"glfnaz" <glfnaz at (no spam) qwesttrash.com> wrote in message
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"Perfect Impact" <gh at (no spam) perfectimpact.com> wrote in message
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"glfnaz" <glfnaz at (no spam) qwesttrash.com> wrote in message
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"Perfect Impact" <gh at (no spam) perfectimpact.com> wrote in message
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As providers the doctors and other providers get caught in the middle,
obvsiously, when the client believes he's covered and the ins. co.
will not pay: 'Bill my INSurance' - so when the payment isn't made,
the doctor is the one getting hurt.
Why is the Doctor not doing a preauthorization to do the proceedure?
At that point everybody knows if there is coverage.
Thats standard everywhere.
How did I not think ahead to this kind of post from you, Brad: I.e., if
Hibbard says anything, find a way to make him wrong.
Your question is a "Have you stopped beating your wife?"
From your perspective, any question you'd put MUST have a premise of
"you don't know what you're talking about."
OId sores open easily, Brad. Cool it.
Huh?
I asked an honest question--and you give me bullshit back?
The Doc is not left "getting hurt" if he does a pre-auth first.
Thats a fact--but you want to play some old card here.
OK--I'll say it--
"you don't know what you're talking about."
I have to give you credit for consistency, Brad. If you don't succeed
with your first miss, say the same thing again LOUDER.
The doctor in question has been in practice 25 years. He is not an idiot.
YOU do not know his facts. And yes, United WAS in the news for their
incredible bonuses to screeners who managed to deny claims. Not bad ones:
good ones.
There's a Brad's "should be" world, and then there's the REAL world.
Here's part of a state of Maine insurance department adjudication of 2002:
4. United Healthcare sent Consumer an Explanation of Benefits on October
10, 2000 denying the claim with the notation LG, "Please submit an
itemized bill with the provider's full name, address, telephone number and
tax identification number," and the notation QN, "Your claim may have been
separated for processing purposes; any additional charges will be
processed as soon as possible."
5. Consumer sent United Healthcare a letter dated March 27, 2002,
providing the name, address and telephone number of Consumer's doctor, and
enclosing records from the hospital where the durable medical equipment
was obtained.
6. United Healthcare sent Consumer and Explanation of Benefits on May 29,
2001 denying the claim with the notation 91A, "in order to process this
claim we need the provider's complete mailing address, tax ID number and
phone numbers. We also need to know if this item was purchased twice as
indicated or just once. Please provide us with this information."
7. Consumer provided the Bureau with a copy of a letter dated June 8, 2001
that Consumer asserts she sent to United Healthcare stating that there was
only one pump purchased and providing the address, phone number and tax ID
information for the DME provider. In response to Consumer's complaint,
United Healthcare has advised the Bureau that it did not receive
Consumer's letter.
8. In response to the complaint Consumer filed with the Bureau, United
Healthcare paid the $6,245.00 claim, with interest in the amount of
$3,243.34. United Healthcare's October 8, 2002 letter to the Bureau
stated, in part: ". as stated in the previous letter, we did not receive
any information regarding the supplier's information . which was requested
by United Healthcare Insurance Company. The letter enclosed was never
received in our offices as well, which explains the continued denial of
this claim. On the date the original [] complaint file was received, we
made an exception to process this claim without the information requested
to benefit our customer due to the escalation and frustration this matter
had caused, not due to the intervention of the Maine Department of
Insurance. United Healthcare mailed to our customer two different requests
for this information, and do not have any records reflecting the response
regarding.the information."
BUREAU'S FINDINGS
9. The Consumer met her obligation under the Policy by providing United
Healthcare with the name and address of the DME provider. United
Healthcare's delay in reimbursing Consumer for out-of-pocket expenses was
not warranted. If United Healthcare needed the DME provider's tax ID, it
could have requested that information from the DME provider.
10. United Healthcare Insurance Company is a Maine licensed insurer as of
October 25, 1972, license number LHF 700, and the Superintendent is the
official charged with administering and enforcing Maine's insurance laws
and regulations. Title 24-A M.R.S.A. § 12-A provides that the
Superintendent may issue a Letter of Reprimand to any licensee after
providing an opportunity for a hearing. In accordance with 24-A M.R.S.A.
§229(3), you have 30 days from the time you receive this Letter of
Reprimand to request a hearing.
---------
I'll presume you don't need a brushup on reading comprehension--it's all
there.
You may or may not know that when you see one in court or the
equivalent--pursuing a complaint with a state office, where people
actually pay lawyers unforgiveably high hourly rates for representation or
where obviously many personal hours are spent in pursuing their rights,
there are likely thousands that are simply not brought to trial or to the
point where the review board bothers with it.
Since the amount here was over $6000, obviously the effort was warranted.
But for the nuisance ones of a couple thousand or less, people simply
can't afford to bother with the expense and hassle. They have to be at
work and earn a living. And a million small cases "under the radar" are
of MUCH more benefit to the crooks, and considerably easier, than a few
large ones with red flags etc. written all over them.
Brad, you are so G damned judgmental, shallow and just plain stupid, you
really get to me--who'd a thunk I'd get so angry over a stupid couple of
posts in a newsgroup.
I'll save you arguing about this one by posting this URL for the rest the
story.
http://maine.gov/pfr/insurance/letters/03206.htm
On the FIRST page of my Google search, there were 20 cases under the
search "United Healthcare Denial of Benefits.
