Thread regarding Centene Corp. layoffs

I can only take it that you've not paid attention to the EOBs for even your own healthcare. The entire healthcare/insurance industry is that way. A few years ago my wife had cancer and if you looked at the billings for all of her treatments the totals were > $350K but insurance actually paid out a little over $28K + I paid about $5K out of pocket.
I was involved in an accident a few years ago and took an ambulance ride to the hospital. Several months later when I hadn't received a bill I called them to inquire. They hadn't received my insurance info so thought I was self paying. If I paid out of pocket it was like $700, if insurance was paying it was $2300...
Some states have tried to make providers publish rates for procedures but it has never gained much traction or made much of a dent in billing processes.

They have started with sending configurations overseas as well. They are messing up everything.

Read the contract which is on the Medicaid website for each state. AZ does not allow offshoring anything with PHI and it is reportable to The Office of Inspector General (OIG) i if it is done. The department I was in would not return any calls from an offshore inquiry (i.e. South Asian accent) when google showed the phone number was not an American company.

What is the CPT code? AHCCCS in AZ has complete transparency on their CPT allowables on their web site.

re: payment - a contract is a contract. I don’t believe your story on the cardiac surgery. and of course we have oversight on any offshore work; lots of xenophobia in this thread.

Also , as a former insurance specialist at one of the largest hospitals around, I can tell you that for every 1 person seen with commercial insurance (such as us FTE), we are billed for 10 medicaid patients. yes, we all know insurance is a scam in every single industry. Providers are never paid what they should be because hospitals make sure they get the bulk of it first.

Offshoring is becoming more common in healthcare. Two companies doing it off the top of my head are Ascension Health (they use the vendor R1) and Optum (owned by UnitedHealth Group). Both have massive billing and coding operations overseas. The Philippines has become a popular for this. Of course Centene uses Optum as one of its major vendors too.

I hate it. It makes me uncomfortable that my PHI and sensitive information is in a place where we have zero oversight.

I am in claims and I gotta tell you I have no idea. I have seen claims with charges in the millions that pay out a couple thousand. Unclear how they charge one thing and CMS (or Medicaid) only allows a certain amount but it also depends on their contract agreement. It actually doesn't make any sense to me...its not like going to the store where they charge you $3.50 for milk and you pay $3.50 for the milk. As far as offshoring there have been huge issues with that such as language barriers and comprehension resulting in repeated claims being processed incorrectly. And yes the biggest concern would be data security. Chances are a lot (if not all) of these providers/members have no clue their information is in India (or whatever other country they have been outsourced to).