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When you compare HD readers on subjects like Social Security, health care, retirement, saving and investing, 401k, managing money and all that goes with those topics, with the general public, well, there is no comparison. HD readers know their stuff or know when to ask when they aren’t sure of the facts.
And, of course, discussions, even disagreements remain civil – except maybe when I write about my theory of retirement income replacement. 😎.
I scan several social media sites each day. The comments about the subjects I mentioned are startling. They are uninformed to the max, perhaps intentionally misleading and display a frightening ignorance on the subjects, especially Social Security, health care and saving for retirement in general.
Did you know Social Security would be fine except Congress stole the money? I bet you didn’t realize health insurance companies intentionally deny claims so their CEO can have a private jet.
Very sad indeed.
Social media has a high content tone lamenting that things are too tough, unfair and the wealthy take it all – everything would be fine, if we just taxed the wealthy more.
I wonder how these people function today, let alone in future retirement.
All this babble would be harmless except for the fact policymakers are influenced by mass media, right or wrong. Future changes to SS, retirement plans, health benefits, even taxes may be affected.
I’m guessing many in the HD community are the prudent savers, investors and planners with above average incomes and net worth who may be most affected in the future by poorly designed changes – based on ignorance.
My primary insurance is Medicare and secondary is United Healthcare. I do not have any experience of denied care from United Healthcare.
Not really same comparison as Medigap just spins off the Medicare EOB to UHC and I Medicare allowed so must UHC or any Medigap insurer.
Apparently a lot of people feel they are paying a lot (US most expensive health care in the world) but aren’t receiving care with insurance companies playing games and denying care. Wars have been started with similar beliefs.
They do, but they are looking in the wrong place. No insurance company can deny care, no insurance provides care.
I remember the days back in the 1960s when our insurance covered only fixed number of hospital days and in-patient physician services. Fixed amount for X-rays and lab work per year.
No coverage for any other services even prescriptions and yet we still went to the doctor and took medication. Now a $20 co-pay is unacceptable. You expect me to spend my money?
We have become so insulated from costs, we think it should all be “free.”
Can you reconcile your statement with the 2022 report by the Office of the Inspector General?
Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care
Our case file reviews determined that MAOs sometimes delayed or denied Medicare Advantage beneficiaries’ access to services, even though the requests met Medicare coverage rules. MAOs also denied payments to providers for some services that met both Medicare coverage rules and MAO billing rules. Denied requests that meet Medicare coverage rules may prevent or delay beneficiaries from receiving medically necessary care and can burden providers.
https://oig.hhs.gov/reports/all/2022/some-medicare-advantage-organization-denials-of-prior-authorization-requests-raise-concerns-about-beneficiary-access-to-medically-necessary-care/
First, “sometimes” second MA is managed care that will be far more strict than regular insurance.
Yes, they and all insurance screws up at times. In this case not following Medicare rules. Hospitals are criticized for not following the rules too, so has Medicare by the GAO for not following its own rules and for not attempting to manage claim claims.
That is far from a general pattern of intentional denial of valid claims. MA plans in many cases are overpaid by Medicare, but that’s another issue.
No system works without limits, there are no blank checks as some people seem to feel they are entitled to.
Many claims are not a simple yes or no, eligible or not. They don’t fit into a perfect template, there is judgement involved, even difference of opinion.
If any plan has a pattern of intentional denial of legitimate claims, it should be put out of business.
There is a lot of unnecessary care provided in this country- some estimates by doctors of up to 25% How do we deal with that?
I love reading your posts! They often “hit on a nerve” as evidenced by the comments here. I think we each have our own biases, and social media too often takes the filter off and nakedly displays those biases – warts and all. I look forward to reading HD every day because, even when the conversation gets a little heated, the comments (at least those that get published) are thoughtful and respectful.
As a recently retired gastroenterologist I’ll offer my two cents. The denial of care was a real thing. Of course we had the right to appeal a denial and to discuss the case with a “peer reviewer “. Usually this would involve me explaining a highly complicated inflammatory bowel disease patient experiencing complications and why a particular treatment or course of action was recommended. The “peer” would usually be a retired GP who didn’t know what the hell I was talking about and more often than not would deny the request based on what his “handbook said”. United Healthcare was the worst. After so many of these denials I simply gave up which I’m sure was their goal all along.
This post was not about health care. However, is it your position that what you describe is routine, part of a business model, that insurers plan their income on denying claims? How many claims submitted went through on a routine basis?
i thought I posted the above on your forum post from yesterday. Hard to tell whether it was a fat finger error or an iPad gremlin. You are correct, the majority of claims went through routinely. However those that were flagged were inevitably expensive alternatives for my sickest patients who needed them. The time and effort it took to appeal their decisions were onerous and often led me and my colleagues to abandon the effort. I don’t think that was accidental. In addition United Health Care and others had “ report cards” for their customers for physicians who exhibited “best practices”. Translation: the cheapest care.
People tend to equate price with quality. I recall one claim where our coverage would not pay for a NYC obstetrician charging extremely high fees. There was no medical reason like complications, the wife of our employee just wanted to go to “the best.” Upon investigation over the claim it turned out the high fee doc was also the subject of several malpractice claims. I don’t think your conclusion that cheap is a best practice criteria is correct. Besides how do we measure the quality of care for an individual physician?
“This post was not about health care.”
I think that would be an example of something being incorrectly coded…valid comment in the wrong thread/category.
Even here on HD, is a post about “health insurers denying claims” where the supporting “backstory” is an ad from an injury attorney!? I guess we all have our own sources of “the truth” and where we do our research for being informed.
Are you going to tell us what the truth is?
One way to think about the opinions of others, especially that of pundits, is to ask yourself whether or not they have skin in the game. I tell people all the time to be careful who you vote for, and be careful where you get your news from. Now more than ever, we need to have a healthy skepticism about what we see and hear. Arguably, critical thinking has never been more important and I’m afraid many in our great country lack even basic skills in this area.
I totally agree that social media is to blame for much of our misunderstanding. I don’t post political stuff on Facebook, still, somehow FB knows that I’m a Democrat and supplies me with all the left wing posts I could ever want (I don’t want any of it) and no or very little right wing stuff. Those posts are like mini-editorials that at best only present one view, and at worst promote half-truths or lies. I’m sure the right wing posts are no better.
At lunch last week with old friends, I was asked how tax on SS worked. Over my shoulder, another guy injected that there would soon be no tax on SS. I opined that I didn’t think that would come to pass and explained the 3 sources of spending, how eliminating that source of funding would accelerate the depletion of the trust fund, and the likely effect it could have on our benefits if other solutions were not made. In response he launched into thigs like aid to Ukraine and people in North Carolina without homes. While those issues are worthy of our attention, I’m still trying to figure out their connection to SS.
Flip side, the internet has made more people, more aware of what is actually happening than ever before.
Sometimes yes, but going down a rabbit hole of internet links from sources with an agenda doesn’t make one more aware, it’s just confirming biases.
2 things that are true at the same time. We are living in the most info available era by far. That doesn’t mean we’re immune from confirmation bias. Confirmation bias pre-existed the internet and social media, I don’t think it’s going anywhere.
Agreed Scott
The internet, possibly. Social media, not so much.
I find Twitter and how it’s allowing information flow that bypasses major media (that was very comfy curating and setting the agenda for everyone) fascinating and likely for the good.
The resistance to Twitter is almost exclusively driven by the classes of people that used to wield the power that Twitter is taking away.
I’m also starting to find the open long form interviews found on YouTube to be very informative. That type of info is simply unavailable in the legacy media.
So I think that SM perhaps gets a bad label mainly because of the way people use it. There’s good there if you’re willing to ferret it out.
I’ve never had a FB account. Or Instagram or Tik-Tok for that matter. I gave up on Twitter early on because it took up so much time. I’m sure my life is more peaceful as a result.
Typical response you received and based on a lack of knowledge or gained from fake or biased “news.”
I visit HD daily because there is so much about personal finance I simply don’t know.
And HD is a great resource.
No one on here writes like they have “The Answer”. It’s refreshing.
Perhaps that’s why this little corner ofthe internet is titled “HUMBLE Dollar”.
Sadly, this is the strategy McKinsey recommended to insurers. Here’s the backstory. It’s an accepted fact now that this is going on. The extent, absolute level of malfeasance, is what is uncertain.
A really simple solution would be requiring an appeals process that requires outside examination. Requiring that the Ins Co turn over their files to someone else for review. One has to wonder why the ACA didn’t make this a requirement.
Allstate for Pete’s sake? They are not a major health insurer. Allstate Health Solutions is focused on providing supplemental and short-term coverage options to individuals and associations.
Did you put this on wrong post? I just realized
Accepted fact? I disagree. There is too much discretion in medical care, too many variables and opinions for what is and is not necessary and appropriate care.
There is a formal appeals procedure under federal law including third party review and for insured plans, most states have a commission to complain to as well.
‘’Keep in mind that 65% of workers are in self-insured plans where the insurance company processing claims has no financial stake in spending.
I was involved in claim processing and appeals for decades, denial and necessary care are not always what they seem, especially when the patient’s point of view is their insurance should pay for anything and everything, no questions asked. Of course, they don’t want those payments reflected in premiums.
On top of that, federal law requires a minimum loss ratio of 80% meaning 80% of premiums must be spent on claims and services to the insured.
Are you denying the reality that the largest most influential business and management consulting group created a report that encouraged insurance companies to engage in the “deny, delay, deter” process.
If you are then you’re engaging in willful disbelief and there’s nothing else to say (facts however inconvenient are facts)
I’m denying that insurance companies have a policy or practice to deny eligible claims. To do so would involve compromising the integrity of claim examiners, physician and other reviewers.
They are required to spend a minimum on claims as a percentage of premium ir refund. Profit margins are around 6%. The law outlines a required appeal procedure so there are checks.
Are there screwups, some claims denied (or approved for that matter) incorrectly, sure. Is there a grey area regarding medical necessity? Absolutely.
is a significant percentage of care provided unnecessary? Yup
What’s unknown is who is doing what and how pernicious it is. But it’s kind of a built in problem when you enshrine a middle man as cost manager in health care, the middle man will be motivated to hit their sweet spot maximize their profits.
So, if there is an area of judgement like the length of post hospital non-custodial care or even define medical care versus custodial care like a nursing home, what do we do, always pay?
maximizing profits is based on maximizing the number of insured and hoping you have a good risk pool thus attracting good low cost risks. It’s not based on denying a few large claims. The more insured the better you are. There is no percentage in denying valid claims, too many risks.
consumers will always side with the provider regardless because nobody wants to have any third party interfere. In addition, we have lost the concept of insurance covering unforeseen significant risk in favor of covering everything 100%.
This is incorrect. The entire process enables denying valid claims via the appeals process. There is zero risk in denying a claim, because the appeals process puts the onus on the insured to follow up.
If 1-5% of an insurers claims generate 10-25% of the losses (entirely likely). And of those claims, half of them have multiple treatments and that they can range from x to 10x in cost. It becomes clear that there’s a no risk path to higher profits.
They can deny those claims knowing they’ll approve the appeal. Why? Because it will eliminate some percentage of people that won’t appeal, saving money and knowing that the appeals cost them close to nothing.