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how.... how... can they reject anything that the hospital says?
by bosie 4y ago
how.... how... can they reject anything that the hospital says?
- 1123581321 4y agoThey are rejecting on the presumption that the billing is erroneous. The hospital would follow up and get it approved. It’s a crude system and I’m not excusing it.
- soco 4y agoBecause they are allowed to. Having no (useful) regulation allows that and more. And no it's not abuse, it's the system working as designed. If there's a problem with it, don't take it with the people in the system, as tempting as it might be. They will be replaced by others with the same reject-happy finger. It needs a new system, heavily regulated like in Europe, and this means exactly the uphill battle you would expect.
- lotsofpulp 4y agoThey are not rejecting what the hospital says. I imagine pigsty’s account is missing some nuance, such as an uncommon diagnosis or prescription requiring further proof. The doctor might think (and might very well be guessing correctly), but the protocols require a certain level of evidence that was not provided. It could also be malfeasance, but I doubt that is happening on a systemic level at the big health insurance companies. They benefit from more healthcare spending, so I do not see why they would want to tamp down on necessary expenses.
- callahad 4y agoPropublica just ran a good article on UHG's attempts to deny coverage to a university student with severe ulcerative colitis. Apparently the insurer has its own panels of MDs that it can deploy to lobby the patient's doctor into different courses of treatment. In this case, UHG staff completely fabricated statements from the patient's doctor in order to justify reducing care to an ineffective level. https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis https://www.propublica.org/article/unitedhealth-healthcare-i...