30 Days of US Healthcare: Automated Claim Denials

Day 12

[victorhoralko]

I feel that, if you are trying to incite a riot against UH you are doing a great job, all while providing excellent entertainment 😂

[gwine]

As someone who worked for a healthcare insurance company, I can attest that they are totally amoral.

[oneminuteofmyday]

I had a nurse at the hospital ask me why I had waited a week with a multi-day migraine to come in for an infusion. I told her I hadn’t waited, the insurance company had. She sighed, hunched her shoulders, and quietly said that’s why she had quit her job at an insurance company — she couldn’t handle telling people “no” when they really needed help. From her body language and voice, it was obvious she carried a lot of guilt over that. I give her credit for leaving a job over that.

[perilousrange]

I'm an senior engineer at a major medical billing company. We process a bazillion claims. It's actually worse than the video describes. I'm talking routine, automated denials on technically flawless claims, which I've personally validated. We've got the data. We know who is doing it, we know how often. I think we're the first to aggregate it. Pain is coming for these insurance dirtbags.

[NorninTGK]

The more I learn about US healthcare, the more I become convinced that you guys live in a dystopia.

[happygurlevr]

Fun story! An insurance company once told us that their third party system had information loaded incorrectly and it was our responsibility to let them know! Because we definitely knew the information was loaded incorrectly on a platform that THEY maintain 🙃

[piyawatamornthatri]

At this point I don’t understand anymore why US people have to buy health insurance because without it, it’s still the same.

[emilymorley]

I have done billing for a small nursing home for many years. It's all true; the patient loses, the provider loses, insurance collects. You will always get a denial first (especially from UHC) they wear you down and drag out the process, even after you fix everything and jump through every hoop ultimately the insurance rep will tell you - "I dont know what happened - we'll escalate this claim, you can check again in 30 days".

[DemonicNightmare]

When I worked for an HR company, I would get a number of claims that were denied for the stupidest reasons and now I'm wondering if they were just auto-denied.

I always walked the caller through the process of how to get it approved, or what it needed to be submitted as to be approved. (e.g., inhalers weren't covered but medicine and devices to assist breathing were - so if an inhaler was submitted as a normal medication it got denied. If it was submitted as specifically something to assist with breathing it got approved. This also happened a lot with diabetes medication, too.)

[natashka]

Watching these videos made me realize why medical tourism is such a good business in some countries....

[ghalam]

As someone forced to go through United Healthcare because of work every one of these videos fills me with anger. Thank you for posting them.

[andreazoss]

Boss is always in such a great mood. Always so happy to see Jimothy. Turns out that joy is easy to access when the needle on your moral compass spins like a pinwheel.

[KayleeKerin]

Thank you SO much for using your platform to point out the ABSURDITY of US healthcare the supposed "best in the world" line NEEDS to die.

[KittenMcCoolson]

I was denied for my insulin once... I'm a type 1 diabetic. I informed my insurance company that I will be heading to the ED for an insulin drip as my other option is a slow and painful death... they called back 5 minutes later with an approval. Every year my autoimmune inflammatory arthritis injections, which I have been on for 5 years, gets denied. In the 6 weeks it takes for the "review process" I end up with more permanent and irreversible bone damage... These denials will eventually cause me to go onto permanent disability, thanks American Healthcare!!

[sam]

This series is both hilarious and soul-crushing at the same time.

[markgodish]

I'm just waiting for the video where Dr Glauck explains that patients aren't allowed to sue their insurance (automatic arbitration) and even the most that insurance commissioners can do legally is say "no, actually pay for the treatment" with no penalties to the insurance company for egregiously breaking their contract to the patients.

[MythicFox]

"And, for an instant, she stared directly into those soft blue eyes and knew, with an instinctive mammalian certainty, that the exceedingly rich were no longer even remotely human."-- William Gibson, 'Count Zero'

[kimberleyomalley]

I love Jimothy as a their moral compass. As a psych nurse, I can tell you I was once told by an insurance Samoans that my patient had not required enough sutures after a stated suicide attempt to warrant inpatient TX. Yes, you read that right.

[terrasilvershade]

My insurance tried to deny my claim after I was hospitalized after my appendectomy had serious complications(had a tumor and internal bleeding they didn't know about) and I had to stay in the hospital for three days with a hemoglobin score of 8. They deemed it "not medically necessary".

[BREEZEMAYES]

Years ago I worked for a reconstructive surgeon. Once the ins clerk asked me to explain why he did emergency surgery on a Saturday instead of getting approval on Monday first for a foot, because Kai$er was refusing authorize payment. I picked up the phone and said" well he dropped the chain saw when he fell off the barrel he was standing on and it almost completely cut his foot off & it was either fix it then or finish cutting it off and throwing it in the refrigerator til your on call emergency number was answered on Monday." They authorized it & our ins clerk almost passed out.