BIG F..king LIE: "Medicare pays over 95% of dollars collected back out in benefit cla

[healthmyths]

Why do people insist on being so IGNORANT---
when the Internet PROVES them so wrong!!!

Common MYTH statement:

"Medicare pays over 95% of dollars collected back out in benefit claims.
The best private health insurance bureaucracies can boast is 80%,
most are closer to 70%."

MYTH!!!

FACT is Medicare spent in 2010 $37 billion more then they collected!

FROM the people that would know:
2011 Annual report of the Boards of Trustees for Medicare
which you can download from:
https://www.cms.gov/reportstrustfunds/downloads/tr2011.pdf

Page 10 of the report shows in 2010:
income $486 billion (to you means money coming in!!!)
expenditures $523 billion (of which $516 billion were for claims)
Means there was $37 billion MORE going out then came in!

Which to almost everyone

MEANS Medicare spend $37 billion more then there is income..

MEANS MEDICARE IS BROKE!

NO health insurance company would BE allowed to exist by any state insurance regulations if they spent more then their income!

Medicare by definition is BANKRUPT.
Medicare's expenses are greater then income .. BROKE!!

Then this OTHER MYTH!!!
The best private health insurance bureaucracies can boast is 80%, most are closer to 70%."

FACTS why are people so ignorant when the Internet provides this!
1) % of premiums spent on Claims:
% of Premium 2009 paid in claims

• UnitedHealth Group 82.30%
• WellPoint 80.60%
• Aetna 76.90%
• Humana 83.20%
• Cigna 82.30%
• Health Net 83.90%

AVERAGE % of Premiums paid in claims: 81.53%!!!

Fortune 500 2009: Industry: Health Care: Insurance and Managed Care

2) Percent of DENIALS!!!
To the evidently IGNORANT Medicare DENIES a higher % then
private insurance!

Payer % of claim lines Denied

• Medicare 6.85%
• Aetna 6.80%
• Anthem 4.62%
• Health Net 3.88%
• Cigna 3.44%
• Humana 2.90%
• Coventry 2.88%

"Denied Claims Page 5 of 2008 National Health Insurer Report Card The Type of claims denied:"


http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf

 

[8537]

So you're saying that Medicare pays MORE than 95% of money collected in benefits?

Somehow I doubt that's what you meant to stress.

 

[Steelplate]

No... he's talking about "for Profit" doctors and hospitals OVERCHARGING Medicare for Services.

If anything, the doctors and hospitals ought to be audited with a fine tooth comb and retrieve our taxpayer money back.

I love the way people blame government for the sins of the private sector. Same with the thread on the rebuilding of the WTC, same with the bullshit that went on in the Banking industry that damn near killed us.

Yes the government can be an "easy mark" for greedy assholes, but make no mistake... the sin is directly on the greedy asshole.

 

[healthmyths]

So you're saying that Medicare pays MORE than 95% of money collected in benefits?

Somehow I doubt that's what you meant to stress.

Well let's see how that works out!
If Medicare takes in $486 billion

Pays out $523 billion that would be 107% of what they take IN!

AND THAT would NEVER happen with private health insurance because state regulators would CLOSE THEM!

AND YES Medicare is OK with paying out 107% of what they take IN!

Again I think you are totally UNAWARE of what the MAJOR contributor to
health costs occurred as an "unintended consequence of a good intention"!
It was called in 1986 EMTALA!

"In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay."

So Medicare KNOWS when they see a claim with a 6,000% markup that's because the hospital is "padding and passing" on the costs of EMTALA!

Medicare is OK with paying 6,000% mark up because Medicare KNOWS that the providers are passing on to Medicare the $600 billion in defensive medicine costs! Again proof was Obamacare was very quick to tax tanning salons BUT tort reform that would reduce the $600 billion in fear of lawsuits?

 

[8537]

So you're saying that Medicare pays MORE than 95% of money collected in benefits?

Somehow I doubt that's what you meant to stress.

Well let's see how that works out!
If Medicare takes in $486 billion

Pays out $523 billion that would be 107% of what they take IN!

AND THAT would NEVER happen with private health insurance because state regulators would CLOSE THEM!

Really? An insurance company with a few hundred billion in reserves would be shut down because during one fiscal year they had losses equal to 7% of total revenue?

Really?

Again I think you are totally UNAWARE of what the MAJOR contributor to
health costs occurred as an "unintended consequence of a good intention"!
It was called in 1986 EMTALA!

"In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay."

indeed, here in the United States we don't let people die outside Emergency Room doors because they can't pay the price of admission.

 

[Bfgrn]

Hey Healthmyths, I appreciate that your user name is honest, you DO post health myths.

You're confused. What the 95% signifies is called medical loss ratio.

Let's have a 20 year Executive VP at CIGNA explain:

BILL MOYERS: Why is public insurance, a public option, so fiercely opposed by the industry?

WENDELL POTTER: The industry doesn't want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don't want any more competition period. They certainly don't want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so.

BILL MOYERS: Compared to the industry's--

WENDELL POTTER: They spend about 20 cents of every premium dollar on overhead, which is administrative expense or profit. So they don't want to compete against a more efficient competitor.

BILL MOYERS: You told Congress that the industry has hijacked our health care system and turned it into a giant ATM for Wall Street. You said, "I saw how they confuse their customers and dump the sick, all so they can satisfy their Wall Street investors." How do they satisfy their Wall Street investors?

WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?

WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.

But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

BILL MOYERS: So, the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.

WENDELL POTTER: That's right. Exactly right.

BILL MOYERS: So they want to reverse that. They don't want my premium to go for my health care, right?

WENDELL POTTER: Exactly right. They--

BILL MOYERS: Where does it go?

WENDELL POTTER: Well, a big chunk of it goes into shareholders' pockets. It's returned to them as part of the investment to them. It goes into the exorbitant salaries that a lot of the executives make. It goes into paying sales, marketing, and underwriting expenses. So a lot of it goes to pay those kinds of administrative functions. Overhead.

Bill Moyers Journal . Wendell Potter on Profits Before Patients | PBS

 

[Steelplate]

cue the "Wendell Potter is a Marxist" mantra in 3....2.....1....

 

[Mr. Shaman]

Why do people insist on being so IGNORANT---
when the Internet PROVES them so wrong!!!

Common MYTH statement:

"Medicare pays over 95% of dollars collected back out in benefit claims.
The best private health insurance bureaucracies can boast is 80%,
most are closer to 70%."

MYTH!!!

FACT is Medicare spent in 2010 $37 billion more then they collected!

FROM the people that would know:
2011 Annual report of the Boards of Trustees for Medicare
which you can download from:
https://www.cms.gov/reportstrustfunds/downloads/tr2011.pdf

Page 10 of the report shows in 2010:
income $486 billion (to you means money coming in!!!)
expenditures $523 billion (of which $516 billion were for claims)
Means there was $37 billion MORE going out then came in!

Which to almost everyone

MEANS Medicare spend $37 billion more then there is income..

MEANS MEDICARE IS BROKE!

NO health insurance company would BE allowed to exist by any state insurance regulations if they spent more then their income!

Medicare by definition is BANKRUPT.
Medicare's expenses are greater then income .. BROKE!!

Then this OTHER MYTH!!!
The best private health insurance bureaucracies can boast is 80%, most are closer to 70%."

FACTS why are people so ignorant when the Internet provides this!
1) % of premiums spent on Claims:
% of Premium 2009 paid in claims

• UnitedHealth Group 82.30%
• WellPoint 80.60%
• Aetna 76.90%
• Humana 83.20%
• Cigna 82.30%
• Health Net 83.90%

AVERAGE % of Premiums paid in claims: 81.53%!!!

Fortune 500 2009: Industry: Health Care: Insurance and Managed Care

2) Percent of DENIALS!!!
To the evidently IGNORANT Medicare DENIES a higher % then
private insurance!

Payer % of claim lines Denied

• Medicare 6.85%
• Aetna 6.80%
• Anthem 4.62%
• Health Net 3.88%
• Cigna 3.44%
• Humana 2.90%
• Coventry 2.88%

"Denied Claims Page 5 of 2008 National Health Insurer Report Card The Type of claims denied:"


http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf

Wendell Potter;
American HERO!!!!​

July 10, 2009​

WENDELL POTTER: The industry has always tried to make Americans think that government-run systems are the worst thing that could possibly happen to them, that if you even consider that, you're heading down on the slippery slope towards socialism. So they have used scare tactics for years and years and years, to keep that from happening. If there were a broader program like our Medicare program, it could potentially reduce the profits of these big companies. So that is their biggest concern.

*​

BILL MOYERS: You told Congress that the industry has hijacked our health care system and turned it into a giant ATM for Wall Street. You said, "I saw how they confuse their customers and dump the sick, all so they can satisfy their Wall Street investors." How do they satisfy their Wall Street investors?

WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio."

Profits Before Patients​

[ame=http://www.youtube.com/watch?v=7QwX_soZ1GI]BILL MOYERS JOURNAL | Wendell Potter | PBS - YouTube[/ame]​

12/02/2011​

"I have long argued that the impact of the Affordable Care Act is not nearly as big of a deal as opponents would have you believe. At the end of the day, the law is – in the main – little more than a successful effort to put an end to some of the more egregious health insurer abuses while creating an environment that should bring more Americans into programs that will give them at least some of the health care coverage they need.

There is, however, one notable exception – and it’s one that should have a long lasting and powerful impact on the future of health care in our country.

That would be the provision of the law, called the medical loss ratio, that requires health insurance companies to spend 80% of the consumers’ premium dollars they collect—85% for large group insurers—on actual medical care rather than overhead, marketing expenses and profit. Failure on the part of insurers to meet this requirement will result in the insurers having to send their customers a rebate check representing the amount in which they underspend on actual medical care.

This is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Today, that bomb goes off."

Hallelujah!​

 

[Bfgrn]

New measures gearing up to fight Medicare fraud

The Affordable Care Act aims to stop criminals from defrauding taxpayers billions of dollars every year

Federal health officials announced new security measures to combat Medicare fraud, including tougher screenings for providers and the ability to withhold payments during investigations.

Authorities recovered $2.5 billion in health care fraud judgments last year -- a record high up 50 percent from 2009 -- according to a new report.

Authorities have long said the solution to solving the nation's estimated $60 billion to $90 billion a year Medicare fraud problem lies in vigorously screening providers and stopping payment to suspicious ones, ending the antiquated "pay and chase" system authorities say has kept them one step behind criminals.

Health and Human Services Secretary Kathleen Sebelius touted the Affordable Care Act as one of the toughest anti-fraud laws in history.

More...

 

[healthmyths]

Hey Healthmyths, I appreciate that your user name is honest, you DO post health myths.

You're confused. What the 95% signifies is called medical loss ratio.

Let's have a 20 year Executive VP at CIGNA explain:

BILL MOYERS: Why is public insurance, a public option, so fiercely opposed by the industry?

WENDELL POTTER: The industry doesn't want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don't want any more competition period. They certainly don't want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so.

BILL MOYERS: Compared to the industry's--

WENDELL POTTER: They spend about 20 cents of every premium dollar on overhead, which is administrative expense or profit. So they don't want to compete against a more efficient competitor.

BILL MOYERS: You told Congress that the industry has hijacked our health care system and turned it into a giant ATM for Wall Street. You said, "I saw how they confuse their customers and dump the sick, all so they can satisfy their Wall Street investors." How do they satisfy their Wall Street investors?

WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?

WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.

But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

BILL MOYERS: So, the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.

WENDELL POTTER: That's right. Exactly right.

BILL MOYERS: So they want to reverse that. They don't want my premium to go for my health care, right?

WENDELL POTTER: Exactly right. They--

BILL MOYERS: Where does it go?

WENDELL POTTER: Well, a big chunk of it goes into shareholders' pockets. It's returned to them as part of the investment to them. It goes into the exorbitant salaries that a lot of the executives make. It goes into paying sales, marketing, and underwriting expenses. So a lot of it goes to pay those kinds of administrative functions. Overhead.

Bill Moyers Journal . Wendell Potter on Profits Before Patients | PBS

Wendell Potter and Bill Moyers are frauds!
Again I'm not confused! THE insurance companies average 80% of their premiums going out in claims! THAT is a fact under penalty of prison when CEOs sign false Sarbanes- Oxley that state false expenses, i.e. how much spent on claims!
And any idiot then should know when you divide claim expenses by
premiums the average reported health insurance medical ratio is 80%!

Reed Abelson of the New York Times reports that in 2008, the for-profit average medical loss ratio was 84 percent in policies offered to large employers and 80 percent in policies offered to small businesses. In the individual market, there was an average medical loss ratio of 74 percent. Rockefeller specifically accuses CIGNA of breaking the law and inaccurately reporting information to the NAIC -- they had claimed a medical loss ratio of 93 percent.

HEALTH REFORM: Medical Loss Ratio or Just Medical Loss? | New America Blogs

 

[8537]

Is Healthmyths secretly trying to convince people that we need a publicly-funded universal health care program? So far, he's doing a nice job of demonstrating that.

 

[healthmyths]

Why do people insist on being so IGNORANT---
when the Internet PROVES them so wrong!!!

Common MYTH statement:

"Medicare pays over 95% of dollars collected back out in benefit claims.
The best private health insurance bureaucracies can boast is 80%,
most are closer to 70%."

MYTH!!!

FACT is Medicare spent in 2010 $37 billion more then they collected!

FROM the people that would know:
2011 Annual report of the Boards of Trustees for Medicare
which you can download from:
https://www.cms.gov/reportstrustfunds/downloads/tr2011.pdf

Page 10 of the report shows in 2010:
income $486 billion (to you means money coming in!!!)
expenditures $523 billion (of which $516 billion were for claims)
Means there was $37 billion MORE going out then came in!

Which to almost everyone

MEANS Medicare spend $37 billion more then there is income..

MEANS MEDICARE IS BROKE!

NO health insurance company would BE allowed to exist by any state insurance regulations if they spent more then their income!

Medicare by definition is BANKRUPT.
Medicare's expenses are greater then income .. BROKE!!

Then this OTHER MYTH!!!
The best private health insurance bureaucracies can boast is 80%, most are closer to 70%."

FACTS why are people so ignorant when the Internet provides this!
1) % of premiums spent on Claims:
% of Premium 2009 paid in claims

• UnitedHealth Group 82.30%
• WellPoint 80.60%
• Aetna 76.90%
• Humana 83.20%
• Cigna 82.30%
• Health Net 83.90%

AVERAGE % of Premiums paid in claims: 81.53%!!!

Fortune 500 2009: Industry: Health Care: Insurance and Managed Care

2) Percent of DENIALS!!!
To the evidently IGNORANT Medicare DENIES a higher % then
private insurance!

Payer % of claim lines Denied

• Medicare 6.85%
• Aetna 6.80%
• Anthem 4.62%
• Health Net 3.88%
• Cigna 3.44%
• Humana 2.90%
• Coventry 2.88%

"Denied Claims Page 5 of 2008 National Health Insurer Report Card The Type of claims denied:"


http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf

Wendell Potter;
American HERO!!!!​

July 10, 2009​

WENDELL POTTER: The industry has always tried to make Americans think that government-run systems are the worst thing that could possibly happen to them, that if you even consider that, you're heading down on the slippery slope towards socialism. So they have used scare tactics for years and years and years, to keep that from happening. If there were a broader program like our Medicare program, it could potentially reduce the profits of these big companies. So that is their biggest concern.

*​

BILL MOYERS: You told Congress that the industry has hijacked our health care system and turned it into a giant ATM for Wall Street. You said, "I saw how they confuse their customers and dump the sick, all so they can satisfy their Wall Street investors." How do they satisfy their Wall Street investors?

WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio."

Profits Before Patients​

[ame=http://www.youtube.com/watch?v=7QwX_soZ1GI]BILL MOYERS JOURNAL | Wendell Potter | PBS - YouTube[/ame]​

12/02/2011​

"I have long argued that the impact of the Affordable Care Act is not nearly as big of a deal as opponents would have you believe. At the end of the day, the law is – in the main – little more than a successful effort to put an end to some of the more egregious health insurer abuses while creating an environment that should bring more Americans into programs that will give them at least some of the health care coverage they need.

There is, however, one notable exception – and it’s one that should have a long lasting and powerful impact on the future of health care in our country.

That would be the provision of the law, called the medical loss ratio, that requires health insurance companies to spend 80% of the consumers’ premium dollars they collect—85% for large group insurers—on actual medical care rather than overhead, marketing expenses and profit. Failure on the part of insurers to meet this requirement will result in the insurers having to send their customers a rebate check representing the amount in which they underspend on actual medical care.

This is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Today, that bomb goes off."

Hallelujah!​

RIGHT 1996!
The BIRTH of why when you go into the pharmacy you have to stand behind so you won't hear any PHI that is PROTECTED BY HIPAA!

Health Insurance Portability and Accountability Act

AND YOU don't think HIPAA added cost to the process of health care???

 

[Steelplate]

Why do people insist on being so IGNORANT---
when the Internet PROVES them so wrong!!!

Common MYTH statement:

"Medicare pays over 95% of dollars collected back out in benefit claims.
The best private health insurance bureaucracies can boast is 80%,
most are closer to 70%."

MYTH!!!

FACT is Medicare spent in 2010 $37 billion more then they collected!

FROM the people that would know:
2011 Annual report of the Boards of Trustees for Medicare
which you can download from:
https://www.cms.gov/reportstrustfunds/downloads/tr2011.pdf

Page 10 of the report shows in 2010:
income $486 billion (to you means money coming in!!!)
expenditures $523 billion (of which $516 billion were for claims)
Means there was $37 billion MORE going out then came in!

Which to almost everyone

MEANS Medicare spend $37 billion more then there is income..

MEANS MEDICARE IS BROKE!

NO health insurance company would BE allowed to exist by any state insurance regulations if they spent more then their income!

Medicare by definition is BANKRUPT.
Medicare's expenses are greater then income .. BROKE!!

Then this OTHER MYTH!!!
The best private health insurance bureaucracies can boast is 80%, most are closer to 70%."

FACTS why are people so ignorant when the Internet provides this!
1) % of premiums spent on Claims:
% of Premium 2009 paid in claims

• UnitedHealth Group 82.30%
• WellPoint 80.60%
• Aetna 76.90%
• Humana 83.20%
• Cigna 82.30%
• Health Net 83.90%

AVERAGE % of Premiums paid in claims: 81.53%!!!

Fortune 500 2009: Industry: Health Care: Insurance and Managed Care

2) Percent of DENIALS!!!
To the evidently IGNORANT Medicare DENIES a higher % then
private insurance!

Payer % of claim lines Denied

• Medicare 6.85%
• Aetna 6.80%
• Anthem 4.62%
• Health Net 3.88%
• Cigna 3.44%
• Humana 2.90%
• Coventry 2.88%

"Denied Claims Page 5 of 2008 National Health Insurer Report Card The Type of claims denied:"


http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf

Wendell Potter;
American HERO!!!!



[ame=http://www.youtube.com/watch?v=7QwX_soZ1GI]BILL MOYERS JOURNAL | Wendell Potter | PBS - YouTube[/ame]​

12/02/2011​

"I have long argued that the impact of the Affordable Care Act is not nearly as big of a deal as opponents would have you believe. At the end of the day, the law is – in the main – little more than a successful effort to put an end to some of the more egregious health insurer abuses while creating an environment that should bring more Americans into programs that will give them at least some of the health care coverage they need.

There is, however, one notable exception – and it’s one that should have a long lasting and powerful impact on the future of health care in our country.

That would be the provision of the law, called the medical loss ratio, that requires health insurance companies to spend 80% of the consumers’ premium dollars they collect—85% for large group insurers—on actual medical care rather than overhead, marketing expenses and profit. Failure on the part of insurers to meet this requirement will result in the insurers having to send their customers a rebate check representing the amount in which they underspend on actual medical care.

This is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Today, that bomb goes off."

Hallelujah!​

RIGHT 1996!
The BIRTH of why when you go into the pharmacy you have to stand behind so you won't hear any PHI that is PROTECTED BY HIPAA!

Health Insurance Portability and Accountability Act

AND YOU don't think HIPAA added cost to the process of health care???

Why should anyone else know you health information?

 

[Bfgrn]

Hey Healthmyths, I appreciate that your user name is honest, you DO post health myths.

You're confused. What the 95% signifies is called medical loss ratio.

Let's have a 20 year Executive VP at CIGNA explain:

BILL MOYERS: Why is public insurance, a public option, so fiercely opposed by the industry?

WENDELL POTTER: The industry doesn't want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don't want any more competition period. They certainly don't want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so.

BILL MOYERS: Compared to the industry's--

WENDELL POTTER: They spend about 20 cents of every premium dollar on overhead, which is administrative expense or profit. So they don't want to compete against a more efficient competitor.

BILL MOYERS: You told Congress that the industry has hijacked our health care system and turned it into a giant ATM for Wall Street. You said, "I saw how they confuse their customers and dump the sick, all so they can satisfy their Wall Street investors." How do they satisfy their Wall Street investors?

WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?

WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.

But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

BILL MOYERS: So, the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.

WENDELL POTTER: That's right. Exactly right.

BILL MOYERS: So they want to reverse that. They don't want my premium to go for my health care, right?

WENDELL POTTER: Exactly right. They--

BILL MOYERS: Where does it go?

WENDELL POTTER: Well, a big chunk of it goes into shareholders' pockets. It's returned to them as part of the investment to them. It goes into the exorbitant salaries that a lot of the executives make. It goes into paying sales, marketing, and underwriting expenses. So a lot of it goes to pay those kinds of administrative functions. Overhead.

Bill Moyers Journal . Wendell Potter on Profits Before Patients | PBS

Wendell Potter and Bill Moyers are frauds!
Again I'm not confused! THE insurance companies average 80% of their premiums going out in claims! THAT is a fact under penalty of prison when CEOs sign false Sarbanes- Oxley that state false expenses, i.e. how much spent on claims!
And any idiot then should know when you divide claim expenses by
premiums the average reported health insurance medical ratio is 80%!

Reed Abelson of the New York Times reports that in 2008, the for-profit average medical loss ratio was 84 percent in policies offered to large employers and 80 percent in policies offered to small businesses. In the individual market, there was an average medical loss ratio of 74 percent. Rockefeller specifically accuses CIGNA of breaking the law and inaccurately reporting information to the NAIC -- they had claimed a medical loss ratio of 93 percent.

HEALTH REFORM: Medical Loss Ratio or Just Medical Loss? | New America Blogs

Thanks for posting an article that supports my claims, and trashes yours. Maybe you should ask an adult to read and interpret for you.

From YOUR linked article:

The Senate analysis shows that the health insurance industry "provided one set of premium-benefit numbers to the public and to Congress, and presented a different one to their investors." The letter says that America's Health Insurance Plans' (AHIP) claim that the industry spends 87 cents of every premium dollar on medical care was part of an "expensive public relations effort." The publicly-traded health insurers' own financial reporting to the Securities and Exchange Commission does not come close to supporting the figure -- see page 7 of the letter to CIGNA for the individual breakdown.

The Commerce Committee revealed that the "largest for-profit insurance companies appear to be squeezing more profits for Wall Street investors by spending a lower percentage of premium dollars on patient care than other insurers." Wendell Potter, a former CIGNA senior executive, in testimony to the Commerce Committee said:

Wall Street investors and analysts look for two key figures: earnings per share and the medical loss ratio...To win the favor of powerful analysts, for-profit insurers must prove that they made more money during the previous quarter than a year earlier and that the portion of the premium going to medical costs is falling. Even very profitable companies can see sharp declines in stock prices moments after admitting they've failed to trim costs. I have seen one insurer's stock price fall 20 percent or more in a single day after executives disclosed that the company had to spend a slightly higher percentage of premiums on medical claims during the quarter than it did during a previous period. The smoking gun was the company's first-quarter medical loss ratio, which had increased from 77.9 percent to 79.4 percent a year later.

 

[Dragon]

"FACT is Medicare spent in 2010 $37 billion more then they collected!"

So it looks like the program's efficiency is actually OVER 100%!

 

[healthmyths]

"FACT is Medicare spent in 2010 $37 billion more then they collected!"

So it looks like the program's efficiency is actually OVER 100%!

ARE YOU REALLY that BRAINWASHED? That Ignorant?

Big letters for such a stupid ignorant person!!

Medicare took in $486 billion!

Total Income DO YOU UNDERSTAND???

Medicare spent $523 billion!

That means THEY HAD to get some money from somewhere
to make up the $37 billion MORE THEY SPENT they what they took in!

THAT MEANS they are NOT efficient BUT BrOKE!
They spent MORE then they took in!

In your household.. If you make $50,000 and you spent $60,000 is that
efficient???

MY Goodness I am so ashamed you are on this forum.. !

 

[Steelplate]

I'd say the problem is private sector, for profit doctors and hospitals gouging the taxpayer.

Amazing how Conservatives are all about Personal Responsibility except when it comes to Business...then the moral of the story changes to "they earned that money!"

 

[8537]

"FACT is Medicare spent in 2010 $37 billion more then they collected!"

So it looks like the program's efficiency is actually OVER 100%!

ARE YOU REALLY that BRAINWASHED? That Ignorant?

Big letters for such a stupid ignorant person!!

Medicare took in $486 billion!

Total Income DO YOU UNDERSTAND???

Medicare spent $523 billion!

That means THEY HAD to get some money from somewhere
to make up the $37 billion MORE THEY SPENT they what they took in!

THAT MEANS they are NOT efficient BUT BrOKE!
They spent MORE then they took in!

In your household.. If you make $50,000 and you spent $60,000 is that
efficient???

MY Goodness I am so ashamed you are on this forum.. !

You can't truly be this ignorant. Can you?

The Medicare Trust, where all excess Medicare revenues are held, has a significant positive balance and is projected to be fully solvent until after 2024. In other words, when you say "THEY HAD to get the money from somewhere", the "somewhere" was from their own trust.

They are not broke.

 

[bripat9643]

No... he's talking about "for Profit" doctors and hospitals OVERCHARGING Medicare for Services.

If anything, the doctors and hospitals ought to be audited with a fine tooth comb and retrieve our taxpayer money back.

I love the way people blame government for the sins of the private sector. Same with the thread on the rebuilding of the WTC, same with the bullshit that went on in the Banking industry that damn near killed us.

Yes the government can be an "easy mark" for greedy assholes, but make no mistake... the sin is directly on the greedy asshole.

ROFL! Yeah, it's always the fault of the those greedy capitalists. Freddie Mac and Fannie Mae lose $300 billion of the taxpayer's money, and no one who works there is to blame. If any private corporation got swindled for 1.0 % of the that amount, the CEO's head would be on the chopping block. Blaming others for their failures is what politicians and bureaucrats specialize in.

Are you libturds always bragging about how the government is so efficient at giving away the taxpayer's money? You forgot to mention that 1/3 of it is for fraud.

 

[bripat9643]

"FACT is Medicare spent in 2010 $37 billion more then they collected!"

So it looks like the program's efficiency is actually OVER 100%!

Medicare is almost as "efficient" as the Mafia or the Gestapo.