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You Have a Right to Know Why a Health Insurer Denied Your Claim. Some Insurers Still Won’t Tell You. (www.propublica.org)

submitted 10 months ago by spaceghoti@lemmy.one to c/politics@lemmy.world

14 comments fedilink hide all child comments

Federal law and regulations require insurers to hand over exactly this sort of information in response to a written request. And they have to do it fast: Most people who get insurance through an employer should get the records, called claim files, within 30 days.

There’s just one catch: Some insurers aren’t turning files over like they’re supposed to. We followed ProPublica readers through the process with five different insurers. Several companies only shared documents with patients after we reached out.

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[-] Kbobabob@lemmy.world 76 points 10 months ago

I'd rather have a system that didn't allow an insurance company decide who is worth saving and who isn't.

[-] PunnyName@lemmy.world 15 points 10 months ago

So let's do both for now.

[-] krayj@sh.itjust.works 67 points 10 months ago* (last edited 10 months ago)

I don't even understand why there is a burden on the part of the insured to have to make a written request for this.

If you have a claim that is denied, the insurer should be required to provide the full details and reasons for the denial automatically at the time of the denial.

[-] PunnyName@lemmy.world 32 points 10 months ago

They shouldn't even be able to deny you as easily as they can. They can basically do it for no damned reason.

[-] sudo@lemmy.today 11 points 10 months ago

They shouldn't exist

[-] PunnyName@lemmy.world 3 points 10 months ago* (last edited 10 months ago)

Agreed. But at the moment, they exist, so we have to work with the hand we're dealt, while also trying to build a better system.

[-] ComradePorkRoll@lemmy.ml 3 points 10 months ago

How about we make them not exist? No concessions with those who profit off of the sick as we distantle and restructure the healthcare system.

[-] PunnyName@lemmy.world 3 points 10 months ago

That's a process. It doesn't happen overnight.

Unless you have ideas for immediately deleting them within the next 24 hours without repercussions.

[-] ComradePorkRoll@lemmy.ml 1 points 10 months ago

That's why I said no concessions.

[-] PunnyName@lemmy.world 1 points 10 months ago

So what are your solutions? Because if you get rid of what we have with the delete button, lots more people then have no method of getting help.

[-] shalafi@lemmy.world 1 points 10 months ago

Next to climate change, this seems our most intractable American problem.

[-] AnonTwo@kbin.social 9 points 10 months ago

My guess is the company wants a lawyer present because they assume that anyone who is requesting this is probably going to bring one as well.

Basically they don't hire people they would authorize to tell you the reason.

[-] cmg@infosec.pub 11 points 10 months ago

This process is such a nightmare.

N letters back and forth then a bill stage where you realize something wasn’t paid for. Then an hour long phone call to start an appeal process asking for more documentation about a test ordered 5 months ago. The denials are handwaves.

Insurance in general is such a nightmare. I’m in the fortunate bucket where I’m well paid and have a decent plan. One kid with chronic conditions. Then the pain of every year being forced to figure out the different game.

[-] shalafi@lemmy.world 2 points 10 months ago

Still beats letting the government make my health care decisions.

I'd much rather a profit-driven company be entrusted to do the right thing. That way if I don't like their decision, I can go fuck myself.

this post was submitted on 09 Nov 2023

318 points (99.4% liked)

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