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In reply to the discussion: If you suddenly found yourself working for an insurance company and received a claim that looks like this for MRI-- [View all]
bucolic_frolic
(47,326 posts)4. That's like a claims adjuster for houses. My 1999 MRI was $500.00.
Cash. 1/2 the going rate.
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If you suddenly found yourself working for an insurance company and received a claim that looks like this for MRI-- [View all]
Silent Type
10 hrs ago
OP
It's not denied in the sense they will never pay. It's denied because they ain't gonna cut a check until they get
Silent Type
10 hrs ago
#5
There are also denials regarding valid claims and treatment approvals with delay tactics
Meowmee
9 hrs ago
#16
In my opinion it's the doc's office responsibility. They have all the information, they under codes,
Silent Type
7 hrs ago
#59
They've gotten care in most "claim" denials. Preauthorization is much the same. For example, Medicare's policy on MRIs
Silent Type
10 hrs ago
#8
You need to understand something. I have been for Medicare/caid-for-All since 1982. If I were to dig through my addict
Silent Type
9 hrs ago
#24
Hospitals and insurance companies work hand-in-hand on thousands of claims a week....
Think. Again.
10 hrs ago
#7
Yeah sure. That's how Medicare or private insurers end up paying claims to providers who don't even exist.
Silent Type
10 hrs ago
#9
One more time. Those are INITIAL denials -- similar to examples above -- that are overturned in over 80% of cases
Silent Type
9 hrs ago
#13
Oh, okay, so this doesn't even address the 34% of final claims denied by UHC.
Think. Again.
9 hrs ago
#15
Because 80+% of initial claim denials are reversed exactly as outlined in the OP. Have a good night.
Silent Type
9 hrs ago
#25
It happens with Medicaid because the government hires unscrupulous people to deny claims
questionseverything
9 hrs ago
#36
Good point, it ain't just private insurance. Medicaid and Medicare are government programs and likely model
Silent Type
9 hrs ago
#37
I'd have to see the bills. He might have been submitting improper bills, that were changed
Silent Type
8 hrs ago
#43
Like Wendell Potter, got rich supporting denying claims and felt guilty. Ask him if anyone died from his
Silent Type
8 hrs ago
#48
Yes. The actual claim form submitted electronically has a Units column. But, good example of claims not always making
Silent Type
9 hrs ago
#14
Example in OP includes meds. The type sedation -- xanax or something -- is pretty cheap. Well, unless provider cheats.
Silent Type
9 hrs ago
#20
If you are uninsured, someone might charge you $50 K. Insurance will not approve $12K, including Medicare.
Silent Type
9 hrs ago
#31
Let's say $12 K is going rate. Should insurer, including Medicare, pay $17K, or deny and ask for additional . . . . . .
Silent Type
9 hrs ago
#32
Give me a break. You know who Luigi shot and his rationale. Heard tonight Luigi was apparently never insured by UHC.
Silent Type
9 hrs ago
#30
So if he was never insured by them he certianly wasnt denied a payment claim by them.
Eko
8 hrs ago
#40
OK, guess his manifesto said nothing about denials, claims, pre authorization. And UHC never insured him
Silent Type
8 hrs ago
#46
Read the last paragraph. I explain that. But very few here are going to understand what an electronic claims looks like.
Silent Type
9 hrs ago
#21
I answered your question since you didn't read the note in OP. Have a good evening.
Silent Type
8 hrs ago
#44
I didn't ask you any questions. Your notes in the OP are inadequate. Good night. eom.
vanessa_ca
8 hrs ago
#49
Got a good laugh out of that, actually. I do care about shooting someone in the back while being misinformed.
Silent Type
9 hrs ago
#26
Get it and envious. But lot of the blame is on greedy providers for prices. I've never seen Medicare or private insurers
Silent Type
9 hrs ago
#33
Fun fact: UHC employees have been ordered to defend their murders. N/t
Hellbound Hellhound
8 hrs ago
#52
Considering the misinformation, Luigi cult, etc., don't blame them too. When people catch on government programs
Silent Type
8 hrs ago
#54
So what do think a typical insurer might pay? Three times Medicare, 1.5, even less than Medicare by requiring
Silent Type
8 hrs ago
#56
Not "defending" anyone. Trying to point out not just insurance. It's also Congress, Medicare, Providers,
Silent Type
6 hrs ago
#61
Think we ought to put blame where it belongs, Congress primarily for failing us.
Silent Type
6 hrs ago
#63