Insurance Claim Denials

[Tellafriend]

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another major carrier tried this shit with me. having a law license certainly has some privileges, with this denial being one which was quickly ameliorated.




they make more money by denying claims with the bare minimum justification and play the lawsuit game to see who will take the next step of hiring an attorney. from there is the game of whether the attorney wants to just write a quick letter for an easy payday or will he follow through with a lawsuit and make them start spending money.


the majors have all this information gathered over decades. it's just another business decision for them.

[Dan Druff]

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Your story checks out.

From the comments I'm reading on X, those who pushed back hard eventually got it done. But I'm guessing most people who argued aren't good enough at arguing legal-type matters, and would eventually grumble and give up.

[Sanlmar]

Zappos kid owned a house in Colorado. She said no one pays for a new roof in Colorado. You just wait for the inevitable hail storm and voila - new roof.

[Dan Druff]

Health insurance (and general medical billing) is often similar.

You need to advocate for yourself, and you need to understand the (very convoluted) system, or you're gonna get fucked.

That's actually my biggest issue with the US system, with the second (related) issue being overall cost.

Fortunately I'm good at knowing the rules, laws, etc, and making a strong case for whatever I'm trying to accomplish. I don't have the law credentials like Tellafriend, but I'm aggressive enough to usually argue my way out of insurance injustice. The key is not just assuming that they're experts and their word is accurate. They just say whatever they need to in order to make you go away, and often it doesn't pass the sanity check if you understand your rights.

[Tellafriend]

The key is not just assuming that they're experts and their word is accurate. They just say whatever they need to in order to make you go away, and often it doesn't pass the sanity check if you understand your rights.

[Dan Druff]

One other suggestion I give friends in medical billing predicaments is to make ZERO payments while bills are being negotiated.

Often you will be pressured to pay what you think you owe, and that you can argue the remainder after. That kills all of your leverage. A lot of people completely stiff medical providers (just because they're deadbeats), so they're happy to get SOME money over no money. If you already give them what you are willing to pay, at that point it becomes a freeroll to keep pressing you for more, and to be as nasty/threatening/difficult as they want.

Of course, this doesn't work with insurance (they don't care if you pay your medical bills), but if insurance isn't covering what you expected, and if you don't get that resolved, your second task is going to be negotiating with the provider.

In every case where I had a medical billing dispute, I told them very clearly that I would pay absolutely zero until I received a paper bill indicating an amount I felt was fair. I would inform them that I didn't care about my credit (not completely true, but also not completely a lie), and that I would stand on principle here. I would inform them that they only way they get a penny from me is if they are willing to hear me out and do what's fair/right.

With insurance, you just need to keep leaning on them, get a copy of the exact policy and read it carefully, and keep shooting down any bullshit they throw at you.

So far I'm batting 1.000 lifetime in getting unfair insurance/medical issues resolved, including on behalf of others who let me help them.

[lol wow]

gaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaayyyyyyyyyyy

[garrett]

One fortunate thing about Medicaid is your always taken or have some Dr's available, with a wait sometimes for specialists

Initially before becoming technically Disabled by the Government, I didn't have Medicaid. Just Lawyers and Drs from the initial hit by a car accident. And over 1.5M in Hospital bills at that point, I didn't wake up for a month so lots of surgeries had happened etc. Woke up a month later fortunate to be alive, in the hospital still and wound up getting tons of Dr/Hospital bills over them next months. Fortunately your Lawyer and the Hospital work it all out pretty well. Eventually got Medicaid and still have it which covers most everything youd need no Copays either.

Once in a while I'll get a bill Humana isn't covering but never expected to give a dime, they just tell the reason probably for billing sake

[Dan Druff]

One fortunate thing about Medicaid is your always taken or have some Dr's available, with a wait sometimes for specialists

Initially before becoming technically Disabled by the Government, I didn't have Medicaid. Just Lawyers and Drs from the initial hit by a car accident. And over 1.5M in Hospital bills at that point, I didn't wake up for a month so lots of surgeries had happened etc. Woke up a month later fortunate to be alive, in the hospital still and wound up getting tons of Dr/Hospital bills over them next months. Fortunately your Lawyer and the Hospital work it all out pretty well. Eventually got Medicaid and still have it which covers most everything youd need no Copays either.

Once in a while I'll get a bill Humana isn't covering but never expected to give a dime, they just tell the reason probably for billing sake

I didn't know you were in a coma for a month! Had you posted that before? Is that month really missing? What did it feel like? Did it appear you had just been asleep for a night?

You're right that Medicaid has a wide choice of doctors and great coverage. I knew someone on Medicaid who was poor (not Master Scalir, if you're wondering), and they had much better coverage than I did, including a much wider choice of doctors. Sad!

[Tellafriend]

You're right that Medicaid has a wide choice of doctors and great coverage. I knew someone on Medicaid who was poor (not Master Scalir, if you're wondering), and they had much better coverage than I did, including a much wider choice of doctors. Sad!

this is untrue, at least in georgia. very few doctors left will accept it. it will pay at best .10-.15 cents on the dollar. those folks typically go to the ER for everything and then get a referral. whomever is on the referral/call list for that night then has to see them. most of those doctors won't even bother billing medcaid and just do it pro bono.

i would assume most states' medicaid is roughly the same, but i have never investigated it.

re: gare -- he is/will be on medicare shortly if not already as a result of social security disability acceptance. it is infinitely better as all doctors pretty much have to take it due to the volume. regardless, there is no reason he should be on medicaid with the settlement he got. medicaid is for the dirt poor and knocked up single moms.

[Dan Druff]

In southern California it’s different. They have a wide choice of doctors and great coverage. I’m jealous.

[garrett]

One fortunate thing about Medicaid is your always taken or have some Dr's available, with a wait sometimes for specialists

Initially before becoming technically Disabled by the Government, I didn't have Medicaid. Just Lawyers and Drs from the initial hit by a car accident. And over 1.5M in Hospital bills at that point, I didn't wake up for a month so lots of surgeries had happened etc. Woke up a month later fortunate to be alive, in the hospital still and wound up getting tons of Dr/Hospital bills over them next months. Fortunately your Lawyer and the Hospital work it all out pretty well. Eventually got Medicaid and still have it which covers most everything youd need no Copays either.

Once in a while I'll get a bill Humana isn't covering but never expected to give a dime, they just tell the reason probably for billing sake

I didn't know you were in a coma for a month! Had you posted that before? Is that month really missing? What did it feel like? Did it appear you had just been asleep for a night?

You're right that Medicaid has a wide choice of doctors and great coverage. I knew someone on Medicaid who was poor (not Master Scalir, if you're wondering), and they had much better coverage than I did, including a much wider choice of doctors. Sad!

Well by the time I was awake and out of the hospital finally was a month, and already had some major surgeries then for another years had more for them injuries. Waking up which was done in the hospital of course felt like I was coming out of a dream maybe, at times i remember actual things like the Super Bowl and my brother being there, other times maybe more seemed i was probably dreaming but not awake. I don't remember a lot of that all now and had a serious traumatic brain injury, was in trauma so the whole situation was traumatic for me, thought id mentioned that at some points over the years here.

[Orko]

I didn't know you were in a coma for a month! Had you posted that before? Is that month really missing? What did it feel like? Did it appear you had just been asleep for a night?

You're right that Medicaid has a wide choice of doctors and great coverage. I knew someone on Medicaid who was poor (not Master Scalir, if you're wondering), and they had much better coverage than I did, including a much wider choice of doctors. Sad!

Well by the time I was awake and out of the hospital finally was a month, and already had some major surgeries then for another years had more for them injuries. Waking up which was done in the hospital of course felt like I was coming out of a dream maybe, at times i remember actual things like the Super Bowl and my brother being there, other times maybe more seemed i was probably dreaming but not awake. I don't remember a lot of that all now and had a serious traumatic brain injury, was in trauma so the whole situation was traumatic for me, thought id mentioned that at some points over the years here.

The $64k question, in your opinion is there an afterlife?

[garrett]

Well by the time I was awake and out of the hospital finally was a month, and already had some major surgeries then for another years had more for them injuries. Waking up which was done in the hospital of course felt like I was coming out of a dream maybe, at times i remember actual things like the Super Bowl and my brother being there, other times maybe more seemed i was probably dreaming but not awake. I don't remember a lot of that all now and had a serious traumatic brain injury, was in trauma so the whole situation was traumatic for me, thought id mentioned that at some points over the years here.

The $64k question, in your opinion is there an afterlife?

That's based on the individual the interpretation of events or trauma

[splitthis]

Medicaid used to not pay for shit, not the case anymore.

[Tellafriend]

Medicaid used to not pay for shit, not the case anymore.

if that is the case, it is bc of the reason i offered --- very few would treat the poors.

[splitthis]

Medicaid used to not pay for shit, not the case anymore.

if that is the case, it is bc of the reason i offered --- very few would treat the poors.

What I learned in nursing is if you have nothing, you receive EVERYTHING FREE.

if you are middle class, any wealth you have accumulated will go to paying for your health.

The rich don’t care.

[Dan Druff]

Here's an actual conversation I had with a longtime female friend (not someone I ever dated) regarding medical debt. She's my age, btw, and not very political.

Her: "I've got tremendous medical debt, and I don't know what to do."

Me: "How did this happen? You would definitely qualify for an insurance subsidy, maybe even free insurance. Why don't you have that?"

Her: "Because I never bothered to sign up for it. I don't know why I didn't. I guess I was just healthy at the time and didn't feel like bothering."

Me: "Okay, well how much is the debt, and what is it from?"

Her: "I ended up in the hospital and had an emergency procedure. They want $20,000 for it."

Me: "Well, you can negotiate that down. That's the price they charge insurance companies, and much of that gets written off anyway. They'll be happy to get anything from you. I can help you negotiate with them if you want."

Her: "Maybe... I'll think about it and let you know. I'm just afraid of what will happen if I don't pay."

Me: "Don't be afraid. You don't own your house, and they get stiffed all the time from ER visits. They are unlikely to come after you, other than sending collections letters and calling you. They might even have a program where they greatly reduce the rate for those who have little money."

Her: "Okay, yeah I think I'd like your help with all of that. Thanks for offering. I'll get back to you soon."

Me: "No problem, let me know when you want to start this."

.
.
.

(3 months pass)

Me: "Hey, what ever happened with that medical bill?"

Her: "Oh, I didn't need your help after all. They agreed to let me send them $150 per month, so I'm cool with that. I can make do. So I've been sending that every month to them."

Me: "$150 per month?! That's going to take 11 years to pay off! You don't need to accept this! Just let me call with you and negotiate it down."

Her: "No need. I can deal with $150/month, even for a long time. Thanks anyway though!"






Unfortunately that's the story with a lot of Americans. You can only help those who want to help themselves.

[Ryback_feed_me_more]

Whats shocking is USAA has been rightfully accused of doing the same shit. Be it a house damage claim or worse somebody who was in a wreck and filed under UI/UM coverage (uninsured/underinsured). They FAFOd and got slapped with $10M in punitive damages by the court.

[Texter]

Druff,

Any advice on getting an ambulance trip discounted? $1547 left of a $2648 bill…insurance already paid the $1k