Let me explain -that "strawmen argument" is when one MISCHARACTERIZES the opponent s argument then argues against the false characterization.
We were discussing legitimate and covered medical services covered by insurance that were not paid by the insurer. That is contract violations by the insurer. YOU falsely characterized the argument by citing cases where your institution rendered services without proper documentation and without medical necessity. That is NOT the topic under discussion.
In your rebuttal you strawman again claiming I suggested you change jobs if it was so bad ... I did no such thing. I clearly stated the YOU need broader perspective on you off-topic claims. It is common to not be paid unless you meet the contrctual requirements includng documentation and case condition. That you complain that your institute doesn't keep proper records and so doesn't get paid is off topic and shows an ignorance of common business practice.
Why wouldn't anyone be skeptical of self-serving claims by people who want more than their contracts allow ? Again - my case is not the sole basis for skepticism, nor do we need a basis for skepticism. The complete lack of evidence that this is a regular pattern of contract violation is more than sufficient. Your domestic domestic abuse analogy fails. People have social reasons to hide abuse. No one has a social reason to hide that their insurance contract was violated.
Your point is OFF-TOPIC. If your institution can't successfully meet the insurance contractual obligations (including paperwork and showing necessity) and can't make a strong enough case to win the contract point - then obviously you've failed to meet the contract terms. That is NOT what this is about.
So now you claim that your institution is providing services without any contract ? That's ridiculous as a business model. It also prevents market forces from correcting insurers who would make bad decision egregiously.
If a service is denied that is covered under contract then it's a contract violation and is actionable. Apparently you provide services without any contract - that's the problem.
Of course an appeal can be denied - what part of that isn't clear and obvious to a child.
Binding 3rd party arbitration is a sort of conventional alternative to tort, but I don't understand your other claim about "can't sue". Please detail your point with evidence.
Please detail. these laws Evidence.
Strawman - I never suggested the problem was medical competence - I clearly said your experts should be able to make the case for necessity, or else you shouldn't be performing non-emergency procedures without contractual agreement.
That was never my argument - strawman ? BTW you can still sue for breech of contract or bad faith compliance even if there is a conflict resolution clause.
I'm not completely happy with insurance, but I'm not some moron expecting more than a contract calls for (or doing business without a contract), and whining when I don't get it. Also - what's to prevent me paying when the insurance doesn't cover ? Of course your institution is busy billing insurers perhaps ~1/3 of the rate the bill the uninsured too - right ?
You so far have failed to show that insurers fail to meet their contractual requirements except on in exceptional cases. Maybe people need to read and understand their insurance contracts(duh). If there is no pattern then all you are saying is that there are exceptional or extraordinary cases at issue, that's very believable. These exceptions are not a basis for making radical changes to the nations health care system.
This goes to the MAIN point of the thread. I have read that ~13% of US physicians currently do not accept medicare assignment. The plan for Obamacare is to decrease payment amounts if funding is insufficient. I don't see this is a practical plan either, however once O'care destroys private insurance then you will have no choice but to take less. You won't be able to cost-shift onto insurance. So when your institution is underpaid by government plans - then who makes up the shortfall. Obviously you are passing the unpaid costs onto insured or the uninsured - right ? Isn't that a huge part of the problem - that the amount billed to insurance and the uninsured is already a market distortion due to government underpayment ? The amount billed vs the "negotiated amounts" are another vast market distortion.
So you charge everyone cost + a reasonable profit, and then you don't lose money when some bills aren't paid ..... nope - doesn't answer my question. WHO is the cost burden shifted to ? To insurance, I'll bet. Perhaps even some to some few of the uninsured who can pay. The important point here is that insurance is underwriting the cost of the government programs underpayments already. What happens when there are few privately insured ? Then obviously you can't continue to do procedures.
Right - and my point has always been that the only denials of concern to me are the ones where the insurer violates their contract. If YOU don't have a contract agreement or YOU don't keep documentation - that's not a cause to blame insurers.
I think you missed the points at several turns. I want to see evidence that either insurers are violating their contracts, or else I'll reject the whining about insuraners. Your arguments, that you don't have a contract and yet provide service on "hope", or that you don't keep documentation and dn't get paid is NOT an issue where we can blame the insurer. *IF* as you imply the insurer is really 'jerking you around' for paperwork, that's bad-faith contract compliance and you can sue.
Someone pays 100% for EVERY expense of your institution plus some profit or else you don''t exist. That's a fiscal fact. The question is, and remains, who pays for these denials and government underpayments you talk about ? Obviously the costs is shifted to other sources of income. Who is being overcharged to make up for the underpayments ? Then the next question is - how long does your institution last when the numbers of government under-payers increase and the insured over-payers decline ?
That your misunderstanding. Skepticism doesn't require any basis - it's a call for evidence. I'm still seeking evidence that there is any pattern of insurers violating their contract terms, and I don't see any so far. I might agree that people want more than their contracts call for, or that people don't bother to read their contracts - but that's a different topic too.
Cherry picking is selectively choosing data for a case, and asking someone who only handles claim-denials is a selection of evidence.
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