Software Helps Insurers Profit from Denials
New York’s attorney general investigates possible fraud in an industry built on denying care, and two U.S. representatives want Medicare to have no part in it.
For the past couple years, Martin Jensen has been sounding an alarm, shouting to doctors and hospitals about the biggest danger they probably don’t know about. As an independent information technology consultant to hospitals, Jensen warns that health insurers are increasingly devising more sophisticated means of denying services either upfront or sniffing out money they believe to have “mistakenly doled out.”
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Thanks for posting this.
As an IT Professional, it has long angered me that the Insurance Companies and also many healthcare providers use incompetence as a weapon. What I mean by that is that anyone you get to talk to in disputing a claim is likely to treat the computers’ output as the unchallengeable word of God, on the one hand, but then to turn around and blame the computers if you manage to prove that they’re in error. Completely absent is any accountability by the insurance company or the health care provider. Also absent any identifiable accounts-receivable best practice that any normal business would want to institute for its own sanity and protection.
My wife has a serious illness that requires multiple repeated trips to healthcare providers for various services and tests. Over time I’ve watched as what was once a single bill now becomes fractured into multiple small sums (many < $10) and every repeat visit is given a new account number (or numbers) so they cannot be paid with a single check. She now has five or six “account numbers” for a single provider.
And insurance companies compound the disaster by making it difficult-to-impossible to match provider bills to explanations of benefits. One piece of a bill will be explained in one place, another in another, and bills from totally different providers will be combined on one explanation of benefits. One-to-one matching is virtually impossible in such circumstances.
I am unable to convince myself that this is not a deliberate attempt to nickel-and-dime the patient to death. By making health care bills and insurance statements impossible to decipher, more charges can be snuck through, escaping the detection that a more straightforward billing statement would provide.
sign of an imploding industry
I am unable to convince myself that this is not a deliberate attempt to nickel-and-dime the patient to death. By making health care bills and insurance statements impossible to decipher, more charges can be snuck through, escaping the detection that a more straightforward billing statement would provide.
I am of the same view, and am glad Cuomo is calling them on it. I hope other politically ambitious AG’s and local prosecutors will follow his example.
I have decided to use my posting privileges at CorrenteWire to post about healthcare and single payer.