Comments on: Health Care Claims Processing and Payment http://www.letstalkhealthcare.org/health-care-costs/health-care-claims-processing-payment/ Tue, 06 Jan 2009 22:37:35 +0000 http://wordpress.org/?v=2.5.1 By: Insurance Guide http://www.letstalkhealthcare.org/health-care-costs/health-care-claims-processing-payment/#comment-6230 Insurance Guide Tue, 25 Nov 2008 09:43:15 +0000 http://www.letstalkhealthcare.org/health-care-costs/health-care-claims-processing-payment/#comment-6230 This blog is really nice and informative. Thanks. This blog is really nice and informative.
Thanks.

]]> By: Charlie Baker http://www.letstalkhealthcare.org/health-care-costs/health-care-claims-processing-payment/#comment-5313 Charlie Baker Tue, 15 Apr 2008 23:58:06 +0000 http://www.letstalkhealthcare.org/health-care-costs/health-care-claims-processing-payment/#comment-5313 Anon - denying claims to reduce costs may be a theoretical possibility, but I've never seen anything in my time at HPHC to suggest that the plans we compete with deliberately deny claims to see if people will re-submit them a second time for payment, thereby reducing their incurred medical expense. I've certainly heard the story, but I don't see it when I look for it. Plans do deny claims for non-covered services - which happens more often than you might think - and if the member eligibility information is wrong. We've worked over time to solve the member eligibility issue with easy online access to member eligibility information, and have tried to keep our plan design fairly simple (to avoid the non-covered services issue). But it happens - no denying that. My point is simply that it's very expensive for the plans to process, re-process, and re-process claims. Believe it or not, we'd rather get it right the first time. It's cheaper. Anon - denying claims to reduce costs may be a theoretical possibility, but I’ve never seen anything in my time at HPHC to suggest that the plans we compete with deliberately deny claims to see if people will re-submit them a second time for payment, thereby reducing their incurred medical expense. I’ve certainly heard the story, but I don’t see it when I look for it.

Plans do deny claims for non-covered services - which happens more often than you might think - and if the member eligibility information is wrong. We’ve worked over time to solve the member eligibility issue with easy online access to member eligibility information, and have tried to keep our plan design fairly simple (to avoid the non-covered services issue). But it happens - no denying that. My point is simply that it’s very expensive for the plans to process, re-process, and re-process claims. Believe it or not, we’d rather get it right the first time. It’s cheaper.

]]> By: Anon http://www.letstalkhealthcare.org/health-care-costs/health-care-claims-processing-payment/#comment-5311 Anon Tue, 15 Apr 2008 10:38:58 +0000 http://www.letstalkhealthcare.org/health-care-costs/health-care-claims-processing-payment/#comment-5311 Wasn't Krugman highlighting the incentive to permanently reduce expenditures by denying certain claims? A health plan that pays out more than competing plans is surely in peril, so it's easy to see how a single plan can trigger a race to the bottom. Wasn’t Krugman highlighting the incentive to permanently reduce expenditures by denying certain claims? A health plan that pays out more than competing plans is surely in peril, so it’s easy to see how a single plan can trigger a race to the bottom.

]]> By: Dr. Val http://www.letstalkhealthcare.org/health-care-costs/health-care-claims-processing-payment/#comment-5307 Dr. Val Mon, 14 Apr 2008 01:01:48 +0000 http://www.letstalkhealthcare.org/health-care-costs/health-care-claims-processing-payment/#comment-5307 Thanks for explaining your perspective. Very enlightening. I hope that more insurance companies will give up their "old fashioned incompetence" for a streamlined process that improves the payment system. Thanks for explaining your perspective. Very enlightening. I hope that more insurance companies will give up their “old fashioned incompetence” for a streamlined process that improves the payment system.

]]> By: Barry Carol http://www.letstalkhealthcare.org/health-care-costs/health-care-claims-processing-payment/#comment-5288 Barry Carol Fri, 11 Apr 2008 22:10:32 +0000 http://www.letstalkhealthcare.org/health-care-costs/health-care-claims-processing-payment/#comment-5288 "It also dramatically improved our relationships with providers, and by extension, our members and employer accounts." Exactly. If you don't please enough customers enough of the time, eventually, you won't have any customers (or members). “It also dramatically improved our relationships with providers, and by extension, our members and employer accounts.”

Exactly. If you don’t please enough customers enough of the time, eventually, you won’t have any customers (or members).

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