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Not Just Any Friday…

August 28th, 2009 by admin · 2 Comments

Here’s some stuff that’s worth reporting…

They’re Not Evil, They’re Your Insurance Company: Wonder how many Humana employees the P.R. staff there considered before offering up Max Shireman to the NYTimes as a typical, non-evil employee? The big paper did a story on how tough it is to work for a company in the middle of the biggest political issue of our time. Shireman got a shot in at his pals over at Papa John’s, implying the food makes you sick. [NYTimes]

More Than 50,000 Drunks Served Since 2004: OK, CityScoot isn’t going to hire me to write slogans. But the local biz was featured in the Times’ story about entrepreneurs in the “take you, your car and your drunk butt home” business. A business that is booming. That’s right, Billy G., you should have called them. [NYTimes]

Count on This Book: It’s hard to hold back praise for Gill Holland, who has added “author” to his list of accolades. He’s just published “Louisville Counts”, an art book for kids featuring 21 local artists and 21 cool things about our little town. Luke, age 11, loved it. Proceeds go to the Art Sparks Interactive Gallery at the Speed Museum. Get one around town or stop by the Green Building, on East Market Street.

Just Another Joe: Don’t forget to watch Animal Planet’s “Jockey” reality series. Tonight’s second episode features 19-year-old jockey Joe Talamo on the road to the Kentucky Derby. Insight 60 at 9. [Animal Planet]

A Look Ahead: Get ready for some national media attention. Ex-PRP football coach Jason Stinson’s trial starts Monday.  A bunch of students have been subpoenaed. [AP]

Taylor Swift?: No, I haven’t suddenly got a thing for teen-age blondes or country music, or whatever Ms. Swift sings about. But please e-mail me if you can find me two tickets to Sunday’s show at the State Fair. For a friend. [e-mail me]

Tags: Art · Books · Charity · High School · Horse Industry · Legal · Music · South End

2 responses so far ↓

  • 1 EdenSprings // Aug 28, 2009 at 10:23 am

    They’re Not Evil (They’re just billed that way): Puh-leeze! I grew up around the medical field & worked in it for many years. Here are some the most popular insurance scams: 1) when you get a bill from a provider, instantly deny it. This allows you to keep your $ for at least another 30 days. If you’re lucky, the provider won’t bother to try and sort it out and the patient will end up paying for it and/or the provider will write it off as uncollectable. 2) If the provider does bother to sort it out, simply deny it again. Bonus: another 30 days the cash stays in your coffers. 3) If the provider pursues it further, you can finally cave in and pay it. Or, claim you need some sort of paperwork prior to payment and keep that money ANOTHER 30 days. 4) You can have an employee sort through all the incoming claims and automaticaly shred those that are first-time claims, refuse to admit you received them and then, when the provider re-bills you, state that you aren’t obligated to pay because you didn’t receive the initial claim within the required 90 days after service was provided. 5) Once claims are paid out, you can hire a third party (or, start your own internal division) to investigate all claims you DID pay in the hopes that the patient wasn’t smart enough to have read the fine print in their policies and/or known the current rules about which insurance is primary, and which is secondary in any given situation. When you find one, you can simply withhold that improperly-paid amount from the next check you owe to that provider, thereby completely messing up the provider’s accounts receivable which they use for inconsequential things like rent on their building & equipment, payroll, etc.

    Next, require that every single medical and dental procedure be assigned a numerical code (which are changed/added to annually). Punish all providers who send in a bill with an incorrect procedure code.

    By the time you are done with code requirements, collection requirements and payment audit procedures, with any luck you will have achieved your goal of not having to pay out a dime and driving the medical establishment at least out of its mind, if not out of business.

    Just as Doc Greathouse how well this system works.

  • 2 davidrc // Aug 28, 2009 at 4:51 pm

    There are so many distortions in Eden Springs post that it would take pages to correct them.
    I have worked as a medical claims adjuster for over 20 years for two different major insurance companies. I can assure you that I always look for ways to pay claims, not deny them
    That said, my experience is that many of the claims that are rejected, not denied (there’s a difference), are rejected due to lack of communication. Things like missing information cause claims to be rejected, not some nefarious plot to hold on to money longer.
    The use of uniform codes, which the poster decries , aid in clarity of communication helping claims to be paid more quickly. I believe the Center for Medicare and Medicaid Services, a government agency, not insurance companies, sets and updates these codes.

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