COVID-related: insurers stiffing hospitals

[Winehole23]

Anthem Blue Cross, the country’s second-biggest health insurance company, is behind on billions of dollars in payments owed to hospitals and doctors because of onerous new reimbursement rules, computer problems and mishandled claims, say hospital officials in multiple states.


. (https://khn.org/news/article/anthem-united-major-insurers-behind-on-payments-billions-owed-hospitals-doctors-covid/view/republish/)
Anthem, like other big insurers, is using the covid-19 crisis as cover to institute “egregious” policies that harm patients and pinch hospital finances, said Molly Smith, group vice president at the American Hospital Association.


“There’s this sense of ‘Everyone’s distracted. We can get this through,’” she said.


Hospitals are also dealing with a spike in retroactive claims denials by UnitedHealthcare, the biggest health insurer, for emergency department care, AHA says.
https://khn.org/news/article/anthem-united-major-insurers-behind-on-payments-billions-owed-hospitals-doctors-covid/

[Thread]

As they should. COVID was presented as a Government responsibility from the start. The vaccines were free. The tests were fre...well, almost free. tee, hee. If they made 'em free the numbers would skyrocket, so, first President Trump denounced tests. Then mother fucker Biden denounced tests after swearing up and down he wouldn't denounce 'em. But that unsavory business aside, this is on the government, let the government pay it. I wouldn't give 'em a dime..."Girl, pull the Caddy around front. I'll get my duds on, slow down at the front desk,,,tell the woman biller there..."Hey, look over there, a white man with an assault rifle!" Then when she turns, or ducks, I'll head for the car. You peel off in 2nd gear, there's a QT 5 miles out and we'll get a cone-a-piece, then home for a happy ending for Dale.

CHARGE!!!

[baseline bum]

Poor hospitals. They're scammers just like the insurance companies, it's all in the game.

[baseline bum]

As they should. COVID was presented as a Government responsibility from the start. The vaccines were free. The tests were fre...well, almost free. tee, hee. If they made 'em free the numbers would skyrocket, so, first President Trump denounced tests. Then mother fucker Biden denounced tests after swearing up and down he wouldn't denounce 'em. But that unsavory business aside, this is on the government, let the government pay it. I wouldn't give 'em a dime..."Girl, pull the Caddy around front. I'll get my duds on, slow down at the front desk,,,tell the woman biller there..."Hey, look over there, a white man with an assault rifle!" Then when she turns, or ducks, I'll head for the car. You peel off in 2nd gear, there's a QT 5 miles out and we'll get a cone-a-piece, then home for a happy ending for Dale.

CHARGE!!!

Um, tests are free.

[pgardn]

Poor hospitals. They're scammers just like the insurance companies, it's all in the game.

Hospitals run a very tough business. Insurance is dead dog easy to make money compared to hospitals. And never forget doctors. They went to school for many years to get PAID. Not to help people. This is not some real clergy that gracefully attempts to help patients. The AMA made sure of that.

[Thread]

Um, tests are free.

Where? Even the VA hedges..."Well, it's.........yes, well,,,,,,you have to make an appointment. You can't just walk in off the street, Dale. But, yes, it's free. We have an appointment available in 3 weeks."

tee, hee.

[Thread]

Poor hospitals. They're scammers just like the insurance companies, it's all in the game.

Precisely. So, you stick it to 'em, jam a ram rod up your asses, and shoulder-to-shoulder with the girl and past the billing desk we go...not run, mind you, just quick step. Climb into the Caddy. "Culver's for a two scooper, Girl?"

"Yes."

"Then upon arrival back at the house a nice happy ending?"

"No."

[Thread]

Hospitals run a very tough business. Insurance is dead dog easy to make money compared to hospitals. And never forget doctors. They went to school for many years to get PAID. Not to help people. This is not some real clergy that gracefully attempts to help patients. The AMA made sure of that.

If the wet ones can use the hospitals as free doctor visits then it's fine for the native born.

[RandomGuy]

https://khn.org/news/article/anthem-united-major-insurers-behind-on-payments-billions-owed-hospitals-doctors-covid/

https://media0.giphy.com/media/3P0oEX5oTmrkY/giphy.gif?cid=549b592d9f414b27eb1e01a49ac68f78ed7f 1fac83e93738&rid=giphy.gif

[DMC]

When it was pointed out that hospitals were falsifying COVID results on death certs to collect the money, people scoffed at it. Now they're calling hospitals corrupt when it suits them.

[baseline bum]

Where? Even the VA hedges..."Well, it's.........yes, well,,,,,,you have to make an appointment. You can't just walk in off the street, Dale. But, yes, it's free. We have an appointment available in 3 weeks."

tee, hee.

I got a PCR test a few weeks ago same day at Walgreens.

[RandomGuy]

Hospitals run a very tough business. Insurance is dead dog easy to make money compared to hospitals. And never forget doctors. They went to school for many years to get PAID. Not to help people. This is not some real clergy that gracefully attempts to help patients. The AMA made sure of that.

1/4 of all the health care dollars in this country are spent on administrative overhead. Billing. Collections.

The "Free market" of private health insurers adds massively to administrative costs due to having to pay so many people to get paid, and the layers of profits for each little sub entity.

This is why our healthcare system is so shitty and expensive.

[DMC]

1/4 of all the health care dollars in this country are spent on administrative overhead. Billing. Collections.

The "Free market" of private health insurers adds massively to administrative costs due to having to pay so many people to get paid, and the layers of profits for each little sub entity.

This is why our healthcare system is so shitty and expensive.

So you lay all those people off who work in the HC industry and tax unemployed people for social medicine. With all the contributors flooding across the border it should be a breeze. There's your solution.

[RandomGuy]

When it was pointed out that hospitals were falsifying COVID results on death certs to collect the money, people scoffed at it. Now they're calling hospitals corrupt when it suits them.

No one scoffed. Feel free to find a single post where it was.

[RandomGuy]

So you lay all those people off who work in the HC industry and tax unemployed people for social medicine. With all the contributors flooding across the border it should be a breeze. There's your solution.

A single payor system paid for by an across the board tax on everybody.

Government pays out the hospitals standard rates, and has bargaining power to tell the shit-fucks at the pharmacuetical companies to get bent when they jack prices.

This is not difficult, and would cost less than what we have now.

[DMC]

No one scoffed. Feel free to find a single post where it was.

:lol

[DMC]

A single payor system paid for by an across the board tax on everybody.

Taxing the unemployed works wonders


Government pays out the hospitals standard rates, and has bargaining power to tell the shit-fucks at the pharmacuetical companies to get bent when they jack prices.

Hospital's standard rates are absurd. Your model failed before conception.


This is not difficult, and would cost less than what we have now.
:lol no

[SnakeBoy]

A single payor system paid for by an across the board tax on everybody.

Government pays out the hospitals standard rates, and has bargaining power to tell the shit-fucks at the pharmacuetical companies to get bent when they jack prices.

This is not difficult, and would cost less than what we have now.

If it is so easy why won't Democrats run on it?

[Thread]

I got a PCR test a few weeks ago same day at Walgreens.

For free? Walgreens wants health insurance proof here in Arizona, or, cash. For a regular test anyway. I wouldn't dare ask them about a PCR test for free. They'd call security.

[baseline bum]

For free? Walgreens wants health insurance proof here in Arizona, or, cash. For a regular test anyway. I wouldn't dare ask them about a PCR test for free. They'd call security.

Not true. If you don't have health insurance the government pays for your tests, if you do they bill your insurance. I'm not talking the tests they have on their shelves, I'm talking about the ones you go schedule online. Walgreens and CVS offer a couple of rapid tests and the PCR. Don't you have Medicare, old man?

[RandomGuy]

:lol

To be fair we are probably talking past each other a bit here.

I have little doubt that hospitals were inflating some of their reporting for money.

I absolutely don't think that had any material affect on the reported total COVID fatalities.

You and the rest of the dupes wanted to use that to prove the virus wasn't as bad as it was, for your cult leader, if you will recall.

[RandomGuy]

If it is so easy why won't Democrats run on it?

They should.

The right wing propaganda machine has very effectively moved the Overton Window of debate on this to where such an idea seems untenable, though.

The special interests that fund that propaganda machine would be kicked into overdrive by donations from the big businesses that would be the biggest losers, and they have very deep pockets.

Fucked and unfuckable, the first rich nation of poor people. Can't afford the healthcare, beg for money on Gofundme. smh

[RandomGuy]

Taxing the unemployed works wonders

Hospital's standard rates are absurd. Your model failed before conception.

:lol no

This model is in place in about thirty other countries and has been functioning in those countries for decades.

Your criticism is ignorant of how and why hospitals price their services. I actually had a rather long conversation with a hospital system CEO about this very thing right after the ACA passed.

[DMC]

To be fair we are probably talking past each other a bit here.

I have little doubt that hospitals were inflating some of their reporting for money.

I absolutely don't think that had any material affect on the reported total COVID fatalities.

You and the rest of the dupes wanted to use that to prove the virus wasn't as bad as it was, for your cult leader, if you will recall.

Are you referring to the body count you've ignored since somewhere near the end of January 2021?

[DMC]

They should.

The right wing propaganda machine has very effectively moved the Overton Window of debate on this to where such an idea seems untenable, though.

The special interests that fund that propaganda machine would be kicked into overdrive by donations from the big businesses that would be the biggest losers, and they have very deep pockets.

Fucked and unfuckable, the first rich nation of poor people. Can't afford the healthcare, beg for money on Gofundme. smh
Oh I see. The dems won't run on that because of the "right wing".

Brilliant

Can't afford healthcare but they get healthcare. Otherwise why are the hospitals overcrowded?

[Thread]

Not true. If you don't have health insurance the government pays for your tests, if you do they bill your insurance. I'm not talking the tests they have on their shelves, I'm talking about the ones you go schedule online. Walgreens and CVS offer a couple of rapid tests and the PCR. Don't you have Medicare, old man?

Not here in Arizona. You have to have insurance, or, cash and you're right, you have to schedule online.

[Thread]

To be fair we are probably talking past each other a bit here.

I have little doubt that hospitals were inflating some of their reporting for money.

I absolutely don't think that had any material affect on the reported total COVID fatalities.

You and the rest of the dupes wanted to use that to prove the virus wasn't as bad as it was, for your cult leader, if you will recall.

Please. Whenever our side said that you called us everything but white men, RG. Don't even start that shit now.

[Winehole23]

stiffing patients too


The Biden administration’s interim final surprise billing rule and the legislation that prompted it, the 2020 No Surprises Act, were mostly a response to companies sending people huge medical bills after they visit hospitals that are part of their insurance networks but treated by doctors or staff who are out of network.

The rule, from the Centers for Medicare & Medicaid Services, also cracks down (https://www.beckershospitalreview.com/finance/cms-surprise-billing-rule-outlaws-payers-retroactive-ed-policies.html) on an absurdly evil health insurance practice: insurers have been retroactively denying emergency room claims and sticking people with massive ER bills, because they say the patients’ medical events were not emergencies.

UnitedHealthcare, the nation’s biggest health insurer, announced (https://www.naplesnews.com/story/news/health/2021/06/09/unitedhealthcare-policy-assess-er-claims-sticking-patients-bills/7616935002/) in June it was planning to more closely scrutinize emergency room visits, warning that claims “determined to be non-emergent will be subject to no coverage or limited coverage.”

Following outcry, the company quickly backtracked with a statement (https://www.uhcprovider.com/en/resource-library/news/2021-network-bulletin-featured-articles/0621-ed-facility-commercial-claims.html) saying it had “decided to delay the implementation of our emergency department program until at least the end” of the COVID-19 pandemic. However, the Daily Poster reported (https://www.jacobinmag.com/2021/06/united-health-care-insurance-profits-emergency-room-bills) on several cases where UnitedHealthcare denied emergency room claims as nonemergency or was accused of doing so.

The rule language bolsters those reports, making clear some insurers have in fact been systematically issuing retroactive ER denials. It says some plans have been denying claims solely based on final diagnosis codes and “might automatically deny coverage based on a list of final diagnosis codes initially, without regard to the individual’s presenting symptoms or any additional review.”

It further indicates that insurers might not consider the federal prudent layperson standard — which is designed to protect patients and allow them to seek emergency care if an average person would believe they need immediate medical attention — unless a patient appeals. Generally speaking, only a tiny fraction (https://www.kff.org/private-insurance/issue-brief/claims-denials-and-appeals-in-aca-marketplace-plans/) of Americans appeal denials, meaning that insurance companies often get away with this scam.

Kahn’s comment letter (https://www.regulations.gov/comment/CMS-2021-0117-7472) thanked the Biden administration for moving to stop these retroactive ER denials, and adds more detail about the various ways insurers are selecting claims to deny.

He wrote that “some plans may violate the Affordable Care Act’s (ACA) patient protections by making an initial coverage determination based on final diagnosis codes and then applying the prudent layperson standard only if the participant, beneficiary, or enrollee appeals or seeks further consideration of the claim. Other plans or issuers may inappropriately require ‘sudden onset’ of the emergency medical condition or impose a time limit between the onset of symptoms and the patient’s presentation at the emergency department.”

Kahn went on to describe several other abusive health insurance practices, such as “inappropriate plan denials based on general plan exclusions and otherwise, down-coding and reclassifications; extended observation care; delayed credentialing to avoid payment; and reference pricing-based plans that operate without a network.”

He further noted that the Health and Human Services Department’s inspector general previously found (https://oig.hhs.gov/oei/reports/oei-09-16-00410.pdf) that private Medicare Advantage insurers “overturned 75 percent of their own denials from 2014-2016 and that independent reviewers at higher levels of review overturned additional denials ‘in favor of beneficiaries and providers.’”

“These activities,” Kahn wrote, “impose inappropriate burdens on patients receiving and providers or facilities furnishing both in-network and out-of-network services, and, in the context of emergency services, generate surprise bills, cause patients to forego seeking emergency services, and burden emergency facilities and providers with unnecessary disputes and administrative burdens.”
https://jacobinmag.com/2021/10/corporate-health-care-industry-surprise-billing-private-insurance-federation-of-american-hospitals-chip-kahn-biden-letter

[RandomGuy]

Are you referring to the body count you've ignored since somewhere near the end of January 2021?

Haven't been ignoring it, sorry.

Haven't been losing much sleep over people who die after life saving vaccines are available though.

I especially haven't been ignoring the efforts the administration has made to try and save lives, even ones in red states.

[RandomGuy]

Oh I see. The dems won't run on that because of the "right wing".

Brilliant

Can't afford healthcare but they get healthcare. Otherwise why are the hospitals overcrowded?

They won't run becasue they think they can't win on it. it is fucked, and they should. Absolutely the fault of the Democratic politicians.

Props to right wing propaganda though, because they have dupes like you convinced that a system that works in dozens of other countries for decades magically won't work here.

[Winehole23]

the idee fixe that the COVID death count has been ignored since Jan 21st approches blindness or senility.

maybe both.

[Chucho]

This is what was going to happen when you built a shitty healthcare initiative on insurance instead of actual healthcare.

Dem coffers were/are just as padded as Repub coffers with Big Pharma and Insurance dollars.

[Winehole23]

This is what was going to happen when you built a shitty healthcare initiative on insurance instead of actual healthcare.

Dem coffers were/are just as padded as Repub coffers with Big Pharma and Insurance dollars.no doubt about it, just look at Sen Sinema

[Chucho]

They won't run becasue they think they can't win on it. it is fucked, and they should. Absolutely the fault of the Democratic politicians.

Props to right wing propaganda though, because they have dupes like you convinced that a system that works in dozens of other countries for decades magically won't work here.

How large are the other countries that this works for? How much in local and global welfare do those countries dole out compared to the US? What are the tax rates in those countries?

Sorry, but to say "Oh, it works in these other countries that are fractions of the size of the US, let alone most of those countries have tax rates that would send most Muricans to the morgue from shock."

You're not going to make it work- it will take decades of cultural change for this to work. You're not going to get the average Murican to work and be taxed extraordinarily high to pay for healthcare. Proportionate correlation and being honest about how greedy and materialistic our society is and it's easy to see why no system that works for a select handful of countries will work for us.

[Thread]

This is what was going to happen when you built a shitty healthcare initiative on insurance instead of actual healthcare.

Dem coffers were/are just as padded as Repub coffers with Big Pharma and Insurance dollars.

Chooch

You're not going to get this gov't to hand out health care. It bugged them no end to hand out that free money the last two years...even to the point that Biden robbed the last $600 of it from both us & President Trump.

[DMC]

Haven't been ignoring it, sorry.

Haven't been losing much sleep over people who die after life saving vaccines are available though.

I especially haven't been ignoring the efforts the administration has made to try and save lives, even ones in red states.

Not ignoring it but no longer care. Got it. All the obesity driven comorbidities that led to a lot of deaths, those were horrible.

[baseline bum]

Not here in Arizona. You have to have insurance, or, cash and you're right, you have to schedule online.

Not true

https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html#az

[RandomGuy]

Not ignoring it but no longer care. Got it. All the obesity driven comorbidities that led to a lot of deaths, those were horrible.

The inaction, and incompetence of the Trump administration really was horrible. :lol Jared's intern task farce.

[Winehole23]

The inaction, and incompetence of the Trump administration really was horrible. :lol Jared's intern task farce.Can't say I'm a fan of Biden's COVID policy either. Rapid testing and contact tracing still haven't been scaled to need.

The decisions not to mandate vaccines until it was too late to prevent another spike and not to regulate workplaces through OSHA were also momentous, as was the decision to deemphasize layered protection. Telling vaccinated people to throw away their masks last spring was utter stupidity, but it dovetailed with a political narrative that overrode and still overrides science -- "back to normality"

Messaging has been awful. The failure to emphasize that COVID is airborne and the suite of protections that entails for congregating indoors -- masking, air quality monitoring, filtration, humidification and ventilation -- could end up undermining the pell-mell rush to reopen in-person schooling, to say nothing of exposing millions of kids to preventable disease and the suite of potentially life-changing outcomes thereto related.

More contuinuity than change, tbh

[RandomGuy]

This is what was going to happen when you built a shitty healthcare initiative on insurance instead of actual healthcare.

Dem coffers were/are just as padded as Repub coffers with Big Pharma and Insurance dollars.

Eyup. Nothing changes until we get money out of PACs and politics. fuck those companies, give me single payor

[RandomGuy]

Can't say I'm a fan of Biden's COVID policy either. Rapid testing and contact tracing still haven't been scaled to need.

The decisions not to mandate vaccines until it was too late to prevent another spike and not to regulate workplaces through OSHA were also momentous, as was the decision to deemphasize layered protection. Telling vaccinated people to throw away their masks last spring was utter stupidity, but it dovetailed with a political narrative that overrode and still overrides science -- "back to normality"

Messaging has been awful. The failure to emphasize that COVID is airborne and the suite of protections that entails for congregating indoors -- masking, air quality monitoring, filtration, humidification and ventilation -- could end up undermining the pell-mell rush to reopen in-person schooling, to say nothing of exposing millions of kids to preventable disease and the suite of potentially life-changing outcomes thereto related.

More contuinuity than change, tbh

Eyup. Well put, and mostly valid criticisms.

Shudder to think what would have happened had Loser McLoserface gotten his second term.

[Winehole23]

Eyup. Well put, and mostly valid criticisms.

Shudder to think what would have happened had Loser McLoserface gotten his second term.can't imagine it would have been any better than his first term.

just saw this, btw

1448094303142785029

[Thread]

can't imagine it would have been any better than his first term.

just saw this, btw

1448094303142785029

I got nary problem with the testing, though President Trump wouldn't do it, and neither will mother fucker Biden. Nothing good can come from it/testing in (their) eyes.

They have no problem touting how the vaccine is free, but you never see anyone trumpet that the testing is free. Nope.

You put that vaccine inside you, that's it, your choice is gone.
You get a clear test and you're happier than a pig in shit. You ain't looking ahead to the next test. You got that clear in your pocket and no vaccine coursing thru your veins forever more. It do not get better than that.

[DMC]

no doubt about it, just look at Sen Sinema

:lmao

"Just look at our own Benedict Arnold!"

[DMC]

The inaction, and incompetence of the Trump administration really was horrible. :lol Jared's intern task farce.

Kamala is knocking out of the park, and Fauci is up for an Emmy just like the gov of NY.. errr... former gov.

[DMC]

Can't say I'm a fan of Biden's COVID policy either. Rapid testing and contact tracing still haven't been scaled to need.

The decisions not to mandate vaccines until it was too late to prevent another spike and not to regulate workplaces through OSHA were also momentous, as was the decision to deemphasize layered protection. Telling vaccinated people to throw away their masks last spring was utter stupidity, but it dovetailed with a political narrative that overrode and still overrides science -- "back to normality"

Messaging has been awful. The failure to emphasize that COVID is airborne and the suite of protections that entails for congregating indoors -- masking, air quality monitoring, filtration, humidification and ventilation -- could end up undermining the pell-mell rush to reopen in-person schooling, to say nothing of exposing millions of kids to preventable disease and the suite of potentially life-changing outcomes thereto related.

More contuinuity than change, tbh

Did a great job not being Trump.

[Winehole23]

:lmao

"Just look at our own Benedict Arnold!"there are plenty of others

[Winehole23]

Did a great job not being Trump.apparently not being Trump beats the fuck out of Trump. i hope it works just as well next time.

[DMC]

there are plenty of others

That's my point. You just went right for the jugular of the one about to be voted off the island even though there are others. Hey it's not your fault, it's a bias you learn from youth and you cannot seem to shake it even if you try.

[DMC]

apparently not being Trump beats the fuck out of Trump. i hope it works just as well next time.

I wasn't the one bitching about how he's handled COVID knowing full well that's not why he was elected.

[Winehole23]

That's my point. You just went right for the jugular of the one about to be voted off the island even though there are others. Hey it's not your fault, it's a bias you learn from youth and you cannot seem to shake it even if you try.lol jugular

maybe i got tired of complaining about Obama's backroom deal with insurers on the ACA

[Winehole23]

I wasn't the one bitching about how he's handled COVID knowing full well that's not why he was elected.Trump mishandling COVID is one big reason wasn't reelected. All he had to do was pretend to care about other people and let other people front out the public health response, but he couldn't do it.

[Winehole23]

recently in the news:

https://www.salon.com/2021/09/23/big-pharma-firms-donated-750k-to-kyrsten-sinema--then-she-opposed-bill/

[Thread]

Trump mishandling COVID is one big reason wasn't reelected. All he had to do was pretend to care about other people and let other people front out the public health response, but he couldn't do it.

Horseshit. President Trump told us what was going to happen and it happened. Mother fucker Biden was told the exact same thing and now has 300k of dead Americans as non-living proof. We're herding it out just like they did 100 years ago when "A piece of gauze proved worthless." Everybody knew it 2 years ago come January and nothing has changed.

Biden has shown less empathy than President Trump did. That fuck Biden has "lost patience with us" because we didn't want to go along with him. He ain't mad that he's overseen the death of 300k Americans. He's mad because he got stuck in-the-middle without a "plan." He knew he didn't have a "plan" but that didn't stop him from peddling that God forsaken lie.

He knew this was going to happen because Hussein/as President was informed and told him before he/Biden ever got sworn.

Biden opened up on July 4th in full knowledge that we were going to get hit broad side. They told him then that it would peak mid-October, but he opened up anyway...and now it's done peaked.

Now Biden's been touched and just detests watching that death count go up each and every day.

Serves him right---that mother fucker.

[RandomGuy]

I wasn't the one bitching about how he's handled COVID knowing full well that's not why he was elected.

Handling of the pandemic was a huge factor in your wanna be dictators loss.

[Thread]

Handling of the pandemic was a huge factor in your wanna be dictators loss.

Mother fucker Biden is nary better. He's got 300k of dead Americans in less than 9 months, RG.

& counting, son.