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.
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.