3 ms·

> the UHC rep asked for her to call back when convenient (not in the middle of surgery) I'll echo the above poster - when an insurance rep calls us we drop ev

> the UHC rep asked for her to call back when convenient (not in the middle of surgery) I'll echo the above poster - when an insurance rep calls us we drop everything on the floor and rush to answer it because otherwise they will continue to deny our claim and not get back for weeks. Then they reject our claim because it's now outside their 3 month window.

legitster 2y ago
In this case though, the claim should have been denied because it was filed incorrectly. Is there also a reason the surgeon themselves needs to get on the phone with insurance? Isn't that what the rest of the staff is for?
- nineplay 2y ago
  > the claim should have been denied because it was filed incorrectly Spoken like someone who has never spent hours online with an insurance company. They have told me that they can't see uploaded forms due to a 'glitch'. They have told me fields were missing when I am looking at the same forms and telling them where the field is and what it contains. They have been carefully instructed to tell lie after lie after lie hoping that the consumer finally gives up.
  - y33t 2y ago
    I've seen the same damned thing. Even when the state has previously gotten involved on behalf of a patient, I've seen insurance try to deny a surgery less than an hour before it was scheduled. Patient's husband called up the state and they said to not worry about it, they'd handle it. But even still, insurance companies do not stop trying it. The penalties they get are a joke to them. Executives need to face criminal penalties and be locked up in federal prison. Fuck it put em in Gitmo, those people are terrorizing us all.
    - nineplay 2y ago
      The goal is to wear you out and it's the context missing from the discussion. An external observer could look at any of my contested insurance claims and say 'They asked for more information, you gave it to them, the claim was approved, so what is the problem?" What's missing is all the days I had to get up, check on my claim, and call them because the claim was still denied and they sure weren't going to call me. What's missing is the hours I spent on the phone with them taking them step-by-step through the same issue each time.
  - roenxi 2y ago
    That seems a bit incredible because it suggests that they would be denying 100% of their claims. If they're going to start lying about a form being filled out correctly in one instance, why ever stop? They can just keep lying forever on all claims. I've had weird experiences online arguing (about shoplifting, as it happened) with people (I assume teenagers) on Discord who seemed to have a genuine belief that buying insurance was a magic positive-sum process for dealing with damages. They hadn't/didn't make the link that the insurer pays out approximately what they take in from premiums. That experience applied to medical insurance leaves me with a strong suspicion that UHC gets a lot of hate because they are the cheap option and people haven't cottoned on to the sad reality that if they want their claims paid out they can't go with the provider that is cheap because it denies a lot of claims. UHC's margins are there but don't seem to be that impressive. It wouldn't be surprising if they have to push back fairly hard or become insufficiently profitable.
    - IG_Semmelweiss 2y ago
      the mistake in your assumption is that they are the "cheap" option. UHC have all kinds of plans, both cheap and expensive, and their denial rates are high, regardless of what plans are purchased.
      - roenxi 2y ago
        Knowing the general madness of US healthcare, I want to stress this isn't rhetorical. So why are people going with UHC? EDIT I want to reply to 2 replies with the same comment, so I'll put it here - if the companies are paying & buying known-dodgy insurance, then why aren't they going with a cheap option?
        nineplay 2y ago
        Because in the madness of our economy we've decided that people need to pay for their healthcare either out of pocket or through their employer. They have limited choices and often need to take the cheapest because its all they can afford. Fortunately for health insurance companies, people who need to take the cheapest healthcare could rarely fight back.
  - legitster 2y ago
    No, but my newborn had to go to the ER once and it kicked off 18 months of billing disputes with the hospital. And the thing I learned was the depths of incompetence, malice, and laziness that a hospital billing department was capable of. One of the key lessons - if a doctor submits an incorrect billing code, insurance can't do anything to change it. If a doctor doesn't want to work with insurance to fix the codes, you as a patient have so few options to do anything.
    - nineplay 2y ago
      I'm very sorry to hear that, I've been through any number of ER visits with my child. I have not personally had any issues with hospital billing departments, so perhaps I have been lucky. It is only the insurance I've had problems from.
      - legitster 2y ago
        But it's not the only billing problem I have had. A hospital billed us double for an emergency c-section (once for the mother, and again for the child) and hit us with $300k in claims. A dermatologist once faked a surgery and sent it to my insurance. And don't even get me started on the exploitative agreements hospitals sign with ambulance companies. We're not even people who spend a lot of time in hospitals - but we are pretty close to a 100% hit rate for billing issues with hospitals. Even during times in my life when I didn't have insurance. I get that people kind of ascribe all sorts of medical billing problems to insurance companies. But I think a lot of it is kind of ignorance comes from inept hospital management shifting blame. And often doctors and practitioners themselves are very removed and unaware of the awful billing at their own practices.
- IG_Semmelweiss 2y ago
  its called Peer to Peer. This happens all the time. Most independent doctors billing OON may also need to speak with 3rd party claims processor, in all likelyhood. Same is true for some WC/NF/Lien claims

legitster 2y ago

In this case though, the claim should have been denied because it was filed incorrectly. Is there also a reason the surgeon themselves needs to get on the phone with insurance? Isn't that what the rest of the staff is for?

nineplay 2y ago
> the claim should have been denied because it was filed incorrectly Spoken like someone who has never spent hours online with an insurance company. They have told me that they can't see uploaded forms due to a 'glitch'. They have told me fields were missing when I am looking at the same forms and telling them where the field is and what it contains. They have been carefully instructed to tell lie after lie after lie hoping that the consumer finally gives up.
- y33t 2y ago
  I've seen the same damned thing. Even when the state has previously gotten involved on behalf of a patient, I've seen insurance try to deny a surgery less than an hour before it was scheduled. Patient's husband called up the state and they said to not worry about it, they'd handle it. But even still, insurance companies do not stop trying it. The penalties they get are a joke to them. Executives need to face criminal penalties and be locked up in federal prison. Fuck it put em in Gitmo, those people are terrorizing us all.
  - nineplay 2y ago
    The goal is to wear you out and it's the context missing from the discussion. An external observer could look at any of my contested insurance claims and say 'They asked for more information, you gave it to them, the claim was approved, so what is the problem?" What's missing is all the days I had to get up, check on my claim, and call them because the claim was still denied and they sure weren't going to call me. What's missing is the hours I spent on the phone with them taking them step-by-step through the same issue each time.
- roenxi 2y ago
  That seems a bit incredible because it suggests that they would be denying 100% of their claims. If they're going to start lying about a form being filled out correctly in one instance, why ever stop? They can just keep lying forever on all claims. I've had weird experiences online arguing (about shoplifting, as it happened) with people (I assume teenagers) on Discord who seemed to have a genuine belief that buying insurance was a magic positive-sum process for dealing with damages. They hadn't/didn't make the link that the insurer pays out approximately what they take in from premiums. That experience applied to medical insurance leaves me with a strong suspicion that UHC gets a lot of hate because they are the cheap option and people haven't cottoned on to the sad reality that if they want their claims paid out they can't go with the provider that is cheap because it denies a lot of claims. UHC's margins are there but don't seem to be that impressive. It wouldn't be surprising if they have to push back fairly hard or become insufficiently profitable.
  - IG_Semmelweiss 2y ago
    the mistake in your assumption is that they are the "cheap" option. UHC have all kinds of plans, both cheap and expensive, and their denial rates are high, regardless of what plans are purchased.
    - roenxi 2y ago
      Knowing the general madness of US healthcare, I want to stress this isn't rhetorical. So why are people going with UHC? EDIT I want to reply to 2 replies with the same comment, so I'll put it here - if the companies are paying & buying known-dodgy insurance, then why aren't they going with a cheap option?
      - nineplay 2y ago
        Because in the madness of our economy we've decided that people need to pay for their healthcare either out of pocket or through their employer. They have limited choices and often need to take the cheapest because its all they can afford. Fortunately for health insurance companies, people who need to take the cheapest healthcare could rarely fight back.
- legitster 2y ago
  No, but my newborn had to go to the ER once and it kicked off 18 months of billing disputes with the hospital. And the thing I learned was the depths of incompetence, malice, and laziness that a hospital billing department was capable of. One of the key lessons - if a doctor submits an incorrect billing code, insurance can't do anything to change it. If a doctor doesn't want to work with insurance to fix the codes, you as a patient have so few options to do anything.
  - nineplay 2y ago
    I'm very sorry to hear that, I've been through any number of ER visits with my child. I have not personally had any issues with hospital billing departments, so perhaps I have been lucky. It is only the insurance I've had problems from.
    - legitster 2y ago
      But it's not the only billing problem I have had. A hospital billed us double for an emergency c-section (once for the mother, and again for the child) and hit us with $300k in claims. A dermatologist once faked a surgery and sent it to my insurance. And don't even get me started on the exploitative agreements hospitals sign with ambulance companies. We're not even people who spend a lot of time in hospitals - but we are pretty close to a 100% hit rate for billing issues with hospitals. Even during times in my life when I didn't have insurance. I get that people kind of ascribe all sorts of medical billing problems to insurance companies. But I think a lot of it is kind of ignorance comes from inept hospital management shifting blame. And often doctors and practitioners themselves are very removed and unaware of the awful billing at their own practices.
IG_Semmelweiss 2y ago
its called Peer to Peer. This happens all the time. Most independent doctors billing OON may also need to speak with 3rd party claims processor, in all likelyhood. Same is true for some WC/NF/Lien claims