Claim Denied - Revisited
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Medical Denials Revisited
I wanted to spend a little time on claims denials. Remember that the longer the insurance company denies claims, the longer they hold the cash invested, the more money they make. It is not in their financial interest to pay claims.
Succinctly, insurance companies can deny claims or decline prior authorization for what doctors determine is medically necessary. They do not follow any uniform standards for their denials. They can claim that they have data that is more relevant than the doctor’s. It can be based on local patient experiences, or not, it can be their suite of patient experiences, or not. It can be software generated, or not. But it is usually not a peer reviewed process and generally favors denying treatment to those that need it most.
Here is a link to a good Pro Publica story. They found that state insurance commissioners in only 2 states release denial data. In other states it is either held as private information or not collected. It is crucial for someone who is buying insurance to know whether their choice pays 97% of the time or 50% of the time. Your choice of insurer may be a life and death decision or may portend bankruptcy. Yet insurance companies say denial rates are not directly comparable from one health plan to another and could lead consumers to make inaccurate conclusions on the robustness of the health plan. So says Blue Cross.
For Affordable Care Act plans the Kaiser Family Foundation found that about 17% of all claims were denied over the 230 insurance companies offering such plans. Here is a link to the story. They found denial rates between 5.7% and 41.9%. Here’s the data.
About 85% of people with insurance who responded to a survey said they want regulators to compel insurers to disclose how often they deny claims.
It isn’t a pretty picture. Until we have universal healthcare we need to demand the data that we need to be informed consumers to make the best choices for our health. Let’s let our state legislators and governors know we want this transparency.
ACTION
You can use this link https://www.usa.gov/elected-officials to find emails for your state legislators and your governor and let them know you want them to collect and publish claims denials and prior authorization denial rates from every health insurer licensed in your state. Or use RESISTBOT to send the email below by texting SIGN PLKSWI to 50409 from your cell phone.
“I am your constituent and I want you to know that a Kaiser Family review of Affordable Care Act data found that health insurance claims denials varied between 5.7% and 41.9%. It is incredibly hard to find health insurance claims denial rates and prior authorization denial rates for each type of policy. Good news - you can fix this and make all of us better consumers by enacting legislation that has our state’s insurance commissioner collect the data yearly and publish it yearly. I want you to do that. I am sure you don’t want the insurance company with a 41.9% denial rate, do you?
Thank you.
Coffee Cure? Additional Details
Last week we reported on a University of Texas team that has an early demonstration that used coffee grounds to generate a potential protection from neurodegenerative diseases like Alzheimer’s, Parkinson’s, and Huntington’s that affect millions of people in the United States.
The team processed the used coffee grounds by cooking them at 200 degrees (F) to reorient the caffeic-acid-based Carbon Quantum Dots (CACQDs) according to a recent story in Sci Tech Daily.
They then demonstrated the protective capability of the CACQDs on cells in the lab.
CQDs are quasi-spherical particles less than 10 nm in size with remarkable physicochemical features like low toxicity, inexpensive, chemical inertness, biocompatibility, and high photostability.
The point of this discourse was to make sure that we all know that this was a lab experiment on cells only. We have no idea how we might somehow apply this to live brain cells in humans at this time.
Other Coffee Studies
Here is a research review. “Neuroprotective and Neurodegenerative Aspects of Coffee and Its Active Ingredients in View of Scientific Literature” that was at the NIH website.
The idea was to examine studies that have been done on the effect of coffee to lower the risk of cognitive decline and other neurodegenerative diseases. Many epidemiological studies in their literature review have shown coffee to reduce the risk of developing dementia, stroke, and Alzheimer's disease. It may also have a positive impact on the disease course of amyotrophic lateral sclerosis, Parkinson's disease, and depression.
The optimal benefits achieved from coffee seemed to rely on high daily doses. Most of its effects are attributed to caffeine but chorogenic acid may also be a positive contributor. Their conclusion was that coffee may reduce the overall risk of neurocognitive decline and play a beneficial role in other neurodegenerative diseases when consumed in moderate amounts. There were few harmful side effects (look out for blood pressure) and exact mechanisms are not well understood.
Bottom line - more study to do. I’ll have another cup of coffee.
RESOURCES
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Important Healthcare Resources
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Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water RESISTBOT write up
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Hi Alan,
I’ve read many articles and studies about coffee and health and recall that most of them report that decaf has comparable benefits to the jittery stuff. Also, for me and others, small amounts of caffeinated coffee don’t raise blood pressure. I’ve recently read that genes have a lot to do with how fast someone metabolizes coffee, with the rapid version having more tolerance. A good source to find such source information is to use the search button on Home-Barista.com and enter something like “coffee health.”
https://www.home-barista.com/
Buon caffe!
P.S. I’ll be happy to provide you with very tasty decaf.