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Ok, so what’s the reason for this title? The only leg apparently there is to stand on here is to prove that Blue Shield paid less than 70% on healthcare. Guess what you need some audit algorithms and not take them for their word as there might be mistakes and errors. If you read the...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Fri, Jan 14 2011
Filed under:
Filed under: Insurance, Microsoft/Windows News, My Commentaries, healthcare, health insurance, California, Non Profit, Algorithms, Blue Shield, premiums, audit, healthcare reform, medical care, rates, CIOs
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HealthNet increases are said to average around 4% but actual increases for individuals will vary. HealthNet was slated to have met the 70% requirement for spending on healthcare as is the law in California as it stands today. Blue Shield’s proposed increases are the ones that seem to be the...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Wed, Jan 12 2011
Filed under:
Filed under: Medically Related, Insurance, healthcare, health insurance, California, Non Profit, Blue Shield, premiums, United HealthCare, healthcare reform, HealthNet, medical care, PacifiCare, rates, Atena
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In reading this some policy holders had contracts that guaranteed no raises for a year and those are going to be the ones hit with the highest increase all at one time. Now compared to Blue Cross, Blue Shield is a non profit and quite a bit smaller but it’s still a lot of people. The only...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Thu, Jan 6 2011
Filed under:
Filed under: Medically Related, Insurance, healthcare, health insurance, California, Non Profit, Blue Shield, premiums, healthcare reform, medical care, rates
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This is a good example from a physician citing an example of what happens when medical claims are evaluated and/or “scored” and in addition scanned for potential fraud. The word “fraud” is an open end “algorithm” that runs to find fraud of course, but in addition it also runs queries to look for...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Thu, Jul 15 2010
Filed under:
Filed under: Medically Related, Technology, Insurance, My Commentaries, health insurance, Politics, Medical Claims, Doctors, Algorithms, Blue Shield, co-pay, scoring, reimbursements, pap test, examination
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Nobody likes fraud and every time someone is caught is is a plus. From prior posts and articles, this is more than just an effort on running algorithms as the people committing fraud are usually “better billers” as they have one focus only and don’t see patients. The link below contains...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Wed, May 26 2010
Filed under:
Filed under: Medically Related, Insurance, healthcare, health insurance, Blue Cross, Patients, Blue Shield, formulas, Contracts, Ingenix, scoring health claims, algorithms fraud, claim denials
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Does all this free credit (they have to pay for this) for members have anything to do with the recent premium increases? It certainly seems like there’s a lot of this type of expenditure going out and this should not be classified under the “healthcare” area as this is an administrative type of...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Mon, Apr 19 2010
Filed under:
Filed under: Medically Related, Insurance, privacy, health insurance, Blue Cross, Security Breach, Blue Shield, heatlhcare reform, surveys, Rhose Island
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With the talk of reform and policy cost improving, there’s still a lot of money in the till for acquisitions it appears. You can check out the website and again this i s one more program focused at employers. They have a gym in Seattle that goes along with the program. They also have...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Fri, Mar 12 2010
Filed under:
Filed under: Medically Related, Insurance, healthcare, health insurance, Blue Shield, Fitness, wellness, heatlhcare reform, coaching, Kinetix
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The focus here is for more money spent on preventive care, but when the big ones come, such as a knee or hip, or even cardiac care, it will be more out of pocket for the employees here. It is lowering the cost on the preventive side, where we can usually afford, but passing along the bigger expense...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Fri, Mar 12 2010
Filed under:
Filed under: Medically Related, Insurance, healthcare, health insurance, Blue Cross, preventive medicine, Doctors, Algorithms, Blue Shield, formulas, ER, healthcare reform
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Doctors want to practice medicine and discuss having the 3rd party calling the shots, the health insurance companies. If you missed the show, you can watch is all here and see real discussions and interviews or use the link below to view on NBC. Also, you will see an old familiar face...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Mon, Jan 25 2010
Filed under:
Filed under: Medically Related, Insurance, Rehabilitation, health insurance, Cigna, Patient Advocacy, Algorithms, Blue Shield, United HealthCare, Contracts, Wendell Potter, life or death decisions, NBC
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Also in the news this week from the Los Angeles Times, Blue Shield it telling people if they are late or miss a payment, cancelled. They do state that one can reapply but your premiums could stand to be higher along with additional restrictions. The grace period goes from 45 to 28 days, so...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Thu, Dec 17 2009
Filed under:
Filed under: Medically Related, Insurance, health insurance, Non Profit, Blue Shield, healthcare reform, CDC, payments, for profit, stock exchange
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Well maybe not the good news we wanted to hear about the notebook possibly being found, but here’s the next best available bit of news on the security breach with providers from Blue Cross, one extra year of credit monitoring. Just a question, but does anyone really pay for this service unti l...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Mon, Nov 16 2009
Filed under:
Filed under: Technology, Insurance, healthcare, health insurance, Physicians, Hospitals, Blue Cross, Data Breach, Data, Blue Shield, theft, credit bureaus
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This is not a big pool and you really have to be on your toes to get in here a this is for people who have been turned down and have pre-existing conditions. 7100 enrollees is the maximum so if you are enrollee number 7101, you are out of luck. Even with being accepted, the rates are not...
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This is the press release sent out. Use the link at the bottom to read the entire article. What is not addressed are those who would like to enjoy this type of coverage but can’t afford it as exists with today’s business models and the number is growing daily. Every other business today...
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The company claims to be growing and hiring additional sales and other support personnel. Patients fill out information on the tablet and it can either be printed or sent to an EMR. They are wireless and run off Windows CE. In February they brought in over 11 million with Sandbox and...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Fri, May 22 2009
Filed under:
Filed under: Tablet PCs, Medically Related, Technology, Insurance, healthcare, health insurance, Business Intelligence, Blue Cross, Programming, Blue Shield, Blue Cross Venture Capital, Phreesia
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Rescission of Health Insurance is still legal and this will more than likely represent a land mark case to perhaps get some type of resolution to the situation everybody hates, using Business Intelligence software to scour, analyze and deny coverage and claims. Despite fines and other investigations...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Mon, May 18 2009
Filed under:
Filed under: Medically Related, Insurance, health insurance, Business Intelligence, Balance Billing, Fines, MIB, Health Net, Algorithms, Blue Shield, United HealthCare, Venture Capital, Trial