“Most of the time, my relationship with my health insurance company is more adversarial than collaborative,” she said. “You’re trying to force them to comply with the rules, and they’re trying to spend the least amount of money.”
A Fight Health Insurance user can scan their insurance denial, and the system will craft several appeal letters to choose from and modify.
The “dirty secret” of the insurance industry is that most denials can be successfully appealed, according to Dr. Harley Schultz, a patient advocate in the Bay Area.
“Very few people know about the process, and even fewer take advantage of it, because it’s rather cumbersome, arcane, and confusing, by design,” he said. “But if you fight hard enough and long enough, most denials get overturned.”
It’s often assumed that only doctors can file appeals, but patients can do it too, he added. Insurers reject about 1 in 7 claims for treatment (Schultz estimates that it could be as high as 25% for some companies), and the reality is that physicians just don’t have time for all that filing.
“I was in practice for many years, and if I fought every insurance denial, there wouldn’t be any time to do anything else,” Schultz said.
“In an ideal world, we would have a different system, but we don’t live in an ideal world, so what I’m shooting for here is incremental progress and making the world suck a little less,” she said.
So far, dozens have used the platform to generate an appeal, and Karau is assessing their feedback to fine-tune the platform and make it more effective and easier to use.
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