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Originally Posted by flstf
Surely they are not denying valid claims just to improve the bottom line.
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Of course they do. Can you imagine how profits would soar if you deny particularly expensive claims? Pacificare denies
39.6% of all claims. There's no way that 2/5ths of all claims made are simply medically unsound.
You don't go into business to help people, you go into business to make money. That's what businesses do. If you can make a ton of money by helping people, great, but that's pretty rare.
Quote:
Originally Posted by flstf
Wouldn't lawyers have a field day with these cases?
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Medical insurance companies employ lawyers, too, and they're likely very good at ensuring that the language denying the claim is air tight. "That wasn't covered" or "the procedure is investigational" are incredibly difficult to demonstrate as fraudulent in court.