So here’s a fun fact about that number, that’s after appeals and refilling.
I worked at BCBS, specifically dealing with rejected claims many many years ago. Most of the rejected claims are ultimately paid, generally there’s a clerical error and once it’s fixed, it’s paid. About a third of the time it’s a chiropractor doing something fucking shady. A shocking number of rejected claims are chiropractors doing borderline illegal shit.
The remaining handful of rejected claims are for either weird shit that no one covers, such as helicopter landing fees, or stuff that would be covered up to a certain limit that they’ve exceeded. Very, very rarely did we see something that we rejected, they appealed, that went on to be reviewed by actual doctors who still found it to be unnecessary, and when it was it was because the doctor ordering it really dropped the ball on the lab work to prove it was necessary.
One time we had a patient effectively being held hostage in Mexico because they wouldn’t release him before the 23 hour mark because he was having a heart attack, but because he had no coverage out of his home state, they also wouldn’t release him until he paid for his visit. BCBS paid that claim. Admittedly the state I worked for was pretty lenient with approvals. Other states were much worse, and not dissimilar from UHC.
The fact that UHC was denying claims nationally at a rate double BCBS nationally, I’m lead to believe that they’re just rejecting everything that isn’t standard preventive care out of hand and only paying a handful of the appeals.
So here’s a fun fact about that number, that’s after appeals and refilling.
I worked at BCBS, specifically dealing with rejected claims many many years ago. Most of the rejected claims are ultimately paid, generally there’s a clerical error and once it’s fixed, it’s paid. About a third of the time it’s a chiropractor doing something fucking shady. A shocking number of rejected claims are chiropractors doing borderline illegal shit.
The remaining handful of rejected claims are for either weird shit that no one covers, such as helicopter landing fees, or stuff that would be covered up to a certain limit that they’ve exceeded. Very, very rarely did we see something that we rejected, they appealed, that went on to be reviewed by actual doctors who still found it to be unnecessary, and when it was it was because the doctor ordering it really dropped the ball on the lab work to prove it was necessary.
One time we had a patient effectively being held hostage in Mexico because they wouldn’t release him before the 23 hour mark because he was having a heart attack, but because he had no coverage out of his home state, they also wouldn’t release him until he paid for his visit. BCBS paid that claim. Admittedly the state I worked for was pretty lenient with approvals. Other states were much worse, and not dissimilar from UHC.
The fact that UHC was denying claims nationally at a rate double BCBS nationally, I’m lead to believe that they’re just rejecting everything that isn’t standard preventive care out of hand and only paying a handful of the appeals.