Having worked in the health insurance industry for 17 years for big national companies and smaller regional ones, I can tell you this is BS. Health Insurance companies are tightly regulated by the states in which the coverage policies are written. In most states, medical necessity criteria used to deny claims must be scientifically sound AND approved by state regulators.
Any such policy of random denial would be quickly spotted by the regulators. Furthermore, there would be far fewer denied claims if physicians didn't instill unrealistic expectations in patients and order unnecessary tests.
I won’t dispute your contention. As I said, I was looking at it from the consumer’s point of view, where it is very difficult to see any sense in the procedures. To us, it appears random.
It could be they cleaned up their act, generally. Or maybe our doctors got better at filing claims. Hard to say. I will say we have been having remarkably fewer problems in recent years.
“Having worked in the health insurance industry for 17 years for big national companies and smaller regional ones, I can tell you this is BS. Health Insurance companies are tightly regulated by the states in which the coverage policies are written.”
Perhaps it is for some companies. I trust the people I’ve talked with. I also have experienced claims being denied and then mysteriously being allowed after a call to the company.
“Furthermore, there would be far fewer denied claims if physicians didn’t instill unrealistic expectations in patients and order unnecessary tests.”
Those tests are ordered because of liability suits. Did I mention that ambulance chasing Lawyers suck? IMHO
“In most states, medical necessity criteria used to deny claims must be scientifically sound AND approved by state regulators.”
That is true however most denials do not make it to the state. Most are either disputed or are paid by the insured. If the stars get out of alignment and the state does notice something the insurance companies just claim it was a mistake.
Most people in the insurance companies are honest. The companies themselves are not. Remove morals, ethics, and a conscience from corporate leaders and then add greed and you get an uncaring monster.