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Seeing my health insurance deny hospital claims that were pre-authorized has been insane. The hospital checked in advance with my insurance that several operati

Seeing my health insurance deny hospital claims that were pre-authorized has been insane. The hospital checked in advance with my insurance that several operations would be covered and the insurance approved. Now that the bill comes, the insurance company has repeatedly denied and denied their claims. Health insurance companies are horrible and parasitic to everyone involved.

breadwinner 2y ago
Do us a service and please name your health insurance.
- culi 2y ago
  Statistically speaking, it's probably United Healthcare. The largest insurer and also has the highest denial rate
  - FireBeyond 2y ago
    That makes zero sense. Largest number of denials? Certainly. Largest denial rate is not implied by being the largest insurer. Yet by their denial rates, 30% above the industry average, you can reach one of two conclusions: 1. Every other insurer is acting as a charity and under denying claims it should, or… 2. UHC is issuing excessive denials.
- bentt 2y ago
  Yep, no reason to protect the insurer here.
solumos 2y ago
The big problem with health insurance is that it accounts for 17% of the US GDP, so although it's parasitic for everyone involved, it's basically indispensable to the economy. That's a big reason why the Affordable Care Act panned out the way it did, as a partnership with the insurance companies.
- jfengel 2y ago
  Under the ACA, 20% of that is overhead for the insurers. So you could boost the economy by 20% x 17% = a full year's GDP growth for free.
- EA-3167 2y ago
  It's a closed circle, Tax money comes in, Insurance companies suck it up with a straw. That same economic activity could still occur with that money, it would just be in other sectors, and ideally ones that produce real economic value.
- Jcampuzano2 2y ago
  If for-profit health insurance is really almost 1/5th of US GDP, something is entirely wrong. Then again, maybe it makes sense the country that perpetuates suffering all over the globe through being global police and lately just fucking up any sense of stability is the same one where almost 1/5th of our "output" is built on top of making money off of prolonging our own peoples pain and suffering.
- knome 2y ago
  >it accounts for 17% of the US GDP, so although it's parasitic for everyone involved, it's basically indispensable to the economy if people weren't forced to spend it on healthcare, they would spend it elsewhere. if healthcare was free tomorrow, the GDP would be fine, just redistributed.
  - wahnfrieden 2y ago
    They would also be healthier to contribute other economically productive labor and organization. When people get sick or die they stop working.
    - jimt1234 2y ago
      And more than half of my 50s-year-old friends would be able to retire from jobs where they do the bare minimum just to maintain their health insurance.
dboreham 2y ago
This happened in our family a few years ago. It was a penny dropping moment when the hospital revealed to me thar they routinely record all calls with insurance companies. So they had a recording of the insurer approving the procedure. They still refused to pay nevertheless.
1123581321 2y ago
Obviously frustrating and shouldn’t be happening. If it was pre-authed, is it possibly a billing code mismatch? That may be correctable if you book an in-person appointment with the hospital’s financial office.
- wahnfrieden 2y ago
  Who do you book an appointment or call with if it's corruption and not a simple billing mistake in their favor?
  - infamouscow 2y ago
    You call Luigi Mangione.
  - 1123581321 2y ago
    You’d start with that office and escalate to the ombuds of both the hospital and the insurer, with your lawyer and the pre-authorization document and communication trail. I get your question is facetious but it’s still worth knowing how to navigate a broken system.
- Sakos 2y ago
  "shouldn't be happening" is a weird way to describe the behaviour of health insurance companies in the US that they engage in every day.
  - 1123581321 2y ago
    Why? I wanted to express sympathy for suffering in our system while offering practical advice. It seemed rude to just launch into advice without acknowledging it shouldn’t be necessary in the first place. What phrase would you have used?
Nomadeon 2y ago
I've had BCBS reject prescriptions they've already pre-approved multiple times. First time, they denied all knowledge of the REQUEST (when my doctor has their APPROVAL fax in hand). Second time they acknowledged they had approved it but had to contact their pharmacy group to put in an "override". I've submitted a complaint with the state insurance regulator though I doubt it goes anywhere. Anyone for a class action lawsuit on the grounds of bad faith breach of contract and medical malpractice for obstructing access to care they already admit is medically necessary (by denying something already pre-approved)? I don't even want money. I want a Consent Decree enforced by the court that strikes fear across their whole industry. Audio record every interaction you have with insurance and tell 'em you're on a recorded line.
- FireBeyond 2y ago
  > medical malpractice for obstructing access to care they already admit is medically necessary This has been tried before and failed. The insurers argument is that they are not denying care, they are just not willing to pay for it, which isn’t practicing medicine.
- 42772827 2y ago
  > Audio record every interaction you have with insurance and tell 'em you're on a recorded line. I’ve tried this. They just hang up. So I record and then have a transcript generated, and I save my call logs.

breadwinner 2y ago

Do us a service and please name your health insurance.

culi 2y ago
Statistically speaking, it's probably United Healthcare. The largest insurer and also has the highest denial rate
- FireBeyond 2y ago
  That makes zero sense. Largest number of denials? Certainly. Largest denial rate is not implied by being the largest insurer. Yet by their denial rates, 30% above the industry average, you can reach one of two conclusions: 1. Every other insurer is acting as a charity and under denying claims it should, or… 2. UHC is issuing excessive denials.
bentt 2y ago
Yep, no reason to protect the insurer here.

solumos 2y ago

The big problem with health insurance is that it accounts for 17% of the US GDP, so although it's parasitic for everyone involved, it's basically indispensable to the economy. That's a big reason why the Affordable Care Act panned out the way it did, as a partnership with the insurance companies.

jfengel 2y ago
Under the ACA, 20% of that is overhead for the insurers. So you could boost the economy by 20% x 17% = a full year's GDP growth for free.
EA-3167 2y ago
It's a closed circle, Tax money comes in, Insurance companies suck it up with a straw. That same economic activity could still occur with that money, it would just be in other sectors, and ideally ones that produce real economic value.
Jcampuzano2 2y ago
If for-profit health insurance is really almost 1/5th of US GDP, something is entirely wrong. Then again, maybe it makes sense the country that perpetuates suffering all over the globe through being global police and lately just fucking up any sense of stability is the same one where almost 1/5th of our "output" is built on top of making money off of prolonging our own peoples pain and suffering.
knome 2y ago
>it accounts for 17% of the US GDP, so although it's parasitic for everyone involved, it's basically indispensable to the economy if people weren't forced to spend it on healthcare, they would spend it elsewhere. if healthcare was free tomorrow, the GDP would be fine, just redistributed.
- wahnfrieden 2y ago
  They would also be healthier to contribute other economically productive labor and organization. When people get sick or die they stop working.
  - jimt1234 2y ago
    And more than half of my 50s-year-old friends would be able to retire from jobs where they do the bare minimum just to maintain their health insurance.

dboreham 2y ago

This happened in our family a few years ago. It was a penny dropping moment when the hospital revealed to me thar they routinely record all calls with insurance companies. So they had a recording of the insurer approving the procedure. They still refused to pay nevertheless.

1123581321 2y ago

Obviously frustrating and shouldn’t be happening. If it was pre-authed, is it possibly a billing code mismatch? That may be correctable if you book an in-person appointment with the hospital’s financial office.

wahnfrieden 2y ago
Who do you book an appointment or call with if it's corruption and not a simple billing mistake in their favor?
- infamouscow 2y ago
  You call Luigi Mangione.
- 1123581321 2y ago
  You’d start with that office and escalate to the ombuds of both the hospital and the insurer, with your lawyer and the pre-authorization document and communication trail. I get your question is facetious but it’s still worth knowing how to navigate a broken system.
Sakos 2y ago
"shouldn't be happening" is a weird way to describe the behaviour of health insurance companies in the US that they engage in every day.
- 1123581321 2y ago
  Why? I wanted to express sympathy for suffering in our system while offering practical advice. It seemed rude to just launch into advice without acknowledging it shouldn’t be necessary in the first place. What phrase would you have used?

Nomadeon 2y ago

I've had BCBS reject prescriptions they've already pre-approved multiple times. First time, they denied all knowledge of the REQUEST (when my doctor has their APPROVAL fax in hand). Second time they acknowledged they had approved it but had to contact their pharmacy group to put in an "override". I've submitted a complaint with the state insurance regulator though I doubt it goes anywhere. Anyone for a class action lawsuit on the grounds of bad faith breach of contract and medical malpractice for obstructing access to care they already admit is medically necessary (by denying something already pre-approved)? I don't even want money. I want a Consent Decree enforced by the court that strikes fear across their whole industry. Audio record every interaction you have with insurance and tell 'em you're on a recorded line.

FireBeyond 2y ago
> medical malpractice for obstructing access to care they already admit is medically necessary This has been tried before and failed. The insurers argument is that they are not denying care, they are just not willing to pay for it, which isn’t practicing medicine.
42772827 2y ago
> Audio record every interaction you have with insurance and tell 'em you're on a recorded line. I’ve tried this. They just hang up. So I record and then have a transcript generated, and I save my call logs.