Thread: Medicare Biggest Denier of Care

According to page 5 of the 2008 Health Insurance Report Card released by the American Medical Association, the “carrier” with the highest percentage of denials is…..Medicare. www.hsabenefitsconsulting.com/2009/10/05/which-health-insurance-carrier-denies-the-most-claims/

Metric 5—Contracted payment rate adherence
Description: On what percentage of records does the payer’s allowed amount equal the contracted payment rate?
Source: MITSI
Payer
Count of records
Contracted payment rate adherence percentage
Date range
Aetna
78,650
70.78%
02/01/08 – 03/31/08
Anthem
29,497
72.14%
02/01/08 – 03/31/08
CIGNA
28,072
66.23%
02/01/08 – 03/31/08
Coventry
4,919
86.74%
02/01/08 – 03/31/08
Health Net
Not reported
Not reported
02/01/08 – 03/31/08
Humana
11,833
84.20%
02/01/08 – 03/31/08
UHC
134,542
61.55%
02/01/08 – 03/31/08
Medicare
898,672
98.12%
02/01/08 – 03/31/08

Apples and oranges.

Originally Posted by chairmanoftheward

Apples and oranges.

This is true. However, the numbers of claims denied are collected by the companies themselves. Can we really trust companies to be honest in regard to the numbers that make them look bad?




The issue of claims surfaced recently in California. The state Nurses Association issued a press release saying that data it obtained from the Web site of the state's Department of Managed Health Care showed that in just the first half of 2009, California's six largest HMOs had rejected more than 31 million claims -- 21 percent of those they had received.

Feel free to respond to what I posted.

Why does Medicare pay what they're requested to pay 98% of the time, while private insurers only pay that amount roughly 70% of the time?

Originally Posted by standing0

Feel free to respond to what I posted.

Why does Medicare pay what they're requested to pay 98% of the time, while private insurers only pay that amount roughly 70% of the time?

Already did dumbass. Medicare dictates what it will pay not what actual cost is. Another example of plans to deny care. "The 2010 rules, which will be finalized next month, visit an 11% overall cut on cardiology and 19% on radiation oncology. They're targets only because of cost: Two-thirds of morbidity or mortality among Medicare patients owes to cancer or heart disease." Todays WSJ Couldnt get link to fire

Now you can respond to what was posted why does medicare have such high denial rate?

Originally Posted by chairmanoftheward

Now you can respond to what was posted why does medicare have such high denial rate?

Take a good, hard gander at metric 13.

No answer... what a surprise.

Originally Posted by chairmanoftheward

No answer... what a surprise.

No answer? More likely you chose not to look.

Medicare's #1 denial reason:

27.8% Claim/service lacks information which is needed for adjudication