Monday, March 26, 2007

The Truest Thing I've Read In The New York Times

This is from an article in today's NYT. “The bottom line is that insurance companies make money when they don’t pay claims,” said Mary Beth Senkewicz, who resigned last year as a senior executive at the National Association of Insurance Commissioners. “They’ll do anything to avoid paying, because if they wait long enough, they know the policyholders will die.”

I deal with insurance companies every day. Some are good, some aren't, but to some extent, all of them follow this maxim. There is an insurance company I deal with on a regular basis that routinely denies a certain percentage of "clean claims". That is to say, there's nothing special about them, they don't have any errors and when you call in to their provider service line, they say "My bad, we'll reprocess." The point of doing this is two fold. One, they got to keep their money in their accounts a little longer. Two, some of these claims will not be called on for several reasons and the insurance company will not have to pay. This is a big part of my job. It's my job because I can be persistent without being rude. I call these people and get claims reprocessed and I will keep at it and at it. Sometimes though, my boss will say, "Nevermind, the cost of your time vs. that claim isn't worth it." It's true the claim in question is usually short money, but multiply that out. How many companies? How many claims? Just by denying claims on the first and sometimes second level (which doesn't cost the insurance companies anything significant - just a form letter), how much are they making? It's fraud and there is nothing I can do about it. Every company does it, Medicare too.
I have no solutions, I have no answers. I am just venting.
This rant in no way endorses socialized medicine, Clinton medicine or Romney medicine. At least the way it's done now patients still get choice and quality and providers make money. We just get cheated a little. It's like having to kick up a little to the "boss".

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