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View Diary: Dear Supremes: An Expose of The Health Care Monster By An Industry Insider (100 comments)

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  •  Most Insightful Non- Industry Post I've Seen..... (2+ / 0-)
    Recommended by:
    glorificus, antirove

    Kudos antirove. Nohing I admire more than consumer activism. Your grasp of the issues is laudible, In response to some of the points and questions you raised, I will say that  NO ONE CALLS. Claims are generally submitted electronically then scanned electronically using various industry "software".  

    Claims can and genrally are processed and adjudicated by a computer that scans the varying codes (there are actually six different sets of codes: HCPC, ICD -9, CPT and varying location or type of service codes. The computer keys these off the member's unique ID number which then plots/reads/decides the claim based on the member's unique plan. I am not an IT person so forigve my pedestrain terminology but you get the point. The porcesing of claims, upto and including an auto generated mailing to the member can be done 100% without no human interaction. Yes, it really is that impersonal. if no one objects, there will BE no human interaction either.  Payments are then automatically made through EDI to the provider (where applicable)  using the proivders national provider index and financial acct numbers.

    V62 diagnosis codes are not really a "score" per se and I am unware of any integration between dtata bases other than helath related ones. I do know that your health information "follows" you wherever you go and all HIPPA does in protect your rights to privcacy for other non entitlted entitites to access it without your consent. I am an entitled entity.

    I know more about your heath than you do,since it is rare for this info to be shared with you by your provider (s).  I know when you contracted a minor STD though you are married. I know when your spouse infilicted a blow to your person.  I know your psyhcological history if you ever sought treatment, I know what drugs you take and how much you pay for them I also have all your personal ID information up to and including your checking account info if you pay my company with this method. I know where you work, how long you've been there and the names of all your children.  I know what brand name birth control your daughter usues. I have your home, cell and work phone numbers. I know exactly where you live, how long you've been there and who resides with you. I know if you are in a domestic partner relationship (in states where this is the law).

    In fact, if you are a member of my company's extensive data base of "insureds" I can find you anywhere. I can do this without supervision, permission or just cause.
     

    •  Head's Up: The Above Reply Ought To Scare (1+ / 0-)
      Recommended by:
      glorificus

      the bejesus out of you and everyone else.....An insurance corporation's data base  might be the most exhaustive and comprehensive collection of personal information in the US.  Hypothetically, if yoou have been with the company you work for say, 10 years and they have always used my company, I will absolutley be able to know more about you than you know.....

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