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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: skinowski who wrote (7523)	7/14/2009 9:44:24 AM
From: i-node	Read Replies (1) \| Respond to of 42652

We often see changes in coverage or in billing requirements where nobody knows stuff changed. You just keep filing it as you always have and they deny it. At first you think they made a mistake and resubmit it, then you try changing things on the claim to make it go through, you call and get no help, before you know it six months has elapsed. Happens all the time. A year or so ago they, out of the blue, started requiring certain lab results on some nephro/onco claims. It probably took on average six months for people to figure out what they wanted it and a couple more for me to figure out where they want the data on the claim and to get the software modified to provide that data.

To: skinowski who wrote (7523)	7/14/2009 11:54:07 AM
From: Lane3	Read Replies (1) \| Respond to of 42652

I remember many examples. Here is one. That is an example of something they don't cover. I appreciate that they changed their policy from covering it to not covering it and that you didn't know about the change or they didn't give enough lead time on the change, but that's a different problem from denying a claim arbitrarily. And whether or not this or that ought to be covered is also a different problem. As I said earlier, it's my understanding that if they cover X and don't cover Y, then all the X's get paid while all of the Y's are denied. Mindlessly. That will continue to be my understanding until I see an example of arbitrary rejection of claims.