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> any justification is just going to point to some made up excuse or insanely complicated internal policy designed for obfuscation. I don't see how you can cla

> any justification is just going to point to some made up excuse or insanely complicated internal policy designed for obfuscation. I don't see how you can claim that without seeing all the records in question. Maybe it was deliberately obfuscated, maybe someone just screwed up. Guess what, human error is a thing. In fact, the article itself showcases a bunch of human errors -- those of people not knowing that their employer is required by law to provide claim files within 30 days.

Zigurd 3y ago
There might also be a teakettle on the far side of the Moon.
whoomp12341 3y ago
you haven't fought a claim yet, have you. Its beyond infuriating, especially when you are on the hook for a large bill
- dboreham 3y ago
  Beyond infuriating is when the Dr requests pre-approval then does the procedure and then they deny it. And keep denying they approved it even after the hospital has revealed they record all calls with insurance companies, and they have the recording where the procedure was pre-approved.
CocaKoala 3y ago
Eh, we're currently fighting to get some claims covered. Before a certain date, all the claims are denied; after a certain date, all the claims are approved. The claims are all for the same thing, related to the same procedure (physical therapy after a joint replacement). Could the claims have been rejected due to a simple human error? Sure, it's plausible. Was there another human error that caused the claims to be rejected after we appealed? Maybe, but probably not. Could a third human error cause the claims to be rejected again after our second appeal? Seems pretty unlikely.
- quadrifoliate 3y ago
  Yeah, in your case it seems reasonable that the denials are malicious. I guess I'm not seeing why the poster I was replying to declared that getting access to the claims file was useless. Wouldn't getting access to that file make it easier to prove that claims were wrongfully denied?

Zigurd 3y ago

There might also be a teakettle on the far side of the Moon.

whoomp12341 3y ago

you haven't fought a claim yet, have you. Its beyond infuriating, especially when you are on the hook for a large bill

dboreham 3y ago
Beyond infuriating is when the Dr requests pre-approval then does the procedure and then they deny it. And keep denying they approved it even after the hospital has revealed they record all calls with insurance companies, and they have the recording where the procedure was pre-approved.

CocaKoala 3y ago

Eh, we're currently fighting to get some claims covered. Before a certain date, all the claims are denied; after a certain date, all the claims are approved. The claims are all for the same thing, related to the same procedure (physical therapy after a joint replacement). Could the claims have been rejected due to a simple human error? Sure, it's plausible. Was there another human error that caused the claims to be rejected after we appealed? Maybe, but probably not. Could a third human error cause the claims to be rejected again after our second appeal? Seems pretty unlikely.

quadrifoliate 3y ago
Yeah, in your case it seems reasonable that the denials are malicious. I guess I'm not seeing why the poster I was replying to declared that getting access to the claims file was useless. Wouldn't getting access to that file make it easier to prove that claims were wrongfully denied?