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End-of-life Counseling or Advanced Directives Are a Good Thing for Medicare But What Direction Would Health Insurers Drive It For Compliance To Reduce Exposure for Profit?

Patients and doctors have been preparing advanced directives and living wills for years and if kept in it’s proper context, it is a good thing and sure you want to have this conversation with a doctor you trust and feel capable of talking to you about...

Published Tue, Dec 12 2010 5:38 PM by The Medical Quack

Filed under: Medically Related, Insurance, medicare, health insurance, Fraud, Coding, ethics, Advanced Directive, heatlhcare reform, costs, algoirthms, Algo man, end of life

Humana To Purchase Concentra Wellness In Texas Offering Coupons and An Entire Portfolio of Health Programs and Clinics

One more acquisition from Humana and everyone is in the algorithmic data game as the more they know about you and how you act, the more they are investing in technologies to not only predict but to also monitor how you live. Last week we had the...

Published Mon, Nov 11 2010 1:12 PM by The Medical Quack

Filed under: Medically Related, Insurance, My Commentaries, healthcare, health insurance, Data, Humana, wellness, biometric monitoring, algoirthms, Concentra

International Survey States Dissatisfaction with Health Insurance Higher in the US Than Anywhere Else

The systems keep getting more complicated and as human bodies we are shoved into data bases, analyzed and sometimes treated less than human when inquires are sent or claim denials are questioned. Unfortunately our health insurance industry sees...

Published Thu, Nov 11 2010 12:12 PM by The Medical Quack

Filed under: Medically Related, Insurance, healthcare, medicare, health insurance, Survey, formulas, healthcare reform, WebMD, algoirthms

MED3OOO (Company with Tenet Analytics Joint Venture Solution) Acquires Insurance Solutions Group - Subsidiary Watch

The joint venture with Tenet was announced in May of 2009. You can also read more on the Med3000 website here with their activities with Tenet. This involved a medical records system as well as practice management software and below...

Published Tue, Oct 10 2010 1:51 PM by The Medical Quack

Filed under: Medically Related, Insurance, EMR, healthcare, health insurance, EHR, Business Intelligence, Tenet, Hospitals, Heatlhcare, Admissions, Profits, Med3000, goals, algoirthms, Insurance Solutions Groups

Baby Denied Medical Coverage–The Pre-Existing Condition Algorithm Complicated by So Called Insufficient Coding - Aetna

This comes right back around to what I have been saying for 2 years again, it’s those algorithms and the general public does not understand this and this story below goes through those motions. Nobody at Aetna would solve the issue in a way that...

Published Sun, Oct 10 2010 3:00 PM by The Medical Quack

Filed under: Insurance, Microsoft/Windows News, My Commentaries, health insurance, Aetna, Fraud, Coding, ethics, heatlhcare reform, costs, algoirthms, Algo man

Insurers Denied Coverage Based on Pre-Existing Conditions–Risk Assessment Algorithms We Have to Live With Until 2014

Scoring and risk assessments can still continue until these provisions of healthcare reform come into place in a few years. With reform, carriers can adjust their algorithms up and down so the parameters to be met can change. We have no idea...

Published Wed, Oct 10 2010 3:41 PM by The Medical Quack

Filed under: Medically Related, Insurance, My Commentaries, health insurance, MIB, Algorithms, Profits, cherry picking, algoirthms, risk assessment, pre-existing medical conditions, costing

Are We Growing to the Point to Where We Need A Mobile App To Figure Out Where to Go To Stay In Network with Insurers And Their Complex Plans and Benefits?

I have been quite vocal about everybody and their mobile apps and it’s time to begin aggregating some of this stuff, you know kind of like what Microsoft did years ago with taking Word, Excel, etc. and creating an Office Suite. Every day today we have...

Published Tue, Oct 10 2010 4:03 PM by The Medical Quack

Filed under: Medically Related, Insurance, healthcare, health insurance, Health IT, healthcare reform, apps, algoirthms, mHealth, mobile information

Health Insurers Rolling Out Programs To Doctors and Hospitals to Help Keep the Cost Down With Even Additional Focus on Admissions

We all know about the new Medicare rules and guidelines too but I had to somewhat chuckle a little when I read the line below from the Aetna executive who basically had dreams of eliminating the need all together for hospitalization and that goal might...

Published Fri, Oct 10 2010 7:15 PM by The Medical Quack

Filed under: Medically Related, Insurance, My Commentaries, health insurance, Business Intelligence, United HealthCare, healthcare reform, algoirthms, Aetna Cigna

Thomson Reuters Buys Healthcare Data Management–Acquiring Some Data Mining Algorithms for Employer Self Insured Plans

You know all these press releases are all looking the same today with the pre- fabricated marketing built in . I wonder sometimes if the writers of some of these think about the consumer and their care as the last thing that holds any interest here is...

Published Wed, Sep 09 2010 1:10 PM by The Medical Quack

Filed under: Medically Related, Technology, Insurance, My Commentaries, health insurance, Mergers and Acquisitions, healthcare reform, press release, algoirthms, Thomson Reuters, Benefits Watch, Healthcare Data Management, tranaction fees

Trizetto Adding Disease Management Algorithms For Insurers With “Value Based Benefit Solutions” To Manage Program Members And Log Compliance

In short we have more algorithms and transaction fees being added to pay for additional intelligence with software. Patients will essentially be guided to remain in network when identified as chronic care members, and gee any more are we not all...

Published Thu, Aug 08 2010 4:52 PM by The Medical Quack

Filed under: Medically Related, Technology, Insurance, My Commentaries, health insurance, EHR, CEO, medical billing, Cerner, Mergers and Acquisitions, Ingenix, President, healthcare reform, Trizetto, algoirthms, UnitedHeatlhcare, QNTX

Plastic Surgeon Performs Wound Repair Surgery-Approved by Health Insurance Company-Later Denied When Claim Data Clashed With the “Denial Algorithm”

Plastic surgery is not always a nose job or something cosmetic and there are cases such as this one here with a patient who literally had a big gaping wound that required surgery to heal properly . When you read below about the size where you could...

Published Thu, Aug 08 2010 11:38 AM by The Medical Quack

Filed under: Medically Related, Insurance, My Commentaries, healthcare, health insurance, Plastic Surgery, Claims, Doctors, Patients, healthcare reform, denials, algoirthms, wound repair

President Obama Message to Insurers – Time to Dump Risk Management Algorithms That Are No Longer Legal

This is basically it in a nutshell, some of those mathematical formulas are no more. When you listen to the President speak, this is the entire issue of the entire health insurance business and what has made the American public unhappy over the...

Published Wed, Jun 06 2010 11:14 AM by The Medical Quack

Filed under: Medically Related, Insurance, healthcare, health insurance, HHS, Obama, Profits, healthcare reform, Sebelius, monitoring, algoirthms

CMA Offering Help and Assistance for Doctors in California Filing for United Healthcare/Ingenix Underpayment Claims And Taking Active Role for the Same Settlement with Blue Cross

I had posted already about the AMA offering forms and help and if you are in California, the CMA has some additional information and help available. As noted in the article they are taking the lead here in pursuing the same type of settlement with...

Published Mon, May 05 2010 9:04 PM by The Medical Quack

Filed under: Medically Related, Technology, Insurance, health insurance, CMA, Legal, Blue Cross, AMA, Fraud, United HealthCare, Ingenix, Non participants, algoirthms, PacifCare

California Insurers Stopping the Process of Policy Recissions – The “Shi**y Deal” in Healthcare

Finally some headway on this long battled process which has cancelled policies when patients became ill and needed coverage the most. Kaiser Permanente stopped the process back in 2006, so others are following in this process. Once again it...

Published Wed, Apr 04 2010 12:48 PM by The Medical Quack

Filed under: Medically Related, Insurance, Kaiser, health insurance, California, Blue Cross, Gambling, Senate, Wall Street, Non Profit, Wellpoint, ethics, healthcare reform, for profit, recission, algoirthms, financial reform

Intuit Does a Study That Reveals Most American Do Not Understand Medical Bills and and EOBs – Not Big News Here

I talk a lot about the need for education and have commented frequently on how are consumers going to understand how to use “Quicken Health” if they don’t understand how to use a personal health record? Intuit confirms this now with their own study...

Published Tue, Apr 04 2010 1:13 PM by The Medical Quack

Filed under: Medically Related, Technology, Insurance, healthcare, health insurance, Education, PHR, Congress, Cigna, Allscripts, Study, Sofware, United HealthCare, personal heatlh records, Quicken Health, Intuit, algoirthms

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