Unfair Denials of Insurance Claims Could Be Making Your Medical Debt Worse
If you still live in Florida after so many hurricanes, you must be a relentless optimist. Therefore, the relentless optimist in you will look at the cost of your health insurance premiums and the amount you still have to pay after your insurance covers its portion and be glad that you have health insurance. Many Floridians have no one at all to help them pay for healthcare. Florida is one of only ten states that have not adopted the Medicaid expansion. This means that people whose income would qualify them for Medicaid in most other states are left in the lurch in Florida. Of course, your health insurance only brings you financial relief if your insurer approves your doctors’ claims. A recent report by ProPublica describes the disturbing frequency with which health insurance companies deny medical necessary procedures for policyholders. If the unfair denial of a medical insurance claim has harmed your health and finances, contact a Miami debt lawyer.
Meet the Bots Making the Decisions to Deny Your Insurance Claims
The ProPublica report sounds like a cautionary tale about the dangers of letting machines make decisions that affect human life, but it is not dystopian fiction; if anything, it is dystopian reality. Anyone who is old enough to be the policyholder of an insurance policy knows that the main goal of insurance companies is to make money for themselves. According to the ProPublica report, the major health insurance companies rely on a software called EviCore to decide whether to grant or deny prior authorizations for health insurance claims. EviCore uses an algorithm to decide which ones to deny and which ones to accept. Of course, every algorithm has an author, usually a human, although it is possible for algorithms to generate other algorithms. Much like the human cops who train their K9 partners to act like they smell drugs, the clients of EviCore can adjust its algorithm to decide which percentage of claims to deny. It might tell your insurance company to deny your doctor’s request for prior authorization for surgery, even when your doctor just told you that you needed the surgery to save your life.
You Can’t Pay Medical Bills Unless You Are Alive
Finding out that you need expensive medical treatment for a serious health condition is bad enough, but hearing that your health insurance will not pay for it is worse. When this happens, you should think about your health first. Your life and health are priceless. There is time to appeal the denial of the claim, and if the insurance company refuses to pay for it, the hospital will work with you on reducing the cost and setting up an installment payment plan. If, after you have recovered to the point where you can think long-term about debt, the medical debt is still casting a dark shadow on your finances, you can think about options like debt consolidation and bankruptcy.
Work With a Debt Lawyer About Medical Debt
A South Florida debt lawyer can help you think clearly about medical debt, including debts arising from unfairly denied insurance claims. Contact Nowack & Olson, PLLC in Miami, Florida to discuss your case.
Source:
propublica.org/article/evicore-health-insurance-denials-cigna-unitedhealthcare-aetna-prior-authorizations
