Smart Expert Tips if You Need an Insurance Payout
Too often, insurers deny claims with little or no basis — but you don’t have to just accept it…
If you’ve ever had an insurance claim denied, especially a medical claim, you’re not alone.
Insurers Deny Claims without Reviewing Medical Records and Worse
In 2015, an Aetna medical director testified under oath that he never looked at patients’ medical records before accepting or denying claims, making those decisions based on nurse recommendations.
The case led to the insurer ultimately agreeing to an undisclosed settlement with the plaintiff.
According to KFF, in 2021, about one in seven in-network health insurance claims were denied, though some insurers denied as many as 49 percent of claims!
Only about one in 500 people whose claim was denied appealed the denial and most denials appealed were upheld by insurers.
A ProPublica report decries how difficult it is to get definitive numbers on the prevalence of claim denials but that the rate is likely between one in five to one in 10.
They quote Wendell Potter, a former Cigna communications executive, as saying, “Refusing payment for medical care and drugs has become a staple of [insurers]…
