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Ama Issues First Report Card on Health Insurance
While it is usual for health insurance companies rate doctors on their performance, it is now becoming the other way round. American Medical Association issued its first health insurance report card at the group’s annual meeting Monday. The primary focus is on how quickly and accurately doctors get paid. “Physicians are spending 14 percent of their total revenue to simply obtain what they’ve earned,” said Dr. William Dolan, an AMA board member.
Dr. Dolan explained that the report card is an effort to reduce the cost of claims processing to doctors and help them as they negotiate contracts with insurance companies; adding that the report card will help patients if it reduces wasteful administrative costs. The report card compares Medicare and seven national commercial health insurers on the timeliness and accuracy of claims processing. It is based on a random sample drawn from 3 million claims.
There are no grades like A, B and C, and many of the technical measures may not mean much to most patients. But business leaders and health policy makers are interested in cutting an estimated annual 0 billion in wasted administrative claims processing costs, AMA leaders said.
Four years ago, Dr. Marcy Zwelling got so frustrated with the time and cost of making sure she was paid accurately by insurers that she stopped dealing with them. She now runs a so-called “boutique” practice. Most of her patients pay her an annual fee out of their own pockets.
“The best thing is, I get to be a doctor” instead of a claims processor, said Zwelling, of Los Alamitos, Calif. She says she doesn’t make any more money than she did when she accepted insurance, but she has more time with patients.
UnitedHealthcare had the lowest rate of contract compliance, according to the AMA report. About 62 percent of medical services billed were paid by UnitedHealthcare at the contracted rate, compared with 71 percent for Aetna and 98 percent for Medicare.
UnitedHealthcare spokesman Gregory Thompson said doctors and their billing services share responsibility for prompt payment. “Data show there is often a significant lag time between when services are provided and physician claims are submitted,” he said.
He said UnitedHealthcare has improved its electronic claims systems and noted the AMA gave the company higher ratings on other measures.
Medicare performed better than the private insurers in most areas, said Dr. Lawrence Casalino, a University of Chicago health economist and former physician. Commercial insurance plans compete by promising employers that they are tough on holding down the cost of claims, he said.
“There’s no question that administrative costs for doctors and the country would be a lot lower in a single-payer system,” Casalino said in an interview after the meeting. But a market-based system has advantages of competition, choice and innovation, he said. “Are the benefits enough to justify the cost?”
Peter Lee of the Pacific Business Group on Health welcomed the report card, but said he hoped the AMA would look at a broader range of areas that would be helpful to consumers.
“Increased payments to physicians means increased premiums and increased costs in a system that is spiraling out of control,” Lee said.
Susan Pisano, a spokeswoman for America’s Health Insurance Plans, said that for claims to be processed accurately and quickly it takes two parties: insurers and doctors. She complained that while insurance companies that rate doctors generally share the information with doctors before they make it public, the AMA did not share its report with insurers before releasing it online Monday.
City Negotiates Health Insurance Snag
A city firefighter involved in an off-duty motorcycle crash in June was denied health insurance coverage for his injuries because the city’s health insurance required him to wear a helmet.
Lt. James Baker waited to see if the city council would accept a negotiated settlement this evening that would pay a reduced amount.
The Sebring City Council will meet at 6:30 p.m. today at 368 S. Commerce Ave. to vote on this and several other issues.
Baker suffered injuries from a motorcycle crash on U.S. 27 for which the medical claim came to about ,000. He was airlifted to the Tampa General Hospital’s trauma center.
“I was out for a little less than two months,” said Baker. “I returned to full duty around the first of August 2009.”
Baker’s insurance claim was initially denied because a clause added to the city’s health insurance policy in 2005 on “activities of a hazardous nature,” excluded from coverage motor cycle accidents without helmets.
Baker claimed he would have been injured regardless of whether he wore a helmet, and thus the claim should be paid. He suffered mostly abdominal injuries and no head injuries, he said Monday.
In 1998 when he was hired, Baker said he received a copy of his insurance policy, and at time the exclusion clause was not there. He had no recollection of being notified that it was added, he added.
Had he known of the exclusion, he would have been wearing a helmet, he said.
At a city Health Insurance Committee meeting, City Clerk Kathy Haley said she was not sure if the notice of the added exclusions were handed out to city employees, the minutes of the meeting show.
Mayor George Hensley said a committee or an employee might consider different activities “hazardous.”
City Administrator Scott Noethlich agreed, but asked how one defined “hazardous.”
Representatives of the city’s health insurance administrator, Anchor Benefit, negotiated a settlement of ,750, which they will have to pay.
At a special meeting held Feb. 25, the committee recommended that the council accept Anchor Benefit’s negotiated discount with the understanding that Baker pays his remaining out-of-pocket maximum for the year of 4.74 and a 5 fee to negotiate the claims.
The tentative agreement further concluded that the basis of the recommendation was that Baker did not receive any head injuries and that he would have been injured even if he was wearing a helmet at the time of the crash.
However, it remains up to the city council to approve the deal.
Hensley said Monday that representatives of Anchor Benefit consulting had advised that this exclusion is not usually found in insurance policies, and Hensley believed the city would probably take a closer look at it.
Baker has since stopped riding a motorcycle, citing his love for his wife and five children.
He said that his wife told him while he was still in Tampa General Hospital that she knew how much he loved riding a motorcycle and she would not ask him to stop.
“That was a hobby,” said Baker. “I was ready to give it up, not to put my family through that again.”
On July 1, 2000, Florida exempted adult motorcyclists and moped riders from wearing helmets provided they have 000 in medical insurance, according to Andreas Muller, in the April 2004, American Journal of Public Health.
Since then, Florida statutes have required motorcycle riders younger than 21 years to wear helmets.
The statute was signed into law by former Gov. Jeb Bush.
Before that Florida had a helmet law that required all riders to wear safety helmets.
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Health Insurance Cost Per Month – Save Money On Your Health Insurance
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