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Zikan posted:i'm sure it will be fi Yesss.....they are becoming sentient. obligatory fat woofer Hastings fucked around with this message at 21:40 on Apr 26, 2017 |
# ? Apr 26, 2017 21:38 |
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# ? May 28, 2024 14:37 |
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https://mobile.twitter.com/Phil_Mattingly/status/857619846883946496
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# ? Apr 27, 2017 18:25 |
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clockworkjoe posted:My fear is Trump and Price sabotage the ACA so badly that it will be essentially repealed anyway.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. 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.
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# ? Apr 27, 2017 18:34 |
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So just straight up admitting that death is preferable than living under republican rule. Well at least they are being honest about it at least.
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# ? Apr 27, 2017 20:22 |
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The GOP healthcare plan: deathiscertainwizard.png
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# ? Apr 27, 2017 20:24 |
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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. It's not a smokescreen, it's Trump refusing to accept a loss and screaming at the GOP to keep trying until they get it right. They'll try to gut it anyway, but this is not a calculated maneuver.
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# ? Apr 27, 2017 20:29 |
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Lol at people with substance use problems spending $20,000 per year on healthcare. This plan will preserve Medicare solvency the hard way.
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# ? Apr 28, 2017 01:03 |
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https://twitter.com/BraddJaffy/status/857782117287301120
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# ? Apr 28, 2017 03:31 |
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Insurance companies don't have to pay out poo poo if they don't want to and there is virtually nothing that can be done to stop them from breaking their contractual obligations.quote:LA Times Article: http://www.latimes.com/business/lazarus/la-fi-lazarus-healthcare-crazy-insurance-system-20170428-story.html This is a HUGE problem for smaller local hospitals and private practices that don't have an army of lawyers on staff. Lets say you are a private practice physician that does everything by the book, follow your patient's and all patient insurance company guidelines for documentation of an appointment/procedure, follow the coding guidelines of an appointment/procedure, maybe even follow Medicare guidelines which are the strictest guidelines for reimbursement and what every private insurance company partially models their payment structure after. You see your patient, evaluate/treat your patient, submit all the correct ICD codes and documentation, and submit a claim to the patient's insurance company for payment. You then receive a fax a day later saying "PAYMENT DENIED". What can you do? 1) Bill your patient directly which typically means the patient will just go to collections, never pay you anything, and you end up providing hundreds to thousands of dollars of testing and care essentially for free. 2) Nothing. There is no enforcement, oversight, or regulation process ensuring that insurance companies hold up their end of the contract with the patient and with the provider. They don't have to pay anything if they don't want to and the only way to make sure they do is to sue their asses. The problem is, no individual patient can typically front the money for a prolonged legal battle with a massive corporate insurance company and no private practice doctor/small hospital can do so either. Lately, many private insurance companies have been taking advantage of Trump's rhetoric and have been denying claims outright just because they know there will be no recourse. Example with terrifyingly enough, minimal hyperbole: "Hi, I'm some dumbshit rep with FYGM insurance. I see you submitted a claim to get paid for an office visit and the claim was denied. Even though your patient has had COPD for the past 15 years, has had prior testing confirming the diagnosis, has been actively treated for years, and COPD by definition is a chronic, permanent affliction, we are not going to cover your office visit, the patient's medications, etc. because maybe the COPD fairy came along and the patient is now cured. Also, we need updated imaging and lung function tests done to cover COPD-based care but we're not going to cover those tests either because that kind of stuff is only approved for people who have active COPD which your patient may or may not have. Also, we're just going to ignore NIH, WHO, and AMA guidelines+recommendations completely which specify in great detail what testing must be done to properly diagnose a condition and what treatments must be provided to optimally treat a condition because we have someone on staff with a masters degree in psychology that says COPD can be effectively treated with Tylenol. And gently caress you, give us more money." Medicare, an evil bloated inefficient GUBMUNT program, is actually more efficient and is paying providers better than many private insurance companies. They even have a nice appeals process with denied claims and pretty much cover everything as long as their guidelines are met. Now if you're part of a massive hospital group with a colossal law team on staff, these assholes will be less likely to pull this kind of poo poo, but not always as in the above article. How can these companies be held accountable? Free market bullshit doesn't work here: "Well, I'm gonna quit my job and get a new job because my employer sponsored plan is with Anthem and Anthem loving sucks. That'll show em! O wait, every employer in the state has a plan under Anthem. Well, I'm going to move to a different state and get a new job because Anthem sucks! The free market works!" Avalanche fucked around with this message at 12:13 on Apr 28, 2017 |
# ? Apr 28, 2017 12:03 |
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The best thing to do would be to get rid of margin billing so insurance companies can't gently caress over the people they're supposed to be insuring
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# ? Apr 28, 2017 12:31 |
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Avalanche posted:The problem is, no individual patient can typically front the money for a prolonged legal battle with a massive corporate insurance company 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? eviltastic fucked around with this message at 16:17 on Apr 28, 2017 |
# ? Apr 28, 2017 16:14 |
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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? There's an awful lot of ways to drag your feet, no standardized recordkeeping protocols so proving bad faith is incredibly hard, and it turns out betting on sick/dying people not having enough energy to exhaust their legal options is a lot safer than you'd expect. At the end of the day, if I told you 15% of the time you spun the wheel you made 100K, 83% of the time you lost a couple thousand bucks worth of employee time, and 2% of the time you lost 400K, you start spinning that wheel and you don't stop spinning it any time soon. There's a reason for the direct relationship between number of claims denied and executive compensation in the health insurance industry.
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# ? Apr 28, 2017 16:30 |
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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
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# ? Apr 28, 2017 16:49 |
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). 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.
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# ? Apr 28, 2017 16:55 |
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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. eviltastic fucked around with this message at 17:04 on Apr 28, 2017 |
# ? Apr 28, 2017 16:58 |
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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). Only one state mandates that insurers back up their numbers with anything more than "we say so," and it's Vermont. Law went into effect back in 2013. Miraculously, overnight Cigna's claim denial rates went from a claimed 2% to 21%. Funny how that happens.
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# ? Apr 28, 2017 16:59 |
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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. I thought I read somewhere that the ACA's external review process was working pretty well. If the new process has been shown to be insufficient or biased I'd definitely be interested in reading more. Maybe that only applies to patients though, not sure about the initial process on the provider side.
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# ? Apr 28, 2017 17:13 |
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. 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. None of those are given, and statistically the insurance industry profits at each hurdle, because each hurdle causes a certain percentage to stumble. Our legal system shuffles a lot of costs onto those least able to bear them, by design.
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# ? Apr 28, 2017 17:16 |
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Ze Pollack posted:
I think I'm missing where your article says the 2 to 21% thing. Not that the the high administrative denial rate isnt terrible in itself.
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# ? Apr 28, 2017 17:20 |
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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.
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# ? Apr 28, 2017 17:20 |
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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.
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# ? Apr 28, 2017 17:26 |
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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. 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.
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# ? Apr 28, 2017 17:39 |
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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. Insurance is mainly regulated by the states so of course you're getting hosed in Texas.
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# ? Apr 28, 2017 17:41 |
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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. Docs and healthcare providers are scum (like all humans), but there are more functional medical institution regulatory structures, and it's often easier to spot physician harms when they operate within an institution. State level physician regulation is definitely a gaping hole, though. The direction of interests is such that individual hospitals are rarely true moral monsters as overarching institutions. That tends to be 1. individual people at the middle level operating hospitals, and 2. the ancillary systems that crop up in badly regulated states, like Discendo Vox fucked around with this message at 19:03 on Apr 28, 2017 |
# ? Apr 28, 2017 18:59 |
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.
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# ? Apr 28, 2017 19:05 |
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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. That is a common problem in the industry right now. Providers have zero incentive to fix lovely and inaccurate billing systems when they can externalize the cost by having patients go through the process of resolving the problem. Medical billing is a huge cluster gently caress because until the ICD10 rollover a huge number of providers had created their own coding systems. The lookups and crosswalks between their internal systems and the ICD9 payers were using was garbage. Hopefully forcing native compliance should resolve those issues. In time forcing everyone to use the same code set should and finally digitizing should resolve most of those problems. Shocking as it may be but even in 2008 most of the billing side in hospitals was still done on dead trees.
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# ? Apr 28, 2017 19:18 |
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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.
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# ? Apr 28, 2017 19:47 |
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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. This is me right now. I'm being denied an emergency visit for antibiotics and pain medicine for a mouth infection that flared up. I have a separate dental plan and had scheduled a dental visit the next day but the pain became unbearable late in the night. For a doctor to look into my mouth for 3 minutes and write the prescription I now look at paying the full $450 for the visit. Had the pain came from another region it would be fine but the mouth counts as dental which isn't part of my employer's plan, yet the drugs were covered... So yeah, and this is with the essential health benefits we already have. Just imagine the shitshow if AHCA gets passed.
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# ? Apr 28, 2017 23:43 |
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I wonder what happened to this: http://thehill.com/homenews/house/319314-right-set-to-fight-back-on-town-hall-protestsquote: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. Could the tea party be slipping in power and influence?
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# ? Apr 29, 2017 07:58 |
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clockworkjoe posted:I wonder what happened to this: http://thehill.com/homenews/house/319314-right-set-to-fight-back-on-town-hall-protests I'm sure conservatives will have a lot to say about these literally paid protestors
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# ? Apr 29, 2017 08:22 |
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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. But that's fair because the doctor's office usually submitted the claim, so the mistake is quite probably their fault.
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# ? Apr 29, 2017 16:25 |
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clockworkjoe posted:I wonder what happened to this: http://thehill.com/homenews/house/319314-right-set-to-fight-back-on-town-hall-protests There were a couple of decent articles on this, but the short form is that the Tea Party as a coherent political entity died and died ugly around the 2012 elections, replaced by the Tea Party as lucrative grifting opportunity. There's nobody giving the Freedom Caucus marching orders beyond a vague sense of fundamental malevolence.
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# ? Apr 30, 2017 00:52 |
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Ogmius815 posted:But that's fair because the doctor's office usually submitted the claim, so the mistake is quite probably their fault. 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.
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# ? Apr 30, 2017 04:00 |
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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." 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.
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# ? Apr 30, 2017 04:12 |
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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. 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.
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# ? Apr 30, 2017 04:19 |
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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. 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.
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# ? Apr 30, 2017 04:21 |
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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. Yep, they were definitely ignoring the icd 10 extension.
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# ? Apr 30, 2017 04:29 |
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cis autodrag posted:Yep, they were definitely ignoring the icd 10 extension. You're saying that the insurer caused this mess because they truncated the input to just "arthritis"?
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# ? Apr 30, 2017 05:17 |
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hobbesmaster posted:You're saying that the insurer caused this mess because they truncated the input to just "arthritis"? For reference, each month's supply of this drug costs 6000 dollars from my pharmacy, so by managing to deny me for 4 months my insurer saved 24,000 dollars. I mean, I assume that's why they do that because every single financial incentive in insurance is to cover as little as possible as infrequently as possible.
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# ? Apr 30, 2017 05:37 |
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# ? May 28, 2024 14:37 |
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Aren't they required to pay out 80 percent of premiums as healthcare anyway? How do they meet that standard while doing this?
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# ? Apr 30, 2017 06:38 |