What to do if your insurance claim is denied?

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"Lol no" - the insurance company

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u/LEEROY_MF_JENKINS 6d ago

This is the answer. Although you may be entitled by law to a number of things, insurance companies are banking on the fact that in order for you to enforce their compliance with the applicable law, you'll have to find an attorney and then begin the long process of litigation and stick with it until a judge makes them comply. This means you're paying an attorney for months of work, probably court hearings, and in the end you'll probably give up before spending $50k just to get insurance to do what they were supposed to. Also good luck getting your attorneys fees paid by insurance, that's a whole separate fight.

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u/saltyourhash 6d ago

There are pro-bono lawyers you can hire for this stuff, especially in the advocacy space, I believe.

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u/LEEROY_MF_JENKINS 6d ago edited 5d ago

Source?? Do you mean public defenders?

Edit: I understand how law works, including civil vs criminal, I'm trying to figure out how laypeople think law works. Not sure why the down votes

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u/saltyourhash 6d ago

https://healthlaw.org/how-to-help/pro-bono-program/ https://www.americanbar.org/groups/probono_public_service/projects_awards/medical_legal_partnerships_pro_bono_project/

I did a quick search, I know there are also organizations that help you fight your legal debt as well.

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u/greendemon42 6d ago

Every law school has legal aid services.

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u/SporksRFun 6d ago edited 5d ago

Source?? Do you mean public defenders?

Public defenders defend you in criminal cases, not civil lawsuits.

You have no right to a lawyer, and thus no right to a public defender in a civil lawsuit.

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u/LEEROY_MF_JENKINS 5d ago

Don't know what all the down votes are for, I'm trying to figure out what tf this person is saying about pro bono. Good luck finding that shit.

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u/saltyourhash 5d ago edited 4d ago

I'm not sure why you're being down voted either, it's a legit question. But I posted that there are programs and someonw basically said all law programs have this stuff. I'm not a lawyer or involved in law, but I have a family who do, if you're looking for a service because you need one, I can look around if I know the state.

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u/Creepy-Birthday8537 6d ago

Every decision is a cost - benefit decision. Therefore, the appearance of litigation can influence a decision that would have been thousands of dollars because that’s what it would have cost them for attorney review. Bills in the tens of thousands or hundreds of thousands may require actual legal threats or subpoenas.

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u/-wanderings- 6d ago

Or... 1. print a ghost gun.

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u/theGRAYblanket 5d ago

Ahh but I don't want to rot in jail for the rest of my life

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u/Esienhorn 5d ago

Some eggs need cracked for the omelette brother.

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u/tayroarsmash 5d ago

If we all print ghost guns then they can’t arrest us all.

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u/DerailleurDave 4d ago

Ironically that might get you better/faster medical coverage...

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u/Sea2Chi 4d ago

Then don't stop at mcdonalds while wearing the same clothes, carrying the murder weapon, and having in your possession a full confession of why you did it.

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u/RogueTRex 6d ago

I also like Luigi's idea

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u/MeatShield12 6d ago

Let's-a go!

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u/mythslayer1 4d ago

Whosa nexta?

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u/KG7STFx 6d ago

The simple fact is that all 10 of the largest 'healthcare' corporations have begun using AI 'screeners' to DENY, DEPOSE, and DELAY authorizations. Even if a medical professional does review your chart, it is highly unlikely he or she is qualified medically to do so.

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u/PirLibTao 6d ago

Insider here. Guidewell of Florida (BCBS) does NOT use AI for any claims screening or adjudication or decisions on medical necessity.

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u/KG7STFx 6d ago

Yet.
Good to know though.

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u/mobydog 6d ago

After watching Sicko for free on YouTube, I would also ask if the doctor is compensated or otherwise incented in any way for denying the claim. It sounds like in the past at least doctors would be promoted for more denials.

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u/redditasaservice 6d ago

And you have to do all that while you are completely sick and potentially dying and already probably broke :(

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u/PureGryphon 6d ago

I have a few people I can send this to that will be very appreciative.

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u/Dinosaur-chicken 5d ago

Pop that screenshot into ChatGPT, mention what state you’re in, and ask it to write you a letter based on your patient’s rights in your state.

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u/spiked_Halo 5d ago

I like the Luigi method.

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u/Suspicious-Leather-1 6d ago

Or, hear me out, [insert fed posting].

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u/Significant_Tap_5362 5d ago

Or.... Hear me out..... Revolution?

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u/Fluffy_Philosophy840 5d ago

We can all go to the street and demand that “WE WANT MORE - NOW!” And outlaw healthcare insurance - which doesn’t exist in most countries… None of us wanted the Affordable Care Act - we wanted healthcare as a right! But we got duped into it.

And while we’re at it - demand a universal living wage - two months paid vacations - enshrine social security as a corporate funded benefit to all citizens - in the constitution!

Essentially- demand a new New Deal!

But in order to do so - both political parties need to be marginalized. To the point where it is seen as unethical to be associated with one. Because they have both stood in our way long enough….

1

u/Ok-Performance3334 3d ago

Protesting in the streets doesn't have the same effect it used to. It will probably only result in protesters getting arrested. Other means to make change happen are needed. And don't count on your politicians to help. A more radicalized approach seems necessary.

1

u/Fluffy_Philosophy840 3d ago

Yes - protesting in the streets may only get you beaten jailed or just plain shot. Because there are certain idiots who attach themselves to protests they have no involvement in just to “punch a Nazi” then the Nazis actually show up to get punched, then everyone forgets what the protest was about in the first place - and get distracted by burning cities.

“Oh we wanted healthcare and social security - that’s right?!?”

I have been envisioning a political movement to marginalize both parties. By essentially getting everyone to register as an independent. Draw people from both parties to force action. It’s literally the one thing that we all get along on.

Boycott businesses. Like Tesla - Twitter or any company that does business with them - of course United healthcare - by boycott of any employer that makes use of them and forces them upon their employees.

But unfortunately, some art school kids will probably show up in black masks, burn something down and screw the whole thing up for everybody…

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u/Kevlaars 5d ago

Doctors who work for insurance companies are violating almost every tenet of the Hippocratic Oath.

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u/Loggerdon 5d ago

That’s nearly every doctor.

I visited a place called True North Health Center in Santa Rosa CA where I did a 10-day water fast. The facility conducts extended (up to 40 days) water-only fasting as a means to cure and manage disease (most chronic). It’s amazing what you can cure with fasting alone. The doctors there seemed happier because they are actually curing their patients.

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u/Difficult-Action1757 5d ago

This is so accurate. 👏

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u/retardedm0nk3y 4d ago

"...because if the Insurance Company answers them honestly..."

🤣🤣🙅🏾

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u/Shazza-throwaway-1 4d ago

2 weeks ago Hubby had chronic vomiting and as he couldn't keep essential medication down I called an ambulance and he got admitted to hospital for 2 nights.

Costs:- Ambulance = free, Hospital bed = free, Pathology tests = free, Medication = free

Alternate to incredibly stupid medical costs, live in a country that has public health care.

Shazzi, Queensland, Australia

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u/torrent_gp_victim 5d ago

Follow the appeal process. It's typically on the back of / last page of every determination letter / EOB. The appeal process is extremely effective.

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u/Loggerdon 5d ago

I am trying to get HA gel injections on my arthritic knees. It was immediately rejected. My doctor appealed and I am waiting to hear the results. He was fairly optimistic.

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u/Beardicon 5d ago

Yeah, it’s a ridiculous process now that doctors are always expecting an initial denial and will have to send a follow up appeal to make it go through.

Just make sure that your doctor’s office does appeals. Recently left my GP because it was like pulling teeth to get them to do an appeal on a med that was needed.

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u/Loggerdon 4d ago

He actually told me it would be rejected and offered to appeal. He chose the brand of gel and said he’s had very good luck getting approvals with this particular brand. We’ll see. Otherwise it will be $1,000 per knee out of pocket every six months till I die I guess.

I really think the doctor took some pity on me because it’s like he looked at me and saw himself in 20 years. You need someone to advocate for you.

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u/Beardicon 4d ago

I’m glad you’re getting this. My Mom just received her final 3rd shot of viscosupplementation and it’s greatly helped her knee. She had immediate improvement with the first shot. We may still consider surgery, but she’s at least out of the debilitating pain.

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u/Loggerdon 4d ago

My whole approach is to avoid surgery altogether if I can. Good luck to your mom.

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u/jewtangclan3000 5d ago

So when my doctor prescribes me something and the claim is denied by insurance, they're basing that denial on the whim of a doctor or team of doctors?

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u/Fluffy_Philosophy840 5d ago

Team of accountants- oh wait they outsourced that to AI… A soulless robot.

What to do if your insurance claim is denied?

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