Insurance Claims Processing Times Twelve

Simple shift could give 10,000 kids insurance

Lynn Bonner, Staff Writer
The state could save nearly $16 million and use the money to provide about 10,000 more children with government-sponsored health insurance by switching responsibility for handling medical bills from one state office to another, according to a state audit.

The state Department of Health and Human Services can process claims for the state children's health insurance plan cheaper than the state health plan, said a report that State Auditor Les Merritt's office issued Tuesday.

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The health and human services department uses Electronic Data Systems Corp. to process Medicaid claims at a cost of 41 cents per claim. It costs about 12 times more, or $4.88, to process a medical claim through the state health plan, which uses Blue Cross and Blue Shield of North Carolina, the audit said.


Four dollars and eighty-eight cents versus forty-one cents. Sounds like BCBSNC needs to talk to EDS about how to save money on claims processing.
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A Consumer Blacklist?

Please read this short post first, The Customer is NOT Always Right.

Now, fast forward to some time in the future.

A roofing contractor gets a call from a homeowner who wants some work done on his roof. Prior to returning the homeowner's call, the roofer performs a few searches of the potential client's name on the Internet. He learns some interesting things.

This homeowner has a lawsuit pending against a plumber, one against an electrician, and one against a swimming pool maintenance company. The roofer says to himself, "Nope - too much baggage," and chooses not to return the homeowner's calls.


Let's look even further into the future. Same scenario. A potential customer wants some sort of service. What he doesn't know is that there are websites that have been developed that track customer complaints and name names for those who are chronic complainers. Service organizations who are contacted cold by consumers may consult these sites, sort of the way consumers look at the Better Business Bureau to determine poor business practices. If a particular customer's name's on the list, they may just choose to send them packing.

Is there a law that states whomever contacts a business, the business must give them their business? I doubt it, In fact, I think I have seen disclaimers that say, "We have the right to refuse to serve anyone for any reason." No shirt, no shoes, no service.

Where does this leave the consumer? Does this mean if you're wrongfully served, you shouldn't take action in the event that some time in the future there may be a website tracking your activity? I don't think so. The BBB reports companies' track records for serving their customers. I can't speak for others, but I don't think I would boycott a business just because they had one unresolved complaint.

But if you are a chronic complainer, and have nothing better to do than to try to bring suit against everyone who tries to serve you, don't be surprised if some time in the future you may find it difficult to find anyone who wants your business.
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Can an Injured Intruder Sue a Homeowner?

A warning shot fired by a 79 year old former Army sharpshooter ricocheted off the ceiling and lodged into the skull of an intruder in Hickory, NC this week.

From Warning shot wounds intruder in The News & Observer,

Cook used his .22-caliber gun to fire a warning shot into the ceiling, but the bullet ricocheted and part of it hit the intruder in the forehead, said Lt. Hank Guess with the Hickory Police Department. "I wasn't aiming for him. If I wanted to hit him, I would have," Cook said.

The intruder ... had a bullet fragment in his skull and a fractured hand he suffered while breaking in. He was arrested.

Let's hope the intruder doesn't decide to sue the homeowner for injuries suffered while "visiting" his home. Stranger lawsuits have occurred in this country. In that case, Cook may have wished he had aimed a bit lower. To paraphrase a popular expression, Dead Men Do Not Hire Lawyers.
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