Patrick Tuohey of biggovernment.com reports that AMA-endorsed Medicare denies 6.85% of all medical claims, more than any private insurer surveyed and almost double the rate of all private insurers combined.
The AMA represents only 29% of physicians according to it’s own numbers.
What appears to be the official blog of President Obama’s administration is all aflutter because the President will welcome, “doctors from across the United States to the White House to share their unique perspective on the struggles that American families face every day when it comes to health care.” (They posted today’s agenda in the name of transparency!)
The post even links to a National Public Radio (NPR) story in which a survey of medical professionals indicates they are among the biggest supporters of the so-called “public option.” A co-sponsor of the study, Dr. Alex Federman, indicates that, “physicians favored Medicare when it came to delivering care to patients. They thought Medicare was better when it came to autonomy and their decision making and their ability to get patients the care that they thought the patients needed.”
Furthermore, the American Medical Association (AMA) has endorsed the public option after an appeal from the President and despite, according to ABC News, the fact that “some member physicians at the group’s annual meeting [in June] likened the notion to communism.”
Beverly Gossage, Research Fellow for Show-Me Institute and founder of HSA Benefits Consulting wondered which insurance companies rejected the most claims. She found her answer in the AMA’s own 2008 National Health Insurer Report Card. The chart below appears on page 5 of the 16-page report.
Of the eight insurers listed, Medicare is most likely to reject a claim, sending away 6.85% of requests. This is more than any private insurer and double that of the private insurers’ average!
In short, the AMA is endorsing a plan whose closest existing example is the most frequent denier of claims. How the public option exemplifies “delivering care to patients” is unclear.
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A little-known fact about Medicare, the Federal health insurance program for millions of elderly and disabled people: Claims are reviewed and paid by private insurance companies serving as agents of the Federal Government, and their standards vary from place to place…Most people think of Medicare as a Federal program with uniform benefits nationwide. But we are learning that Medicare is really a crazy quilt of separate and dramatically different programs run by 34 private insurance carriers.
And what’s interesting is how denial rates vary from state to state and even within states. For example:
An older woman whose doctor prescribed a diagnostic mammogram to detect breast cancer was 180 times more likely to have a claim denied in Southern California than in Northern California or in North Carolina, the auditors said.
Likewise, for angioplasty, a technique for opening clogged blood vessels, Medicare denied 1,824 claims as unnecessary for every 10,000 approved in Southern California. Denial rates in North Carolina and Wisconsin were about 300 per 10,000. But in South Carolina and Illinois, Medicare did not reject any claims for this service in 1992.
Again, it is the INSURANCE COMPANIES who are denying claims, not the federal government!
Excellent points, Gail! I disagree with your conclusions, however.
These regional intermediaries contract with CMS and are subject to strict regulation and oversight. They must follow policy. Granted each interprets policy in some cases and respond to “Local Practice Standards”.
The big problem with Medicare is the fact that there is no competition allowed! The focus is on fixing prices instead of considering total costs. The very best most efficient surgeon gets paid exactly the same as the careless incompetent next door, who, because of mistakes in diagnosis and treatment decisions and unnecessary tests and imaging designed to cover his posterior in case of lawsuits winds up delivering care that costs twice as much.
The government does some things well, but health care is not one of them!
One other example, There have been tremendous advances in “disease State Management” in the past decade. Proactive management of certain disease processes such as congestive heart failure, COPD, Diabetes. etc, can make huge differences in both the quality and length of life for sufferers as well as greatly reduce the costs associated with care. These are not available to the mainstream Medicare recipients, but are only available to those opting for a Medicare Advantage Plan offered by a private insurer. We need reform for sure. Insurance reform, tort reform, and health reform. But we need more competition and free enterprise, not less of it.
If you are interested, please see our diagnosis and prescription for reform here: http://www.libertysarmy.com/2009/09/06/health-care/patient-centered-free-enterprise-health-care-reform/