I'm not ignoring the rest of your post but this jumped out at me. I have a friend who, as a grad student, was being insured by what turned out to be sequential six month policies. Apparently she let one lapse by a couple of weeks. She went in to have a procedure done that was diagnosed during the previous six month term. They denied the procedure due to it being a "pre-existing condition", even though she had been with the same company for at least the previous three years.
I also agree that the insurance companies should be the focus, not the Dr's offices. By your own description it sounds like you spend more time doing work for or working around obstacles put up by insurers. That's not health care IMO.
That is exactly right!
The worst insurance company out there to get auths with is BC/BS. A patient who gets injured(non emergency) has to have reg xrays, then3-6 wks physical therapy prior to getting an mri. Now, 3-6wks of PT can cost a patient 15-45 dollars a visit for a copay and that is 2-3 visits per week. Of course there still is a percentage of that PT that is not covered and the patient has to pay it. Just crazy.
Kind of off topic and I dont want to have anyone get pissed at this part but this is what bothers me. The US will give medicare to a person who is not a citizen. They have legal residency but are not a citizen. Someone explain that one to me. Then that person applies for disability and gets it! Yes, this is a patient at the office I work in. This patient can not speak any english at all but is covered by medicare with full benefits! Where is the logic with this?
Health care for everyone isnt the issue, the issue Obama needs to work on is the pharmaceutical companies and the insurance companies. They are the ones making health care so expensive with their regulations.
What part of the business are you in or intimate with that you know this?
BTW, the Blues are about 40 different plans, operating independently and largely within state or multi-state boundaries. They can have radically different policies because most regulation is at the state level. Someone not knowing this, or issuing a blanket statement that BC/BS is the worst tells me they are not familiar with the issue and are just throwing out vague claims derived from false or partially true anecdotes.
Also, temporary policies quite explicitly (the ones I've read) call out that they are NOT continuous coverage. Very short-sighted of someone (or their agent) to purchase consecutive temporary coverages. Though in more progressive states these can be counted as continuing coverage credits, the limited benefits of most such contracts makes them not very attractive as a long term solution. They are intended to get a person thru a waiting period (some employers, especially small business, have 30, 60, or 90 day probationary periods), fill in between jobs, cover a person while waiting for approval, etc.
Repurchasing temporary coverage for 3 years running is a very poor choice (to put it in kind words).
Yes, there are obstacles to claims submission; if you call getting it right an obstacle. Want to know the biggest reasons for claims delays/denials? #1, far and away - lack of basic info such as correct patient DOB, place of service, ID# - real tough stuff like that. Thankfully, most of that simple stuff can be figured out from the other field on the claim. #2 is duplicate claims. How fucking hard can that be. Submit once, if nothing seems to be happening, follow up - DO NOT JUST SUBMIT AGAIN! For the plans I've consulted with, 80% of claims are never seen by human eyes, 93% process within 7 days, 98% in 21. Code correctly, don't play games trying to maximize payment, and follow up if there is a delay.
For the vast bulk of services, automated processing ensures accurate and quick handling. The biggest problems are missing info, outdated info, and outright fraud.
I have been working in the medical field front and back office since 2000. I spend 65-75 percent of my time working on auths for referrals when not working directly with patients. I have worked on the West coast of the US and the East coast. Now that you know that, I will correct my statement and say that the majority of BC/BS plain suck ASS! Yes, in the last few years it is much easier to obtain auth's for patients via internet but there are still obsticales you have to go thru- to get things authed. That was my point. Medicaid is easier to get patients in for certain tests.
It isnt getting it right, it is the insurance company wanting the patient to pay out the ass for extra visits they cant afford. The insurance company sets up rules/guidelines so they get more copays.
We can go back and forth on this if you would like but I am sure we have both stated our points to one another about it.
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I love vodka.I love vodka cause it rhymes with Tuaca~LisaH
You having a clean thought is like billyvance having a clean post.iluvtofly
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What part of the business are you in or intimate with that you know this?
BTW, the Blues are about 40 different plans, operating independently and largely within state or multi-state boundaries. They can have radically different policies because most regulation is at the state level. Someone not knowing this, or issuing a blanket statement that BC/BS is the worst tells me they are not familiar with the issue and are just throwing out vague claims derived from false or partially true anecdotes.
Also, temporary policies quite explicitly (the ones I've read) call out that they are NOT continuous coverage. Very short-sighted of someone (or their agent) to purchase consecutive temporary coverages. Though in more progressive states these can be counted as continuing coverage credits, the limited benefits of most such contracts makes them not very attractive as a long term solution. They are intended to get a person thru a waiting period (some employers, especially small business, have 30, 60, or 90 day probationary periods), fill in between jobs, cover a person while waiting for approval, etc.
Repurchasing temporary coverage for 3 years running is a very poor choice (to put it in kind words).
Yes, there are obstacles to claims submission; if you call getting it right an obstacle. Want to know the biggest reasons for claims delays/denials? #1, far and away - lack of basic info such as correct patient DOB, place of service, ID# - real tough stuff like that. Thankfully, most of that simple stuff can be figured out from the other field on the claim. #2 is duplicate claims. How fucking hard can that be. Submit once, if nothing seems to be happening, follow up - DO NOT JUST SUBMIT AGAIN! For the plans I've consulted with, 80% of claims are never seen by human eyes, 93% process within 7 days, 98% in 21. Code correctly, don't play games trying to maximize payment, and follow up if there is a delay.
For the vast bulk of services, automated processing ensures accurate and quick handling. The biggest problems are missing info, outdated info, and outright fraud.
I have been working in the medical field front and back office since 2000. I spend 65-75 percent of my time working on auths for referrals when not working directly with patients. I have worked on the West coast of the US and the East coast. Now that you know that, I will correct my statement and say that the majority of BC/BS plain suck ASS! Yes, in the last few years it is much easier to obtain auth's for patients via internet but there are still obsticales you have to go thru- to get things authed. That was my point. Medicaid is easier to get patients in for certain tests.
It isnt getting it right, it is the insurance company wanting the patient to pay out the ass for extra visits they cant afford. The insurance company sets up rules/guidelines so they get more copays.
We can go back and forth on this if you would like but I am sure we have both stated our points to one another about it.
I love vodka.I love vodka cause it rhymes with Tuaca~LisaH
You having a clean thought is like billyvance having a clean post.iluvtofly