Denial of care as a business model
[I'm leaving this sticky because we've got two RL stories in comments already, one where this series of posts saved a reader over $1000. Read on! -- lambert]
An estimated 10 to 15 percent of claims are denied for various reasons, some of them technical, such as not meeting filing deadlines or failing to get pretreatment authorizations.
And now they are going to be assisted not only by laws that grant them the legal right to manage a patient’s care above and beyond – or even in place of – a licensed MD’s care. Insurance companies have the right to deny patients care their doctor feels is essential to the well-being of the patient, and if the patient and doctor challenge the denial, the insurance company often still gets the final say in the matter.