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I'm sure there was a technical mistake on the doc's end! But it's because UHC wants absolutely everyone to make 'mistakes' constantly, because every mistake delays or avoids a payment. Even a delayed payment moves an expense forward, maybe even into a new period, while the revenues are always captured promptly when your employer pays your premium. So, UHC's processes are purposely designed to add as much uncertainty and to be as easy as possible to derail. The system insurance companies designed works something like this: Provider: Enters patient ID, procedure code, date, etc. into the insurance billing system. Insurance company: Applies an automated check to find reasons why this claim might be denied. For example: "Our records show that you amputated her right arm yesterday, so we can't pay for wrist surgery with a date of today" or "automatically deny all claims for XXXXXX as 'not medically necessary' and wait for them to appeal by following a separate process". If it finds any reasons, claim is denied. Some limited info is sent to the provider or patient, usually with a lot of latency. Doctor or Patient: Must play a game with the insurance company to figure out (1) why insurance company thinks [insert wrong belief] (2) how to satisfactorily prove to them otherwise and (3) why despite after solving 1 and 2, the claim is still showing as denied. Providers are overwhelmed with hundreds of instances of this at all times, so they can't always handle doing this for you, and patients often lack the documentation, medical knowledge, and legal definitions in the policy, to be able to advocate for themselves. If it were designed by anyone other than a bunch of ghouls looking to profit off killing people, there would be good ways to asynchronously but promptly enumerate and solve the problems that prevent claims from being paid. This would be tricky to build, but not impossible if the parties involved wanted to cure disease and save lives more than they wanted to be rich. |