On Mon, 26 Oct 2009 10:22:39 -0700, "nom=de=plume"
wrote:

wrote in message
.. .
On Mon, 26 Oct 2009 04:22:26 -0600, Vic Smith
wrote:

On Mon, 26 Oct 2009 00:55:30 -0400, wrote:


Besides, that article has some other gems, such as the there's no
evidence the private insurers do any better with fraud than does
Medicare.


Did you see 60 Minutes tonight? They are talking about billions in
medicare fraud.

No, missed that. But see above. Maybe you missed it.
Somehow the Medicare fraud doesn't bother me as much after seeing
that.
After all, we're paying almost 10 times more to Aetna than to
Medicare.
So for every buck of mine going to a crook cheating Medicare, there's
nearly a sawbuck of mine going to the crook cheating Aetna.
Great system. Pretty equitable for the crooks percentage wise.
Lucky I can afford it. Good luck to those who can't.
They'll need it.

--Vic

I bet Aetna doesn't have near the fraud rate of medicare. They said
the whole Florida medicare department only had 3 investigators and
they called the process "pay and chase". They paid the claim, then
they determined if it was valid. The crooks would start and close the
fraudulent businesses faster than the investigators could look into
the claims.


I'm sure you're right. The "fraud" with Aetna (not singling them out
particularly) is that they're doing all the other bad activities (for
individuals). The problem with the Medicare fraud is that it's partly a
legislative issue. They must issue payment within I recall 30 days. The
investigative arm is underfunded (just got a $200M boost, but that's still
light in my view).

And you're both most likely wrong. As I said, the article I posted
was what seemed like a pretty good examination of Medicare and the
private insurance industry. They said they could find no evidence
that there was less fraud in private insurance than there is in
Medicare.
What is the funding of Aetna anti-fraud?
Don't know, do you?
Well, why should you? After all, 60 minutes isn't doing features
about Aetna. Taxpayers aren't squawking about Aetna.
Furthermore, where is the competitive pressure that would force them
to address it? There's a sweet little oligopoly of health carriers
here, as in most states.
Fraud costs go up? Who cares, raise the premiums.
It's easy to live with mythical assumptions, but it's a lot more fun
to examine them.

--Vic

wrote in message
...
On Mon, 26 Oct 2009 14:40:40 -0600, Vic Smith
wrote:

And you're both most likely wrong. As I said, the article I posted
was what seemed like a pretty good examination of Medicare and the
private insurance industry. They said they could find no evidence
that there was less fraud in private insurance than there is in
Medicare.
What is the funding of Aetna anti-fraud?
Don't know, do you?
Well, why should you? After all, 60 minutes isn't doing features
about Aetna. Taxpayers aren't squawking about Aetna.
Furthermore, where is the competitive pressure that would force them
to address it? There's a sweet little oligopoly of health carriers
here, as in most states.
Fraud costs go up? Who cares, raise the premiums.
It's easy to live with mythical assumptions, but it's a lot more fun
to examine them.

Who wrote the article you read and what was the source? I am just
basing my opinion on the amount of denials you get from insurance
companies and the hoops you have to go through to get paid. That is
not the rubber stamp you have with Medicare.
I did just go through this with Aetna and I know they wanted to see
the referrals for everything I claimed . It sure wasn't anything like
that thing 60 minutes was talking about where a storefront with no
bona fides can simply send medicare a bill for something and get paid
in a few days.


Hmmm... the funding of Aetna anti-fraud is the profit motive? Makes sense.
Of course, they do everything for the profit motive, which is the problem.
That's why it takes multiple tries to get reimbursed. I don't have Aetna,
but it's the same story... send it in, wait, nothing, send it in, repeat.
It's obvious to me that neither completely for-profit nor completely
non-profit, gov't run is the answer to stamping out fraud. I believe in
competition, but I also believe in taking the fear and worry out of medical
expense issues.

--
Nom=de=Plume

On Mon, 26 Oct 2009 17:24:19 -0400, wrote:


Who wrote the article you read and what was the source?

Not going there. One reason I bailed from any discussion of this is
depth is I'm just not going to repeat the same thing over and over.
Or argue when my links are disputed without being read.
It's in the thread. No hard feelings. Like I said, I can pay for my
insurance, and outside of mythbusting I'm not real interested right
now.

I am just
basing my opinion on the amount of denials you get from insurance
companies and the hoops you have to go through to get paid. That is
not the rubber stamp you have with Medicare.

I haven't ever been denied by my major carriers, except coding error
bull****. The provider bills, the insurer pays.
And I don't even normally see what is billed. Don't know if it's
double-billed, misbilled, or anything else. It just gets paid.
BTW, though the doc who did my recent colonoscopy said he removed 11
polyps, and will bill Aetna for that, he only took 4 pics and I can
only make out 3 polyps. But I'm not a doc, and was deep asleep when
it was done. Not suggesting anything here, of course.
The doc had just flown in from a European vacation and lack of clear
photographic evidence might be due to jet lag.

I did just go through this with Aetna and I know they wanted to see
the referrals for everything I claimed .

Aetna again, eh? You in Florida, me in Illinois. They do get around.
Bet they're bigger than Medicare. I know they are for me.
Getting almost 30% of every dollar of my wife's gross wages.

It sure wasn't anything like
that thing 60 minutes was talking about where a storefront with no
bona fides can simply send medicare a bill for something and get paid
in a few days.

Probably not. The crooks use different methods for Aetna, and are
probably different crooks. But a crook is a crook by any other name.

--Vic