primuspilus.bsky.social
@primuspilus.bsky.social
No. I just understand the complexities of our system. I'm not opposed to a universal option but I think it's crazy to be okay with the CEO of an insurance company being murdered.
December 5, 2024 at 3:49 AM
Referrals aren't contingent on the whims of the insurance company. If the proper procedures are followed then the referral is basically auto-approved. If you don't like this limitation then get Original Medicare. I'm not sure how we are blaming health insurance companies for this?
December 5, 2024 at 2:03 AM
Did you read it? "Although Medicare Advantage plans are required to cover at least the same services as original Medicare, you may have different deductibles and copayments and fewer out-of-pocket costs.". Medicare Advantage normally offers more than Original Medicare like dental and vision
December 5, 2024 at 12:42 AM
Medicare advantage follows Medicare rules...
December 4, 2024 at 9:33 PM
Why do you think it's blanket denials? Most of those claims denials are probably coding errors because the claims are being billed correctly. Most of them would be corrected and paid after the initial denial. You can just look at data like that and draw massive conclusions.
December 4, 2024 at 8:48 PM
Okay? Do they still fit into the 80/20 rule? Do they have the most of a certain population that might have more claim denials? Do they have more stringent claim processing rules? Initial denial % doesn't really tell you anything...
December 4, 2024 at 7:32 PM
Who is denying life-saving care? We have EMTALA for a reason.
December 4, 2024 at 7:25 PM
Are you implying that every claim should be paid? The ratio is even worse for large group plans where it's 85/15.
December 4, 2024 at 7:20 PM
The 80/20 rule is effectively a cap on profit margin. There should be a similar rule for hospitals/providers imo.
December 4, 2024 at 6:43 PM
Health insurance companies have capped profits. Hospitals and other healthcare providers don't...
December 4, 2024 at 5:07 PM