It appears that many claims are first reviewed by administrative staff who determine if any medical personnel even see the claims. They are awful & absurd
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Pure greed. They take your money then find ridiculous reasons not to pay for services. Then their shareholders make money & the C-Suite gets millions in bonuses. This can’t go on. It’s unethical, amoral, unfair.
It sounds horrible. So bad in fact, that many good people in the medical care system are leaving the business. Most people who own Botox salons used to provide medical care to people. They just don't want to deal w/ insurance companies anymore.
I still contend that if MDs & hospitals had refused their capitated payments in the 80s when this started, we would be in a better spot. They used to refuse to pay for blood & would send the least educated people to deny claims in hospital business office.
Hospitals started having RNs defend the bills & they were starting to owe more money. They were stealing 10s of thousands of $ per ER patient on what they determined were blood products. When a patient arrives in the ER in shock, they need volume replacement & plasma is a great choice.
Plasma is a blood product but it was not being used to replace blood. It was being used to replace fluid volume. RNs knew that. The insurance companies couldn’t win that round. There were a lot of those small wins but not enough to stem the tide of their deplorable tactics.
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