Friday September 18, 2009 at 17:29
“Are health insurance companies generally being fair and honest when they reject claims from policy holders?”
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In Health Care, Number Of Claims Denied Remains A Mystery
Lemme take a crack at this. Um, I seem to recall some recent posts from colleagues that tell a pretty grim tale regarding rejections.
OK, not all claim rejections are such horror stories. I had claims rejected because I forgot to fill in a box on the form correctly. I found the number of the insurer, waited on hold, had to provide a bunch of codes to prove who I was, then the clerk would look up the claim in question and tell me why it was rejected “You didn’t put a modifier on the procedure code.”
“Oh. What modifier should I have used?”
“We’re not permitted to tell you that.”
That kind of thing is an every day occurrence. It is why doctors have to hire more and more staff to deal with with the minutia that makes the difference between being paid & not being paid.
The rules change every year. They are different for each insurer. They differ for each benefit plan the insurer offers.
“Oh, you have Blue Million with the preferred rider from employer X? That means you have only a $5 co-pay if this is a sick child visit first visit without a procedure and not on an emergency basis or after hours.”
I asked an insurance guy about what seemed like a systematic delay or denial of payment:
“Oh, we make a lot of money through short term investing of the pool of money we take in before we send it out. It’s called the ‘float.’ The longer we hold on to the float the more we make.”
All I can think of in reply is how messed up this system is where they do better financially by screwing me.
