UHC covers far more people than most national systems despite not being national (I’m sure china is bigger, but most countries have much smaller populations). National systems often have ways of saying “that isn’t covered” that mean the claim isn’t even attempted. there are many different national systems with different rules. There are lots of other complications here that need to be studied in depth.
Somebody posted a graph of the stats in another thread, and there was a great follow-up by somebody who had worked in claims at another company about just how bad those stats really were.
The national average for denied claims is 16%. UHC denies 39% of claims. The real kicker here, as they pointed out, is that this is after appeals. They worked at some branch of Blue Cross, which sits at 17% of claims, and said how most claims that are appealed are approved and that the vast majority of those that are denied are things like chiropractors putting in claims for procedures that end up being malpractice or stuff where the paperwork was wrong. Basically, if you get something denied by insurance, you’re almost guaranteed to get it approved after an appeal. They said that for UHC to hit the numbers that they do, they would effectively have to deny almost every claim that they get that isn’t a routine medical visit like an annual physical.
I think you’re getting this kind of backwards. Individual claims aren’t denied under universal healthcare. It’s not opaque like a private insurer. Specific procedures are the thing not covered, and that becomes part of a national legislative/policy discussion.
The fact that the system is transparent, that every one is denied in a way that is public knowledge, makes the system much easier to change. It’s not directly comparable to the opaque way that US insurance companies deny claims, and the way you said “often have ways” implies the same level of subterfuge.
I feel like you also missed the other commenter’s point entirely. No one makes comparisons on raw numbers, that would be silly. But the rate at which UHC denies claims is likely greater.
Rate is just one data point. I’m back again to asking for in depth analysis. Do people who use UHC submit more bogus claims than those who use other insurance for example? There are many more important questions that need to be asked.
Not to the extent of UHC
Do you have detailed numbers or just a feeling?
UHC covers far more people than most national systems despite not being national (I’m sure china is bigger, but most countries have much smaller populations). National systems often have ways of saying “that isn’t covered” that mean the claim isn’t even attempted. there are many different national systems with different rules. There are lots of other complications here that need to be studied in depth.
Somebody posted a graph of the stats in another thread, and there was a great follow-up by somebody who had worked in claims at another company about just how bad those stats really were.
The national average for denied claims is 16%. UHC denies 39% of claims. The real kicker here, as they pointed out, is that this is after appeals. They worked at some branch of Blue Cross, which sits at 17% of claims, and said how most claims that are appealed are approved and that the vast majority of those that are denied are things like chiropractors putting in claims for procedures that end up being malpractice or stuff where the paperwork was wrong. Basically, if you get something denied by insurance, you’re almost guaranteed to get it approved after an appeal. They said that for UHC to hit the numbers that they do, they would effectively have to deny almost every claim that they get that isn’t a routine medical visit like an annual physical.
I think you’re getting this kind of backwards. Individual claims aren’t denied under universal healthcare. It’s not opaque like a private insurer. Specific procedures are the thing not covered, and that becomes part of a national legislative/policy discussion.
What is the difference if you need a treatment you cannot get
The fact that the system is transparent, that every one is denied in a way that is public knowledge, makes the system much easier to change. It’s not directly comparable to the opaque way that US insurance companies deny claims, and the way you said “often have ways” implies the same level of subterfuge.
I feel like you also missed the other commenter’s point entirely. No one makes comparisons on raw numbers, that would be silly. But the rate at which UHC denies claims is likely greater.
Rate is just one data point. I’m back again to asking for in depth analysis. Do people who use UHC submit more bogus claims than those who use other insurance for example? There are many more important questions that need to be asked.
Holy moly, are you really this much of a bootlicker that you buy “bogus claims” as an excuse for insurance denying people life-saving treatment?
You’re right, rate is just one data point. One I think you purposefully ignored now.
I’ve been around long enough to know that people who want to make a point will yell about one number in their favor and ignore everything else.
How’s that leather taste mate?
https://www.reddit.com/r/dataisbeautiful/s/y8a8GXP4EC