>Few patients appeal when insurers decline to pay for their care. Many don’t even know they can. But new data show that when they do, they frequently win — in some plans, nine out of 10 times.

If 90% of denials that are challenged end up being reversed, and the delay in delivering the care that the insurer contractually agreed to deliver is deleterious to the patient's overall health and leads to prolonged suffering, why is this not a cause of action? Until there is some sort of downside introduced, the "deny til they die" health insurance model is going to continue to thrive at the expense of people not getting the care they paid for and are entitled to.

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nostrademons a day ago | parent | next [-]

It can be! If you've got a crack legal team at your disposal, you can absolutely sue over insurance denials that put your health at risk. The problem is that most folks who need an insurance plan that regularly denies them also don't have the money to afford a crack legal team to sue the insurer. (If you're that wealthy, typically you would just have a private physician that you're paying directly, who has no problems treating you promptly because that's what they're paid to do.)

This is representative of a general problem with the legal system today. It's too expensive, and operates too slowly. When the economics of cheating people were that you might be able to cheat 10 people before you pick on the wrong guy who has a lawyer that puts you out of business, you have an incentive to follow through on your contracts and do what you say you'll do. When the economics became that you can cheat 10 million people before you pick on the wrong guy who sues you, it becomes rational to take the money from those 10M people and use it to outspend the guy who sues you, or at least just pay him off so he goes away. And so our western notions of democracy and contract law get subsumed into a feudal system where only big corporations get protection of law, and you must join the local protection racket to slot into that system.

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FireBeyond a day ago | parent [-]

The problem is that when such things happens, insurers have said - and won - in Court with:

"We are not denying or delaying care for our customer. We are, instead, only noting that we are not going to be the Responsible Party for paying for it. They are, as they have been all along, free to get the care they believe they need and pay for it themselves."

	▲	ratelimitsteve 9 hours ago \| parent [-]
		This brought to you by the same legal scholars that brought you theories such as "Everyone knows 'own' doesn't mean 'own'" and "It's okay to give the judge hearing your case tons of money because that's just gifts between friends as long as you don't explicitly say it's a bribe". Our legal system seems to be based around deciding on the outcome you want regardless of rationality or the law, talking nonsense long enough that it seems like there's intractable disagreement and then declaring your solution to be the common-sense middle ground.

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ActorNightly a day ago | parent | prev [-]

They don't count the claims that are never fought in the first place. Which i would wager is the majority.

	▲	ratelimitsteve a day ago \| parent [-]
		but do you have any evidence beyond intuition that those denials differ significantly in reversal rate? one would guess that things that are never going to be covered get denied and then never appealed but one would also guess that things that are never going to be covered don't get submitted in the first place. assuming that the rate of legitimate denials is higher among those claims never appealed, what rate of illegitimate denials is acceptable? why would denying even one person care that they're contractually entitled to receive be okay? why shouldn't insurance companies have to do what they promise to do and accept money for?