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inefficiencies with private payers Inefficiencies like billions of dollars in overbilling annually?
by inferiorhuman 2y ago
inefficiencies with private payers
Inefficiencies like billions of dollars in overbilling annually?
- tptacek 2y agoProviders overbill. Insurers inappropriately deny coverage. This is pretty basic stuff. What would insurer overbilling even mean? You pay a fixed premium.
- inferiorhuman 2y agoWhat would insurer overbilling even mean? It would mean something like this: https://www.nytimes.com/2017/05/19/business/dealbook/unitedhealth-sued-medicare-overbilling.html https://www.nytimes.com/2017/05/19/business/dealbook/unitedh... Or this: https://www.sacbee.com/news/local/health-and-medicine/article262352507.html https://www.sacbee.com/news/local/health-and-medicine/articl...
- tptacek 2y agoYour second link is literally Anthem passing provider fees (in violation of their contract, sure!) through to customers. The bills were from providers. Fuck if I know what's going on between Medicare and UHC. It's a mess. Medicare Advantage is a hybrid Medicare/private system; once again, whatever fees were being passed to Medicare, they were coming from providers. Insurers can certainly inappropriately deny coverage, but they don't generally make de novo charges up. Charges come from providers. Upcoding scandals, which literally appear to be what the UnitedHealth link you provided was about, were exactly what Anthem was trying to control for with its new announcement.
- nradov 2y agoMedicare Advantage is a capitated program. The provider fees aren't being passed through to Medicare.