Health care claim denial

 

When I went looking for denial rates, I was shocked, shocked I was, 

 

to find United Health Care denied 1/3 of all claims, according to ValuePenguin which did comparative rating of insurance corporations.

The office manager for my primary care doc confirmed this with her assessment: UHC was the worst to deal with.

So, I started digging deeper & found 1/7 of claims to all insurers nationwide are initially rejected per https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis.

https://blog.persius.org/investigations/claims_denials is a highly useful data source about denials, as this picture shows:

So, it happens frequently, even though Oregon is one of the least worst for denials. And, folks don't appeal often enough, as the report shows:

"While claims denials occur frequently, internal appeal rates are vanishingly low; this fact remains true across all categories of denial, so far as can be told from the data which reports sufficient detail to make such a determination.

Among internally appealed claims denials overturn rates are high.

The monetary value historically recouped in the observed data through internal appeals overturns is large, despite the fact that internal appeals are vanishingly rare."

Not only can we fight back and win, we can make it easy with the same automation corporations use to deny. Here's a stellar example: https://sfstandard.com/2024/08/23/holden-karau-fight-health-insurance-appeal-claims-denials/

And, a link to the AI we all can use to appeal: https://fighthealthinsurance.com/

But if appealing to the insurance corporation fails, there's further recourse without hiring a lawyer. "Historically, most consumers that have navigated their way through an internal appeal process and lost do not... proceed with an independent external review, as we will see in the data below.:" - op cit.

For example, appeals to California's Insurance Commission, over an 11 year period, were successful half the time.

And, in the past few years, those appeals have become more successful.

 

But, sometimes, as with this UHC-insured patient, litigation is necessary (he won, because the lawsuit discoved 'cut-and-paste' denials, as well as much fibbing on UHC's part).

So, when you're confronted by corporate DENY-DEFER-DEFEND, demurely fight back.  If in no other way, by public shaming.