Appealing Your Insurance Denial: A Mind-Boggling Labyrinth

https://www.propublica.org/article/how-to-appeal-insurance-denials-too-complicated

by cainxinth • 3 years ago

5 2 3 years ago

Bostonian• 3 years ago

Health "insurance" in the U.S. is largely just health care paid by a 3rd party, which is inherently more cumbersome than paying for something yourself. If have say $1 mil in stocks your net worth bounces around $10K per day as stocks rise or fall 1%. You don't expect to be insured against such changes, and similarly you should pay at least the first $10K of annual health care expenses yourself. Your health insurance premiums would fall commensurately.

If you expect a 3rd party to pay all your health care costs, expect paperwork, since the 3rd party needs to guard against fraud.

quarterdime• 3 years ago

I have heard this argument before, and it made sense to me until I became a patient. First of all, if the 3rd party (insurance company) was so incentivized to guard against fraud, why would they repeatedly lose documents that had been submitted to them?

For starters, she said bluntly, “we know everything is going to get denied.” It’s almost a given, she said, that the insurer will lose the first batch of records. “We often have to send records two or three times before they finally admit they actually received them. … They play all of these kinds of delaying games.”

Insurance companies costs come less from the first $10k of patients' spending, and much more from the next $10M. Very few, very expensive patients make up the bulk of the cost. This article (and other great Pro Publica reporting) demonstrates some of the ways that insurance companies cut these costs--ultimately by refusing to pay (or delaying) for necessary care.

Appealing Your Insurance Denial: A Mind-Boggling Labyrinth

Related Stories