AMA Wants Accuracy from Insurers, Another Hospital Revenue Stream, and State Insurance Officials Urge Slow Reform
AMA: One in five medical claims is processed inaccurately by commercial health insurers. Not addressed: are the mistakes random, or do they tend to favor the insurer?
British hospital makes nearly £2 million by “clamping” illegally parked cars. Others issue tickets and charge fees.
Unintended consequences: Insurance commissioners fear “a mass exit of insurers from the individual market.” The 80% loss ratio regulation is the chief culprit.
Proponents of the new health reform law tend to dislike the individual market because of medical underwriting. This trend is (arguably) a welcome sight to those that have always wanted to convert the individual market into a group exchange. However, if firms leave the individual market before the mandate starts in 2014, how do backers expect there to be firms willing to write insurance in the state-based insurance Exchanges that are supposed to insure 30 million people?
There is something unseemly about a hospital ticketing and clamping the cars outside. People wouldn’t be at the hospital if there were not a probem.
It’s sort of like establisheing a tax on the sick.
People would be very surprised if they knew how many insurers are thinking about closing up shop.
I have been told that the errors mysteriously favor the insurance companies way more than half the time.
The quote from a professor in the Times article is a very nice display of magical thinking. Mark Twain’s comment about removing all doubt comes to mind.
Apparently being a health law professor means that you know more about running a health insurance company than the people who actually do it. According to Professor Jost:
“The National Association of Insurance Commissioners finds itself in a difficult position, facing essentially a threat from the industry,” said Prof. Timothy S. Jost, an expert on health law at Washington and Lee University.
“A mass exit of insurers from the individual market would, of course, not be in the interest of consumers,” said Mr. Jost, one of several consumer representatives advising the association. “On the other hand, the 80 percent loss ratio should be attainable by a well-run insurer.”
Really? How does he know, especially given the uncertainty in the current environment?
I’m amazed and disappointed that the AMA did not include Medicare in its report this year. The methodology for the 2010 report states that it had Medicare data. In the 2008 and 2009 reports, Medicare came out pretty badly on some measurements (although I’m not quite sure what this meant, because I think it would be more meaningful to report the data for each Medicare contractor).
This makes me wonder of the AMA left Medicare out of the analysis at the urging of the U.S. government, which does not want to be measured. This is a very disturbing development.