I have tried to be patient and cooperative. I pay the premiums for my top-tier PPO plan on time. I have accepted the fact I must cover a sizable deductible, copays, and coinsurance. It’s harder to swallow the exorbitant “out of pocket maximums” we are required to pay before a health plan will cover at 100%. Not many people hit that mark, and are likely bankrupt by then.
it appears that a health plan’s modus operandi is: When in doubt, deny. Unfortunately, at times I discover that a claim has been denied only after being contacted by a collections agency. Why? Because insurance approval or denial decisions can be delayed while providers are grilled for “more information” to justify their treatment plans, and bills deemed delinquent are routinely sent to collections.
Claims are typically rejected for one or more of these reasons:
Preauthorization forms or superbills are not submitted properly.
The facility or doctor is not in network.
The treatment is not medically necessary. (That one is my all-time favorite.)
www.huffpost.com
it appears that a health plan’s modus operandi is: When in doubt, deny. Unfortunately, at times I discover that a claim has been denied only after being contacted by a collections agency. Why? Because insurance approval or denial decisions can be delayed while providers are grilled for “more information” to justify their treatment plans, and bills deemed delinquent are routinely sent to collections.
Claims are typically rejected for one or more of these reasons:
Preauthorization forms or superbills are not submitted properly.
The facility or doctor is not in network.
The treatment is not medically necessary. (That one is my all-time favorite.)
My Health Insurance Company Is Trying To Kill Me
"They are genius (and stealthy) in their tactics to exhaust me financially, emotionally and physically."
