General Discussion

MedicalAdmin

(4,143 posts)

85. Neither of those are medical review.

Mon Jan 2, 2012, 07:28 AM

Jan 2012

Both of them are already considered admin costs and will remain so. Utilization review is a clerk looking to see if the language if your contract covers your problem. This is a good thing.

(btw - the NAIC is already being invaded on a state by state basis by insurance stooges - appointed by governors of the red persuasion - see recommendations: ALEC) so don't expect those rulings to keep coming.

However medical review is not that at all. It has nothing to do with contract language. It is hired medical guns who will vow under oath that the problem you have isn't a problem or that you are lying and fine. And if you are denied treatment and dont have the money to get it anyway, you won't have tangible evidence that you had a problem. If they can keep you from proving it on paper, then that is that. You are one more in a legion of the fucked.

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The Bomb Buried In Obamacare Explodes Today-Hallelujah! [View all] jorno67 Dec 2011 OP

A step in the right direction. nt ZombieHorde Dec 2011 #1

A teeny, tiny step, but a step nontheless. russspeakeasy Dec 2011 #4

The longest journey begins with a teeny, tiny step. nt gateley Dec 2011 #16

No, it's pretty f'ing huge. The Doctor. Jan 2012 #74

This "Teeny, tiny step" will lead to the ultimate end of for-profit insurance companies WonderGrunion Jan 2012 #115

Will that get Huckleberry off my TV? Blacksheep214 Dec 2011 #2

he is just cashing in, repeal is impossible Motown_Johnny Dec 2011 #13

Huckleberry. leeroysphitz Jan 2012 #28

someone should ask him who pays his health insurance LiberalFighter Jan 2012 #47

Notice how Forbes frames a tiny little slice of justice for the consumer and against corporations... MilesColtrane Dec 2011 #3

Our insurance company is sponsoring First Night in downtown Pgh. tonight livetohike Dec 2011 #5

HA HA! mistertrickster Dec 2011 #6

Not much of a bomb as most larger carriers already exceed that ratio leveymg Dec 2011 #7

So if the Premiums are Not Going to Earnings, Compensation, and Other Overhead, On the Road Dec 2011 #9

Salaries and share equity - BC/BS is an association of hospitals, clinics and health care providers. leveymg Dec 2011 #14

OK, But Aren't Many of Those Things Part of the the 7% Overhead? On the Road Jan 2012 #39

No salary cost-containment in the US system - compensation isn't overhead, it's most of the 93% leveymg Jan 2012 #44

We pay Blue Shield $1200 a month. Seriously. tblue Dec 2011 #8

I do too, but my two autistic children make that a good deal. Throckmorton Jan 2012 #71

I'm very glad you have coverage! tblue Jan 2012 #114

Please keep this in mind. MedicalAdmin Dec 2011 #10

Have you got a link for that claim? Bob Wallace Jan 2012 #51

Claim verification yes. MedicalAdmin Jan 2012 #57

What's the thinking behind denying claims? Bob Wallace Jan 2012 #58

It works like this. MedicalAdmin Jan 2012 #61

I don't understand that thinking... Bob Wallace Jan 2012 #66

So ... The invisible hand of the market MedicalAdmin Jan 2012 #75

No, but market forces are a tool that can be used. Bob Wallace Jan 2012 #78

Lol. Now THAT is funny. MedicalAdmin Jan 2012 #82

Yep... Bob Wallace Jan 2012 #90

Anti monopoly laws stop monopolies from forming. MedicalAdmin Jan 2012 #97

Market forces break down in the absence of anti-trust regulation. Selatius Jan 2012 #128

You think that will hold once the Exchange is in place... Bob Wallace Jan 2012 #129

Anecdotal evidence? MedicalAdmin Jan 2012 #130

Skunk!!! (Holds nose when confronted with stinky attitude) Bob Wallace Jan 2012 #132

Regarding your second sentence. MedicalAdmin Jan 2012 #133

You read me incorrectly... Bob Wallace Jan 2012 #134

I'm not sure if my case is applicable here, but I'll play along anyway. MedicalAdmin Jan 2012 #136

Wow. All I can say is that you really don't understand these companies. At all. MedicalAdmin Jan 2012 #84

Please... Bob Wallace Jan 2012 #92

This message was self-deleted by its author MedicalAdmin Jan 2012 #98

There is so much WRONG with this.... bvar22 Jan 2012 #116

I live in a very rural part of a very thinly populated county... Bob Wallace Jan 2012 #125

I work in the claims payment industry.. sendero Jan 2012 #124

Thank you for telling me that I sound like some sort of a libertarian fool... Bob Wallace Jan 2012 #126

I might have found the answer... Bob Wallace Jan 2012 #80

Neither of those are medical review. MedicalAdmin Jan 2012 #85

Again... Bob Wallace Jan 2012 #93

Can you ship me some of that weed. MedicalAdmin Jan 2012 #94

I do not think that is true, according to the final rule on calculating the Medical Loss Ratio. Hoyt Jan 2012 #87

All of which doesn't matter a gnats fart in a hurricane without... MedicalAdmin Jan 2012 #95

Oh come on. What does that have to do with this topic? Hoyt Jan 2012 #100

Are you kidding? MedicalAdmin Jan 2012 #105

You are the one spreading incorrect information on how the MLR will be calculated. Hoyt Jan 2012 #106

OK. you win. MedicalAdmin Jan 2012 #108

No. The real BOMB explodes in 2014... bvar22 Dec 2011 #11

Here is the outrageous truth. nt woo me with science Jan 2012 #25

A sad +1 n/t wakemewhenitsover Jan 2012 #27

You got it SixthSense Jan 2012 #33

Don't believe MLR calculation is left up to insurers, although I understand your suspicion. Hoyt Jan 2012 #88

THANK YOU for keeping it real fascisthunter Jan 2012 #36

Thanks for keeping it real Oilwellian Jan 2012 #37

+1 area51 Jan 2012 #40

Only those who are uninsured by choice will be bothered. lumberjack_jeff Jan 2012 #43

Candidate Obama disagreed with you. bvar22 Jan 2012 #45

He was wrong then, and that's why I supported Hillary. lumberjack_jeff Jan 2012 #48

People who don't have any money with get free insurance. Bob Wallace Jan 2012 #52

Could you provide a link, please. Cameron27 Jan 2012 #68

I can give you something of a link... Bob Wallace Jan 2012 #70

Thank you very much. Cameron27 Jan 2012 #73

Earnest Dealer. The Doctor. Jan 2012 #77

So I am uninsured by choice? MedicalAdmin Jan 2012 #59

My Wife & I are "Uninsured by Choice" too. bvar22 Jan 2012 #89

Right back atcha. MedicalAdmin Jan 2012 #96

+1000, until the 'for-profit' nature of medical care is ripped asunder, the US people are screwed stockholmer Jan 2012 #46

They won't be the only ones who are pissed. hughee99 Jan 2012 #65

McCarran-Ferguson act E6-B Dec 2011 #12

Excellent point. MedicalAdmin Jan 2012 #62

This was almost a month ago, new stuff happens 1/1/2012 Motown_Johnny Dec 2011 #15

AKA the shift administrative costs to the doctors MedicalAdmin Jan 2012 #60

it seems to be an attempt to reduce billing costs Motown_Johnny Jan 2012 #72

Good, but we've still got ~ 15% of our precious healthcare dollars... Scuba Dec 2011 #17

And 1% to 3% for Canadian health care murphyj87 Dec 2011 #22

All good points but canada's overhead percentage MedicalAdmin Jan 2012 #63

Statistics show murphyj87 Jan 2012 #81

Holy crap. That is a freakishly great post. MedicalAdmin Jan 2012 #86

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And no doubt some private insurance dollars go to fraud and abuse.... Scuba Jan 2012 #50

Administrative costs are mostly employee salaries. bornskeptic Jan 2012 #55

Is there data to support that? Scuba Jan 2012 #56

As time goes on... Bob Wallace Jan 2012 #53

This was Franken's idea, right? LiberalAndProud Dec 2011 #18

A business that can pull a 10% profit margin for doing nothing but shuffling paper. Whoopee. Sirveri Dec 2011 #19

No health insurance company approaches a 10% profit margin. bornskeptic Jan 2012 #69

which is why this does nothing. Sirveri Jan 2012 #101

No universal health care means Americans are NOT getting what we want. just1voice Dec 2011 #20

That was nearly a month ago. Courtesy Flush Dec 2011 #21

I thought that was last month? tavalon Jan 2012 #23

As if they will enforce this anyway. fasttense Jan 2012 #24

Call in the accountants! Bragi Jan 2012 #30

k&r... spanone Jan 2012 #26

Excellent! eom MoonRiver Jan 2012 #29

A bomb most likely to cause systemic cost to increase. Watch as the allowable costs rise. TheKentuckian Jan 2012 #31

If 'today' means 'last month' then yes, it is today.... Bluenorthwest Jan 2012 #32

Here's ProSense Jan 2012 #34

So another win for the God Damn doctors and hospitals! RB TexLa Jan 2012 #35

Convince me that cost of insurance won't go up? BadgerKid Jan 2012 #38

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We will have a more competitive market than we've had before.... Bob Wallace Jan 2012 #54

What? MedicalAdmin Jan 2012 #64

Come on... Bob Wallace Jan 2012 #67

I hope it gets fixed. MedicalAdmin Jan 2012 #76

What happens before the bill goes into effect... Bob Wallace Jan 2012 #79

Please define "higher value care." What does that mean? MedicalAdmin Jan 2012 #83

I'm getting tired of your bitterness... Bob Wallace Jan 2012 #91

Did you just call me bitter? MedicalAdmin Jan 2012 #99

Bitter... Bob Wallace Jan 2012 #103

I have acknowledged much of that. MedicalAdmin Jan 2012 #107

I'm not holding your attitude against you... Bob Wallace Jan 2012 #109

Really? Bitter, I believe you said. MedicalAdmin Jan 2012 #110

If premiums go up at an unreasonable rate... Bob Wallace Jan 2012 #111

They work both ends of the street. MedicalAdmin Jan 2012 #112

This is getting tiresome... Bob Wallace Jan 2012 #113

If Costco is involved, what could go wrong? MedicalAdmin Jan 2012 #127

Difficult to Shop for Insurance? bvar22 Jan 2012 #117

I just did that... Bob Wallace Jan 2012 #119

expect the cost of healthcare to rise boston bean Jan 2012 #42

There is no differnce to make up. former9thward Jan 2012 #104

Do you realize the way to make more money is to increase costs? dkf Jan 2012 #102

Sort of correct... Bob Wallace Jan 2012 #120

Personally I have one provider through my employer. dkf Jan 2012 #121

That makes it easy... Bob Wallace Jan 2012 #122

I'll believe this when I see it. icymist Jan 2012 #118

kick spanone Jan 2012 #123

Now..this is a good thing...OK..I am late on this..but K and R anyway.. Stuart G Jan 2012 #131

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