Fight Back Against an Insurance Claim Denial or Avoid It Altogether

The horror stories of dealing with health insurance in America keep rolling in. I see it with my assisted living residents on a regular basis.

A Kaiser Foundation report from 2023 found that 1 in 5 claims are denied. One former healthcare employee that now consults for people said that 5% of the insurance industry’s clients make up 50% of their costs.

So if insurance companies want to make more money, it makes sense to be hard on the people who are costing them a lot of money.

Denying claims is a great way to make insurance companies money.

If you are shopping for insurance and want to know which plans deny the most claims, you can find some statistics here (they also have some ideas on how to appeal):

Here is a screenshot of a 10-step process to appeal your insurance denial:

I hope it helps. Sure doesn’t seem easy. Lots of your time to go through this process. Personally I am disgusted to see the way health care and health insurance works in the US.

Are you disgusted yet as well?

I’m trying to illustrate how bad it is to have a medical condition in the United States. Even if your insurance claim is approved, you still may not receive care that fixes it. You just have to ‘manage’ the chronic disease.

And potentially deal with these insurance companies the rest of your life.

My advice? Print out those two screenshots and put them on your refrigerator and pantry. Or the refrigerator and pantry of your family members.

Remind yourself or them that every time you reach in one of those two places for that sinful desert, for that soda or snack, that you increase your chances of dealing with those insurance companies for the rest of your life.

It’s easy to think that you’re paying for health insurance. So if you become sick, the treatment is free. Whenever I suggest a new therapy at my assisted living homes, the first question I receive from the family is, of course…

“Is it covered by insurance?”

Maybe. Maybe not. 1 in 5 people are going to have it denied, right? For United Health people it might be 1 in 3.

And then how free is it to spend hours on the phone or researching what you can do to have the claim appealed?

Even if it is approved, in many cases that means more medications, more tests, and more hospital stays. With no guarantee of success. And possibly some unpleasant side effects.

@justtommyduh

#CapCut Side effects! #cancer #death #medication #viral

I say all this because the best solution is not to need any of these headaches.

Take your health into your own hands. Don’t let the temptation of ‘free’ medical care convince you to let down on doing whatever you can to stay healthy.

Even if you live in another country where healthcare is paid by the government, you’ll still hear horror stories of people denied care, or ridiculously long waits for procedures.

Insurance is something you want to pay for and never need. Think of health insurance the way you think of car insurance or life insurance.

Want some help avoiding the insurance appeal process or the medical industry all together? Book  a call with my health coach and me to see if you’d like to join our online community to help you thrive at your home. Not in a hospital or nursing home.