I had a major issue with the insurance company denying my claim. They denied it AFTER they approved it so the hospital was looking to me to pay for the bill. It was for brain surgery so it was expensive. I tried every way to convince them to pay up but they refused. So I got the State Insurance Commissioner involved. After he was done whupping on them, all was better than it could have been. I ended up with a pocketful of cash, my hospital bill paid and the insurance company not allowed to sell any new policies in the State for three years as punishment.

 

Good for you!

Their stupid denial move cost them big time.

Insurance companies fear being reported to state insurance commissioners.

I reported my medicare advantage company over making it a pain to get a dental claim paid.

When the state S.H.I.P. gave them a call, the claim was processed rather quickly.

 

States have different quality of insurance officials. I remember in early 2000s Louisiana had like 3 commissioners go to federal prision.

 

Think about it this way.

Insurance premiums = cost of health care + ins. employees + ins. lawyers + ins. CEO bonuses + ins. company facility expenses + + + etc....

Health insurance is one of many scams in the medical industry.

 

Be careful using AI. There are more than a couple of lawyers in real trouble for using AI to generate motions and briefings in court. AI was making up case citations and getting facts and rules wrong. AI would rather lie and give you bad information than say, "I don't know." AI has an annoying habit of lying anyway. Not saying don't use it-just don't print it off and file it without looking at it. Look at it as closely as you know how.

 

I have a cousin that was in a major car accident at 17, massive internal bleeding. Intestines ruptured. Spleen removed. Pelvis shattered, ribs broken, lung collapsed. His heart stopped twice.

The insurance company was saying it was liable for the basic trauma kit that was used to stop the bleeding.

...Eventually they paid...

 

When my wife had our daughter, the insurance covered everything, but denied the epidural removal. I called them and told them the only way I could see it getting denied was if they felt it didn't take a professional to do it. I asked them in case I ever needed to do it if I should pull it out slowly or grab it and yank like I'm trying to start my weedeater. They put me on hold for literally 5 minutes and came back and said they would cover it.

 

Word of caution. Not all "prior authorizations" are actually authorization. Some insurance carriers only provide a statement that no authorization is required with the caveat they will determine coverage based on individual policies once the bill is submitted.