Medical Billing Forum

General Category => General Questions => Topic started by: switcheroo on August 11, 2015, 12:28:00 AM

Title: Choosing our own health insurance based on how they pay
Post by: switcheroo on August 11, 2015, 12:28:00 AM
Hello, everyone. I only worked temporarily in a billing office once, so I'm not too knowledgeable. I have questions from the standpoint of a buyer of health insurance.

First thing, I searched Google for "anthem california reviews" and similarly for other insurers. They all have terrible reputations about paying claims and customer service.

Insurance is less valuable if the insurer works hard to deny claims based on lack of medical necessity or other excuses. I would have thought that an insurer's decision to pay versus deny a claim would be strictly determined by medical necessity. But apparently, judging from those reviews, necessity is a debatable concept and insurers have wiggle room to exploit.

So I've been looking at the American Medical Association's (AMA) National Health Insurer Report Card (NHIRC). I found it by searching Google for that.

I'm curious about your opinion: which of their metrics are most useful? (e.g. "Percentage of claim lines paid $0" versus "Contracted fee schedule match rate" versus "Percentage of total claim lines reduced to $0 by disclosed and undisclosed claim edits" versus "Percentage of claim lines denied" etc)

Also, where do I learn the meaning of "disclosed and undisclosed claim edits"?

In addition, I wonder whether any of your billing offices have done their own number crunching to figure out which insurers most hurt the patients with ruthless practices in handling claims. I'm hoping the billing staff would be curious about this, so they'd be interested and willing to check it out.

FYI, I'm in California. Thanks for any insights about rationally choosing health insurers for our own personal insurance!
Title: Re: Choosing our own health insurance based on how they pay
Post by: rofakamrd on August 11, 2015, 01:53:08 PM
good luck!
Title: Re: Choosing our own health insurance based on how they pay
Post by: Michele on August 30, 2015, 03:53:37 PM
I'm not sure exactly what you are trying to figure out, which is the worst insurance from a patient standpoint?  From a provider standpoint?