claim denial rates by insurance company

[BlueWaveNeverEnd]

[LogDog75]

1. Never trust health insurance companies

Back in the late 90s, I knew a woman who worked for a healthcare insurance company that reviewed requests for tests or procedures. Her job, as she described it, was to deny requests regardless if they were needed or covered by the insurance policy. She quit after three months.

[mitch96]

2. I worked in hospitals in my previous life. Doctors were always bitching about insurance companies having them

jump thru hoops to get things done for the patients.
The first thing insurance companies do is deny deny deny. It was all about the money..Follow the money.
It will give you lots of answers on why this is happening...
The less they pay out, the more profits the company makes, the more the stockholders make.

m

[leftstreet]

3. DURec

[onecaliberal]

4. Wow

[IronLionZion]

5. Yeah but those sweet profits (sarcasm)

United Health is the world's 9th largest company by revenue.

Strangely enough, they donate more money to Dems than GOP. They've done very well with selling ACA and Medicare Advantage plans.

https://www.opensecrets.org/orgs/unitedhealth-group/summary?id=D000000348

[PhylliPretzel]

6. Please notice

that traditional Medicare is NOT on this list. If the treatment a patient needs is on the very long list of covered procedures, all the health care providers need do is prescribe it, and it will be covered. There is no such thing as pre-approval and denial of benefits. The companies listed here may provide "Medicare (so-called) Advantage," but it is neither Medicare nor advantageous.

[xmas74]

7. The list isn't quite accurate

Because it only deals with Marketplace policies, not traditional commercial/employer/government programs.

I will say that at the start of my cancer I had my surgery while on Anthem. I started a new job and had the surgery done while my old employer policy was in effect. Surgery was on the 27th, new Marketplace policy with Ambetter started on the first of the next month to hold over until I was eligible with the new employer.

Anthem denied several claims, even though I'd already met both my deductible and coinsurance. Ambetter,otoh, was wonderful and paid exactly as stated. When they received my first oncology bill with a referral for chemo Ambetter had a nurse case manager reach out to me to discuss everything happening. She called weekly during chemo,asking for updates and how I felt. She gave me lists for therapists in their network who worked with patients dealing with health issues. She discussed other things to look into, such as a RD and a pelvic floor PT and gave me lists for them. She also sent me links to websites they worked with for wigs, in case I was interested.

I had a fantastic experience with Ambetter/Home State Health. Anthem and United can eat it.