I have several theories on how health insurance companies continue to make outrageous profits.

1. Most insurers deny a certain number of claims out right for no particular reason. Sure there’s a coded explanation like “Not medically necessary,” or “voluntary procedure.” Often times people have already had the procedure that has been denied. If they aren’t up for fighting, they just pay.
2. I’ve heard that 66% or all claims are processed incorrectly. This is the fault of both insurers and providers. I know from an audit I had done on my claims that 94 out of 156 claims were filed wrong. That’s almost exactly 66%. Most people don’t know that their claims are being filed incorrectly so they pay $30 instead of $20 to see a specialist or some similar situation. That’s all profit for insurers.
3. The systems the insurers use are purposefully confusing and convoluted. Example: I received a note from my doctor that I wanted to include in my claim. It came as a digital file. I had to print it out and fax it to the insurance company. While on the phone with my representative, she had to print out the fax (which had been digitized again), walk it over to another system and scan it in. This process took a long time and three phone calls. If I weren’t committed, I would have quit and just paid the money. Or I would have given up and let the bill collectors come after me.

I’m still trying to get to the bottom of the real problems in the health insurance system. But I’m having people report their health insurance nightmares to me. Please share your stories or, if you don’t have a story, share this with someone who does. www.thedigitalchampion.com