Various healthcare
- Thread starter Marvin the Martian
- Start date
I think insurance companies use that law every time they deny a Colorado claim. I suggested a neighbor go to an attorney with that statute over a claim denial for a hail damaged roof. An inspector said he needed a new one.I wonder how often this law is used. I read an article that said your first step is to appeal, then if that is denied to ask for an external appeal. They suggest if your health is at risk, you can go straight to external appeal. Yet nationwide only .1% of denials are appealed:
Yes. One in seven claims are denied across the country, and health insurance claims. So it affects a lot of people. And yet one study found that 0.1 percent of all people who experience those denials actually took it to a step to do a formal appeal. When you're going about your day to day, maybe you're facing an illness or you're facing a chronic disease, it's hard to find the time and wherewithal to be able to figure out how to appeal these claims. And the reality is that very few people do.
How algorithms are being used to deny health insurance claims in bulk
Federal data shows that health insurance companies denied more than 49 millions claims in 2021, but customers appealed less than 0.2 percent of them. Investigative journalists at ProPublica found that the insurance company Cigna is using an automated system to assess, and often deny, claims in...www.google.com
With that statute an insurer is running a big risk by using pre-programmed denial algorithms.
One thing we don’t need is for the insurance lobby to push federal legislation and more red tape to fix this.
I am a little skeptical none of those thousands of denials be signed off on in just seconds are Colorado citizens. There might be a solution somewhere.
The lawyer full employment act is good for lawyers I am sure.
I haven't suggested a federal law, just pointing out there is a problem with insurance companies. Who also hire good lawyers. The federal issue is your strawman.
Is there a timeframe for these trials? If medicine is critically needed, do people have time to wait?
I don't have a fix, but recognizing the problem is a good start.
Not every denial needs to be litigated for the law to have a positive effect. The Colorado statute is a good one.
So we need to find denial percentage by state and see if CO has a statistically significant percentage. I do not know if that stat exist.
In some reading on that law, articles suggest most states have a bad faith law. So all those denials are coming from just the minority of states?
Or, what I suspect, companies deny expecting to overturn if appealed. I suspect courts won't intervene until the process plays out. That seems to be how are courts are about everything.
Colorado law is beyond “bad faith”. denial. It is an “ unreasonable” denial. Bad faith isn’t required.
Do you think judges will require the appeals process to play out? It seems courts always want the contractual appeals carried through.
Of course people's overall costs increased. That's what happens when you enlarge the pool to include those with pre-existing conditions and those who have to prioritize food, rent, and utilities over "healthy lifestyle." Some of those costs could have been offset had the individual mandate been retained, but it is what it is. The "public option" would have helped as well.
20-40 million people (depending on how you view it) have benefited from the ACA. Even those whose costs have risen are paying for a better product than they previously could have. With all its flaws and shortcomings, it's had a huge positive impact on health care coverage.
Exhaustion of remedies is an issue in some cases. The Colorado statute doesn’t require that, but that doesn’t mean a court wouldn’t require it to establish unreasonableness. I’ve been out of the game now for more than 10 years.
Yes and no. As an FP I see a lot more insured patients since the ACA came into being. But when an Ambetter patient needs a specialist it’s a cluster
