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I genuinely think every health insurance denial should have to come from a named doctor at the health insurance company who is personally and professionally lia
by ncallaway 4y ago
I genuinely think every health insurance denial should have to come from a named doctor at the health insurance company who is personally and professionally liable for the health outcomes from a denial.
Deny someone life-saving care without a sound medical reason? That’s a malpractice lawsuit and a potential loss of their medical license.
- theGnuMe 4y agoThere's some doc on twitter who was denied by insurance and he filed a board complaint against the insurance doc claiming malpractice. I think he won.
- d1str0 4y agoKnow any more details? This seems rather promising.
- theGnuMe 4y agohttps://twitter.com/generalorthomd/status/1632074816378507264 https://twitter.com/generalorthomd/status/163207481637850726...
- IG_Semmelweiss 4y agothe claim denier worked for insurance. he had a complaint on file for entering a hip replacement backwards the tweeter thread shows devastating images . the point is that a provider like that, has no business denying coverage. plus apparently he was not board cert and other issues from lapses in licensing
- ncallaway 4y agoYep, basically we should make it much easier to identify the specific doctor that is responsible for the denial (to make them easier to sue personally, and discipline professionally), and we should make the liability for such a denial extremely explicit.
- kube-system 4y agoThat doesn’t make any sense. Insurance claims are submitted to insurers after providers have already performed the care.
- IG_Semmelweiss 4y agoA claim denial will result in patient responsibility, which ends up with a service but costing patients a lot of $$. OR in this case, the pa was denied for the cpts requested. In which case care may be denies by the provider or facility
- ncallaway 4y agoCritically, many patients also require ongoing services, where a claim denial wouldn’t prevent you from receiving the first service, but it may absolutely impact the second, third, etc. So, I don’t think I’d exempt claim denials from my proposed regulation. Named doctor, personally and professionally liable from the consequences of their denial.
- thallium205 4y agoWhat about prior authorizations?
- kube-system 4y agoThe article is about claims, which are a difficult thing than pre-auths. There are some restrictions on pre-auths and when an insurer can require one. If you are in need of immediate care to save your life, they are not required and your provider will give you care before even telling your insurance company about it. The grey area with pre-auths is with nonemergency care that could lengthen someone’s life. There are requirements by law for appealing these denials but yes, this is where those stories about “I can’t get my cancer treatment” come from. This is not the situations in the article, though. What’s shitty about the actions in the article is that many people don’t even realize that erroneous health insurance denials are common and they just accept the denial and pay out of pocket. It is very common to get a denial, send in a challenge like “no this should be covered” and then they pay.
- conductr 4y agoIn a way, a denial is accusing the ordering/prescribing of trying to commit some type of insurance fraud. I agree if you’re trying to override a doctor that knows me, has cared for me, likely already done some labs/scans/etc to make their order, well - the burden should be yours to prove it’s not necessary.