[HN Gopher] The Company Helping America's Health Insurers Deny C...
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The Company Helping America's Health Insurers Deny Coverage for
Care
Author : dopylitty
Score : 27 points
Date : 2024-10-23 19:35 UTC (3 hours ago)
(HTM) web link (www.propublica.org)
(TXT) w3m dump (www.propublica.org)
| blackeyeblitzar wrote:
| Evicore is a highly suspicious company, and the story of the
| patient who passed away in this article is sad. But I have
| noticed insurers do this (false claim denials) all on their own
| too. I and many friends have experienced Aetna routinely denying
| things that are explicitly covered by their plans and mentioned
| in the plan documents. They force you into an exhaustive cat and
| mouse game of chasing their team to reprocess denied claims. But
| after the initial denial, every conversation goes to some other
| part of their support team with hour long waiting times (meaning
| you may have to try multiple times across multiple weeks due to
| other obligations in your schedule), incompetent staff that
| barely speak English (making it hard to get the info or action
| you want), and very loose commitments from Aetna (they'll promise
| getting back in 45 _business days_ but even with that they won't
| have done anything when you check in weeks later). I think these
| are purposeful games meant to deter people from successfully
| filing claims, by exhausting them, or simply shifting their
| payments into the future. I feel it is criminal. Not just in
| terms of fraudulent denial but in affecting people's health by
| creating stress for them over big medical bills that should be
| covered.
| toomuchtodo wrote:
| When it appears a legitimate claim is going to be denied, I
| recommend immediately opening a case with your state's
| insurance regulator. If it's an employer sponsored plan, the
| Dept of Labor. Success is not assured, but it creates a paper
| trail for regulators and other interested parties, including
| attorneys you might eventually involve.
|
| (volunteer patient advocate)
| blackeyeblitzar wrote:
| That's a great tip. I remember wanting to report this to some
| authority then but just didn't have the time to deal with it.
| I wonder if I can still do it now after this has been settled
| (the claim was eventually paid, months late, after many many
| hours spent on phone calls).
| toomuchtodo wrote:
| You can still file a complaint even if the issue has been
| resolved. It will be logged.
| scottLobster wrote:
| It's not even just insurance companies. My wife and I had a
| child earlier this year, uncomplicated natural birth, fully
| covered under insurance. However the hospital initially filed
| the claim incorrectly, causing the claim to be denied and us to
| receive a bill in the thousands well in excess of our
| deductible/coinsurance.
|
| Hours of phone calls to insurance and hospital later, we think
| we have it resolved but are informed it may take up to 6 weeks
| to process. Fine, we wait six weeks. Hospital starts
| threatening to send us to collections for non-payment. Hours of
| phone calls later it turns out they were waiting on information
| from insurance that they never received. So six phone calls
| later we think we've gotten it all sorted out. This time people
| actually follow through, hospital switches our payment to
| pending and that's the last we heard of it. Got confirmation
| that insurance paid out several months later.
|
| Again, the hospital messed up the paperwork, but the burden of
| solving the problem falls on us, with serious financial
| consequences if we don't. While we're dealing with a newborn no
| less. There should really be a law that makes institutions
| liable for such errors.
|
| Also insurance was a little shady as well. The amount of the
| outstanding bill should have pushed us over our out-of-pocket-
| max for the year, but when they finally paid out they marked it
| as an "adjustment". Which means we're still in the coinsurance
| part of plan. So we're getting deeply discounted healthcare for
| the rest of the year, but not free. It's not worth the time for
| us to run down, and maybe they're doing everything in line with
| the fine print, but it definitely smells rotten.
| DangitBobby wrote:
| I'm in a similar situation now. I don't understand why the
| insurance company and the hospital billing staff can't talk
| to each other, and require me to act as a mediator. At this
| point it feels malicious.
| a_vanderbilt wrote:
| In all practical ways, it is malicious. The system is
| intentionally designed to pay out as few claims as legally
| possible and use every legal means to obstruct and draw out
| the claims process. The U.S. healthcare system as a whole
| is a bastion of inefficiency and corruption.
| toomuchtodo wrote:
| This is the answer.
| Terr_ wrote:
| > There should really be a law that makes institutions liable
| for such errors.
|
| Does there need to be an explicit law?
|
| Could one sue in small-claims court for the time and expense
| damages?
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