By Amy Silverman
By Olivia LaVecchia
By Monica Alonzo and Stephen Lemons
By Chris Parker
By Michael Lacey
By Weston Phippen
At this point, as far as I'm concerned, the joke is on the city. No, all us hayseed artists aren't pawing the ground to rush downtown and create an exciting cultural periphery to Jerry's world and the Jerde reservation. Downtown (the Copper Square area) is DEAD. Where do small eclectic businesses fit into concrete mega-blocks and real estate that's priced for Starbucks and Hard Rock Cafe? The city and DPP have made their bed and now they can lie in it -- with all the other squares who want to hang out at Copper Square. Unfortunately, all that concrete deadness has cost and is continuing to cost taxpayers millions of dollars.
Claim jumpers: Regarding "Hypocritic Oath" (Paul Rubin, December 18): Companies are forced to pass on huge premium increases to their employees because they can no longer afford to absorb the increases in insurance premiums. What the hell is going on with the insurance industry? All the rules and regulations and nothing that enforces loss prevention?
The problem is that current regulations enforcing patient privacy require more automated claims processing, which means that nobody is reviewing the claims any longer. Today's claims processors have become glorified data entry clerks who usually don't have access to reference material needed to understand what they are authorizing payment for. Processor training is limited to understanding which codes go into which fields in order for the system to take it from there. Entry level processors don't know what they're paying for, yet are meeting production goals of 150 to 200 claims a day. Huge insurance companies are paying millions of dollars in fraudulent medical expenses because of inadequate review policies, and now all premium ratings are increased based on overinflated statistics.
I've been in the claims industry for 15 years, and medical necessity, precertification, reasonable and customary, unbundled services and assignment of benefits are just a few simple checks and balances that should have flagged this type of abuse right away. Un-F-ing believable!
Name withheld by request