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Politics : A US National Health Care System?

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To: skinowski who wrote (7521)	7/14/2009 7:54:32 AM
From: Lane3	Read Replies (2) of 42652

"Regular" Medicare intervenes quite regularly by simply denying payment - AFTER the fact. On what basis do they do that? My understanding is that they cover X and not Y. If you bill for Y, they will deny it. If you bill for X, they will pay it mindlessly. I didn't think they had any mechanism for paying for your X but not my X, for example. Since I've been under Medicare I have gotten two notices that they were billed for Y when Y is not covered. And that, since they presume that I didn't have any way to know that Y was not covered, I am not obligated to pay the provider for it. But they go on to say that now I know so if it happens again, I'm stuck with paying. So it seems to me that they place the burden on the provider to know what is covered and what isn't. I don't know that I would construe that as "simply denying payment - AFTER the fact." If you have examples of arbitrary denials, I'd be interested. (I would not let the bills go unpaid. If Blue Cross didn't pick them up, I would pay them, assuming they were appropriate charges for services I approved.)

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