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Posted at 6:00 AM ET, 09/ 2/2009

My Health-Care Story: A Controlled Experiment

By editors

By Tom Smerling
Chevy Chase

When my father died last year, I inherited a 15-inch stack of medical bills. I sorted it into two piles: Medicare vs. private supplemental insurance.

The Medicare statements, I quickly discovered, required zero work. They were all paid. Amazed, I simply threw them away.

In contrast, the private insurer tried every trick in the book to deny coverage. I spent countless hours studying arcane denial codes, phoning the insurance company, waiting on hold, wrangling with the company’s representatives, and faxing and re-faxing documentation, all while fending off increasingly threatening bill collectors. After months of fighting, the private insurer finally paid up.

It was like a controlled experiment: Same patient, same costly treatments, same excellent doctors.

Which was better? The government-run insurer that simply paid the bills or the private insurer that fought me tooth and nail?

The private insurer was more efficient at only one thing: denying claims. If I were eligible for Medicare or a new public plan, I’d sign up today.

By editors  | September 2, 2009; 6:00 AM ET
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Oh, if only it were that neat...
Look, Medicare has a little secret they don't tell you civilians - but us soldiers down in the trenches know it..

First Medicare may mark the bill PAID and you never hear another word about it, but that does not mean the hospital/doctor/whoever, got more than a pittance, and often nothing... We are required by LAW to accept whatever they give us, including zero...
You see there are DRG's... Let's say your dad had pneumonia, DRG89, the hospital got a set fee to provide ALL the care he needed... Now if he were out of the hospital in the 2.8 to 3.3 day range, then the hospital about broke even... But if he lingered for 5.5 days, went home, then spiked a fever and was back in a day and a half later, they got nothing for the readmission, and lost their rear on him... The bill is still marked paid...

I am not defending the weaseling, slimy, private insurers - but if they had a deal like that, they would all pay in a heartbeat - just like Medicare does, throw down a $20 bill and mark it paid...

dr. o

Posted by: ad4hk2004 | September 2, 2009 12:21 PM | Report abuse

Don't feel sorry for the hospital. They
are the biggest cause of runaway prices in health care. I know. My job is patient billing at a hospital. I think that Medicare does a great job and would sign up for it in a minute once I was eligble for it.

Posted by: rag4w | September 2, 2009 1:00 PM | Report abuse

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