Excerpt from April 6, 2010 press release from the Delaware Insurance Commissioner:
The Commissioner said, “From the day I was sworn in, the foundation of my policies regarding health care has been the same as the philosophy of the Mayo Clinic, namely ‘The Patient Comes First’. Over the past year, I have met with cardiologists, pulmonologists, oncologists, emergency room doctors, etc., to discuss and develop policies, regulations and legislation to meet the many challenges that the current health care environment presents to providers and their patients.” The Commissioner concluded, “For my department to successfully serve Delaware’s citizens, they and their physicians must promptly notify us of the difficulties they are encountering getting their tests covered, their claims paid, and with any other issues that we have the authority to address. Where necessary, I will also contact the appropriate authorities regarding Medicare, ERISA plans and any other areas where we do not have jurisdiction, in order to make as certain as we can that our citizens are not at risk and their claims are paid in full and in a timely manner. If any member of the public needs to contact the DOI, they should call the department’s Consumer hotline at 1-800-282-8611”.
Is this a reasonable or one sided approach? Is this a continuation of the insurance company scapegoating so essential in the health care reform debate? Tests covered, their claims paid in full? So now there is widespread unjustified claim denial and only partial payment of claims, and it may not be only those bad for-profit companines but self-insured employers as well she is after (but has no authority over).
Let’s hope she is also talking to the people processing claims and that she looks at over utilization, medical necessity criteria and little things like that. She may also want to read the CBO report criticizing Medicare for just paying claims without sufficient evaluation.
Oh heck, why bother, we know every claim is valid and every test necessary don’t we? Remember, its the Patient Protection Affordable Care Act
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