Big Insurers Underspend On Medical Care, Senate Probe Finds

Posted on 03. Nov, 2009 by Editor.

Which big health insurance company did lawmakers single out? Is it the one that gives you the most denials trouble?

A US Senate probe confirms what many coders and billers have been suspecting all along — that six major medical insurers aren’t spending as much as they should providing actual health care.

Insurance industry officials say that all health insurers spend an average of 87 cents of every dollar on medical care, reports The Wall Street Journal. For the trade-group-curious, America’s Health Insurance Plans (AHIP) came up with the ‘87 cents’ figure.

And I bet you can tell me the names of the insurers that ‘underspend’ without reading the rest of the article. But just for grins — they’re Aetna Inc., Cigna Corp., Coventry Health Care Inc., Humana Inc., Unitedhealth Group Inc. and Wellpoint Inc., reports the Journal. These big fish spend an average of 74 cents on every dollar individuals pay in premiums on medical care (if they’re on individual plans). That figure goes up a bit for small group (80 cents). However, even the large group insurance average (84 cents) for these six insurers doesn’t hit AHIP’s estimate of how much premium money goes to actual medical care.

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Pssssssst. Payer Report Cards Are Out

Posted on 05. Aug, 2009 by Editor.

If you know your payers’ strengths and weaknesses, you’re better equipped to fight denials and negotiate contracts that are in your best interest.

So check out the American Medical Association’s second annual National Health Insurer Report Card. The AMA has gathered data and rated large payers on criteria like payment timeliness, accuracy, claim edit sources and denials, according to an American Medical News article that summarizes trends in the report card.

Drawback: The AMA’s payer report card looks only at big, national insurers (Aetna, Anthem, Blue Cross and Blue Shield, Cigna, Coventry, Health Net, Humana, UnitedHealthcare and Medicare). To get the dirt on smaller or regional payers, check out this resource from Athenahealth.

To see the AMA’s payer report card, go here.

Are your payers ‘remedial’ at best? USE THE APPEALS PROCESS LIKE A PRO, with APPEALS QUEEN Barbara Cobuzzi.

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Tool: How Do Your Payers Measure Up?

Posted on 12. Jun, 2009 by Editor.

Coders & Billers: Can you feel your life getting a little easier? Overall, payers are reimbursing providers faster (up 5.3% from last year) and denying 9% fewer claims.

That’s according to Athenahealth, an online medical billing service that has ranked 172 health insurers nationwide for how well they pay up in the physician and hospital arenas. Among the 7 health insurance giants, Humana ranked first, and Coventry Health Care came in last. For more winners and losers, see this summary from Athenahealth.

Cool Tool: Also on the site, a revealing window into how well YOUR PAYERS stack up. Simply select your region, and see how the ‘usual suspects’ rank overall, as well as in particular areas, such as timeliness and ‘transparency’ of denials.

Still don’t feel like you can relax and break out the bubblebath just yet? That’s OK. Audioeducator has an on-demand class coming up that teaches you how to USE THE APPEALS PROCESS LIKE A PRO, with APPEALS QUEEN Barbara Cobuzzi.

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