New Yorker: A Man Was Murdered in Cold Blood and You're Laughing?

[Silent Type]

14. You accept every thing you read. That's initial denials AND requests for additional info.

Private insurers are more likely to deny suspected improper claims up front than through audits years later. Over 80% of initial denials by MA are overturned when the doctor provides additional information like, "Oh, chit, we forgot to mention that the patient developed pneumonia just before the typical discharge date, please allow the additional days."

Many of the denials are partial denials, Doctor asked for 14 days of therapy, but we are only approving 10 days at this point and will reconsider additional days if patient is making progress. Original Medicare's payment policy might also deny claims after the typical, standard of care, period. If you read, UHC, Aetna, Cigna, etc., coverage policies, they mostly follow CMS/Medicare policies word for word. Whether those policies are applied correctly is another matter, but that's true under original Medicare too.

Medicare similarly denies claims.