California's Real Death Panels: Insurers Deny 21% of Claims

[ryoder 1,397]

http://www.reuters.com/article/pressRelease/idUS202570+02-Sep-2009+PRN20090902

"There are only three things of value: younger women, faster airplanes, and bigger crocodiles" - Arthur Jones.

[wmw999 2,146]

Of course, the other elephant in the corner is that if every single procedure were to be approved, then the insurance companies would go broke, or would have to raise rates drastically (they already are).

What I don't understand is why all these private companies wouldn't prefer to turn this over to the government now, so that the government can take the blame?

There will always be care available for those with infinite dollars. What we're fighting over is what's left.

Wendy P.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[rushmc 18]

Very generic in its info.
The devil is in the detail
This is a classic hit piece with no supporting info.

Also, care to guess which state in the nation has the most mandates forced by state regulators into the program?

21%? Fine, but 21% of what?

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[bodypilot90 0]

Because the gov't can't run anything well. Look at amtrack, ect, ect

[GeorgiaDon 340]

Quote

This is a classic hit piece with no supporting info.

Directly from the article Ryoder posted:

Quote

Kaiser Permanente, which denied 28 percent of all claims in the first half of
2009, was one of two systems to reject options for radiation and chemotherapy
for 57-year-old Bob Scott of Sacramento after his diagnosis of a brain tumor
in 2005. The reason cited was his age, says wife Cheryl Scott, RN. "He had
been in perfect health all of his life. This was his first problem other than
a sprained ankle. He died six months later."

Several other examples of specific instances of patients being denied life-saving care are given in the article. Perhaps you just prefer to not see them because they conflict with your ideal that private industry can do no wrong? I think telling a 57-year-old that his cancer is not worth treating because he is "too old" is the epitome of the "death panel" scenario.

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[wmw999 2,146]

In all fairness, I'm sure a decent number of these were appealed and eventually granted. A decent number of rejections are because the form was filled out incorrectly.

Of course, if each company didn't have its own form, things might be easier, huh? Maybe the healthcare plan to start with is simply a single unified insurance form. That won't address everything, but it might make the ancillary costs of administering medical care go down.

Of course, companies wouldn't like that because they'd have to change, and we all know that change is bad.

Wendy P.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[rushmc 18]

Quote

Quote

This is a classic hit piece with no supporting info.

Directly from the article Ryoder posted:

Quote

Kaiser Permanente, which denied 28 percent of all claims in the first half of
2009, was one of two systems to reject options for radiation and chemotherapy
for 57-year-old Bob Scott of Sacramento after his diagnosis of a brain tumor
in 2005. The reason cited was his age, says wife Cheryl Scott, RN. "He had
been in perfect health all of his life. This was his first problem other than
a sprained ankle. He died six months later."

Several other examples of specific instances of patients being denied life-saving care are given in the article. Perhaps you just prefer to not see them because they conflict with your ideal that private industry can do no wrong? I think telling a 57-year-old that his cancer is not worth treating because he is "too old" is the epitome of the "death panel" scenario.

Don

One off examples. Wendy makes a good point also.

Its a hit piece. Simple as that

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[wmw999 2,146]

Marc, the real point of the article is that the straw man of "death panels" already exist with private insurance companies. That's absolutely true. That argument against the new health plan is a bullshit argument.

But I hate taking data points and using them as though they exist in a vacuum.

However, the more I think about it, the more I like the idea of a single, centralized insurance company form. That would not fix all of the problems and rejections. But if it could reduce wrong-information rejections noticeably, that's probably substantive. Sounds like a L6S project

Wendy P.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[GeorgiaDon 340]

Quote

Also, care to guess which state in the nation has the most mandates forced by state regulators into the program?

A while ago you posted a link to a paper that showed that premiums tend to be higher in states that regulate minimum standards of care that must be covered by an insurance plan (what you call mandates). I pointed out that the paper did not examine the quality of the coverage (is the plan any good if you get sick?) in states with and without mandates. Sure, premiums can be low if the insurer can drop you, or deny necessary procedures and you are left with no avenue to appeal in time to save your life, but that coverage is worth nothing. So what if it covers homeopathy or colonotherapy if it won't cover oncology, and they don't tell you that until you need treatment. Mandates were brought in because of questionable business practices on the part of some (not saying all) insurers.

What specific mandates would you like to see dropped, and why?

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[rushmc 18]

Quote

Marc, the real point of the article is that the straw man of "death panels" already exist with private insurance companies. That's absolutely true. That argument against the new health plan is a bullshit argument.

But I hate taking data points and using them as though they exist in a vacuum.

However, the more I think about it, the more I like the idea of a single, centralized insurance company form. That would not fix all of the problems and rejections. But if it could reduce wrong-information rejections noticeably, that's probably substantive. Sounds like a L6S project

Wendy P.

Sorry Wendy, I don't agree. The only way to control costs in a system like what is proposed it to limit coverage. Someone will have to decide. It is not bullshit. Look at Canada and the just recent reports from the UK.

The article is a hit piece not news. A piece to help with the Obama agenda with which they obviously agree

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[rushmc 18]

Quote

Quote

Also, care to guess which state in the nation has the most mandates forced by state regulators into the program?

A while ago you posted a link to a paper that showed that premiums tend to be higher in states that regulate minimum standards of care that must be covered by an insurance plan (what you call mandates). I pointed out that the paper did not examine the quality of the coverage (is the plan any good if you get sick?) in states with and without mandates. Sure, premiums can be low if the insurer can drop you, or deny necessary procedures and you are left with no avenue to appeal in time to save your life, but that coverage is worth nothing. So what if it covers homeopathy or colonotherapy if it won't cover oncology, and they don't tell you that until you need treatment. Mandates were brought in because of questionable business practices on the part of some (not saying all) insurers.

What specific mandates would you like to see dropped, and why?

Don

Any and all that would be elective. The bigger benefit would come from opening up the states boarders.

Edited to add.

With open competition you would be able to make sure the plan you have has the coverage you want. Today, you take what the states mandate

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[wmw999 2,146]

So you're saying that when the government does it, it's a death panel, and when private insurance companies do it, it's just controlling costs?

Wendy P.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[tkhayes 140]

Quote

Very generic in its info.

Claims denial rates by leading California insurers, first six months of 2009:

PacifiCare -- 39.6 percent
Cigna -- 32.7 percent
HealthNet -- 30 percent
Kaiser Permanente -- 28.3 percent
Blue Cross -- 27.9 percent
Aetna -- 6.4 percent

looks pretty specific to me....

Quote

The devil is in the detail

The details appear to have come from Public records available from the California government on Managed Care.

Quote

This is a classic hit piece with no supporting info.

says you - I see plenty of supporting info.

Quote

21%? Fine, but 21% of what?

More than one of every five requests for medical claims for insured patients, even when recommended by a patient's physician, are rejected by California's largest private insurers, amounting to very real death panels in practice daily in the nation's biggest state, according to data released Wednesday by the California Nurses Association/National Nurses Organizing Committee.

CNA/NNOC researchers analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, six of the largest insurers operating in California rejected 47.7 million claims for care -- 22 percent of all claims.

21% of THAT......

[lawrocket 3]

Quote

the real point of the article is that the straw man of "death panels" already exist with private insurance companies. That's absolutely true. That argument against the new health plan is a bullshit argument.

Yep. The other point is that it's gonna cost me more, I'll get less. I'll be worse off.

I'm home horrifically ill right now. IT was nice to be on the way back from work calling around for which urgent cares were open and what was the wait. I chose one, got there at 6:00, was out by 6:45 (Doc said he was wondering whether to send me to ER). Got my prescriptions and was home.

I can't say I'll have those options, Wendy. The visit cost me $10.00 (on top of my premium), plus $35 for the prescriptions.

Will I get that kind of choice or service under Uncle Sam? Probably not. Will it cost me more? Probably.

I've only had one claim denied - ever. It was for a surgery in 03. I merely provided a certificate of credible coverage and they paid for it.

I wonder - how many of these denied claims are for medical marijuana?

My wife is hotter than your wife.

[kallend 1,644]

Quote

Because the gov't can't run anything well.

Army, Navy, Marine Corps, Air Force...

...

The only sure way to survive a canopy collision is not to have one.

[nanook 1]

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Quote

Because the gov't can't run anything well.

Army, Navy, Marine Corps, Air Force...

This right here hammers that nail in deeper for me. When the govt runs out of money for the fiscal year, we don't get more to cover unsuspected costs. We cut back and completely stop many programs altogether. Example, we are not moving anybody back and forth between duty stations and halting new orders till next fiscal year. No new people. No new parts, no more support, ect ect.

What happens if the National health care costs runs over in the U.S. for a given fiscal year? They will scale back a lot of programs. This is a common occurence regardless of upturns or downturns.

_____________________________

"The trouble with quotes on the internet is that you can never know if they are genuine" - Abraham Lincoln

[billvon 2,426]

>Look at amtrack, ect, ect

Look at the Manhattan and Apollo projects. We can do as good a job as we want to do - or as lousy a job as we want to do.

[billvon 2,426]

>The only way to control costs in a system like what is proposed it to
>limit coverage.

OK, so you support death panels.

>The article is a hit piece not news.

Are you claiming the actual examples they give are false?

[downwardspiral 0]

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Quote

Because the gov't can't run anything well.

Army, Navy, Marine Corps, Air Force...

Korean War, Vietnam, Iran Hostage Rescue, Somalia, Iraq, Afghanistan.

www.FourWheelerHB.com

[billvon 2,426]

>Korean War, Vietnam, Iran Hostage Rescue, Somalia, Iraq, Afghanistan.

World War 1, World War 2. Best fought war was the Cold War, which we won by not fighting it.

[downwardspiral 0]

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>Korean War, Vietnam, Iran Hostage Rescue, Somalia, Iraq, Afghanistan.

World War 1, World War 2. Best fought war was the Cold War, which we won by not fighting it.

The cold war was an economic win. Had we actually gone to war we would have lost.

www.FourWheelerHB.com

[billvon 2,426]

>The cold war was an economic win. Had we actually gone to war we would
>have lost.

That's what I mean. We were smart enough to engage the USSR in an arena where we had the advantage.

[downwardspiral 0]

Quote

>The cold war was an economic win. Had we actually gone to war we would
>have lost.

That's what I mean. We were smart enough to engage the USSR in an arena where we had the advantage.

Right but I wouldn't call the cold war a military success. Also wasn't Reagan's budget largely responsible?

www.FourWheelerHB.com

[kallend 1,644]

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Quote

>The cold war was an economic win. Had we actually gone to war we would
>have lost.

That's what I mean. We were smart enough to engage the USSR in an arena where we had the advantage.

Right but I wouldn't call the cold war a military success. Also wasn't Reagan's budget largely responsible?

SO you disagree with bodypilot90, then, The govt. CAN do things right.

...

The only sure way to survive a canopy collision is not to have one.

[downwardspiral 0]

Quote

Quote

Quote

>The cold war was an economic win. Had we actually gone to war we would
>have lost.

That's what I mean. We were smart enough to engage the USSR in an arena where we had the advantage.

Right but I wouldn't call the cold war a military success. Also wasn't Reagan's budget largely responsible?

SO you disagree with bodypilot90, then, The govt. CAN do things right.

Not necessarily. Especially in light of the phrase even a blind squirrel finds a nut every once and a while.

www.FourWheelerHB.com