Doctors Support a Public Plan Because Our Chances of Actually Getting Paid Are Better Than From Private Insurance

Big Government claims that, in supporting a public plan, doctors are endorsing the largest denier of health care claims. The selected data they cite is misleading and the blog’s argument is contrary to our actual experience. The chances of getting paid is far better from Medicare than most private insurance companies assuming Medicare was correctly billed as primary insurance. Such personal experience is what is going to influence physician support for a public plan–not selective quoting of statistics by conservative blogs.

The post lists a column on percentage of claim lines denied but doesn’t account for the reason. In real world experience, the number of denials is a small fraction of this. Another number which is far more consistent with my real world experience is percentage of claim lines reduced to zero. By this measurement Medicare is far more likely to actually send payment.

When my office does have Medicare claims rejected, by far the most common reason is that the patient was enrolled in a Medicare Advantage plan but is unaware that their coverage was changed. When physicians support a public plan we are supporting a plan based upon the original government Medicare program before it was screwed up by George Bush and the Republicans. I have also seen far more incorrect rejections of claims from Medicare Advantage plans, often taking multiple phone calls and faxes to fix, than I see from the government Medicare plan.

The second most common reason for denials I see is when a patient has Medicare but the patient or a spouse are working and another policy is actually primary. Medicare for All would fix that problem.

There are also situations where Medicare is pickier than other insurances on technical matters, but these rejections are easy to fix. The most common rejection of this type I experience is when an employee makes a mistake in typing in the Medicare number.

When a claim does need to be corrected, it is generally a simple matter to correct and resubmit the claim electronically. In contrast, if many private insurance plans initially reject a claim they will then reject fixed claims as duplicates, making it more difficult (and time consuming for physician offices) to actually get payment.

Medicare also has a number of rules by which they pay for certain services but their rules are all posted on line. It is generally easy to figure out what it takes to get a claim paid, but I’m sure that some physicians fail to pay attention to this and might be responsible for a larger number of rejections. In contrast, private insurance plans often reject claims without providing any good explanation. Often private plans will require prior authorization, taking up more staff time and increasing office overhead.

Private plans reject claims due to preexisting conditions. Medicare never does this. Private plans sometimes also find ways to drop a patient when they become too expensive, but this is not a problem with Medicare. Once a patient is dropped by private insurance plans, no more claims are submitted and this is not reflected in their percentage.

The bottom line is that in general Medicare pays us more reliably than private plans. It is also less expensive to bill Medicare as they don’t play the types of games private insurance plans often do in order to get payment. It is no surprise that so many doctors support a public plan as part of health care reform, with many also supporting Medicare for All.

Update: Another important factor is that there is a fair system of appeals and due process when Medicare claims are rejected. On rare cases where I have had rejections because of Medicare claiming that something was not necessary I have been successful in appealing their decision and receiving payment. If an appeal is not successful it can be taken to an administrative law judge. This is far less likely to be successful with private insurance.

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11 Comments

  1. 1
    Matthew Elliot says:

    Lying via statistics? Nah, Breitbart’s TOTALLY ETHICAL journamalists would *never* do such a thing http://is.gd/40tdV #hcr #p2

  2. 2
    Chris says:

    I am very happy for you and your office staff that you anticipate more smooth billing and payment with a public option.  Were that to be the only argument for/against this proposal….I might agree with you.  Regardless of your own micro-experience, the public option is expensive to the tune of bilions of untold numbers of dollars that not even the President can accurately define.  Will your smoother office procedures offset my taxpayer costs and loss of benefits and delays?  I think not.

  3. 3
    Ron Chusid says:

    You are incorrect about the public option. There are no extra taxpayer costs associated with it, and it will not cost you any benefits or delays. The public plan is to be paid out of premiums of those who choose it, not tax dollars. Health care reform will improve, not decrease your benefits. If you find you have delays, then switch to the public option. Based upon experience with Medicare you should have far less problems with delays than under most private plans.

  4. 4
    Eclectic Radical says:

    Chris is eating up the right wing trope that ‘public option’ is code for ‘single payer’ and that higher taxes will support lower premiums designed to run private insurance out of the market.
     
    Unfortunately, this is not the case.
     

  5. 5
    Ron Chusid says:

    As usual, the right wing attacks on health care reform have little to do with what is actually being proposed.

  6. 6
    matttbastard says:

    Lying via statistics? Nah, Breitbart’s TOTALLY ETHICAL journamalists would *never* do such a thing http://is.gd/40tdV #hcr #p2

  7. 7
    Eclectic Radical says:

    Eh,  as usual the right wing attacks on nearly everything have little to do with what is actually being proposed.
     
    I remember when Fox News was claiming then-Senator Obama was the ‘most liberal’ candidate for president in a field that included Dennis Kucinich and Mike Gravel! I wrote about that, back then.
     
    Some people believe it’s true because it’s on tv, and more and more of those people watch Fox News.
     

  8. 8
    Ron Chusid says:

    They also claimed that John Kerry was the most liberal member of the Senate and far to the left of the Democratic Party and past candidates back in 2004.

  9. 9
    jacksmith says:

    A state based public insurance option is NOT!! a Public Option. Nor is it a Strong, National, Medicare like Public Option.

    A majority of voters would rather have a Democrats only bill with a Public Option. Rather than a bipartisan bill without a Public Option.

    ATTENTION!! Congress Has The Votes Needed To Pass A Public Option – TODAY  http://bit.ly/TCq7O

    Why A Strong Public Option Is Essential – By jacksmith – Working Class

    Robert Reich explains the pubic option:  http://bit.ly/dDYSJ  http://robertreich.blogspot.com/

    Hollywood Supports The Public Option :-)  http://bit.ly/3XLwPi

    It’s not just because more than two thirds of the American people want a single payer health care system. And if they cant have a single payer system 77% of all Americans want a strong government-run public option on day one (86% of democrats, 75% of independents, and 72% republicans). Basically everyone.

    It’s not just because according to a new AARP POLL: 86 percent of seniors want universal healthcare security for All, including 93% of Democrats, 87% of Independents, and 78% of Republicans. With 79% of seniors supporting creating a new strong Government-run public option plan, available immediately. Including 89% of Democrats, 80% of Independents, and 61% of Republicans, STUNNING!!

    It’s not just because it will lower cost. Because a strong public option will dramatically lower cost for everyone. And dramatically improved the quality of care everyone receives in America and around the World. Rich, middle class, and poor a like.

    It’s not just because it will save trillions of dollars and prevent the needless deaths of millions more of YOU, caused by a rush to profit by the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX!

    It’s not just because every expert in every field, including economist, and Nobel laureates all agree that free market based healthcare systems don’t work. Never have and never will. The US has the only truly free market based healthcare system in the World. And as you all know now, IT IS A DISASTER!

    It’s not just because providing or denying medically necessary care for profit motivations is wrong. Because it is WRONG! It’s professionally, ethically, and morally REPUGNANT!, Animalistic, VILE and EVIL.

    THE REASON THE PUBLIC OPTION IS ESSENTIAL:

    The public option is ESSENTIAL because over 200 million of you are trapped in the forest of the wolves. Which is the forest of the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! With no way out except through needless inhumane suffering, and DEATH. While the wolves tear at your flesh, and rip you limb from lib. Then feast on your lifeless bodies like a dead carcase for transplant parts.

    At the most vulnerable times of your lives (when you were sick and hurting), millions of you have had to fight and loose cruel, but heroic battles. Fighting against the big guns of the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! in the forest of the wolves. All because you have no place else to go. You have no other CHOICE!

    But the PUBLIC OPTION will give you someplace safe to go. And it will give us someplace safe to take you. The public option will be your refugium (your refuge). Where the wolves cannot get at you when your down, hurting, and vulnerable. Where everyone who needs it can find rest, security, comfort and the care they need. Protected by the BIG GUNS of We The People Of The United States. THE MOST POWERFUL PEOPLE AND COUNTRY ON EARTH.

    This is why it is so critical that we do not lead another 50 million vulnerable, uninsured Americans into the forest of the wolves, without the protections of a Strong Government-run MEDICARE like public option. We The People Of The United States MUST NOT LET THAT HAPPEN to any more of our fellow Americans. If healthcare reform does not contain a strong MEDICARE like public option on day one. YOU MUST! KILL IT. Or you will do far more harm than good. And millions more will die needlessly. Rich, middle class, and poor a like.

    To those who would continue to obstruct good and true healthcare reform for the American people, and who seek to trap millions more vulnerable Americans in the forest of the wolves. We will continue to fight you. We are prepared to wage all out war against you, and will eagerly DESTROY! you. Time…is…UP! YOU HAVE BEEN WARNED! No Co-op’s! No Triggers! NO INDIVIDUAL MANDATES! without a Strong MEDICARE like public option on day one.

    Healthcare reform can be the GREATEST! Accomplishment of our time and century. A time when future generations may say of us, that we were all, AMERICAS GREATEST GENERATIONS.

    BUT WE MUST ACT!

    I therefore call on all my fellow Americans and the peoples of the World. To join us in this fight so that we may finish becoming the better America that we aspire to be for everyone.

    SPREAD THE WORD!

    I have been privileged to be witness as many of you fought, and struggled to take your first breath, and your last breath on this earth. Rich, middle class, and poor a like. Life is precious.

    Whatever the cost. WE! MUST SUCCEED.

    God Bless You My Fellow Human Beings

    jacksmith – Working Class

    Things You Can Do To Help NOW! http://www.everydaycitizen.com.....die_n.html

    No Triggers! http://www.huffingtonpost.com/.....77910.html

    Triggers http://www.huffingtonpost.com/.....83583.html

    Krugman on heathcare  (http://krugman.blogs.nytimes.c.....ealthcare/)

    Senator Bernie Sanders on healthcare (http://www.youtube.com/watch?v.....r_embedded)

    John Garamendi on the Public Option and the Grassroots:  http://bit.ly/TJMty

    Howard Dean on the Public Option http://www.youtube.com/watch?v.....r_embedded

    We’re Number 37! in quality of health care http://www.youtube.com/watch?v.....r_embedded

    Twitter search (#welovethenhs #NHS #hc09 #hcr #healthcar #obama #p2 #topprog #) Check it out.

  10. 10
    Eclectic Radical says:

    Well, while Kerry is not a screaming lefty, he is a liberal Democrat. While he was certainly not the most liberal member of the Senate in 2004, he was definitely on the liberal side of the aisle.
     
    Obama, on the other hand, is a very moderate Democrat. In some senses he is every bit as much of a ‘neoconservative’ as some Republicans. He’s just not hidebound by that ideology and understands the pragmatic role of the government as something more than a corporate feeding trough.

  11. 11
    Marcy Dennis says:

    » Doctors Support a Public Plan Because Our Chances of Actually… http://tinyurl.com/ya3kkv7

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