- Dean Peterson of Los Angeles said he was shocked when he was denied payment for a heart procedure to treat an arrhythmia, which had caused him to pass out with a heart rate of 300 beats per minute. After all, he had insurers pre-approval for the expensive $143,206 surgery. Even more confusing, the denial letter stated that the application had been denied because he had asked for coverage for injections into the nerves in his spine (he hadn’t) that weren’t medically necessary. Months later, after dozens of phone calls and a patient asking for assistance, the situation is still not resolved.
- A letter from the insurer was sent directly to a newborn denying coverage on his fourth day in a NICU. You’re drinking from a bottle, he said on the rejection notice, and you’re breathing on your own. If only the child could read.
- Deirdre O’Reilly’s college-aged son, suffering from a life-threatening anaphylactic allergic reaction, was saved by injections of adrenaline and intravenous steroids in a hospital emergency room. Her mother, completely relieved by the news, was less pleased to be told by the family’s insurer that the treatment was not medically necessary.
The ProPublicas investigation, released in March, found that an automated system, called PXDX, allowed Cigna medical reviewers to sign 50 charts in 10 seconds, allegedly without even reviewing patient records.
#Opinion #Denials #health #insurance #claims #rise #weirder