@@thomasjust2663 The US government spent almost 2 trillion dollars on medicare and medicaid in 2021. The health care system in the US is so utterly fucked and broken that looking to Government just seems insane to me at this point. We could have both the largest military in the world and the best public healthcare if people didn't worship the god they call money and operated under a philosophy of honor and integrity over profits and politics. I really don't like the idea of our health care decisions being in the hands of people whose job it is to turn a profit. Preventative care and people not being obese and unhealthy is almost non-existent and would go a long, long way to stick it to the insurance companies and would literally and directly benefit everyone. Along with insurance companies not being able to fucking deny something a doctor says their patient needs. Obviously they shouldn't have to pay for any crazy thing someone wants done at their whim but a lot of times Doctors can't even order full spectrum blood panels without a battle if their insurance deems it "unnecessary". Wait until they're sick, we'll make more money that way. I think this is one of, if not the single worst, most criminal, evil and completely fucked up, and yet underrated, issues in the US and has been for a long time.
So a non medical person approving and denying medical procedures overruling a primary doctors advisement. Isn't that considered practicing medicine without a medical licence? And isn't that illegal?
@@ahealthcarez if a patients is paying for insurance to cover medical costs, and insurance decides its not necessary and refused pay... then not only is that making medical decisions for the patient, but that would also make it a scam.
I recently was diagnosed with 3 herniated neck discs c5,c6,and c7.I have health insurance which covers MRIs.They fought to deny covering an MRI for me that was in network.After finally getting approved it showed why Im in horrible pain.The doctors can stop the pain with a spinal injection and submitted all documents to my insurance company to authorize treatment.They keep denying.When I call they will promise they will approve "in the morning".Just empty promises and now Ive lost my job waiting on treatment approval.I feel hopeless and left in pain all day and night.Soon I will lose my home.Can insurance companies deny customers treatment without reason and just let them suffer if they wish?Is there anything a patient can do about it?
Hi, Eric Breker I have seen ur video n just wanna know more about denials since I m working in one of medical company where we do work on behalf of provider n work on claims wherein we get denials from insurance company. As I m new to this industry so, sometime I face challenges n problems in resolving claims so, could you please explain all denials which we get mostly?
Hi Vishakha, Sorry for the very late reply. Unfortunately, there is not a single, straight-forward answer. The first place to start is by calling the insurance company and finding out the reason for the denial, then go from there.
It was billed to the wrong payer u may have billed the local but they still forwarded it to the correct payer, but make sure you still call the provider number on the back of the card to ensure they received your claim and ask them for the correct payer ID
I fucking hate the US health insurance. they can pretty much deny anything with no repercussions.
The government rather wants to pay for the largest military im the world than public healthcare option for its citizens
@@thomasjust2663 The US government spent almost 2 trillion dollars on medicare and medicaid in 2021. The health care system in the US is so utterly fucked and broken that looking to Government just seems insane to me at this point. We could have both the largest military in the world and the best public healthcare if people didn't worship the god they call money and operated under a philosophy of honor and integrity over profits and politics. I really don't like the idea of our health care decisions being in the hands of people whose job it is to turn a profit. Preventative care and people not being obese and unhealthy is almost non-existent and would go a long, long way to stick it to the insurance companies and would literally and directly benefit everyone. Along with insurance companies not being able to fucking deny something a doctor says their patient needs. Obviously they shouldn't have to pay for any crazy thing someone wants done at their whim but a lot of times Doctors can't even order full spectrum blood panels without a battle if their insurance deems it "unnecessary". Wait until they're sick, we'll make more money that way. I think this is one of, if not the single worst, most criminal, evil and completely fucked up, and yet underrated, issues in the US and has been for a long time.
So a non medical person approving and denying medical procedures overruling a primary doctors advisement. Isn't that considered practicing medicine without a medical licence? And isn't that illegal?
Many believe yes. However, denying payment is not considered denying care and practicing medicine from a legal standpoint.
@@ahealthcarez if a patients is paying for insurance to cover medical costs, and insurance decides its not necessary and refused pay... then not only is that making medical decisions for the patient, but that would also make it a scam.
I recently was diagnosed with 3 herniated neck discs c5,c6,and c7.I have health insurance which covers MRIs.They fought to deny covering an MRI for me that was in network.After finally getting approved it showed why Im in horrible pain.The doctors can stop the pain with a spinal injection and submitted all documents to my insurance company to authorize treatment.They keep denying.When I call they will promise they will approve "in the morning".Just empty promises and now Ive lost my job waiting on treatment approval.I feel hopeless and left in pain all day and night.Soon I will lose my home.Can insurance companies deny customers treatment without reason and just let them suffer if they wish?Is there anything a patient can do about it?
I’m sorry about your situation. You can report them to your State Department of Insurance.
Hi, Eric Breker I have seen ur video n just wanna know more about denials since I m working in one of medical company where we do work on behalf of provider n work on claims wherein we get denials from insurance company. As I m new to this industry so, sometime I face challenges n problems in resolving claims so, could you please explain all denials which we get mostly?
Hey can you please tell me how many type of denial have . I think it's 24 resins of denial by a insurance company to the providers right
What will be denial code or reversal processing
Hi Vishakha, Sorry for the very late reply. Unfortunately, there is not a single, straight-forward answer. The first place to start is by calling the insurance company and finding out the reason for the denial, then go from there.
FB and WO, you can see that in bottom of the ERA
Hi Eric
could you please advise What's the denial code for insurance reason "claim will be forwarded to the plan for processing"
Hmmm, not sure. I am not familiar with that one. Sorry I could not be more helpful.
Hi
The reason code is B11
It was billed to the wrong payer u may have billed the local but they still forwarded it to the correct payer, but make sure you still call the provider number on the back of the card to ensure they received your claim and ask them for the correct payer ID
Somos