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RE: Your baby is too fat - 10/12/2009 2:11:50 PM

hlen5

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Being in the 99th percentile doesn't even mean he's considered too fat! It only means that of out of 100 babies onee would only find ONE larger than the baby in question. The baby doesn't even have any underlying health conditions.

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RE: Your baby is too fat - 10/12/2009 2:18:31 PM

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~FR~

People do realize that Medicare has turned down claims, and for sometimes pretty ludicrous reasons, right? So if private insurance and the government both turn down claims for ludicrous reasons, what is the solution?

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RE: Your baby is too fat - 10/12/2009 2:19:56 PM

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mix it up so they are not all turning down the same claims. strength in numbers of options.

R

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RE: Your baby is too fat - 10/12/2009 2:48:33 PM

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C-sections are now a pre-existing condition and can get you dropped.
Spousal abuse is one too.

In essence, a crime against a woman can prevent her from getting or keeping insurance. Having a baby can as well. Having a baby who grows too "quickly" can get the baby dropped.

Anyone but me sensing a theme here?

http://alt.nntp2http.com/society/liberalism/2009/09/3a2fc9c2f888891d5d724f684dab2e34.html
http://www.seiu.org/mt/mt-search.cgi?blog_id=1&tag=pre-existing+conditions&limit=20

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RE: Your baby is too fat - 10/12/2009 3:14:50 PM

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I am not denying that the reason for the denial in the OP is pretty ludicrous. I was just wondering if anyone had seen the AMA study March of 2007 to March of 2008 that shows that Medicare had the highest denial rate of any provider, including private insurance companies? Percent of claims lines denied for Medicare is 6.85%, Aetna is 6.80%, and the third is Anthem with 4.62% . With this being the case, and Medicare having some pretty ludicrous denial as well, I am not sure what the OP proves.

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RE: Your baby is too fat - 10/12/2009 3:24:20 PM

Newyorkcouple10

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Well, given that Medicare is only provided to people 65 and older, it would seem more likely that its denial rate is higher: just a lot more experimental procedures requested to extend a cancer victim's life for 3 weeks at age 80 than at age 8.

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RE: Your baby is too fat - 10/12/2009 3:32:26 PM

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Come on NewYorkCouple bothersome littel tidbits like that could get Yyou a bad reputation around here.
By the way....welcome to the boards.

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RE: Your baby is too fat - 10/12/2009 3:47:25 PM

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Do you have the link to that, Master Orion? Im curious to see if they state the reasons for the denials.

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RE: Your baby is too fat - 10/12/2009 4:45:34 PM

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Y'all do realize that insurance is a for-profit industry, right? The only way for insurance companies to exist is to bring in more in premiums than they pay out in benefits. Nobody throws a shit-fit when other insurance companies (fire, auto, homeowners) do the same thing. If the insurer decides that it's probable that they will pay out more in benefits than they will take in in premiums for a particular potential client, it makes sense for them to not enter into a contract with that individual. Heck, auto insurance companies make pricing decisions based partially on statistical measures that are unrelated to a specific driver. A 24-year-old driver with a perfect record will pay more for insurance than a 40-year-old with the same record, just because he's statistically more likely to have an accident and cost the insurance company money. Why is this accepted as a normal business practice, while health insurance companies are vilified for similar practices?

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RE: Your baby is too fat - 10/12/2009 4:57:50 PM

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quote:

ORIGINAL: einstien5201

Y'all do realize that insurance is a for-profit industry, right? The only way for insurance companies to exist is to bring in more in premiums than they pay out in benefits. Nobody throws a shit-fit when other insurance companies (fire, auto, homeowners) do the same thing. If the insurer decides that it's probable that they will pay out more in benefits than they will take in in premiums for a particular potential client, it makes sense for them to not enter into a contract with that individual. Heck, auto insurance companies make pricing decisions based partially on statistical measures that are unrelated to a specific driver. A 24-year-old driver with a perfect record will pay more for insurance than a 40-year-old with the same record, just because he's statistically more likely to have an accident and cost the insurance company money. Why is this accepted as a normal business practice, while health insurance companies are vilified for similar practices?

Could it be that some of us don't beleive that the health of their fellow Americans should be adversley affected by the bottom line of an insurance company?Could it be that some of us beleive health care in this country should not be a for profit system?

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RE: Your baby is too fat - 10/12/2009 5:04:16 PM

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Guess you dont recall the fall out over insurance companies after Katrina... and im not talking about the health kind.

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Duchess of Dissent 1
Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

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RE: Your baby is too fat - 10/12/2009 6:03:27 PM

hlen5

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quote:

ORIGINAL: einstien5201

Y'all do realize that insurance is a for-profit industry, right? The only way for insurance companies to exist is to bring in more in premiums than they pay out in benefits. Nobody throws a shit-fit when other insurance companies (fire, auto, homeowners) do the same thing. If the insurer decides that it's probable that they will pay out more in benefits than they will take in in premiums for a particular potential client, it makes sense for them to not enter into a contract with that individual. Heck, auto insurance companies make pricing decisions based partially on statistical measures that are unrelated to a specific driver. A 24-year-old driver with a perfect record will pay more for insurance than a 40-year-old with the same record, just because he's statistically more likely to have an accident and cost the insurance company money. Why is this accepted as a normal business practice, while health insurance companies are vilified for similar practices?

Yes they are in business to make a profit, as all companies should be. However, one cannot afford health care without insurance. Insurance is one of the middle men that is squeezing out the availability of healthcare. I don't agree with putting caps on damages for incompetent care, but that is a factor, too.
We need to start over from the ground up to ensure the health of all our residents ( I was going to say citizens, but I can't condemn the illegals or their children to no health care).

I don't have a solution, but I do know preventative care is cheaper than using the ER like a convenient care clinic.

Denying a baby healthcare coverage (with no presenting problems) on his statistics is ridiculous.

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RE: Your baby is too fat - 10/12/2009 6:03:46 PM

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Oh god tazzy, I knew someone would ask and I did not save the one for the AMA site, but here is where I started (very biased site), and they have the chart copied into their report/editorial. From there I did some search on the key words. Looked in my history for IE and nothing jumps out at me.

Good luck, as it took a while to find the actual AMA report: http://newsbusters.org/blogs/tom-blumer/2009/10/06/deny-guess-who-has-highest-medical-claim-rejection-rate

Funny the original reason I researched this is someone made a ludicrous statement that Medicare made 10 times more line item denials than anyone else, and actually it was correct. Medicare covers about ten times as many though, so the stat was painted a certain way.

quote:

ORIGINAL: tazzygirl

Do you have the link to that, Master Orion? Im curious to see if they state the reasons for the denials.

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RE: Your baby is too fat - 10/12/2009 6:07:12 PM

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Actually, i am curious to know if the problem stems from the billing errors we have heard so much about, Master. With so many companies, and so many billing codes, the wrong code can kick out a denial. Was just curious as to how many of those percentages were attributed to that. Thank you for the link, Master.

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Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
Duchess of Dissent 1
Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

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RE: Your baby is too fat - 10/12/2009 6:50:26 PM

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This just in...LMAO always wanted to say that
UPDATE: Rocky Mountain Health Plans has now said it will cover Alex Lange, a baby they previously refused to give health insurance because of his weight.
"A recent situation in which we denied coverage to a heavy, yet healthy, infant brought to our attention a flaw in our underwriting system for approving infants," says Steve ErkenBrack, president and CEO, Rocky Mountain Health Plans. "Because we are a small company dedicated to the people of Colorado, we are pleased to be in a position to act quickly. We have changed our policy, corrected our underwriting guidelines and are working to notify the parents of the infant who we earlier denied.
" http://www.huffingtonpost.com/2009/10/12/alex-lange-denied-health_n_317337.html

there is also a PDF of the news release.
Yay there was something about there being an uproar over this, but I couldnt find a non huff post article...

Lucy
edited for the horrible code that snuck in while I wasnt looking

< Message edited by Lucylastic -- 10/12/2009 6:52:50 PM >

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RE: Your baby is too fat - 10/12/2009 7:02:09 PM

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LOL... gotta love how fast they covered their tracks!!!

At least the little fella will have some insurance... until they find another reason.

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Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
Duchess of Dissent 1
Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

(in reply to Lucylastic)

RE: Your baby is too fat - 10/12/2009 7:12:28 PM

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A private insurance company has to maintain its public image, while a government bureau with a monopoly wouldn't have to worry like that.

Down at the DMV their motto is, "We don't care - we don't have to."

quote:

ORIGINAL: tazzygirl

LOL... gotta love how fast they covered their tracks!!!

At least the little fella will have some insurance... until they find another reason.

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RE: Your baby is too fat - 10/12/2009 7:16:19 PM

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They also dont care if they turn a profit, because they, themselves, wont make a single dime more if they all or deny a claim. They work by the rules they are given... much more than i can say about the insurance companies who always have their eye on the bonus line

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Telling me to take Midol wont help your butthurt.
RIP, my demon-child 5-16-11
Duchess of Dissent 1
Dont judge me because I sin differently than you.
If you want it sugar coated, dont ask me what i think! It would violate TOS.

(in reply to Sanity)

RE: Your baby is too fat - 10/12/2009 7:16:49 PM

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you mean like this???
Hilda Sarkisyan went with supporters to Cigna's headquarters in Philadelphia in 2008, seeking an apology for her daughter's death. While inside the building, she said, some employees heckled her at one point and one person made an obscene gesture at her.
http://www.latimes.com/business/la-fi-cigna8-2009oct08,0,5656637.story

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RE: Your baby is too fat - 10/12/2009 7:35:49 PM

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Profits hinge on efficiency and customer service and company image. Profits aren't evil, they're incentives to produce, to work your ass off in order to succeed. The profit incentive is what built this country, not government. Bureaucracies are horribly inefficient and waste tremendous amounts of tax dollars. They're not accountable to anyone...

quote:

ORIGINAL: tazzygirl

They also dont care if they turn a profit, because they, themselves, wont make a single dime more if they all or deny a claim. They work by the rules they are given... much more than i can say about the insurance companies who always have their eye on the bonus line

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