Pro Publica recently published an article regarding how often insurers deny claims.
Insurers are notorious for denying clean claims or making mistakes system-wide affecting healthcare providers and their patients. Ask any doctor or health system and they will tell you that many carriers routinely deny a portion of the clean and approved claims regularly. They then agree with regulators to correct these errors affecting us all.
Meanwhile, the game continues as we spend more than any other country on healthcare, and doctors and their staff are busy just trying to get paid. In many cases, patients too are directly affected, even when there are high deductible plans involved and the insurance is paying nothing until the deductible is met. I am familiar with this as it was done to our family, denying a legitimate test.
A single-payer system would clarify the rules, and eliminate the games and the frustrations caused by a system that is about paying so little, denying regularly, and making it difficult to be patient and trust that your claims will be covered.
Check out the article recently published by ProPublica
How Often Do Health Insurers Say No to Patients? No One Knows.
Insurers’ denial rates — a critical measure of how reliably they pay for customers’ care — remain mostly secret to the public. Federal and state regulators have done little to change that.
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It’s one of the most crucial questions people have when deciding which health plan to choose: If my doctor orders a test or treatment, will my insurer refuse to pay for it?
After all, an insurance company that routinely rejects recommended care could damage both your health and your finances. The question becomes ever more pressing as many working Americans see their premiums rise as their benefits shrink.
Yet, how often insurance companies say no is a closely held secret. There’s nowhere that a consumer or an employer can go to look up all insurers’ denial rates — let alone whether a particular company is likely to decline to pay for procedures or drugs that its plans appear to cover.
The lack of transparency is especially galling because state and federal regulators have the power to fix it, but haven’t.