A short thread on how to get a health insurance claim denial reversed (UPDATED)
Originally found on Bluesky here, I am reposting here on Tumblr hoping that this gains some traction coz I know a LOT of folks who could benefit from it here in the US healthcare system.
Please, please, please reblog this and TAG it (if you have additional ideas for tags, go for it).
UPDATE: And then ProPublica added a godsdamned FORM you can use!
You likely have the right to access records that explain why your insurer denied your claim or prior authorization request. Use ProPublica’s
[ Image Description: A series of posts by rahaeli @/rahaeli.bsky.social. The thread reads: "To everyone in a similar scenario: the tactic my doctor's office has taught me is to ask, in writing, for: 1) the name, board speciality, and license number of the doctor making the determination the treatment was not medically necessary;
2) copies of all materials they relied on to make their determination; 3) proof the doctor making the determination has maintained registration in your specific state and documentation of their meeting all their continuing education requirements;
4) the aggregate rate at which similar treatments are denied vs approved by the specific doctor being used for peer review.
You are not entitled by law to *all* of these things in most states, but you're entitled to some of them, and you can always ask for them.
This is, she says, a wildly successful tactic, because if the insurance company answers them honestly, it gives you evidence that the "doctors" making these determinations are practicing medicine out of scope, without proper licensing and qualifications, in areas they are not competent in.
Everyone knows this is true; it's not a secret in any way. But it's in violation of a number of regulations, and a LOT of times the company will just give up and pay the bill rather than handing you proof they're violating the regs. It's a tactic that has worked for me many times." / End ID ]
