In this case though, the claim should have been denied because it was filed incorrectly.

Is there also a reason the surgeon themselves needs to get on the phone with insurance? Isn't that what the rest of the staff is for?

> the claim should have been denied because it was filed incorrectly

Spoken like someone who has never spent hours online with an insurance company. They have told me that they can't see uploaded forms due to a 'glitch'. They have told me fields were missing when I am looking at the same forms and telling them where the field is and what it contains. They have been carefully instructed to tell lie after lie after lie hoping that the consumer finally gives up.

No, but my newborn had to go to the ER once and it kicked off 18 months of billing disputes with the hospital. And the thing I learned was the depths of incompetence, malice, and laziness that a hospital billing department was capable of.

One of the key lessons - if a doctor submits an incorrect billing code, insurance can't do anything to change it. If a doctor doesn't want to work with insurance to fix the codes, you as a patient have so few options to do anything.

I'm very sorry to hear that, I've been through any number of ER visits with my child. I have not personally had any issues with hospital billing departments, so perhaps I have been lucky. It is only the insurance I've had problems from.

But it's not the only billing problem I have had. A hospital billed us double for an emergency c-section (once for the mother, and again for the child) and hit us with $300k in claims. A dermatologist once faked a surgery and sent it to my insurance. And don't even get me started on the exploitative agreements hospitals sign with ambulance companies.

We're not even people who spend a lot of time in hospitals - but we are pretty close to a 100% hit rate for billing issues with hospitals. Even during times in my life when I didn't have insurance.

I get that people kind of ascribe all sorts of medical billing problems to insurance companies. But I think a lot of it is kind of ignorance comes from inept hospital management shifting blame. And often doctors and practitioners themselves are very removed and unaware of the awful billing at their own practices.

That seems a bit incredible because it suggests that they would be denying 100% of their claims. If they're going to start lying about a form being filled out correctly in one instance, why ever stop? They can just keep lying forever on all claims.

I've had weird experiences online arguing (about shoplifting, as it happened) with people (I assume teenagers) on Discord who seemed to have a genuine belief that buying insurance was a magic positive-sum process for dealing with damages. They hadn't/didn't make the link that the insurer pays out approximately what they take in from premiums. That experience applied to medical insurance leaves me with a strong suspicion that UHC gets a lot of hate because they are the cheap option and people haven't cottoned on to the sad reality that if they want their claims paid out they can't go with the provider that is cheap because it denies a lot of claims. UHC's margins are there but don't seem to be that impressive. It wouldn't be surprising if they have to push back fairly hard or become insufficiently profitable.

the mistake in your assumption is that they are the "cheap" option.

UHC have all kinds of plans, both cheap and expensive, and their denial rates are high, regardless of what plans are purchased.

Knowing the general madness of US healthcare, I want to stress this isn't rhetorical.

So why are people going with UHC?

EDIT I want to reply to 2 replies with the same comment, so I'll put it here - if the companies are paying & buying known-dodgy insurance, then why aren't they going with a cheap option?

You have very little choice in healthcare in the US. While you have the “option” of trying to get healthcare on your own, if you have an income it’s usually prohibitively expensive as most companies are able to both a: negotiate a better rate as a bulk deal for bringing all of their employees to the plan at once, and b: subsidize the plan for employees.

What this means is that the most choice Americans face is whether to take the high or low deductible option their plan offers and whether they take the single or family plan.

If your company picks UHC and you don’t have a spouse whose job has something better, then you’re getting UHC or nothing

> So why are people going with UHC?

Most get it through work, and most areas have only a handful that count local docs as in-network. If you're lucky, work might offer a choice between two insurers.

Because in the madness of our economy we've decided that people need to pay for their healthcare either out of pocket or through their employer. They have limited choices and often need to take the cheapest because its all they can afford.

Fortunately for health insurance companies, people who need to take the cheapest healthcare could rarely fight back.

These companies - every company - know how to maximize profit. They know how many claims they can deny, they know what kind of claims they can deny, they know who is or isn't likely to fight back.

Hint - the people with the fewest resource are the least able to fight back.

UHC shouldn't have margins. Healthcare and profit are a deadly combination.

I've seen the same damned thing. Even when the state has previously gotten involved on behalf of a patient, I've seen insurance try to deny a surgery less than an hour before it was scheduled. Patient's husband called up the state and they said to not worry about it, they'd handle it. But even still, insurance companies do not stop trying it. The penalties they get are a joke to them. Executives need to face criminal penalties and be locked up in federal prison. Fuck it put em in Gitmo, those people are terrorizing us all.

The goal is to wear you out and it's the context missing from the discussion. An external observer could look at any of my contested insurance claims and say 'They asked for more information, you gave it to them, the claim was approved, so what is the problem?"

What's missing is all the days I had to get up, check on my claim, and call them because the claim was still denied and they sure weren't going to call me.

What's missing is the hours I spent on the phone with them taking them step-by-step through the same issue each time.

its called Peer to Peer.

This happens all the time.

Most independent doctors billing OON may also need to speak with 3rd party claims processor, in all likelyhood. Same is true for some WC/NF/Lien claims