ONTD Political

Nevermind that Medicare does not deny people coverage for pre-existing conditions, and 6 times as many covered as the next leading insurer.

Also, lol @ the source. So I'm taking this with a grain of salt. Several, in fact.

I think she means biggovernment.com (and I agree, lol @ that source)

Quite so, old chap, quite so. The source of "biggovernment.com" DID prompt me to take this information with a shaker of salt, but facts are facts, and attacking the source who reiterates the numbers simply because it leans a way you don't like won't win you any debates. You have to say, "Okay, this smells fishy, what's the larger context here?" and do some research if you don't already know. gmth already said it better than I would have, but I'll just add that another number to throw into the mix is the level of satisfaction people have with Medicare, but I doubt that'll ever show up on biggovernment.com.

No, biggovernment.com which wrote the article using the data- conveniently comparing apples to oranges. Defenders of Glenn Beck's brand of crazy.

except that in this case, the source is part of the problem -- they present the data without any context.

It's like watching Fox News report on the teabagger's protest march on Washington and then say "Well, it's not THEIR fault that they overestimated the size by 930,000 people." Of course it is.

sometimes a source is so biased, you can't trust anything that comes out of it.

As I said -- Medicare likely turns down more claims because of sheer volume and because they cover the people who aren't covered by anyone else.

I already stated my case- Simply comparing Medicare, which A) only serves a certain part of the population B) Serves 6 times as many participants and C) does NOT deny coverage for pre-existing conditions as other insurers do, makes simply saying "Medicare denies more claims than other health insurers!" misleading and seriously flawed.

And yes, sources matter, so, until I read what the study actually says (a study, after all, done by an organization that by and large supports the idea of either a single payer system or a public option), I'm taking the article with an ocean's worth of salt.

But then again, I'm sure why I'm bothering to argue this with you.

The AMA? You mean one of the organizations that has traditionally been THE biggest roadblock to health care reform?

I'll bet you dollars to doughnuts that a big part of that is because Medicare tends to cover people who are more sick and more elderly.

If the covered populations were the same, the numbers would be different.

go read the comments on the site. THEY certainly believe it.

Gah, Medicare just can't win! One day, conservatives accuse it of massive fraud, and now they're aren't paying for enough procedures...You can't have it both ways.

This is probably because people don't realize Medicare, just like every other insurance plan, doesn't cover absolutely everything. There are certain categories of products and procedures that aren't covered because they may not be medically necessary (e.g., plastic surgery or certain drugs belonging to classes where both generics and incredibly expensive brand names are available; they will always cover the generics but not necessarily the brands). This is true of ALL insurance plans, but people seem to think Medicare covers every drug/device/procedure under the sun and so file for it even if it's not covered. Those claims all have to be denied. The fact that Medicare covers so many people means there are many, many more such claims filed. Seniors covered by Medicare most likely are NOT being denied if the claim is legitimate.

There is also the matter of the "doughnut hole" that our wonderful Congress voted in a few years ago, where seniors get screwed until they meet a certain (very high) level of prescription drug costs in a 12-month period. Those claims are probably all showing up in the "denied" column as well. Talk to your Congressperson about that if you don't like it, don't blame Medicare.

It also occurs to me that Medicare not only covers those with pre-existing conditions, but they can't kick people out of Medicare the way private providers can. The second a customer becomes "too costly" to cover for the private insurance company, they will kick them loose....hence, rather than more denied claims, they simply short circuit that process by pulling their coverage all together.

This is an excellent point, too.

Biggovernment.com is generously supplying this info, huh?

Welp, nothing to do now but join the Libertarian Party I guess. :/

Oh, the group that accused Truman of communism when he pushed for universal health care in 1946 - 1946, and which represents fewer and fewer doctors every year (something like 38% now) - and who are also obsessed with TORT REFORM (trial lawyers!!!!!!!) as a main means of , er, "reforming" heath care? That shitty group? Got it.

Meaningful health care reform finally gets put on the table, here comes biggoervnent,com, bashing Medicare. What a world. I guess they're just sayin', is all.

I'd need to see this study controlled for... like a lot of stuff. Medicare does not cover the same population as private insurance. It's like comparing an inner-city elementary school to a suburban private high school and saying the elementary school is failing because the kids can't read Jane Austen.

gmth pretty much made the point I was going to ask (my initial reply was about what was being rejected... through some really dumb stuff on my part I tried to use my insurance to pay for a basic dental checkup — the rejection was totally because I forgot if my plan covered dental and my dentist figured it couldn't hurt to check. But that would probably show up on this chart as much as when the same insurance said I didn't need anesthesia for surgery).

THAT said, I'll laugh if the Republican party tries to use this as a new talking point, right after Michael Steele said the AMA has no credibility.

EVEN I WOULDNT DO THAT.

no, srsly, i wouldnt.

One quick afterthought too...

I notice the chart says that a denial means anytime they're not charged $0. I wish that partial coverage and outright denial was separate.

The data set is questionable at best. The AMA obtains the data from National Healthcare Exchange Services,
Inc. NHES is an application service provider that provides contract compliance and denial management solutions. Essentially, physicians that have problems getting paid use them to get paid. The data set only involves 7,000 physicians from 27 states, and with regards to their denial analysis, it doesn't look like they attempted to implement any controls. They just looked at all of the denials without regard for other issues that crop up (geography, etc.).

Medicare is available in every state—so for all 27 states that are represented by the data set, Medicare is going to have claims and denials in each state. Private insurance polices are not available in every state. The 2009 report card indicates that Anthem's denials went from 6.8% to 1.8%. Medicare's denials went from 6.8% to 4.0%, with most of the other insurance companies holding steady.

One positive aspect of the report card is that it codes the reasons behind each denial. So, the 2009 report card indicates that 28% of Medicare's denials were denied because the provider sent the bill to Medicare instead of the correct payor contractor. 10% were denied because the patient's name and identification number didn't match. 9% were denied because the doctor didn't provide enough information to determine if the claim was covered. 6.4% were denied because the patient couldn't be identified as insured under Medicare.

Ultimately, the purpose of the report card isn't to figure out who denies more claims via a nationwide analysis. The purpose is to show why claims are being denied in order to better enable physicians to submit claims for services that won't be denied.

When you read a summary of another report, it's really in your best interest to look at the original report instead of accepting what the summary says. For example, if you look at the AMA report's breakdown of the reasons for each insurers denials, you'll see that Medicare's distribution is quite different from the others'. Medicare's top reason for a denial was information is missing. This is not a real denial, it is a denial with a request for more information. There was no follow-up done to see if the claim was actually denied at the end of the process.

This table above is the metric 12 table. The metric 13 table is where the real information is. Look at the distributions starting on page 6* and the following table to get a real idea of what's going on.

* These are some badly done histograms but you can at least get the basic idea of the differences in denial reasons for the various insurers.

meanwhile 100% of uninsured people remain uninsured and cannot claim jack shit.

yeah i know, gmth did it better.

yup wound up being some excellent comments on this =)

Once the claims are approved, does Medicare put people through the same stalling/nickel-and-diming/gotcha-on-a-technicality bullshit that private insurance companies do?

Exactly. Which is why these "sources" are BS.

The AMA has never been a friend of the public.