Denials

UnitedHealth’s Playbook For Limiting Coverage Puts Countless People At Risk

November 20, 2024 Annie Waldman, ProPublica. Educate! Denials, health, Health Insurance, Insurance, mental health, UnitedHealthcare

For years, it was a mystery: Seemingly out of the blue, therapists would feel like they’d tripped some invisible wire and become a target of UnitedHealth Group. A company representative with the Orwellian title “care advocate” would call and grill them about why they’d seen a patient twice a week or weekly for six months. In case after case, United would refuse to cover care, leaving patients to pay out-of-pocket or go without it. The severity of their issues seemed not to matter. Around 2016, government officials began to pry open United’s black box.

No One Knows How Often Health Insurers Say No To Patients

July 4, 2023 Robin Fields, ProPublica. Educate! Denials, Health Care, Insurance Companies, Transparency

It’s one of the most crucial questions people have when deciding which health plan to choose: If my doctor orders a test or treatment, will my insurer refuse to pay for it? After all, an insurance company that routinely rejects recommended care could damage both your health and your finances. The question becomes ever more pressing as many working Americans see their premiums rise as their benefits shrink. Yet, how often insurance companies say no is a closely held secret. There’s nowhere that a consumer or an employer can go to look up all insurers’ denial rates — let alone whether a particular company is likely to decline to pay for procedures or drugs that its plans appear to cover.

Health Insurance Claim Denied?

May 13, 2023 Maya Miller, Pro Publica. Resist! Appeals, Denials, Health Care, Health Insurance

When a health insurance company is deciding whether to pay for your medical treatment, the company generates a file around your claim. All the records associated with your case should be part of your file. This includes documents explaining the reasons your claim was denied. You have a right to see this file. Federal regulations require most health insurance plans to give people an opportunity to review documents related to their claim for free. So if your insurer talks to your doctor, if a nurse takes notes, or if two people speak about it on the phone, all of those records should be available to you.

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