Claim Denial Rates by U.S. Insurance Company

I had a fun experience with Anthem. Got denied for a CT scan that I needed for a procedure they covered. Couldn’t get the procedure without the CT scan, so by denying the scan they were issuing a de-facto denial of the procedure even though the policy covered it. Went round and round with them for a couple months until one of their people told me the criteria didn’t have to do with Anthem, but this third party company “unaffiliated” with Anthem they used for their imaging standards.

So I looked up the company and read all their standards, then I researched the company, and also researched Anthem, and found out that there was someone who held a senior position at both. So I named that person the next time I called to appeal the issue and also named them in a complaint to an outside advocacy group. And wouldn’t you know it, when I followed up with them a couple weeks later I was approved for the CT scan AND they were giving me extra time on the authorization for my troubles.

UHC is by far the worst of them but every one of those claim denial rates is unacceptable.

There aren’t people going to the doctor and making claims for fucking fun. For every hypochondriac there are hundreds of thousands of normal people just trying to get care. We don’t LIKE going to the goddamn hospital this isn’t a recreational activity for us.

Every single claim they deny is a human being who was asking the company to do what the company said they would do. Until these denial rates are below 1% every dollar the insurance industry makes in profit is money TAKEN FROM US.

A while back, the people rose up and put their rulers to the guillotine.

Is walking up to greedy corporate execs and shoot them the new guillie? Is this a new trend?

As a United Healthcare forced insurance customer who received a $35,000 ER bill because my daughter in college had a severe migraine and United Healthcare denied a fuckton of charges, all I gotta say is that a certain news story this morning doesn’t really upset me at all.

The only reason Ambetter and Oscar are so low is that it’s nearly impossible to find a doctor who takes that insurance. You can’t get a claim rejected if you can’t find a doctor to see in the first place.

I’m starting to understand why that CEO got shot

I hope the other CEO’s are shaking in their boots right about now.

So 1/3 of United healthcare patients are suspects

I’m sure the companies on the top half of this illustration still make plenty of money. The bottom portion, it’s just greed. The American populace for the most part hates this kind of greed. Too bad they don’t hate the greed enough to nationalize healthcare.

Is this what south park meant by navigating the American Healthcare system

Actions have consequences …..

How is the industry average 16% when the largest health insurance company in the world, by a huge margin, is 32%?

Funny story. I know a guy who worked at UH about 15 years ago and supported a thing he referred to as “the rejection machine”. All claims are passed through this system and an arbitrary 1/3 of all claims are rejected. If the claim is not resubmitted, they never have to pay the claim. If it is resubmitted, it goes back into “the rejection machine” and tries its luck again, and so on until the patient/doctor stop resubmitting or until it makes it through “the rejection machine” and will then be reviewed by an an actual human.

So literally, by design, their process is to reject 1/3 or vs all claims out of hand, regardless of their merit. That was what I was told about 15 years ago, and from the looks of this chart, the math still checks out.

I have no idea how they are able to so blatantly operate this way.

Wtf, I never knew it’s this high. This is ridiculous, how is claim denial not regulated? People should be able to appeal to a government judge.