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.