The current anti-health insurance company rhetoric is out of control. Much of it is quite despicable, displaying a level of ignorance that is disturbing. Here are two minor examples.

Not exactly sure what the person below is trying to say… and neither does she. This is like saying you are paying for the homes and cars for the people who administer Medicare or Social Security.
Oh well, the taxes and premiums you pay do fund salaries. In fact, just about anything you buy pays someone’s salary.

In my opinion based on decades of experience managing employer health benefit plans, insurance companies do not intentionally and arbitrarily deny valid claims for medical care.
They are limited in premium profit by federal law. They are regulated by the fifty states. There is a required claim appeal procedure with time limits.
And guess what? Patients often don’t tell the truth about a claim or leave out important information.
Sure there are screwups, some claims denied in error, errors caused by many factors, including how the claim was submitted.
Here’s more garbage.



Every time I read a story that seems to be so outrageous, my first thought is that there is a lot more to the story that we are not being told. Very often when I look into the part that is not being told the decision or outcome actually makes a lot more sense. Often the facts that are left out are intended to deceive, either for gain or simply to make a better story for someone’s benefit.
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As you know, the vast majority of medical claims are processed without human intervention – they are auto-adjudicated, once coverage eligibility is verified, the provider is identified as in-network (subject to previously negotiated rates) or out-of-network, the claims system accepts the claim using CPT codes and applies the plan provisions and limits for those specific codes, then applies the deductibles, copayments and/or coinsurance that are part of the plan design – and then issues a payment, almost always to the provider.
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