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Denial of claims can have ripple effect
Monday, Nov. 9, 2009 | 2:03 a.m.
I enjoyed reading the Las Vegas Sun’s Friday editorial “Seeking insurance reform: Las Vegan’s story should persuade lawmakers to back affordable health care.”
As an associate professor of physics at UNLV, I frequently travel with my students to x-ray synchrotron facilities to do experiments (more than 100 trips made). On one such trip, I developed severe conjunctivitis (“pink eye”) and worried that my students, the local staff and later my family would catch this highly contagious disease.
So I called my insurance provider and was told to go to the nearest urgent care center. There, I received an antibiotic eye drop prescription that I immediately filled at a neighboring pharmacy. No one close to me developed pink eye and our experiments succeeded.
Even though I mailed the necessary documentation and explanation of my urgent care visit for reimbursement, my claim was incomprehensibly denied ($60 from a $75 visit) due to an incorrect billing code in the receipt. To recoup the $60, I would have to return to the clinic in Chicago, waste my precious time, explain what I didn’t fully understand, request a new bill with proper billing code, and then re-request reimbursement from my insurance company — all on my own. I let the issue go.
Now, based on this negative experience, I must weigh the need for treatment away from home (if needed) with the likelihood of nonreimbursement. When insurance companies nickel and dime their patrons to the extent that they must think twice about getting treatment, we will all suffer as a society from epidemics such as H1N1, which are abated with rapid treatment.
Instead of my insurance provider thanking me for saving it (and society) significant money by rapidly resolving my condition, I was penalized because I was “out of network.” What, then, is the purpose of insurance?
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"my claim was denied ($60 from a $75 visit) due to an incorrect billing code in the receipt..."
So Michael Pravica thinks his insurance company should pay a invalid claim no matter what and he has no role to play.
The answer to Michael Pravica $60 mistake is a $1.2 Trillion bill for the rest of us. On 11-7-2009, in a midnight vote, the Nancy Pelosi House passed her 2% solution.
So for $1.2 trillion dollars and 1990 pages the CBO is telling us we are getting:
- 98% of the people NOT covered by the public option
- 29 million NOT covered by health insurance
- A wait time of 6 months if you have a pre-condition
- installs a "Payment Advisory Commission" (wage, price, and rationing control board)
- $490 billion taken away from senior's Medicare
- $280 billion NOT paid to Doctors for services rendered
- A new 5.4% surcharge tax on small businesses
- A new 5.4% income tax surcharge
- Mandatory changes to current insurance policies in five years
- Insurance premium increases
- It does NOT include tort reform to save money
- It does NOT allow plans to cross state lines
- It does NOT reduce the cost of healthcare providers
- It does NOT have a enforceable Individual mandate
- It does NOT allow for catastrophic" healthcare policies.
- It does NOT preclude cost shifting.
- It does NOT impose tort reform to reduce defensive medicine.
Does your car insurance cover the cost of new windshield wipers? Health insurance is so expensive because people expect it to cover relatively minute expenses such as this.
The UNLV insured's copay for an in network urgent care visit in Las Vegas is $45. It appears you had to pay $60 for out of network. All this fuss over $15. I'm glad you were put out of your itchy, oozing eye misery for such a small amount of money. Perspective, my dear lad.
Talk show host Rusty Humpheries, heard on kdox radio in town, filed bankrupcy because of his late wife's medical bills, yet the dittohead opposes healthcare reform. I pay more for my insurance and medical care because uninsured dittoheads file BK on their medical bills and the healthcare providers pass the costs on to the insured or those with the ability to pay.
If you think that is bad......you should hear the horrible stories about Medicare and Medicaid billing nightmares.
digger:
Three years ago, the copay was $15 for urgent care out of network. Regardless of the copay, you missed the point of the letter. Why have insurance at all if you're not covered for mishaps regardless of where they happen? For many in this city, $60 is alot of money. Nickel and diming may bring us some nasty epidemics - just watch as less and less Americans can afford any health care.
Most insurance does not cover everything. Usually there are deductibles, limits of liability, exclusions and items not covered. Read your policy...
Medicaid is available for those who can legitimately not afford to pay for health insurance on their own.
Future:
I would much rather that we divert the many trillions of squandered dollars spent in Iraq, Georgia, Afghanistan, and Kosovo toward healing our country, investing in science and technology, and rebuilding the crumbling infrastructure of our decaying nation. When we cease the Quixotic adventures of our politicians, then let's talk about how to save money in health care for our nation.
You can't pick and chose how your tax dollars are being spent. If you don't like a particular cause or expenditure, contact your elected representatives and voice your opinion to them.
LarryVegas:
My insurance covers out of network urgent care visits. I was approved to go immediately to an urgent care facility in Chicago over the phone. Yet somehow, the insurance still managed to deny my claim. No one told me about being careful in the "billing code" for my receipt neither did my insurance offer any help to me to resolve the issue. If a person with a Ph.D. in physics has a hard time understanding the bureaucratic tangle of "insurance policy/coverage," what does that say about the vast majority of the "insured" who are not lawyers?
LarryVegas:
That's why I write letters to the editor. And I always encourage my fellow Americans to do the same - that's what debate is all about.
Health Care insurance, auto insurance, homeowners insurance, they all have 1 thing in common;
If you file a claim, it will be dissected for ways to deny payment. If the insurance company does pay, they will then raise your rates, AND they will decide whether to drop your coverage outright.
What kind of "insurance" is that, I ask you?
It's basically "PAY YOUR EVER-INCREASING PREMIUMS, AND PAY ON TIME! DO NOT ATTEMPT A CLAIM OR YOU WILL SUFFER CONSEQUENCES!"
Government run health care and affordable health care are two different things.
We do need affordable health care. How about we start by getting government out of the racket? Eliminate taxes on insurance policies, eliminate mandates, and lift restrictions on insurance competition.
Hey gmager... Welcome to the real world. Nobody guaranteed that it would be fair and easy. Oops, I guess the Democratic Party wanted us all to believe that life would be fair and easy if they were in charge...
Just remember. "Change that we can believe in..."
Insurance companies deny nearly 200 million claims for essential medical services per year. This combined with denial of coverage for the sick has caused millions of bankruptcies through the years. Medical debt and job loss are near the top of the list as causes for bankruptcy in the US. In addition Law firms,the court system, collection agencies siphon off billions going after people that can't pay bills that should be going to take care of the sick. A surgery clinic in Florida has a unique way of treating spinal injuries.I was going to go to get an old injury fixed. When i called my insurance to ask about reimbursement they quoted $200-$250 on a $40,000 surgery. I have paid into the system for over 40 years and never had a serious claim. The first time i want to use it this is what i get.
Insurance companies that refuse medical bills are useless. Get rid of them.
Doesn't anyone but me read our insurance contracts?
I have read and know what is and is not covered under my automobile policy. Same goes for our homeowners policy and our health insurance policies.
If I do not like the premiums, coverages, exclusions and deductibles, I look for another company.
If an insurance company does not pay per their contract, each state has an insurance department complete with Insurance Commissioner who will handle your complaint.
Other then whole life insurance, I know of no other insurance that you build up a cash balance. Insurance is an expense, not a savings account. I have had GEICO auto insurance for over 20 years without any claims other than a windshield or two. But I know that if I have several at fault accidents or tickets, I may be canceled at renewal.
Insurance is spreading the risk over a larger group to match premiums with claims. If you are in a group or a company with a high claim rate, they will either raise premiums or eliminate those risks who are causing high claims.
If you are a high risk person you should and will pay a higher price for your insurance...
Good God Larry; You are a shill for greedy insurance companies now? Whoa!
Let me tell ya somethin' there, Lar...
One of the MAIN REASONS we will have health care reform in America is because the greedy insurance companies
ARE RIPPING YOU OFF. And people are FED UP with it. K.O.?
Now, go back to your spin machine and whip us up another whopper!
LarryVegas.....people don't have to have a car. Health care is essential for survival. If your a high risk person you can't get medical coverage for chronic disease in anything other than employer based coverage or the govt.if you have exhausted all financial resources. The insurance provided by the largest employers like Walmart and Mcdonalds is dismal to say the least. Ask anyone that works for these companies who is seriously ill.
A health care system that discriminates against the sick and charges astronomically high prices will go bust eventually. I think the 30-40 trillion in med bills over the next 10 years is the straw that will break the camels back.
"Ask anyone that works for these companies who is seriously ill." Anyone???
If health care is essential for survival, then why do so many who could afford health insurance do not want to purchase health insurance? And how about all those who qualify for medicaid but don't bother to sign up for it because it is easier for them to just to show up at an emergency room.
One of the main reasons will have health care reform in America is because of greedy people who want something for nothing.
And since it was mentioned... It's a lot cheaper to not pay for health insurance and if a medical situation arises, just go bankrupt...
You do not need a government takeover of our health care system to obtain health insurance coverage for those who can't afford it, or obtain health insurance for those who have pre existing conditions.
It's all a matter of self respect and individual determination...
Until you get the freeloaders out of the health system, we, and I do mean we, will be paying more for our health insurance because of the cost of these freeloaders. So there...
LarryVegas...People who are healthy don't buy insurance because they want to roll the dice. They think they will stay healthy and not need it. The problem is illness affects the entire population. Cancer and heart disease alone kill off huge segments of the population at a cost of trillions over time. Just the average cost for care in the last 20 years of life is over 500k. Everybody gets sick eventually, everyones gotta pay. It's the people and employers that refuse or provide substandard coverage that are blowing up the entire system.
Insurance companies have stated publicly numerous times they can't cover the sick without getting premiums from the healthy.They need 100% participation. If insurance won't cover the sick and individuals can't pay trillions in bills who is left if not government.
Larry,
Ghostcommander & zippert1 are pointing to some trees in the forest. There are many.
Why is it the RIGHT cannot see the forest for the trees?
"Insurance companies have stated publicly numerous times they can't cover the sick without getting premiums from the healthy.They need 100% participation."
Exactly right...
Safe drivers with few claims are mixed in a pool of basically safe drivers. Some have no claims and some have a few claims. Our insurance premiums are based on the average of the group.
Drivers out there without insurance causes our premiums to raise because we carry uninsured coverage and have to use our collision coverage when an uninsured causes an accident. The more uninsured drivers out there the more our premiums will raise to make up for their lack of personal responsibility.
Same for the health insurance industry. Those without insurance cause premium increases for those with insurance.
So, get those without insurance covered but don't make the rest of us pay for it by a federal takeover of our health care system...
Larry,
The Mob has stated that they can't cover expenses unless they get 100 percent participation in their protection racket.
You must pay the vig, or Guido will come see you.
Capiche?
If there is a way to get near 100% compliance in private insurance pools it can work. This is exactly how they do it in Switzerland. Private insurance pays ALL bills and the government makes sure EVERYBODY pays into the system. In the US you can't get everybody to get a drivers license. I don't know how we can force everyone to get insurance. The freeloader issue is the big problem. If that can be solved the private sector is capable of handling the whole issue with very little government. This could include medicare,medicaid,work comp...the whole ball of wax.
The reason I want a Medicare card for all is because it's funded through payroll. People can't cheat.
In auto insurance there is what is known as assigned risk. If you have a DUI and four or five moving violations the state assigns you to an insurance company who must cover you. Of course since you are a bad risk you must pay through the nose for it, but it is available.
Why should some 500 pound alcoholic with a multitude of self induced problems get the same coverage at the same price as someone who takes good care of their health. It makes no sense to me.
gmag,
I am prepared to pay the protection money. Just tell Guido to bring a pizza when he comes to collect. Will Guido be bringing Harry with him? My dog needs to maul a politician before Thanksgiving...
Larry,
I'm afraid Guido will be bringing Senator Ensign
Bone Appetito.
zippert1 - You stated "The insurance provided by the largest employers like Walmart and Mcdonalds is dismal to say the least. Ask anyone that works for these companies who is seriously ill."
I work for Wal-Mart (they are self-insured) and I'd like to hear the facts you have to back up your statement. Be careful now, double-check your facts because I have great coverage.
All of these problems would be eliminated with
single payer. People in Canada have no medical bills or co-pays. They also live longer then us.
How stupid are we?
The teamster is correct when he says that "All of these problems would be eliminated with single payer."
And I know that ALL, and I mean ALL of our problems would go away...