Do thieving US richclass insurance companies criminally reject health care claims due to rules – or $ amounts?

[gabrielo19]

Sorry for such an easy question with such an obvious answer -- however rule-breaking by US richclass effects US working class abuse and exploitation unlike any phenomenon ever witnessed in world history. Sometimes an easy question is well-earned by those suffering the bloody US Class War.

http://news.yahoo.com/miracle-tornado-survivor-denied-workers-comp-170556418.html

“'Miracle' tornado survivor denied workers' comp”

“Baldwin said the insurance company's decision is unfathomable because if her brother hadn't been at work, he wouldn't have been hurt. He also could have jumped in his van and driven away from the group home as the tornado approached.”

“Susan said that 132 workers' compensation claims were filed after the tornado. Only eight were denied by insurance companies.”

“Insurance company spokeswoman Stepheni Schlinker said she could not discuss an individual claim or whether the company would reconsider.”

[sceley]

Pluto I formerly worked for a large health insurance comopany and while I wasnt a claims processor I knew alot of them and the process went like....
ins company gets a claim from hospital or doctor... processor looks at the claim.. processor finds an error or missing info.... processor rejects the claim and sends it back to doc or hosp.
Then the office mgr for the doc/hosp fixes the error and resubmits it. claims processor gets it again and if they find another error or missing info they reject it again...
Anyway you see the pattern.
They dont review the whole document find all missing info or corrections that need to be made and provide the doctors office or hospital with all the info. Why? well obviously they can float a claim longer until they have to pay it.

And if you were to ask, yes I am absolutely against this practice. claims should be submitted electronically and comprehensively reviewed so any corrections can be made.
Also the software should be designed so as to eliminate much of this by not allowed the claim to be submitted if its missing information. by analyzing teh procedural codes and so forth.

You can obsess and anger at people who make money if you want. How about we just correct the problem and move on.

[eddis]

How ignorant can you be? They cant afford to cover every damn thing.

[iden]

Thank Obama for the mess.