“GAO report illustrates success rates for appealing denials of health insurance claims - Washington Post” plus 1 more |
| Posted: Don't take no for a final answer when a health insurer rejects a claim and leaves behind an unpaid medical bill. As many as 50 percent of some appeals prompt insurers to reverse their decisions, according to a report from the Government Accountability Office. Insurers frequently deny claims due to billing errors, missing information or judgments on whether the care or service is appropriate, the investigative arm of Congress said in a report released Wednesday. These denials can be based on mistakes like an incorrect code on a claim submitted by a doctor's office, said Nancy Davenport-Ennis, CEO of Patient Advocate Foundation, a not-for-profit that helps people appeal claims denials. "You've got a lot of people in America who are ultimately paying a bill they don't owe because they don't realize it's an incorrect code," said Davenport-Ennis, who wasn't involved in the government study. The GAO studied health insurer rejection rates at the request of Congress, which wanted a better picture of the issue as part of the health care overhaul it passed last year. The overhaul aims to cover millions of uninsured people after it unfolds over the next few years. The GAO studied data collected from a handful of states and reports done by other agencies. It found that as many as 50 percent of appeals to insurers in Maryland in 2009 led to coverage decision reversals. In Ohio, 48 percent of appeals to insurers led to reversals last year. Appeals to a third party can fare decently, too. The GAO cited a report from America's Health Insurance Plans, which studied 37 state external review programs a few years ago and found that about 40 percent of external appeals led to the reversal of a claim denial. These figures do not mean patients have nearly a 50 percent shot at success if they appeal a denial. The statistics are based on cases appealed, and only a small portion of denials are challenged, said John Dicken, a GAO health care director. Patient Advocate Foundation, which works in all 50 states, helped more than 17,000 people deal with insurance claims denials last year. A benefit not covered by a health plan is the most frequent reason they see for claim denials. Davenport-Ennis said coverage parameters can vary widely, and they are often determined by the insurer and the employer that provides group health coverage. For instance, some company plans may not cover Autism treatments or clinical trial enrollments. Davenport-Ennis also said they've seen insurers tighten restrictions on prescription drug coverage in recent years and add cost-control wrinkles like limits on the number of surgeries covered in a year. That means a breast cancer patient in some cases may have her biopsy and lumpectomy covered but not the reconstructive surgery that follows. Patient Advocate Foundation also deals with claims that are denied even though they involve a benefit covered by the insurance plan. "There are many times the claim is denied the first go-round to see if you come back and appeal," Davenport-Ennis said. Copyright 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. ???initialComments:true! pubdate:03/16/2011 17:06 EDT! commentPeriod:3! commentEndDate:3/19/11 5:6 EDT! currentDate:3/19/11 4:16 EDT! allowComments:true! displayComments:false! This entry passed through the Full-Text RSS service — if this is your content and you're reading it on someone else's site, please read our FAQ page at fivefilters.org/content-only/faq.php |
| Minnesota Health Department confirms six measles cases in west metro - Pioneer Press Posted: The Minnesota Department of Health is asking parents to make sure children are up-to-date on vaccinations after five measles cases were confirmed this week, bringing the total for the month to six. The illnesses are worrisome because measles is serious and highly contagious, and not all children in the state have received the vaccine. Three of the children identified this month with measles are Somalis who had not been vaccinated, according to the Health Department. In at least two of those cases, parents were concerned about the safety of the vaccine. "Contrary to misinformation that may still be circulating, the measles vaccine is safe and effective. Without it, the risk of disease is real," Dr. Edward Ehlinger, commissioner of the state Health Department, said in a statement this week. "Children can die from measles." The safety of the vaccine for measles, mumps and rubella — called MMR, for short — was called into question about 12 years ago by a research report that has since been discredited. The study suggested a link between the vaccine and autism but was subsequently retracted; the medical journal in question determined earlier this year that the researcher had faked his data. A few years ago, the Minnesota Department of Health determined that Somali schoolchildren were overrepresented in Minneapolis preschool programs for children with autism spectrum disorder, said Buddy Ferguson, a department spokesman. But that doesn't mean autism rates are elevated in the Somali community."The issue is still under investigation," Ferguson said. "The lack of a link between vaccines and (autism), on the other hand, has been established in a number of large, well-designed studies." As of August 2009, records show that 82 percent of Minnesota children ages 24 to 35 months had received at least one dose of the MMR vaccine, Ferguson said. Two weeks ago, the Health Department reported that it was investigating a case of the illness in a Minneapolis infant. The baby was too young to have been vaccinated, and it was unclear whether the measles exposure occurred in Minnesota or another state, since the child's family had recently moved to the Twin Cities. But the Health Department reported Thursday that three more cases had been confirmed in children from 23 months to 4 years old. The children live in Minneapolis, where they likely acquired their infections. On Friday, the state learned of two more cases. All six cases involve Hennepin County children 9 months to 4 years old. Five were unvaccinated or too young to be vaccinated and the status of the sixth was unknown, Ferguson said. Hennepin County will hold a vaccine clinic for children from 3 to 6 p.m. Monday at its Public Health Clinic, 525 Portland Ave. S. in Minneapolis. Children's Hospitals will hold a clinic for adults and children from 1 to 4 p.m. March 27 at its Children's Specialty Center, 2530 Chicago Ave. S. in Minneapolis. If people who had contact with the children in the first four identified cases were to get measles, symptoms likely would appear between March 1 and April 7, health officials said. Symptoms of measles include fever, runny nose, cough, loss of appetite, watery eyes and a rash. The rash usually lasts five to six days and begins at the hairline, moving to the face and upper neck and proceeding down the body. It generally takes eight to 12 days from exposure to measles to the appearance of the first symptom, which is usually fever. Measles is spread through the air by infectious droplets. It can be transmitted from four days before the rash becomes visible to four days after the rash appears. More information is available online at tinyurl.com/45psoh5. Christopher Snowbeck can be reached at 651-228-5479. This entry passed through the Full-Text RSS service — if this is your content and you're reading it on someone else's site, please read our FAQ page at fivefilters.org/content-only/faq.php |
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