time and has sufficient credentials and experience that he has been used as an expert by the legal and insurance industries. During the course of this discussion on this thread I asked him his best guess of how many insurance claims are paid for claims the insurance company does not owe just to avoid the cost of litigation. He said he is aware of no hard statistics on that, but his best guess would be at least 50%. And it is an absolute certainty that those costs for products, services, and insurance coverage are passed on to us all.

So, unless the patient gets screwed by not being able to receive compensation for real negligence and injury as a result of it, what does it profit us for the government to assume the risk instead of the insurance companies? Now the government gets to decide who the winners and losers will be? I think most of us can see a real danger there.

The best solution except in the most hardship cases--and those could be judged on a case by case basis--is that if the plaintiff loses the case, he pays the court costs and attorney fees for the defendant or his/her insurance company. That would stop almost all opportunistic litigation in its tracks.

I don't know if you saw my last post...so here are the FACTS NOT guesses and it is BETTER far better then the "best guess of 50%" as there are hard statistics so please go to the below and check out the realities that insurance companies REJECT the FIRST time less then 5% NOT 50%

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf

View attachment 34034

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

Absolutely right about the rejected claims. I know because my business helps providers get paid by Medicare so I'm very knowledgeable about it.
But the point of my comments was the insurance companies are NOT the evil guys the majority of people make them out to be!
99% of the people that work for insurance companies are like you and me. And most people portray insurance companies' executives as making huge
salaries and yes a small handful do! But idiots who have NO idea how health insurance or claims' submission or all the issues involved make these
idiotic comments about insurance companies when IN fact the blame should be place in a large part on the ambulance chasing lawyers that
have created this litigious environment that created the $850 billion in defensive medicine that creates the claims in turn are passed on in the form of
higher premiums. A very vicious cycle that proven by the fact because of the Federal Tort Claims Act has half the amount of doctors responding about
defensive medicine!

Insurance companies like any private enterprise charge whatever the market will bear and will minimize their costs as much as the law and their customers will tolerate. They operate on the same principals as any business. There is nothing wrong with this. It's how our economy works. What is evil is not providing regulations to protect the public from abuses that market forces can not prevent.

Do you see any evil in crafting regulations to specifically exploit customers to give certain companies guaranteed profits?

 

[mudwhistle]

I don't know, I hope the Republicans repeal it. That would put the American "health care system" crisis back in the headlines, front-and-center, as millions lose "insurance coverage" and revert to the prior conditions. Let Republicans own their medieval ways.

Millions more are set to lose their coverage anyway when the mandates kick in. It's either repeal Obamacare now and a few million lose it, or wait for the mandates to kick in and hundreds of millions lose it. Half of those insured at the exchanges are most likely illegal immigrants, approximately 2.9 million.

According to the federal register 60% of the currently insured under employer based insurance plans are projected to be dropped and their hours cut to less than 30 hrs /wk.

 

[healthmyths]

I have worked in both the medical and insurance industries so have some first hand experience. And my hubby is a 40-year experienced all lines general insurance adjuster who has worked hands on all that time and has sufficient credentials and experience that he has been used as an expert by the legal and insurance industries. During the course of this discussion on this thread I asked him his best guess of how many insurance claims are paid for claims the insurance company does not owe just to avoid the cost of litigation. He said he is aware of no hard statistics on that, but his best guess would be at least 50%. And it is an absolute certainty that those costs for products, services, and insurance coverage are passed on to us all.

So, unless the patient gets screwed by not being able to receive compensation for real negligence and injury as a result of it, what does it profit us for the government to assume the risk instead of the insurance companies? Now the government gets to decide who the winners and losers will be? I think most of us can see a real danger there.

The best solution except in the most hardship cases--and those could be judged on a case by case basis--is that if the plaintiff loses the case, he pays the court costs and attorney fees for the defendant or his/her insurance company. That would stop almost all opportunistic litigation in its tracks.

I don't know if you saw my last post...so here are the FACTS NOT guesses and it is BETTER far better then the "best guess of 50%" as there are hard statistics so please go to the below and check out the realities that insurance companies REJECT the FIRST time less then 5% NOT 50%

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf

View attachment 34034

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

Absolutely right about the rejected claims. I know because my business helps providers get paid by Medicare so I'm very knowledgeable about it.
But the point of my comments was the insurance companies are NOT the evil guys the majority of people make them out to be!
99% of the people that work for insurance companies are like you and me. And most people portray insurance companies' executives as making huge
salaries and yes a small handful do! But idiots who have NO idea how health insurance or claims' submission or all the issues involved make these
idiotic comments about insurance companies when IN fact the blame should be place in a large part on the ambulance chasing lawyers that
have created this litigious environment that created the $850 billion in defensive medicine that creates the claims in turn are passed on in the form of
higher premiums. A very vicious cycle that proven by the fact because of the Federal Tort Claims Act has half the amount of doctors responding about
defensive medicine!

Insurance companies like any private enterprise charge whatever the market will bear and will minimize their costs as much as the law and their customers will tolerate. They operate on the same principals as any business. There is nothing wrong with this. It's how our economy works. What is evil is not providing regulations to protect the public from abuses that market forces can not prevent.

Do you see any evil in crafting regulations to specifically exploit customers to give certain companies guaranteed profits?

OK... "GUARANTEED PROFITS" WHERE?
See economically ignorant people use that term so freely BUT THERE IS NO SUCH THING!
Let's see how "GUARANTEED "guaranteed profits" are..
1) Assume THE company has a CONTRACT that states "Company can get your payments from your bank without YOUR permission!
NOW that is a solid guaranteed payment...UNLESS the bank closes!
2) So assume company's funds are secured. The service they are being paid for is to pay ANY AND ALL CLAIMS you submit for your health!
3) You submit a claim for $1 million.
4) Company has $1 million in bank and your claim is paid.
Where is the "guaranteed Profits" YOU economic illiterate? Geez what did they teach you in school as to what revenues, costs of services and profits were? Obviously NOTHING!

 

[Foxfyre]

I have worked in both the medical and insurance industries so have some first hand experience. And my hubby is a 40-year experienced all lines general insurance adjuster who has worked hands on all that time and has sufficient credentials and experience that he has been used as an expert by the legal and insurance industries. During the course of this discussion on this thread I asked him his best guess of how many insurance claims are paid for claims the insurance company does not owe just to avoid the cost of litigation. He said he is aware of no hard statistics on that, but his best guess would be at least 50%. And it is an absolute certainty that those costs for products, services, and insurance coverage are passed on to us all.

So, unless the patient gets screwed by not being able to receive compensation for real negligence and injury as a result of it, what does it profit us for the government to assume the risk instead of the insurance companies? Now the government gets to decide who the winners and losers will be? I think most of us can see a real danger there.

The best solution except in the most hardship cases--and those could be judged on a case by case basis--is that if the plaintiff loses the case, he pays the court costs and attorney fees for the defendant or his/her insurance company. That would stop almost all opportunistic litigation in its tracks.

I don't know if you saw my last post...so here are the FACTS NOT guesses and it is BETTER far better then the "best guess of 50%" as there are hard statistics so please go to the below and check out the realities that insurance companies REJECT the FIRST time less then 5% NOT 50%

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf

View attachment 34034

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

Absolutely right about the rejected claims. I know because my business helps providers get paid by Medicare so I'm very knowledgeable about it.
But the point of my comments was the insurance companies are NOT the evil guys the majority of people make them out to be!
99% of the people that work for insurance companies are like you and me. And most people portray insurance companies' executives as making huge
salaries and yes a small handful do! But idiots who have NO idea how health insurance or claims' submission or all the issues involved make these
idiotic comments about insurance companies when IN fact the blame should be place in a large part on the ambulance chasing lawyers that
have created this litigious environment that created the $850 billion in defensive medicine that creates the claims in turn are passed on in the form of
higher premiums. A very vicious cycle that proven by the fact because of the Federal Tort Claims Act has half the amount of doctors responding about
defensive medicine!

Insurance companies like any private enterprise charge whatever the market will bear and will minimize their costs as much as the law and their customers will tolerate. They operate on the same principals as any business. There is nothing wrong with this. It's how our economy works. What is evil is not providing regulations to protect the public from abuses that market forces can not prevent.

Do you see any evil in crafting regulations to specifically exploit customers to give certain companies guaranteed profits?

I don't think guaranteed profits is the correct term, but one of the dirty little secrets of Obamacare is the deal that was cut with the insurance companies so they would go along with it. The insurance companies are guaranteed government subsidies for any losses they take due to reduced premiums to accommodate Obamacare. So of course they don't care what happens to any of us--they'll get paid whether or not the policy holder pays. And just like all other government entitlements, those reimbursements to the insurance companies come out of your and my pockets. And I'm pretty sure its rigged so that the CBO doesn't factor that it when it reports the actual costs of Obamacare and, of course, this is another one of those inconvenient truths that will be under reported by the MSM who does its damndest to prop up leftist policies and programs:

ObamaCare 8217 s insurance company bailout New York Post.

 

[Flopper]

And having a good deal of experience with that, I can say with complete confidence that many MANY unnecessary tests and medical procedures are done and many MANY insurance claims are paid that are not owed, purely because of threatened litigation and the costs of defending those cases would exceed paying the claim that is not owed. And that drives up the basic cost of healthcare for all of us and has driven insurance costs into the stratosphere.

And every time somebody suggests remedying that situation, the trial lawyers, aided and abetted by elected officials who themselves are mostly trial lawyers, will point to the very few cases that go to trial. What we are supposed to believe is that litigation is a tiny part of the medical costs overall. What they don't tell you are the fortunes they are raking in from their clients by just threatening the litigation.

With the onset of Medicare and Medicaid, the deep pockets of government covering those programs has sharply escalated that trend and Obamacare will only worsen it.

THANK YOU!!!!
I've been beating this drum constantly and it appears you are one of the very few that comprehend the magnitude of this gigantic cost driver.
$850 billion a year is what these 90% of physicians admit their reason is fear of lawsuits.
Further proof is this:
Up to 92% of US physicians practice defensive medicine.
76% of physicians report that defensive medicine decreases patient access to healthcare.
53% of physicians report delaying new techniques, procedures, and treatments due to fear of lawsuits.
Patients most affected by defensive medicine include those visiting emergency rooms and those requiring surgery.
Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
BUT NOTE this: "Physicians contracted by the federal government practice significantly less defensive medicine as they are protected
against lawsuits by the Federal Tort Claims Act.
Only 48% practice defensive medicine compared to 92% of non-government physicians.
89% of physicians support a patient’s right to be compensated fairly for true negligence.
SOURCE: Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

And so if government doctors won't be sued because of the Federal Tort Claims Act... why not expand that act to cover the rest of the physicians?
As a result this $850 billion cost would be reduced dramatically.
Then the insurance companies will NOT have claims to pay for these defensive measures and as a result and this is what most people are
grossly uninformed so I'm making it in bold letters!!!

STATE Insurance regulators approve premium increases.
IF insurance companies having to verify their claim costs have gone down, then the states WON"T approve RATE increases but MAY require reductions!

I have worked in both the medical and insurance industries so have some first hand experience. And my hubby is a 40-year experienced all lines general insurance adjuster who has worked hands on all that time and has sufficient credentials and experience that he has been used as an expert by the legal and insurance industries. During the course of this discussion on this thread I asked him his best guess of how many insurance claims are paid for claims the insurance company does not owe just to avoid the cost of litigation. He said he is aware of no hard statistics on that, but his best guess would be at least 50%. And it is an absolute certainty that those costs for products, services, and insurance coverage are passed on to us all.

So, unless the patient gets screwed by not being able to receive compensation for real negligence and injury as a result of it, what does it profit us for the government to assume the risk instead of the insurance companies? Now the government gets to decide who the winners and losers will be? I think most of us can see a real danger there.

The best solution except in the most hardship cases--and those could be judged on a case by case basis--is that if the plaintiff loses the case, he pays the court costs and attorney fees for the defendant or his/her insurance company. That would stop almost all opportunistic litigation in its tracks.

I don't know if you saw my last post...so here are the FACTS NOT guesses and it is BETTER far better then the "best guess of 50%" as there are hard statistics so please go to the below and check out the realities that insurance companies REJECT the FIRST time less then 5% NOT 50%

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf

View attachment 34034

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

I was called by my doctor to remind me of my yearly physical which is the only doctor's appointment I have. So I go in and present my new medical card. New because I was dropped from the old because, according to my company, Obamacare was more affordable, affordable to them. Anyway on the card it says prevenative office visits had a zero copay. The woman at the window says that will be 20 dollars. I point out that it says zero. She says that if the doctor codes it as preventive then I'll get a credit. I asked what else could it be?

So I come out and they charge me the 20 dollars. I say WTF? So they say, OK we will look into it and get back to you, if we coded it wrong we will let you know. Three days later they call and say that he doctor, who did nothing but check me out didn't code it as preventative thus I was charged correctly. They had some BS reasons but I said "HE DIDN'T do anything. Any way it is only 20 bucks but I didn't like their attitude so after 25 years I am going elsewhere.

So no, they are not sure of everyone's policy. I guess when the liberals get what they want and everyone is covered under one plan then they will know.

BTW the insurance company could not of cared less.

All preventive care is not free under Obmacare. Here's what's free:
Preventive care benefits HealthCare.gov

So if you go to the doctor and get a flu shot, pneumonia shot, your blood pressure checked, and cholesterol screening he can not charge you for those services. However, he can charge you for an office visit if anything is done other than delivery of the free preventive care which usually includes questions concerning your health, review of current medications, checking pulse, heart, temperature, etc.

If you go to a doctor and demand only selective preventive no cost services, the doctor most probably would not accept you as a patient because to have a clear picture of the status of your health he needs to be able to do a complete examination which is not free.

The purpose of free preventive care is to remove cost as deterrent so when the patient sees the doctor, he doesn't forgo preventive care due to cost. My son in law's doctor recommended routine colonoscopies since there was a history of colon cancer in the family. If there had been a co-insurance of 20%, about $1,000 I'm quite sure he would have said no. Lucky for him, he had the procedure. They discovered a cancerous polup which was removed and he's doing fine today.

 

[Freewill]

THANK YOU!!!!
I've been beating this drum constantly and it appears you are one of the very few that comprehend the magnitude of this gigantic cost driver.
$850 billion a year is what these 90% of physicians admit their reason is fear of lawsuits.
Further proof is this:
Up to 92% of US physicians practice defensive medicine.
76% of physicians report that defensive medicine decreases patient access to healthcare.
53% of physicians report delaying new techniques, procedures, and treatments due to fear of lawsuits.
Patients most affected by defensive medicine include those visiting emergency rooms and those requiring surgery.
Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
BUT NOTE this: "Physicians contracted by the federal government practice significantly less defensive medicine as they are protected
against lawsuits by the Federal Tort Claims Act.
Only 48% practice defensive medicine compared to 92% of non-government physicians.
89% of physicians support a patient’s right to be compensated fairly for true negligence.
SOURCE: Health News Observer rsaquo Physicians Estimate The Cost Of Defensive Medicine In Us At 650 To 850 Bill Articles

And so if government doctors won't be sued because of the Federal Tort Claims Act... why not expand that act to cover the rest of the physicians?
As a result this $850 billion cost would be reduced dramatically.
Then the insurance companies will NOT have claims to pay for these defensive measures and as a result and this is what most people are
grossly uninformed so I'm making it in bold letters!!!

STATE Insurance regulators approve premium increases.
IF insurance companies having to verify their claim costs have gone down, then the states WON"T approve RATE increases but MAY require reductions!

I have worked in both the medical and insurance industries so have some first hand experience. And my hubby is a 40-year experienced all lines general insurance adjuster who has worked hands on all that time and has sufficient credentials and experience that he has been used as an expert by the legal and insurance industries. During the course of this discussion on this thread I asked him his best guess of how many insurance claims are paid for claims the insurance company does not owe just to avoid the cost of litigation. He said he is aware of no hard statistics on that, but his best guess would be at least 50%. And it is an absolute certainty that those costs for products, services, and insurance coverage are passed on to us all.

So, unless the patient gets screwed by not being able to receive compensation for real negligence and injury as a result of it, what does it profit us for the government to assume the risk instead of the insurance companies? Now the government gets to decide who the winners and losers will be? I think most of us can see a real danger there.

The best solution except in the most hardship cases--and those could be judged on a case by case basis--is that if the plaintiff loses the case, he pays the court costs and attorney fees for the defendant or his/her insurance company. That would stop almost all opportunistic litigation in its tracks.

I don't know if you saw my last post...so here are the FACTS NOT guesses and it is BETTER far better then the "best guess of 50%" as there are hard statistics so please go to the below and check out the realities that insurance companies REJECT the FIRST time less then 5% NOT 50%

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf

View attachment 34034

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

I was called by my doctor to remind me of my yearly physical which is the only doctor's appointment I have. So I go in and present my new medical card. New because I was dropped from the old because, according to my company, Obamacare was more affordable, affordable to them. Anyway on the card it says prevenative office visits had a zero copay. The woman at the window says that will be 20 dollars. I point out that it says zero. She says that if the doctor codes it as preventive then I'll get a credit. I asked what else could it be?

So I come out and they charge me the 20 dollars. I say WTF? So they say, OK we will look into it and get back to you, if we coded it wrong we will let you know. Three days later they call and say that he doctor, who did nothing but check me out didn't code it as preventative thus I was charged correctly. They had some BS reasons but I said "HE DIDN'T do anything. Any way it is only 20 bucks but I didn't like their attitude so after 25 years I am going elsewhere.

So no, they are not sure of everyone's policy. I guess when the liberals get what they want and everyone is covered under one plan then they will know.

BTW the insurance company could not of cared less.

All preventive care is not free under Obmacare. Here's what's free:
Preventive care benefits HealthCare.gov

So if you go to the doctor and get a flu shot, pneumonia shot, your blood pressure checked, and cholesterol screening he can not charge you for those services. However, he can charge you for an office visit if anything is done other than delivery of the free preventive care which usually includes questions concerning your health, review of current medications, checking pulse, heart, temperature, etc.

If you go to a doctor and demand only selective preventive no cost services, the doctor most probably would not accept you as a patient because to have a clear picture of the status of your health he needs to be able to do a complete examination which is not free.

The purpose of free preventive care is to remove cost as deterrent so when the patient sees the doctor, he doesn't forgo preventive care due to cost. My son in law's doctor recommended routine colonoscopies since there was a history of colon cancer in the family. If there had been a co-insurance of 20%, about $1,000 I'm quite sure he would have said no. Lucky for him, he had the procedure. They discovered a cancerous polup which was removed and he's doing fine today.

Sorry that makes no sense. They asked me if I wanted to schedule my next years appointment as preventive. So I said yes. All he did was what you describe above, and checked my prostate. He preformed no procedures, performed no tests other then blood pressure and called me abeast, or something that sounds like that. So what exactly will I miss out on next year? No digital fun?

Besides I assumed it was the Health Insurance that was picking up the 20 dollar co-pay. It really makes no sense if they don't.

OK, on edit, I went and read you link. So as i understand it if i go for a colonoscopy, or anything listed on the site, it is free. If I go in and just have my blood pressure checked it is free. But doing a physical is not. Whow what a system.

Now that you have explain it that makes me want to leave them even more. They have to know that most people do not understand the system and they didn't even take the time you took to explain it. They didn't give a crap if I understood or not all they want to do is bill everyone and make it easy. So when they asked if i wanted to make it prevenative next year they were actually screwing me.

 

[Flopper]

I see ads for signing up for Obamacare. The biggest sales point is that YOU can be eligible for federal help. YOU can become dependent. YOU can have your healthcare dictated to you. It is all up to YOU.

One of the major changes I noticed is the increase in the number of plans on the exchange. In Chicago I found 143 plans. The big surprise is number of higher deductible low cost plans. For a family of two 30yr old non-smokers and a child in Chicago with income of 50,000 family income plans started at $258/mo. Also, there are more zero deductible plans. For the above family, they start $558/mo. For the above family, similar plans start at $210/mo.

 

[Freewill]

I see ads for signing up for Obamacare. The biggest sales point is that YOU can be eligible for federal help. YOU can become dependent. YOU can have your healthcare dictated to you. It is all up to YOU.

One of the major changes I noticed is the increase in the number of plans on the exchange. In Chicago I found 143 plans. The big surprise is number of higher deductible low cost plans. For a family of two 30yr old non-smokers and a child in Chicago with income of 50,000 family income plans started at $258/mo. Also, there are more zero deductible plans. For the above family, they start $558/mo. For the above family, similar plans start at $210/mo.

If those numbers are true and the deductible isn't 6K then that is reasonable. When I went and looked in my area I saw nothing even close to what you are saying. Maybe I need to go and look again.

 

[Flopper]

I have worked in both the medical and insurance industries so have some first hand experience. And my hubby is a 40-year experienced all lines general insurance adjuster who has worked hands on all that time and has sufficient credentials and experience that he has been used as an expert by the legal and insurance industries. During the course of this discussion on this thread I asked him his best guess of how many insurance claims are paid for claims the insurance company does not owe just to avoid the cost of litigation. He said he is aware of no hard statistics on that, but his best guess would be at least 50%. And it is an absolute certainty that those costs for products, services, and insurance coverage are passed on to us all.

So, unless the patient gets screwed by not being able to receive compensation for real negligence and injury as a result of it, what does it profit us for the government to assume the risk instead of the insurance companies? Now the government gets to decide who the winners and losers will be? I think most of us can see a real danger there.

The best solution except in the most hardship cases--and those could be judged on a case by case basis--is that if the plaintiff loses the case, he pays the court costs and attorney fees for the defendant or his/her insurance company. That would stop almost all opportunistic litigation in its tracks.

I don't know if you saw my last post...so here are the FACTS NOT guesses and it is BETTER far better then the "best guess of 50%" as there are hard statistics so please go to the below and check out the realities that insurance companies REJECT the FIRST time less then 5% NOT 50%

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf

View attachment 34034

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

I was called by my doctor to remind me of my yearly physical which is the only doctor's appointment I have. So I go in and present my new medical card. New because I was dropped from the old because, according to my company, Obamacare was more affordable, affordable to them. Anyway on the card it says prevenative office visits had a zero copay. The woman at the window says that will be 20 dollars. I point out that it says zero. She says that if the doctor codes it as preventive then I'll get a credit. I asked what else could it be?

So I come out and they charge me the 20 dollars. I say WTF? So they say, OK we will look into it and get back to you, if we coded it wrong we will let you know. Three days later they call and say that he doctor, who did nothing but check me out didn't code it as preventative thus I was charged correctly. They had some BS reasons but I said "HE DIDN'T do anything. Any way it is only 20 bucks but I didn't like their attitude so after 25 years I am going elsewhere.

So no, they are not sure of everyone's policy. I guess when the liberals get what they want and everyone is covered under one plan then they will know.

BTW the insurance company could not of cared less.

All preventive care is not free under Obmacare. Here's what's free:
Preventive care benefits HealthCare.gov

So if you go to the doctor and get a flu shot, pneumonia shot, your blood pressure checked, and cholesterol screening he can not charge you for those services. However, he can charge you for an office visit if anything is done other than delivery of the free preventive care which usually includes questions concerning your health, review of current medications, checking pulse, heart, temperature, etc.

If you go to a doctor and demand only selective preventive no cost services, the doctor most probably would not accept you as a patient because to have a clear picture of the status of your health he needs to be able to do a complete examination which is not free.

The purpose of free preventive care is to remove cost as deterrent so when the patient sees the doctor, he doesn't forgo preventive care due to cost. My son in law's doctor recommended routine colonoscopies since there was a history of colon cancer in the family. If there had been a co-insurance of 20%, about $1,000 I'm quite sure he would have said no. Lucky for him, he had the procedure. They discovered a cancerous polup which was removed and he's doing fine today.

Sorry that makes no sense. They asked me if I wanted to schedule my next years appointment as preventive. So I said yes. All he did was what you describe above, and checked my prostate. He preformed no procedures, performed no tests other then blood pressure and called me abeast, or something that sounds like that. So what exactly will I miss out on next year? No digital fun?

Besides I assumed it was the Health Insurance that was picking up the 20 dollar co-pay. It really makes no sense if they don't.

OK, on edit, I went and read you link. So as i understand it if i go for a colonoscopy, or anything listed on the site, it is free. If I go in and just have my blood pressure checked it is free. But doing a physical is not. Whow what a system.

Now that you have explain it that makes me want to leave them even more. They have to know that most people do not understand the system and they didn't even take the time you took to explain it. They didn't give a crap if I understood or not all they want to do is bill everyone and make it easy. So when they asked if i wanted to make it prevenative next year they were actually screwing me.

As I said, the purpose of the free preventive care is to make those preventive care procedures free when you visit your doctor, not to make the doctor's visit free.

 

[Flopper]

I see ads for signing up for Obamacare. The biggest sales point is that YOU can be eligible for federal help. YOU can become dependent. YOU can have your healthcare dictated to you. It is all up to YOU.

One of the major changes I noticed is the increase in the number of plans on the exchange. In Chicago I found 143 plans. The big surprise is number of higher deductible low cost plans. For a family of two 30yr old non-smokers and a child in Chicago with income of 50,000 family income plans started at $258/mo. Also, there are more zero deductible plans. For the above family, they start $558/mo. For the above family, similar plans start at $210/mo.

If those numbers are true and the deductible isn't 6K then that is reasonable. When I went and looked in my area I saw nothing even close to what you are saying. Maybe I need to go and look again.

At $258, the deductible is $12,000, $289 for $8,000 deductible, $371 for $4,000, $478 for $0 deductible. I found similar plans in Florida and they were about 20% cheaper. This seems a little less than last year, but it's hard to tell because the plans are different and there's more variation in coverage between the plans.


Health Insurance Marketplace Enroll for 2015 Healthcare Coverage HealthCare.gov

 

[Flopper]

I don't know if you saw my last post...so here are the FACTS NOT guesses and it is BETTER far better then the "best guess of 50%" as there are hard statistics so please go to the below and check out the realities that insurance companies REJECT the FIRST time less then 5% NOT 50%

Without thinking I sure the consequences naive ignorant people like Obama BLAME insurance companies for doing what they are required to do pay claims!
On average The American Medical Association reports that between 1.38% and 5.07% of claims are denied by insurers on first submission.
https://www.optum.com/content/dam/optum/resources/whitePapers/Denial_Management_White_paper.pdf

View attachment 34034

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

Absolutely right about the rejected claims. I know because my business helps providers get paid by Medicare so I'm very knowledgeable about it.
But the point of my comments was the insurance companies are NOT the evil guys the majority of people make them out to be!
99% of the people that work for insurance companies are like you and me. And most people portray insurance companies' executives as making huge
salaries and yes a small handful do! But idiots who have NO idea how health insurance or claims' submission or all the issues involved make these
idiotic comments about insurance companies when IN fact the blame should be place in a large part on the ambulance chasing lawyers that
have created this litigious environment that created the $850 billion in defensive medicine that creates the claims in turn are passed on in the form of
higher premiums. A very vicious cycle that proven by the fact because of the Federal Tort Claims Act has half the amount of doctors responding about
defensive medicine!

Insurance companies like any private enterprise charge whatever the market will bear and will minimize their costs as much as the law and their customers will tolerate. They operate on the same principals as any business. There is nothing wrong with this. It's how our economy works. What is evil is not providing regulations to protect the public from abuses that market forces can not prevent.

Do you see any evil in crafting regulations to specifically exploit customers to give certain companies guaranteed profits?

I don't think guaranteed profits is the correct term, but one of the dirty little secrets of Obamacare is the deal that was cut with the insurance companies so they would go along with it. The insurance companies are guaranteed government subsidies for any losses they take due to reduced premiums to accommodate Obamacare. So of course they don't care what happens to any of us--they'll get paid whether or not the policy holder pays. And just like all other government entitlements, those reimbursements to the insurance companies come out of your and my pockets. And I'm pretty sure its rigged so that the CBO doesn't factor that it when it reports the actual costs of Obamacare and, of course, this is another one of those inconvenient truths that will be under reported by the MSM who does its damndest to prop up leftist policies and programs:

ObamaCare 8217 s insurance company bailout New York Post.

You're speaking of the risk corridor program to stabilize premiums during the first 3 years of the operation of the exchanges. It certainly doesn't guarantee insurance companies a profit.

The insurer may receive a subsidy or may have to pay HHS a portion of the premiums depending on how costs match to targets. The bottom line is that some companies will collect from HHS and other will pay. Most companies will receive or pay HHS very little because they have been able to accurately determine their premiums. Those that receive money from HHS are those companies that end up with sicker subscribers; that is those that establish their premiums too low. Those that pay HHS are those that get healthy subscribers; that is those that have premiums too high above costs. This same program was used when Part D Medicare was started.

The law specifies that insurers that have a ratio of allowable costs to the target amount that is within 3 percentage points in either direction (97-103 percent) will keep all of their profits and be responsible for all of their losses. Insurers with actual costs between 92 percent and 97 percent of the target amount would pay HHS half of their gains within that range, while insurers with costs between 103 percent and 108 percent would be reimbursed half of their losses within that range. Insurers with actual spending below 92 percent of the target amount would refund the federal government 80 percent of those gains within that range.

Conversely, insurers with actual spending above 108 percent would be reimbursed 80 percent of those losses within that range by the government. While the risk corridors are symmetric, the ACA does not require the program to be budget neutral. As a whole, if the market suffers from adverse selection and premiums are inadequate, more payments will go out than are collected. On the other hand, if the market is priced too high, the government will receive more payments than it will spend on reimbursements. Referring to the program as an insurance company subsidy is incorrect.

Without this provision many insurance companies would not offer plans to individuals because they had no data to base their premiums. After 3 years of operation the companies should have a sufficient handle on costs to accurately determine premiums which is why the risk corridor program expires in 2015.

Health Policy Briefs

 

[healthmyths]

My neighbor works in medical billing at a local clinic. She tells me the vast majority of denied claims are clerk or violations of procedures, such as invalid codes, incorrect id's and group numbers. In many cases the insurance company or the provider catches the error and resubmits.

The ACA should eliminate a lot of denials because it forces standardization of plans, making processing easier for both the provider and the company. Prior to the ACA providers were dealing with thousands of plans with large holes in coverage and many ad hoc requirements that made sense only to the insurance seeking to reduce the cost of claims. Today, your doctor is far more likely to know exactly what is covered by your insurance which certainly helps in creating a treatment plan.

Absolutely right about the rejected claims. I know because my business helps providers get paid by Medicare so I'm very knowledgeable about it.
But the point of my comments was the insurance companies are NOT the evil guys the majority of people make them out to be!
99% of the people that work for insurance companies are like you and me. And most people portray insurance companies' executives as making huge
salaries and yes a small handful do! But idiots who have NO idea how health insurance or claims' submission or all the issues involved make these
idiotic comments about insurance companies when IN fact the blame should be place in a large part on the ambulance chasing lawyers that
have created this litigious environment that created the $850 billion in defensive medicine that creates the claims in turn are passed on in the form of
higher premiums. A very vicious cycle that proven by the fact because of the Federal Tort Claims Act has half the amount of doctors responding about
defensive medicine!

Insurance companies like any private enterprise charge whatever the market will bear and will minimize their costs as much as the law and their customers will tolerate. They operate on the same principals as any business. There is nothing wrong with this. It's how our economy works. What is evil is not providing regulations to protect the public from abuses that market forces can not prevent.

Do you see any evil in crafting regulations to specifically exploit customers to give certain companies guaranteed profits?

I don't think guaranteed profits is the correct term, but one of the dirty little secrets of Obamacare is the deal that was cut with the insurance companies so they would go along with it. The insurance companies are guaranteed government subsidies for any losses they take due to reduced premiums to accommodate Obamacare. So of course they don't care what happens to any of us--they'll get paid whether or not the policy holder pays. And just like all other government entitlements, those reimbursements to the insurance companies come out of your and my pockets. And I'm pretty sure its rigged so that the CBO doesn't factor that it when it reports the actual costs of Obamacare and, of course, this is another one of those inconvenient truths that will be under reported by the MSM who does its damndest to prop up leftist policies and programs:

ObamaCare 8217 s insurance company bailout New York Post.

You're speaking of the risk corridor program to stabilize premiums during the first 3 years of the operation of the exchanges. It certainly doesn't guarantee insurance companies a profit.

The insurer may receive a subsidy or may have to pay HHS a portion of the premiums depending on how costs match to targets. The bottom line is that some companies will collect from HHS and other will pay. Most companies will receive or pay HHS very little because they have been able to accurately determine their premiums. Those that receive money from HHS are those companies that end up with sicker subscribers; that is those that establish their premiums too low. Those that pay HHS are those that get healthy subscribers; that is those that have premiums too high above costs. This same program was used when Part D Medicare was started.

The law specifies that insurers that have a ratio of allowable costs to the target amount that is within 3 percentage points in either direction (97-103 percent) will keep all of their profits and be responsible for all of their losses. Insurers with actual costs between 92 percent and 97 percent of the target amount would pay HHS half of their gains within that range, while insurers with costs between 103 percent and 108 percent would be reimbursed half of their losses within that range. Insurers with actual spending below 92 percent of the target amount would refund the federal government 80 percent of those gains within that range.

Conversely, insurers with actual spending above 108 percent would be reimbursed 80 percent of those losses within that range by the government. While the risk corridors are symmetric, the ACA does not require the program to be budget neutral. As a whole, if the market suffers from adverse selection and premiums are inadequate, more payments will go out than are collected. On the other hand, if the market is priced too high, the government will receive more payments than it will spend on reimbursements. Referring to the program as an insurance company subsidy is incorrect.

Without this provision many insurance companies would not offer plans to individuals because they had no data to base their premiums. After 3 years of operation the companies should have a sufficient handle on costs to accurately determine premiums which is why the risk corridor program expires in 2015.

Health Policy Briefs

All of that for less then 4 million people that WERE LEGAL citizens, were not covered by Medicaid and WANTED health insurance!
Wouldn't have been far simpler to tax the lawyers 10% as the tanning salons are taxed in ACA.
The $27 billion in tax revenue would then provide a $5,000 a year premium for any of those 4 million that were uninsured, could not get insurance that wanted insurance.
The 10% tax would be tied to the $850 billion in unnecessary, duplicate tests submitted by physicians that were concerned about being sued...hence
"defensive medicine"!
As the $850 billion decreased because lawyers no longer sued at the drop of a hat, the tax would reduce as an incentive to help reduce premiums that the insurance companies charge because they pay these $850 billion in defensive medicine claims.