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YSK: Pro Publica has a tool that lets you request documentation of why your health insurer denied your claim

Find Out Why Health Insurance Denied Your Claim

https://projects.propublica.org/claimfile

You likely have the right to access records that explain why your insurer denied your claim or prior authorization request. Use ProPublica’s free tool to generate a letter requesting your claim file from your health insurance company.

Find Out Why Health Insurance Denied Your Claim

cross-posted from: https://sh.itjust.works/post/9208209

18 comments

DerisionConsulting

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I'm glad this tool exists, but I am more glad that I don't live in the USA.

dom

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But this shit can come to other countries if they aren't careful. Fight Healthcare privatization with everything you've got

Norgur

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That's a message for the Brits then. As long as the USA are a almost daily reminder as to why completely private healthcare is a really bad idea, mist countries that have public healtcare will probably be very hesitant to even discuss shit like that.

Yet, ideas being obviously and utterly stupid hasn't stopped the Brits very often in the past, has it?

dom

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And the Canadians. Our right wing is cutting Healthcare budgets and saying the reason there are long wait times is because it needs to be privatized.

Sad thing is it's working.

njm1314

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Good lord the balls on those liars to claim private insurance doesn't have long wait times.

Norgur

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Well, lower wait times is a boon of a completely privatized system. But the reason why is something that's conventiently omitted by those using this argument
The reason why the US system can boast with less wait times is that care is sought less often because people can't afford it or fear financial ruin If they seek help for something that wasn't strictly life threatening to treat.

So, the queue at the doctor's become shorter because you kicked out half the people needing help, not because the doctor became faster or something.

HubertManne

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yeah and honestly, from my experience, wait times are plenty high. My wife has had to wait months for specialists and weeks just to see the generalist.

thedirtyknapkin

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is there data to support wait times being faster? because thinking that wait times could be any worse than that already are in the u.s. seems ridiculous. it's not fast here.

Maeve

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They literally kill people for profit.

Moose

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Alberta within the last few months switched from a private company doing lab testing back to the old provincial run system, wait times for appointments went from over a month to a few days for me. And that celebrating was cut short by the fact they want to split up AHS now which is more likely going to screw up a bunch of our healthcare again.

HubertManne

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thats pretty much how everything is ruined in the US. The shining example that disproved it was the postal service and actually medicare and social security and our conservatives have been trying to poison those systems like crazy.

Appoxo

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This will be very piece by piece. The slow boil is the dangerous part.

joelfromaus

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A message for Australians too unfortunately. The LNP (our right-wing party) made efforts within their time in power to coax people into using private insurance and punishing those who do not. And unfortunately even with the more centre-left party in power it doesn’t seem like the public system is getting much more love.

HubertManne

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this stings but I totally get the sentiment. We are in our benefits selection process and I chatted that we should invite our eu counterparts so they can have a laff. You see what you do is you compare the price of the drug with what your insurnace offers versus a private discount card and then you factor in usage of the tax deductible account versus the value of it coming off your deductible. If you every want to know why americans seem angry so often think about that.

Anonymousllama

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Usually don't like jumping on the US healthcare = bad bandwagon, but jeeze having these shithole insurance companies in the middle looks awful.

It's as simple as a doctor giving you a script and the chemist dispensing it here, thank fuck the government takes care of the rest

Ranvier

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I'll spoil this for you, much of the time they didn't even read the medical documentation sent to them, just denied whatever was asked for. And then hoped the patient would drop it and never even let their doctor know it was denied. Or if that fails and the doctor finds out it was denied they hope the busy doctor wouldn't be able to figure out how to contact the company and the right number to do so, navigate phone trees and find archaic long series of ID numbers and case numbers and other information specific to that one company, then schedule a time range of hours, often in the evening at home, to be ready to answer a call at any moment from some "peer" (who's not actually a peer, a doctor, or even in the same specialty) who also never read the medical documentation sent. The doctor points out to the company the rationale meeting all their criteria is clearly met in the medical documentation. But the "peer" states their company has a new additional rule about that treatment and that wasn't included in the initial documentation sent. The doctor points out it was, the "peer" claims they don't have it though. This is followed by another denial. That additional documentation is sent in again, no response for weeks (please allow up to 4 weeks for response). After finally getting a hold of someone, they state that they can't accept this since there was already a denial and now must go through an official appeal hoping the doctor won't know how to find out about their seperate and distinct appeal process. If the doctor figures out how to do that then they hand write a letter again explaining the medical rationale for the treatment being denied including citing sources from the literature. But oh wait that appeal was denied, because this was a Medicare advantage plan or some crap and the appeals process used is not applicable to this plan type. But you may file an appeal with the state insurance authority. And it goes on.

Anyways, three months and much unpaid labor later, treatment finally approved. Which, if they had just read the original note sent, should have been approved in the first place. Not speaking from experience here or anything, lol.

shplane

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Wow what timing. Struggling to get a claim approved with Anthem for a service they've been approving routinely all year. None of their customer service people can help me and I've been on the phone for the past 3 hours. Insurance companies are miserable.

Maeve

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This is great, thank you on* behalf of my family and community!

Edited for clarity