This is amazing, 3 videos here and the other day I blogged one about the station helping on an Aetna denied claim.  This shows how complex health insurance has become.  In addition I was reading an article imagethe other day that relates to coding and billing and now that electronic medical records are using SNOMED terminology in the “patient problem lists” that opens up yet another area for insurers to scrutinize and potentially use as a reason for denying a claim as more and more insurers are comparing every last detail on every claim.  You can than the extensive analytics they use for that.

Injured Good Samaritan Gets $165,000 Bill Denied by Aetna - Local Television Station Helped Him With Part of the Resolution

Here’s the first one, a burger flipper who had a failing kidney and got a hospital bill for $12,000.00 and was covered by his father’s insurance.  United Healthcare said he should have insurance through his own insurance, but he only worked part time and is 18 years old.  United said they never received answers and the patient says that was not the case.  Look at what this did to his life, credit shot, etc.  12 for action stepped in to help. 

Here’s an 87 year old woman, a coding issue that turned into a nightmare for $32,000.00.  She went to the ER and thought she was having a heart attack and spent 3 days having cardiac tests.  She was insured by United Healthcare.  Their issue goes back to the hospital coding and Banner hospital would not change.  It went back and forth between the hospital and United.  12 for action stepped in to help. 

Here’s yet another story and these are all recent within a couple weeks.  This story is a little more complex with a teenager with a rare disorder and her mother had one heck of a fight.  The plan is Medicaid and the doctors want her to go to Pittsburgh for treatment as this is such a rare disease.  United Healthcare has denied the treatment twice.  The girl keeps gaining weight and east 1100 calorie a day diet.  She needs care that is not available in Arizona.  Multiple doctors have written letters.  12 for action stepped in again and no luck so far and now she has to go to a court hearing.  It’s some type of genetic treatment it sounds like. 

This is where we are at now, no pre-existing but narrower networks kick in.

Pre-Existing Conditions With Health Insurance May Be Gone But Narrow Networks Are Providing The Same End Result For Many Ill Patients With Not Being Able To Get Care - Extreme Cases Of New Killer Algorithms Popping Up With Insurance Business Models…

This is interesting after looking at those 3 cases above, the company had not problem paying for a $175,000 hammer to procedure in New York for the wife of a banker, but they even got mad over the charges.  BD

$175,098.80 To Fix A hammer Toe Billed by New York Podiatrist And the Insurer Paid It, Well Sort Of As They Sent the Check to the Patient By Accident, A New Investigation For “Out of Network” Charges Has Resulted


  1. Insurance Companies are Rat Bastards

  2. "Your comment will be visible after approval." Whoa, see this $hit?


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