Zikan posted:

i'm sure it will be fi

https://twitter.com/scottwongDC/status/857285713326460930

clockworkjoe posted:

My fear is Trump and Price sabotage the ACA so badly that it will be essentially repealed anyway. Then they'll offer a similar lovely plan to the AHCA that is an improvement over the heavily sabotaged ACA and try to use that as a bludgeon against the Democratic party.

DaveWoo posted:

https://mobile.twitter.com/Phil_Mattingly/status/857619846883946496

Pollyanna posted:

This is basically what's gonna happen. All this whinging over the current attempt at passing the AHCA is a smokescreen to hide Price gutting the ACA. We're fighting the wrong battle.

DaveWoo posted:

https://mobile.twitter.com/Phil_Mattingly/status/857619846883946496

quote:

LA Times Article: http://www.latimes.com/business/lazarus/la-fi-lazarus-healthcare-crazy-insurance-system-20170428-story.html

He's covered, he makes his payments and his insurer still drags its feet

Most attention on the healthcare front has been focused on Republicans’ single-minded efforts to eviscerate Obamacare. Largely overlooked has been the frustration Americans with employer-based coverage often face in dealing with tight-fisted insurers.

For the roughly 150 million workers and family members covered by employers, healthcare all too frequently is an obstacle course of denied claims, bureaucratic headaches and go-slow tactics intended only, or so it seems, to boost insurers’ bottom line.

Eagle Rock resident Peter Vandeventer is a good case in point. For months he’d been doing battle with Health Net, which covers about 3 million Californians.

The Woodland Hills company dragged its feet in paying hospital bills that accrued after Vandeventer’s son was attacked in New York and required extensive facial-reconstruction surgery.

Vandeventer contacted me after being informed by a doctors’ group at the hospital, New York-Presbyterian/Columbia University Medical Center, that it was done trying to squeeze money out of Health Net. The hospital told him it would instead hold his son responsible for thousands of dollars in outstanding bills.

“These bills aren’t our responsibility if we’re insured,” Vandeventer, 64, told me. “I’m getting screwed around and I don’t like it.”

He’s president and chief executive of a Los Angeles organization called Community Partners, which helps nonprofit groups get off the ground. He and nearly four-dozen staffers, along with family members, have group coverage through Health Net.

I think Health Net is delaying this because that’s just how they do business.

“I checked on how how much we pay to Health Net annually,” Vandeventer said. “Last year it was $362,000 in total premiums.”

Not the sort of customer you’d think a major insurer would play games with. Yet that’s what he said was happening.

Vandeventer’s 21-year-old son, Ethan, a Fordham University student, was hit from behind and knocked out in September while walking in the Bronx. It was apparently a robbery attempt, although the young man wasn’t carrying a wallet or any valuables at the time.

After regaining consciousness, Vandeventer said, his son made his way to his apartment and tried to sleep off the attack. By the next day, it was clear he was in bad shape.

He went to Fordham’s emergency medical services office, which took one look at his swollen face and transported him immediately to New York-Presbyterian/Columbia.

The young man required more than three hours of surgery to repair his shattered right cheekbone. The medical care was excellent and a full recovery is expected.

Vandeventer said Health Net had no problem paying about $4,500 for most of the emergency-room procedures. However, the insurer was balking at the $5,000 anesthesiology tab.

Vandeventer called the hospital’s billing department and learned that Health Net first had insisted that the bill contained an incorrect code. A new bill was submitted. Then, he was told, Health Net contended it never received the second bill, even though it was sent by registered mail.

Vandeventer reached out to Health Net for some answers. He said no one could tell him why the anesthesiology bill remained unpaid.

I fared no better. Brad Kieffer, a Health Net spokesman, declined to discuss Vandeventer’s situation with me, even though both Vandeventer and his son had submitted privacy waivers granting him permission to do so.

“I think Health Net is delaying this because that’s just how they do business,” Vandeventer said. “I think their routine is to wear down the medical service provider to the point where they’ll say, ‘OK, we’ll take whatever.’”

John Romley, a healthcare economist at USC, said that even though New York-Presbyterian/Columbia is an out-of-network hospital for Health Net, “emergency care is usually the least contested.”

Like Vandeventer, he speculated that Health Net may have been deliberately tapping the brakes to try to get a lower price from a facility it has few dealings with.

“If they don’t have a lot of business there, they don’t have a lot to lose,” Romley said.

I don’t think any of us would mind if such money-grubbing was confined to the corporate players in the drama. But it’s not. Vandeventer’s son was caught in the crossfire.

If the hospital turned over its bills to a debt collector, the young man could see his credit score get trashed.

This is an example of healthcare consumers doing everything right — they’re insured, they’ve never missed a payment, they’ve helped expedite the billing process — and still being punished because the hospital and insurer can’t agree on who gets the bigger pile of cash.

It’s also an example of a business apparently only doing what’s right after the prospect of a public shaming arose.

The day after I contacted Health Net, Vandeventer received a call from a senior dispute-resolution official at the insurance company informing him that the anesthesiology bill would be paid immediately.

A spokeswoman for the Columbia doctors’ group subsequently confirmed to me that a payment was in the works.

Again, this isn’t a story about problems with Obamacare. This is America’s primary form of health insurance — employer-based group coverage — coming up short for customers in good standing.

And this isn’t just about the Vandeventers. I’ll bet many people reading these words have had some beef with a health insurer at some point, despite dutifully paying all premiums and deductibles.

As Vandeventer told me, patients should never have to fight fair treatment “when that should be the presumption.” And he asked: “What about the family less knowledgeable and for whom navigating a corporate bureaucracy is unfamiliar or intimidating?”

Sadly, that’s what our profit-hungry healthcare system is counting on.

Avalanche posted:

The problem is, no individual patient can typically front the money for a prolonged legal battle with a massive corporate insurance company

eviltastic posted:

Why on earth would they be fronting costs? Bad faith claim denial is like the poster child for getting a plaintiff side firm salivating over a contingent fee contract. Insurers are one of few entities that regularly get dinged with hefty punitive damages even in states with really conservative or hostile juries. Is there something different about the medical context?

esquilax posted:

Medicare FFS denies just as many claims as other insurers, and I've never seen any evidence that shows insurers deny more claims when they have a profit motive (insured plans) versus when they don't have a profit motive (employer self-funded plans).

For some reason my google skills are failing to find an AMA Health Insurer Report Card that's more recent than 2012, but those tend to have good stats on claim denials

Ze Pollack posted:

esquilax posted:

Medicare FFS denies just as many claims as other insurers, and I've never seen any evidence that shows insurers deny more claims when they have a profit motive (insured plans) versus when they don't have a profit motive (employer self-funded plans).

For some reason my google skills are failing to find an AMA Health Insurer Report Card that's more recent than 2012, but those tend to have good stats on claim denials

Hieronymous Alloy posted:

Medicare and.medicaid have better and easier processes to contest care denials, though. Or at least they did in the past, they're kinda getting cut apart.

eviltastic posted:

Yeah, I know all that. You see things like that in lots of individual insurance markets. It doesn't explain why a firm would refuse to handle it on a contingent fee contract.

e: some quick googling is finding me plenty of firms scattered around that claim expertise in the area of health insurance coverage litigation and are advertising on a contingent fee basis.

Ze Pollack posted:

Miraculously, overnight Cigna's claim denial rates went from a claimed 2% to 21%. Funny how that happens.

Hieronymous Alloy posted:

This is assuming people realize they can go to a lawyer, do in fact manage to contact said lawyer, and explain themselves well enough to said lawyer that he or she takes their case.

eviltastic posted:

Yeah, I know all that. You see things like that in lots of individual insurance markets. It doesn't explain why a firm would refuse to handle it on a contingent fee contract.

e: some quick googling is finding me plenty of firms scattered around that claim expertise in the area of health insurance coverage litigation and are advertising on a contingent fee basis.

dalstrs posted:

Maybe Texas is different but several years ago I tried to find a lawyer for this. It is incredibly hard to find one who does the work and none of them would work on contingency. I seem to remember being told by a couple that here they can't get enough from the insurance companies, beyond what they are supposed to pay, to pay for their time.

silence_kit posted:

I think insurance companies often get to be the Boogeyman in these kinds of discussions. We in the US are taught from a young age that doctors and healthcare providers are altruistic and always have the patients' best interests in mind, and so they tend to get passed over when discussing why healthcare costs so much in the US.

Hieronymous Alloy posted:

I would not be surprised at all if the primary direct cause of most improper denials was simple confusion and staff improperly trained and applying incorrect standards.

But there is no incentive to fix such issues if their existence is profitable.

Hieronymous Alloy posted:

I would not be surprised at all if the primary direct cause of most improper denials was simple confusion and staff improperly trained and applying incorrect standards.

But there is no incentive to fix such issues if their existence is profitable.

quote:

FreedomWorks, the Tea Party-aligned outside group, beginning next month will be organizing rallies and urging its nearly 6 million activists to turn out at town hall events to ensure members of Congress are also getting an earful from ObamaCare detractors.

“There will be more grassroots hand-to-hand combat than we’ve seen in Washington for a long time,” FreedomWorks President and CEO Adam Brandon said Monday during an interview in his office near the Capitol.

“The conservative [lawmakers], they need to see us out there pushing. And if they see that, they’ll be bold,” he continued. “If they don’t see grassroots there on the ground, they’ll start slipping.”

clockworkjoe posted:

I wonder what happened to this: http://thehill.com/homenews/house/319314-right-set-to-fight-back-on-town-hall-protests


Could the tea party be slipping in power and influence?

cis autodrag posted:

It's worth noting that a lot insurers will deny by default any claim with even a slight error on it and since they don't have to send a remittance until the claim is clean and truly paid or denied the doctor is basically the one stuck talking to random insurance staff until they figure out what was wrong with the claim.

clockworkjoe posted:

I wonder what happened to this: http://thehill.com/homenews/house/319314-right-set-to-fight-back-on-town-hall-protests


Could the tea party be slipping in power and influence?

Ogmius815 posted:

But that's fair because the doctor's office usually submitted the claim, so the mistake is quite probably their fault.

cis autodrag posted:

It's really dumb game playing poo poo a lot of the time though like "ssn address and birthday match but you spelled it Shawn instead of Sean in the name field so gently caress you waste lots of time fixing this."

If they only denied for significant errors I'd agree with you.

Night10194 posted:

They claimed my doctor only said I had arthritis so they just assumed it was rheumatoid and refused to give me the medication I'd been prescribed for my psioriatic arthritis. This went on for like 4 months until my doctor managed to hammer into the insurer what I had.

HAP was not eager to have to pay out for humira pens, no sir.

cis autodrag posted:

Sounds like your insurer was pretending the last icd 10 deadline extension didn't happen. I work in the industry (on claims software. Yeah I feel bad every day). There's a laundry list of bs errors they can play games with if they feel like it.

Night10194 posted:

That was like 2 years ago, and the nice part is as soon as I got the stuff it basically turned me from crippled to 'I can't do a pushup but I can do everything else' so that's been nice. Also, you gotta make a living.

cis autodrag posted:

Yep, they were definitely ignoring the icd 10 extension.

hobbesmaster posted:

You're saying that the insurer caused this mess because they truncated the input to just "arthritis"?