Health insurance went up? Blame...

[kallend 2,175]

...the company.

My wife is an MD who recently gave up clinical practice to work for a big health insurance company.

The company has now decided that when coverage is denied on account of not meeting the terms of the policy (more often than you might think)** that they now need 2 separate letters, one for the attending physician and one for the insured patient. Each has to be vetted by the legal team. The one for the patient has to be checked to use language no higher than 5th grade level, and to be "ethnically appropriate".

Note that NONE of this is required by the ACA. The company just decided to do it.

** Most of the claims denied are requests for extended hospitalizations at $5,000/day, not on account of medical necessity, but typically because "Mrs Smith's husband doesn't like having to cook for her...".

...

The only sure way to survive a canopy collision is not to have one.

[RonD1120 62]

Look for the shiny things of God revealed by the Holy Spirit. They only last for an instant but it is a Holy Instant. Let your soul absorb them.

[airdvr 210]

kallend

...the company.

My wife is an MD who recently gave up clinical practice to work for a big health insurance company.

The company has now decided that when coverage is denied on account of not meeting the terms of the policy (more often than you might think)** that they now need 2 separate letters, one for the attending physician and one for the insured patient. Each has to be vetted by the legal team. The one for the patient has to be checked to use language no higher than 5th grade level, and to be "ethnically appropriate".

Note that NONE of this is required by the ACA. The company just decided to do it.

** Most of the claims denied are requests for extended hospitalizations at $5,000/day, not on account of medical necessity, but typically because "Mrs Smith's husband doesn't like having to cook for her...".

Strange that none of what you write here has anything to do with health insurance going up. It does however, point to the failure of the education system in the states despite union's best attempts. Hmmm.

Please don't dent the planet.

Destinations by Roxanne

[SkyDekker 1,465]

airdvr

***
...the company.

My wife is an MD who recently gave up clinical practice to work for a big health insurance company.

The company has now decided that when coverage is denied on account of not meeting the terms of the policy (more often than you might think)** that they now need 2 separate letters, one for the attending physician and one for the insured patient. Each has to be vetted by the legal team. The one for the patient has to be checked to use language no higher than 5th grade level, and to be "ethnically appropriate".

Note that NONE of this is required by the ACA. The company just decided to do it.

** Most of the claims denied are requests for extended hospitalizations at $5,000/day, not on account of medical necessity, but typically because "Mrs Smith's husband doesn't like having to cook for her...".

Strange that none of what you write here has anything to do with health insurance going up. It does however, point to the failure of the education system in the states despite union's best attempts. Hmmm.

You think that having every letter vetted by a lawyer does not effect costs?

[airdvr 210]

SkyDekker

******
...the company.

My wife is an MD who recently gave up clinical practice to work for a big health insurance company.

The company has now decided that when coverage is denied on account of not meeting the terms of the policy (more often than you might think)** that they now need 2 separate letters, one for the attending physician and one for the insured patient. Each has to be vetted by the legal team. The one for the patient has to be checked to use language no higher than 5th grade level, and to be "ethnically appropriate".

Note that NONE of this is required by the ACA. The company just decided to do it.

** Most of the claims denied are requests for extended hospitalizations at $5,000/day, not on account of medical necessity, but typically because "Mrs Smith's husband doesn't like having to cook for her...".

Strange that none of what you write here has anything to do with health insurance going up. It does however, point to the failure of the education system in the states despite union's best attempts. Hmmm.

You think that having every letter vetted by a lawyer does not effect costs?

No, I think having 2 letters vetted by an on-staff legal department has no effect on the cost.

Please don't dent the planet.

Destinations by Roxanne

[SkyDekker 1,465]

airdvr

*********
...the company.

My wife is an MD who recently gave up clinical practice to work for a big health insurance company.

The company has now decided that when coverage is denied on account of not meeting the terms of the policy (more often than you might think)** that they now need 2 separate letters, one for the attending physician and one for the insured patient. Each has to be vetted by the legal team. The one for the patient has to be checked to use language no higher than 5th grade level, and to be "ethnically appropriate".

Note that NONE of this is required by the ACA. The company just decided to do it.

** Most of the claims denied are requests for extended hospitalizations at $5,000/day, not on account of medical necessity, but typically because "Mrs Smith's husband doesn't like having to cook for her...".

Strange that none of what you write here has anything to do with health insurance going up. It does however, point to the failure of the education system in the states despite union's best attempts. Hmmm.

You think that having every letter vetted by a lawyer does not effect costs?

No, I think having 2 letters vetted by an on-staff legal department has no effect on the cost.

Oh, you think there are only 2 letters in total. That explains it. You may want to re-read the original post.

[airdvr 210]

SkyDekker

************
...the company.

My wife is an MD who recently gave up clinical practice to work for a big health insurance company.

The company has now decided that when coverage is denied on account of not meeting the terms of the policy (more often than you might think)** that they now need 2 separate letters, one for the attending physician and one for the insured patient. Each has to be vetted by the legal team. The one for the patient has to be checked to use language no higher than 5th grade level, and to be "ethnically appropriate".

Note that NONE of this is required by the ACA. The company just decided to do it.

** Most of the claims denied are requests for extended hospitalizations at $5,000/day, not on account of medical necessity, but typically because "Mrs Smith's husband doesn't like having to cook for her...".

Strange that none of what you write here has anything to do with health insurance going up. It does however, point to the failure of the education system in the states despite union's best attempts. Hmmm.

You think that having every letter vetted by a lawyer does not effect costs?

No, I think having 2 letters vetted by an on-staff legal department has no effect on the cost.

Oh, you think there are only 2 letters in total. That explains it. You may want to re-read the original post.

Quote

2 separate letters, one for the attending physician and one for the insured patient. Each has to be vetted by the legal team.

Where does it say different?

Please don't dent the planet.

Destinations by Roxanne

[SkyDekker 1,465]

airdvr

***************
...the company.

My wife is an MD who recently gave up clinical practice to work for a big health insurance company.

The company has now decided that when coverage is denied on account of not meeting the terms of the policy (more often than you might think)** that they now need 2 separate letters, one for the attending physician and one for the insured patient. Each has to be vetted by the legal team. The one for the patient has to be checked to use language no higher than 5th grade level, and to be "ethnically appropriate".

Note that NONE of this is required by the ACA. The company just decided to do it.

** Most of the claims denied are requests for extended hospitalizations at $5,000/day, not on account of medical necessity, but typically because "Mrs Smith's husband doesn't like having to cook for her...".

Strange that none of what you write here has anything to do with health insurance going up. It does however, point to the failure of the education system in the states despite union's best attempts. Hmmm.

You think that having every letter vetted by a lawyer does not effect costs?

No, I think having 2 letters vetted by an on-staff legal department has no effect on the cost.

Oh, you think there are only 2 letters in total. That explains it. You may want to re-read the original post.

Quote

2 separate letters, one for the attending physician and one for the insured patient. Each has to be vetted by the legal team.

Where does it say different?

The bolded part.

[Bignugget 0]

For each case.

Of which there are (apparently) a lot of.

[billvon 3,132]

>No, I think having 2 letters vetted by an on-staff legal department has no effect on the cost.

It is precisely this attitude that leads to absurd healthcare costs.

"I think having 2 letters vetted by an on-staff legal department has no effect on the cost. It's only two letters."

"Having procedure codes instead of descriptions has no effect on the cost. Heck it will probably REDUCE costs."

"Publishing procedure code definitions has no effect on the cost. It's just a few pieces of paper."

"Establishing a procedure code exception review process has no effect on cost. Takes a doctor five minutes."

"Having a set of forms to apply for a procedure code exception has no effect on cost. It's just a few pieces of paper."

"We should have to get a doctor's approval before you can get the forms to apply for the procedure exception, to avoid wasting everyone's time. Heck, that will probably save money too."

And the next time you want to get treatment for a problem, and have to see a doctor just to get the FORMS, you'll have yourself to thank.

[airdvr 210]

Bignugget

For each case.

Of which there are (apparently) a lot of.

Possibly. More probable are form letters that needed to be vetted. If it truly is 2 letters reviewed by the legal department for each request then there are also possibilities; 1) the company is run by idiots 2) the company operates in the legal gray area and needs to play CYA when dealing with these types of requests 3) there aren't that many of these types of requests.

Please don't dent the planet.

Destinations by Roxanne

[kallend 2,175]

Surgeons:
www.cbsnews.com/8301-505269_162-57609052/surgeon-salesmen-doctors-profit-from-devices-they-put-in-patients/

...

The only sure way to survive a canopy collision is not to have one.

[regulator 0]

Just wait until all the 20 and 30 somethings who are healthy get notified their premiums just went up and they instead choose to pay the fine and NOT have insurance. If the government gets a massive dose of that they will not be able to float obamacare and it will completely crash. Won't that be fun to watch.

[mirage62 0]

Quote

>No, I think having 2 letters vetted by an on-staff legal department has no effect on the cost.

It is precisely this attitude that leads to absurd healthcare costs.

I'd see this as the company NOT wanting to get SUED which is a different issue all together. It effects cost of course but it a problem that the insurance company has to take into account.

Kevin Keenan is my hero, a double FUP, he does so much with so little

[Bignugget 0]

regulator

Just wait until all the 20 and 30 somethings who are healthy get notified their premiums just went up and they instead choose to pay the fine and NOT have insurance. If the government gets a massive dose of that they will not be able to float obamacare and it will completely crash. Won't that be fun to watch.

I saw you post this a couple times.

You theorize that '20-30 somethings' who currently have health insurance that meets the mandate will CANCEL their health insurance....pay a fine...and walk around uninsured.....because their premiums increased?

[regulator 0]

Why pay for insurance when you arent sick? I never opted to pay the extra money for health insurance until I was 38. Never got sick, used the other money for weed and strippers. Money well invested.

[Bignugget 0]

regulator

Why pay for insurance when you arent sick? I never opted to pay the extra money for health insurance until I was 38. Never got sick, used the other money for weed and strippers. Money well invested.

No problem.

That was your priority and choice.

Now you live with the consequences of your choices and priorities.

Personal responsibility.