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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]dpibel
(3,416 posts)6. Kudos for the diversion!!
In the situations you posit, the insured has already gotten the care, no?
So you--the hypothetical claims adjudicator--are about to be in a fight with the provider.
Especially in the aggravated situation you posit where there are multiple bills for same service, same patient, same day. That, obviously, has nothing to do with the patient at all.
You seem to have missed the fact that the real outrage, which may be misplaced, is not about issues of billing after the treatment.
It's denial of treatment.
And, even if it's ultimately about billing and payment, as you've established, UHC, about which you seem to have tender feelings, is ahead of all the other companies, whether initial denials or final dispositions.
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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
10 hrs ago
#13
Oh, okay, so this doesn't even address the 34% of final claims denied by UHC.
Think. Again.
10 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
10 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
7 hrs ago
#61
Think we ought to put blame where it belongs, Congress primarily for failing us.
Silent Type
6 hrs ago
#63