A few years ago we had lots of these types of stories about insurers not covering major medical bills and it seems like they are now returning and the best help patient can get with some of the issues is to go to a television stations and blast it all over the place. This man tried to save an accident victim and received burns in the process and had to be hospitalized and then Aetna with some algorithmic claim process denied it. Remember these are all mathematical formulas now that dissect each individual part of a bill down to the very bottom.
The bill came for $165,000 and Aetna said no. Watch the video for the details. He has first, second and third degree burns. Aetna didn’t think his injuries were severe enough to have inpatient treatment. He appealed and Aetna denied the claim, then hired an attorney. Aetna through a 3rd party agent paid half of it and the hospital wrote off the rest. So if you get in this type of a spot, get your story on TV. BD
In addition we have also heard a lot in the news about narrow networks, and that has pretty much become the replacement for the old pre-existing clause for keep risk factors down to allow profits. BD