You Should Know

If you read the above headline without thinking it's insane, chances are you are American.
No developed country is as insane as USA, not even close, not even remotely close.
If you are sick, you shouldn't need to fight for treatment, only in a sick society is that necessary.

No. We absolutely should not know how to do this. Because our elected officials should be working to curb Insurance Corporations and Corporat abuse and fraud in the most general sen..... Oh wtf am I talking about. Just hoping when I get sick its a fast death

Non Americans

Luigi

I know someone who works for a major insurance company in the US, in the appeals department. I don't know the intimate details of everything about their job, but one thing I always remembered is if you have an expedited appeal (for a medical emergency), and they're requesting documents that you don't send within the 72 hour deadline an expedited appeal has, the denial gets an automatic administrative overturn - the appeal is approved. Presumably for liability reasons, combined with that the company gets fined if an expedited appeal takes over 72 hours to process. Potentially a usable strategy if you have an expedited appeal that's weak enough to have a chance of the denial being upheld in the end, and they're also requesting documents. Probably a pretty rare combination of factors though.

But I've also been told by them that most denials end up being overturned on appeal in the end. And that they see people appealing denials on a daily basis, where they were denied the absolute stupidest reasons - people who obviously should never have been denied in the first place. Hard to say if this means most denials are bullshit, or if it just means people only bother trying to appeal the most obviously bullshit ones.

I once owed $1100 for bloodwork a teledoc ordered. I had a wellness exam and they ordered a bunch of bloodwork which I got done at a major well known national lab. My insurance said the claim is out of network and refused to pay on some of the bloodwork orders.

Although my teledoc was licensed to practice medicine in my home state, my insurance plan stated it is billed for the providers primary state. In that state, my insurance plan is not contracted with the lab that it's contracted in my state.

I’m going to assume it says that we shouldn’t use ‘the Mangione method’.

insurances

I think mass nouns do not work like that.

I work in pharmacy, and what I see between prescription prices and insurance adjudication processes... it's a fucking eugenics program, plain and simple. I feel awful for people who need insulin and adhd medication in particular.

No, I don't need them. We have real healthcare here.

Throw ****** ********* at the ***** of these corporate overlords, located at ************ or searchable through ***************

Link to Article?

I worked for a non-profit insurance company, (Fidelis Care,) that was purchased by a for profit conglomerate, (Centene.) Health insurance companies deny appropriately billed and coded shit all day long hoping:

• you don't know your rights
• you can't figure out how to submit appeals if you are smart enough to know your rights
• you will give up because the process is too complex, can take as much effort as a full time job, and can lower your credit rating while you wait for the appeals process to pay out.

I witnessed appropriately coded claims get improperly denied all day long. I spent most of my time working there helping people file appeals, or giving them the information to the state agency where they could file external appeals after our own review team denied their internal appeal.

Right before covid hit, a gentleman was approved for pain injections, but couldn’t get into the office before his authorization ran out, because anything non emergent was closed. Once the doctor’s office was open, the doctor submitted a new request, with the same clinical information, and it was denied. I put an appeal together for this man, painstakingly pulling the clinical records from the first authorization, the second authorization, EVERY PAID CLAIM related to his condition, AND EVERY RX CLAIM FOR PAIN MEDS the company paid for to demonstrate medical necessity. 4 hours of work. The appeals team denied it in 15 minutes later, it was absolutely not reviewed. This is the straw that broke the camel's back and made me rage quit Fidelis.