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Demonize Private Insurers For Denying Claims? Better Look Inward…

Beverly Gossage, Research Fellow for Show-Me Institute and founder of HSA Benefits Consulting wondered which insurance companies rejected the most claims. She found her answer in the AMA’s own 2008 National Health Insurer Report Card. The chart below appears on page 5 of the 16-page report.

Here’s the chart…

AMAdenials.jpg

How about that… Interestingly, Stop the ACLU’s headline on this report really does drive home the point: “A Funny Thing Happened On The Way To Demonizing Private Insurance Companies

Funny, indeed… Big Government closes with the following prescient thought.

Of the eight insurers listed, Medicare is most likely to reject a claim, sending away 6.85% of requests. This is more than any private insurer and double that of the private insurers’ average!

In short, the AMA is endorsing a plan whose closest existing example is the most frequent denier of claims. How the public option exemplifies “delivering care to patients” is unclear.

Hard to argue, particularly when the numbers tell the story.

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  • While you're not wrong, there's something interesting to note... In the dicussions, those caveats don't come up until someone points out that Medicare is the undisputed king of claim denials.

    I'd like to see what kind of claims they deny before I make any assumptions on the reasons for those denials.
  • I think there are two things you have to keep in mind. One, Medicare insures a vastly different pool of people than private insurance. Medicare is dealing with people who are closer to the end of life. I'm not an expert but my guess is that influences the type of treatments they are getting. Another guess is that a larger percentage of these treatments are unproven (wouldn't you try anything at that point to improve your health) and lend themselves to being denied.

    Two, private insurers don't have to deal with a lot of these claims because they just don't insure you if you look risky. I don't know of any way that Medicare can discriminate against anyone who is eligible.
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