4 ms·

Patients Who Fight Health Insurance Denials Often Win

44 points by toomuchtodo 1mo ago

toomuchtodo 1mo ago
https://archive.today/zYeNB https://archive.today/zYeNB
- Legend2440 1mo ago
  Seems broken, doesn't contain the entire article text.
  - toomuchtodo 1mo ago
    Gift link: https://www.bloomberg.com/news/features/2026-09-14/about-half-of-health-insurance-denials-get-reversed-analysis-finds?accessToken=eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJzb3VyY2UiOiJTdWJzY3JpYmVyR2lmdGVkQXJ0aWNsZSIsImlhdCI6MTc4OTQxMTQwOSwiZXhwIjoxNzkwMDE2MjA5LCJhcnRpY2xlSWQiOiJUTENRTTJLR0lGUVgwMCIsImJjb25uZWN0SWQiOiI5NDU1RERFRjRCOUU0MDM3QTI5NkMyNEQyNjRENTFFMCJ9.jieTn2r9p9WVCmVFfWgc5N6fQ25cLRwB5RPEc48kg3k https://www.bloomberg.com/news/features/2026-09-14/about-hal...
ratelimitsteve 1mo ago
>Few patients appeal when insurers decline to pay for their care. Many don’t even know they can. But new data show that when they do, they frequently win — in some plans, nine out of 10 times. If 90% of denials that are challenged end up being reversed, and the delay in delivering the care that the insurer contractually agreed to deliver is deleterious to the patient's overall health and leads to prolonged suffering, why is this not a cause of action? Until there is some sort of downside introduced, the "deny til they die" health insurance model is going to continue to thrive at the expense of people not getting the care they paid for and are entitled to.
- ActorNightly 1mo ago
  They don't count the claims that are never fought in the first place. Which i would wager is the majority.
  - ratelimitsteve 1mo ago
    but do you have any evidence beyond intuition that those denials differ significantly in reversal rate? one would guess that things that are never going to be covered get denied and then never appealed but one would also guess that things that are never going to be covered don't get submitted in the first place. assuming that the rate of legitimate denials is higher among those claims never appealed, what rate of illegitimate denials is acceptable? why would denying even one person care that they're contractually entitled to receive be okay? why shouldn't insurance companies have to do what they promise to do and accept money for?
- nostrademons 1mo ago
  It can be! If you've got a crack legal team at your disposal, you can absolutely sue over insurance denials that put your health at risk. The problem is that most folks who need an insurance plan that regularly denies them also don't have the money to afford a crack legal team to sue the insurer. (If you're that wealthy, typically you would just have a private physician that you're paying directly, who has no problems treating you promptly because that's what they're paid to do.) This is representative of a general problem with the legal system today. It's too expensive, and operates too slowly. When the economics of cheating people were that you might be able to cheat 10 people before you pick on the wrong guy who has a lawyer that puts you out of business, you have an incentive to follow through on your contracts and do what you say you'll do. When the economics became that you can cheat 10 million people before you pick on the wrong guy who sues you, it becomes rational to take the money from those 10M people and use it to outspend the guy who sues you, or at least just pay him off so he goes away. And so our western notions of democracy and contract law get subsumed into a feudal system where only big corporations get protection of law, and you must join the local protection racket to slot into that system.
  - 1mo ago
nostrademons 1mo ago
This is pretty standard procedure in a lot of industries: Health insurance will often initially deny coverage, either in the pre-approval or when you get the bill, but if you firmly follow up and hold their feet to the policy they will reverse that. Even if you're uninsured, healthcare providers will usually settle medical debt for about 10c on the dollar if you threaten bankruptcy. Home/auto insurance will often give you a black hole for claims; the adjuster won't get back to you for months at a time. But if you keep calling them enough to be annoying, they will usually eventually pay out. Contractors will often fail to fix shoddy workmanship until you threaten to report them to the local licensing board. Cops will often ticket you, but a surprising number of tickets get reversed if you contest them in court, oftentimes because the cop doesn't even show up. One of my friend's parents in high school vowed never to take a speeding ticket lying down; he was 5-0 on contesting them. The IRS will come at you with the interpretation of tax laws that is most favorable to them given the data they don't have available, particularly if you are high-income. But if you actually know the laws and can show hard data (statements/receipts), you can usually get the bill they claim you owe reduced by 80%+ or even to $0. Colleges will often increase their financial aid packages by thousands of dollars if you have a competing acceptance and are like "Well, I would love to attend your school, but financially it's hard for me to justify paying $X more than this other school I got into." Companies will often increase their compensation offers significantly, sometimes by hundreds of thousands of dollars, if you turn down their offer. It's all negotiation. They put forth an initial low-ball offer because most people accept it. If you make it clear that you are one of the folks who will make a stink about it, they'll often increase their offer significantly to get you to go away.
- FireBeyond 1mo ago
  The difference here is that oftentimes your situation can markedly deteriorate, sometimes irreversibly, as a result of that denial. And the "make a stink" can come at a time you're least equipped to deal with it. > It's all negotiation. They put forth an initial low-ball offer because most people accept it. And that's the problem. People having to make a stink because insurers are doing things that are in contradiction to the policy they wrote, if not the law, because private enterprise wants more money. Private enterprise that has simultaneously almost singlehandedly caused the skyrocketing of medical costs, because the only way to make more money when your profits are regulated is to increase costs, and nobody except the consumer/patient is incentivized to do anything about it, quite the opposite - they're entirely happy to go along with it. And then insurers will stand up in Court and say "Oh, we're not denying care to our customer, we're just saying we won't pay for it. They're free to pay for it out of pocket." My old boss would have received a $1.8M bill for his daughter's care, born at 33 weeks. A coworker of mine had to raise a substantial portion of an expected $1.25M bill for a lung transplant for her son. My kidney stone would have cost $70,000 to have not been resolved (they went in, found infection, retreated and gave me IV antibiotics instead, and revisited the issue two weeks later, which had its own separate bill). My ENT had to put me on two expensive and useless nasal sprays for months so that when he recommended deviated septum surgery for an effectively blocked nostril (90%+ deviation) that insurance wouldn't deny it because (gasp, shock, horror) nasal sprays don't realign or open up cartilage.
deleted 1mo ago
[deleted]
matteoraso 1mo ago
There's a pretty strong selection bias here, where you only challenge a denial if it's likely to be overturned.
0utcast 1mo ago
Cus their goal is to make it really difficult to fight claim denials, so people who don't have the time or energy to, don't fight it.
- FireBeyond 1mo ago
  > so people who don't have the time or energy to For example, people who are sick, ill, or injured...
ksudb 1mo ago
[dead]
timoth3y 1mo ago
An individual who makes a false insurance claim is committing a felony, but a manager who knowingly denies thousands of valid claims is rewarded with bonuses and promotions. CEOs who who structures the company to denies as many valid claims as possible are handsomely rewarded by Wall Street for increasing margins. Things really need to change at a core level in America.
- general1465 1mo ago
  Health insurance should be automatically approved and then prosecuted if there is a suspicion of fraud. Kind of like DMCA works.

44 points by toomuchtodo 1mo ago

toomuchtodo 1mo ago

https://archive.today/zYeNB https://archive.today/zYeNB

Legend2440 1mo ago
Seems broken, doesn't contain the entire article text.
- toomuchtodo 1mo ago
  Gift link: https://www.bloomberg.com/news/features/2026-09-14/about-half-of-health-insurance-denials-get-reversed-analysis-finds?accessToken=eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJzb3VyY2UiOiJTdWJzY3JpYmVyR2lmdGVkQXJ0aWNsZSIsImlhdCI6MTc4OTQxMTQwOSwiZXhwIjoxNzkwMDE2MjA5LCJhcnRpY2xlSWQiOiJUTENRTTJLR0lGUVgwMCIsImJjb25uZWN0SWQiOiI5NDU1RERFRjRCOUU0MDM3QTI5NkMyNEQyNjRENTFFMCJ9.jieTn2r9p9WVCmVFfWgc5N6fQ25cLRwB5RPEc48kg3k https://www.bloomberg.com/news/features/2026-09-14/about-hal...

ratelimitsteve 1mo ago

>Few patients appeal when insurers decline to pay for their care. Many don’t even know they can. But new data show that when they do, they frequently win — in some plans, nine out of 10 times. If 90% of denials that are challenged end up being reversed, and the delay in delivering the care that the insurer contractually agreed to deliver is deleterious to the patient's overall health and leads to prolonged suffering, why is this not a cause of action? Until there is some sort of downside introduced, the "deny til they die" health insurance model is going to continue to thrive at the expense of people not getting the care they paid for and are entitled to.

ActorNightly 1mo ago
They don't count the claims that are never fought in the first place. Which i would wager is the majority.
- ratelimitsteve 1mo ago
  but do you have any evidence beyond intuition that those denials differ significantly in reversal rate? one would guess that things that are never going to be covered get denied and then never appealed but one would also guess that things that are never going to be covered don't get submitted in the first place. assuming that the rate of legitimate denials is higher among those claims never appealed, what rate of illegitimate denials is acceptable? why would denying even one person care that they're contractually entitled to receive be okay? why shouldn't insurance companies have to do what they promise to do and accept money for?
nostrademons 1mo ago
It can be! If you've got a crack legal team at your disposal, you can absolutely sue over insurance denials that put your health at risk. The problem is that most folks who need an insurance plan that regularly denies them also don't have the money to afford a crack legal team to sue the insurer. (If you're that wealthy, typically you would just have a private physician that you're paying directly, who has no problems treating you promptly because that's what they're paid to do.) This is representative of a general problem with the legal system today. It's too expensive, and operates too slowly. When the economics of cheating people were that you might be able to cheat 10 people before you pick on the wrong guy who has a lawyer that puts you out of business, you have an incentive to follow through on your contracts and do what you say you'll do. When the economics became that you can cheat 10 million people before you pick on the wrong guy who sues you, it becomes rational to take the money from those 10M people and use it to outspend the guy who sues you, or at least just pay him off so he goes away. And so our western notions of democracy and contract law get subsumed into a feudal system where only big corporations get protection of law, and you must join the local protection racket to slot into that system.
- 1mo ago

nostrademons 1mo ago

This is pretty standard procedure in a lot of industries: Health insurance will often initially deny coverage, either in the pre-approval or when you get the bill, but if you firmly follow up and hold their feet to the policy they will reverse that. Even if you're uninsured, healthcare providers will usually settle medical debt for about 10c on the dollar if you threaten bankruptcy. Home/auto insurance will often give you a black hole for claims; the adjuster won't get back to you for months at a time. But if you keep calling them enough to be annoying, they will usually eventually pay out. Contractors will often fail to fix shoddy workmanship until you threaten to report them to the local licensing board. Cops will often ticket you, but a surprising number of tickets get reversed if you contest them in court, oftentimes because the cop doesn't even show up. One of my friend's parents in high school vowed never to take a speeding ticket lying down; he was 5-0 on contesting them. The IRS will come at you with the interpretation of tax laws that is most favorable to them given the data they don't have available, particularly if you are high-income. But if you actually know the laws and can show hard data (statements/receipts), you can usually get the bill they claim you owe reduced by 80%+ or even to $0. Colleges will often increase their financial aid packages by thousands of dollars if you have a competing acceptance and are like "Well, I would love to attend your school, but financially it's hard for me to justify paying $X more than this other school I got into." Companies will often increase their compensation offers significantly, sometimes by hundreds of thousands of dollars, if you turn down their offer. It's all negotiation. They put forth an initial low-ball offer because most people accept it. If you make it clear that you are one of the folks who will make a stink about it, they'll often increase their offer significantly to get you to go away.

FireBeyond 1mo ago
The difference here is that oftentimes your situation can markedly deteriorate, sometimes irreversibly, as a result of that denial. And the "make a stink" can come at a time you're least equipped to deal with it. > It's all negotiation. They put forth an initial low-ball offer because most people accept it. And that's the problem. People having to make a stink because insurers are doing things that are in contradiction to the policy they wrote, if not the law, because private enterprise wants more money. Private enterprise that has simultaneously almost singlehandedly caused the skyrocketing of medical costs, because the only way to make more money when your profits are regulated is to increase costs, and nobody except the consumer/patient is incentivized to do anything about it, quite the opposite - they're entirely happy to go along with it. And then insurers will stand up in Court and say "Oh, we're not denying care to our customer, we're just saying we won't pay for it. They're free to pay for it out of pocket." My old boss would have received a $1.8M bill for his daughter's care, born at 33 weeks. A coworker of mine had to raise a substantial portion of an expected $1.25M bill for a lung transplant for her son. My kidney stone would have cost $70,000 to have not been resolved (they went in, found infection, retreated and gave me IV antibiotics instead, and revisited the issue two weeks later, which had its own separate bill). My ENT had to put me on two expensive and useless nasal sprays for months so that when he recommended deviated septum surgery for an effectively blocked nostril (90%+ deviation) that insurance wouldn't deny it because (gasp, shock, horror) nasal sprays don't realign or open up cartilage.

deleted 1mo ago

[deleted]

matteoraso 1mo ago

There's a pretty strong selection bias here, where you only challenge a denial if it's likely to be overturned.

0utcast 1mo ago

Cus their goal is to make it really difficult to fight claim denials, so people who don't have the time or energy to, don't fight it.

FireBeyond 1mo ago
> so people who don't have the time or energy to For example, people who are sick, ill, or injured...

ksudb 1mo ago

[dead]

timoth3y 1mo ago

An individual who makes a false insurance claim is committing a felony, but a manager who knowingly denies thousands of valid claims is rewarded with bonuses and promotions. CEOs who who structures the company to denies as many valid claims as possible are handsomely rewarded by Wall Street for increasing margins. Things really need to change at a core level in America.

general1465 1mo ago
Health insurance should be automatically approved and then prosecuted if there is a suspicion of fraud. Kind of like DMCA works.