Tuesday, October 6, 2009

Which insurance company denies the most claims?

An argument for a government health insurance company:
Those evil insurance companies make money by denying people services and there is a lot of red tape in getting claims processed.

Fact:
The government health care company known as Medicare denies claims at almost twice the rate of private insurance companies and the red tape is worse.

Are you Living in Denial
By Robert Anthony, Physician Practice

[excerpt] Did you know Medicare denies up to 22 percent of medical services, depending on the specialty? If you're in dermatology (the lowest denial rate, at 5.5 percent) or pediatric medicine (a mere 6.22 percent), then you're one of the lucky ones. But if you're an anesthesiology practice (with a daunting 18.55 percent denial rate) or an obstetrics and gynecology practice (the highest, with a whopping 22.42 percent), then Medicare denials can easily become daily occurrences.

"The problem with Medicare is that you can talk to four different people and get four different answers," says Darlene Helmer, CPC, ANP-C, billing manager for Physician Anesthesia Associates of Towson, Md., and co-chair of the Third Party & Reimbursement committee of the Maryland Medical Group Management Association. "They don't always know their own regulations, so you have to be the expert on [them]." (link)

This article shed light on the red tape problems with Medicare and examines the denial claim problem. Given the high claim denial rate of Medicare and the red tape, why does one think a new government "public option" would perform any better than the current public option known as Medicare? I don't understand it.

For more evidence of the claim denial rate of the government compared to private insurance companies, see the chart below. Notice that the Medicare denial rate is 6.85%, compared to a range of 2.68 to 6.80 for other listed insurance companies. For a more detailed discussion of the numbers in the chart below follow this link: HSA Benefits Consulting.

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