1y ago

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

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

Federal regulations require insurers to promptly hand over records to patients facing claim denials. Some insurers only turned over their files after ProPublica reached out.

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.

14 comments

I'd rather have a system that didn't allow an insurance company decide who is worth saving and who isn't.
- So let's do both for now.

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

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.
- 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.

14 comments