Sometimes I think I have a staff working for me. Yesterday, I posted an article about how Medicare denies a ton of claims; moreso than any of the largest private insurers (and by a large number, except for Aetna to whom Medicare is pretty close in denial rates). Jeff, a good friend of mine, reacted in the comments with the following:
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.
Hmmm… Maybe he has a point on Medicare. Maybe Medicare isn’t really rationing as much as it appears to be. Maybe I’m wrong.
Back in May, as discovered by a very talented and brilliant friend, the Boston Globe posted an interesting chart showing the number of days doctors wait for payment and the number of claims denied for various Massachusetts insurance providers and whaddya know? Turns out the slowest to pay and the most claims denied are all from the same provider.
I won’t spoil it. Here’s the chart.
Well well well… Will ya look at that?
Now… I’m not picking on Jeff here, but as far as I know, MassHealth doesn’t just predominantly cover end of life care for older people and instead covers everyone, so can we easily explain this one away, too?
I’m not saying we scrap the idea of covering everyone, but these really are the kinds of things we need to be discussing before we rush ahead to just “pass the bill already.” This isn’t the kind of thing where we can afford to shoot first and ask questions later.