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Politics : Formerly About Advanced Micro Devices -- Ignore unavailable to you. Want to Upgrade?

To: Road Walker who wrote (380081)	4/24/2008 12:15:09 PM
From: michael97123	Respond to of 1578290

Though most of this is above my pay grade, I tend to believe you but go with I-Node because i just cant see the govt doing anything well. Medicare is about to be overrun by boomers and medicaid does not work well at all. In NJ there are few doctors who even accept medicaid forcing 90 year olds to somehow travel to newark or trenton where there are customers to get medicaid services. In some cases these folks just cant do it. I know-- i have an cousins in this boat trying to help their parents.

To: Road Walker who wrote (380081)	4/24/2008 12:47:11 PM
From: i-node	Read Replies (2) \| Respond to of 1578290

I was talking to a front office medical person the other day and she said the first function of insurance companies was to find any reason to deny a claim. We see this happen in one circumstance -- where the claims are filed on paper, which all insurance companies are trying to get away from. So, it isn't unusual to see a paper claim returned as "unprocessable" -- in many instances, for bogus reasons. That said, our customers consistently see a 98-99% approval/payment rate on electronic claims. A few have problems, but that is generally because they have someone who doesn't understand the medical coding/billing process doing the work. When a knowledgeable person is doing the billing, almost all claims will be approved on the first submission. With the systems we now use, when there ARE problems, we generally know it same day, the claims can be fixed and resubmitted that day. If someone is telling you claims are being denied without cause the problem is almost assuredly a personnel problem, not an insurance problem. That's an administrative cost on both ends, multiplied by millions of doctor visits. Then you have the insurance company profits, their sales and marketing costs, and their huge executive salaries. No other industrialized country has these costs... and their system cost half as much. Coincidence? I'll strike the "coincidence" because it assumes a premise which just isn't accurate. I think what you're not getting is that it isn't administrative costs" that drive up private health care. It is the fact that private insurers subsidize government payers. Without private insurers, who pay at least 133% of Medicare for most procedures, and typically 160% or more, the health care system COULD NOT FUNCTION. Take for example a physician who sees ONLY Medicare/Medicaid patients. At most, he'll be able to earn $100-120K/year (which is why no physician would do this) -- and he'll deal with quadruple the red tape in addition. This isn't sufficient to entice new physicians to spend 10 years after high-school to do this job (the same concept applies to hospitals and other facilities). So, health care will suffer over time. You cannot start making changes to this system without exposing the entire system -- the best in existence -- to potentially serious problems. When you move more coverage to government payors, you cut physicians' pay and hospital profits and you cannot expect health care excellence from people who aren't adequately compensated. As to the efficiency of systems, I can give you many, many examples where Medicare/Medicaid are total flops from an efficiency point of view. But private insurers simply cannot do this -- they do not wield the power of Medicare, and providers can simply say, "We don't deal with that insurer because they don't pay their bills". A provider cannot do this with Medicare because he needs Medicare patients to cover the fixed operating costs of his practice. It is, in effect, the commercial insurance company that enables providers to earn any profit at all.