A very long time ago, I ran a self-insured health insurance fund for a non-profit organization. I processed claims, then turned around and filed them with our stop-loss insurer. Much of my job involved making sure the stop-loss insurer paid the claims. This was way back before the Affordable Care Act (the ACA, or Obamacare) changed the landscape of health coverage in the U.S., but some of what I learned is still applicable.
I am impressed by ProPublica’s article on health insurance claim denials: You have a right to know why a health insurer denied your claim. Some insurers still won’t tell you.
I’m even more impressed by their request your claim file site. It’s an excellent resource.
Today, I saw another helpful site for the first time: Fight health insurance with AI
It isn’t associated with ProPublica (as far as I know), but it could be an excellent resource for people who are in a battle with an insurer. I’m generally underwhelmed by anything written by an AI tool, but there are situations in which they are helpful. This is one of them.
I would love to hear from people who are using these tools. (We’re very fortunate in that we don’t have a need for them at the moment.)