My insurance at work denies all my claims

[iwillalwayswonderwhy]

Sends a letter to me and says they won't pay because it is a pre-existing condition. I have had the policy for a year and a half, prior to that I was covered by insurance at the company I worked at before. I sent in all the paperwork showing I was covered.

So I make a claim. They deny it. I call. They apologize, pay it, and tell me my records are now corrected and it won't happen again. And it doesn't. Until I make another claim, and it starts all over.

I believe they deny claims, hoping that I will just pay and not call. I wonder how many people take the time (it generally takes 30-45 minutes to straighten out, mostly while on hold). I wonder how much they save by denying and then claiming administrative error if they get called on it?

[stopbush]

1. Mind sharing who your provider is?

[iwillalwayswonderwhy]

4. BC/BS (nt)

nt

[TimesSquareCowboy]

7. No kidding, we go through endless back-and-forth with BC/BS.

Even if they weren't simply hoping you'd give up, the paperwork generated by that bs is in itself enough to justify single-payer.

[uppityperson]

22. They are the ones who never got my claim forms unless I mailed certified receipt requested

Even if I mailed claims on the same day at the same post office. If it wasn't certified receipt requested, they would never receive them.

[John Q. Citizen]

2. You times thousands equals a bundle. And Obama wants to subsidize them.

[CreekDog]

3. When I had HealthNet I was routinely billed the full amount

and had to call each time to get them to cover it.

they did cover things but seemed like i had to remind them that i had their insurance.

i switched insurers (something many people can't do) and the problem went away.

[DURHAM D]

5. I recently got a claim denial from Blue Cross Blue Shield.

I had not filed a claim. I called them but they didn't seem to care because they had denied it anyway.

I went up through several levels of the company and finally got someone to understand that I was worried about id theft. They never acknowledged much but did send me a letter that stated they were aware that I had not filed a claim.

[TimesSquareCowboy]

9. It was just something they send to everyone once in a while, sort of a catch-all in case they forgot

to deny a claim.

[ellacott]

6. I work in billing and reimbursement for a hospital

They do the same thing to us all the time. They will deny a claim and we will call or appeal then they will pay.

I had an instructor ask. Why do the insurance companies deny so many claims? His answer, because they can get away with it.

[JerseygirlCT]

12. Because they can

You hit it, there.

There really ought to be some sort of penalties built in, so that it's no longer fiscally beneficial to them to work this way.

[ellacott]

14. Yes, it is criminal

[T Wolf]

8. The deny-delay tactic is SOP in the health-don't-care industry. They have rooms and rooms

of people who are trained specifically to deny claims.

Only if you push back, a lot, will you get anything paid for by the thieves.

Changing rules in midstream is only one of their tactics. So is "losing" the paperwork.

Then, they have untrained people working the phones, doing their best to discourage you from obtaining that which you HAVE ALREADY PAID FOR!

[hfojvt]

13. I have not had that problem with mine

but I did have to tell the Hospital that the insurance company had paid most of my bill. Until they got that straightened out, I did not pay my portion.

[Oregone]

10. My single-payer coverage has never denied any of my claims

Even if they were pre-existing

Pretty "draconian", eh? The US needs a major change

[JerseygirlCT]

11. I think your guess is right and they depend on people NOT

calling them on it.

[dflprincess]

16. That's it exactly

The majority of people who have a claim denied may call and question it once - but they don't fight it after they've received the first explanation.

My company switched insurance coverage last year and I can name several of my coworkers who have had to threaten that they will go to the State Attorney General's office with their complaints if their claims don't get paid. Fortunately, in Minnesota, the threat of going to the AG often works with the crooks (thanks to our former Attorney General).

[brooklynite]

15. Place a call to the State Public Service Commission...

...or to whichever State Agency oversees Insurance companies. Then send your Insurance Company a letter informing them that you've done so, and ask them to send you a letter certifying that there are no pre-existing conditions in your record, at which point you'll be happy to withdraw your complaint.

[Warpy]

18. If your state doesn't have one

the state Attorney General's office usually has an office for consumer complaints.

That got me action when a hospital padded the bill and wouldn't back down. My complaint also got that hospital audited by Medicare. They were sold 6 months later.

[Warpy]

17. Your doctor is also spending that kind of time on the phone

arguing with the fuckers. In addition, he must have staff to fill out all the Byzantine paperwork from competing plans.

It's not just BC/BS, they all suck the big green weenie.

Think of the lost productivity our nonsystem causes by tying people up in miles of red tape just to get what they pay for.

It's just another reason to get these vultures the hell out of the health care system.

[alstephenson]

19. That's the business model for the health insurance companies.

Deny, deny, deny. Plain and simple. This needs to change, NOW!

[shanti]

20. well, i have kaiser

and what THEY do is deny procedures (i.e., colonoscopy). you are required to kick up a fuss and file a grievance if you want the procedure, and it is brought before a committee. they then usually allow it. of course, after filing the grievance, you must find another doctor because your relationship with him/her is soured. i had to do that with my last doc. she refused diagnostic procedures, but would throw the drugs at me. :(

[nykym]

21. I think it is in the range of

300 million a year. there was a post earlier today regarding this practice but I can't find it now. So yes it make dollar & cents to them

[abluelady]

23. I've Had The Exact Same Thing Happen to Me

Every claim I submitted was denied. As soon as I called, they were sooo sweet and apologized and paid the claim. They probably save millions every year because many people don't follow up, which is exactly why they do it. By the way, it was United Healthcare.