I worked for a non-profit insurance company, (Fidelis Care,) that was purchased by a for profit conglomerate, (Centene.) Health insurance companies deny appropriately billed and coded shit all day long hoping:

• you don’t know your rights
• you can’t figure out how to submit appeals if you are smart enough to know your rights
• you will give up because the process is too complex, can take as much effort as a full time job, and can lower your credit rating while you wait for the appeals process to pay out.

I witnessed appropriately coded claims get improperly denied all day long. I spent most of my time working there helping people file appeals, or giving them the information to the state agency where they could file external appeals after our own review team denied their internal appeal.

Right before covid hit, a gentleman was approved for pain injections, but couldn’t get into the office before his authorization ran out, because anything non emergent was closed. Once the doctor’s office was open, the doctor submitted a new request, with the same clinical information, and it was denied. I put an appeal together for this man, painstakingly pulling the clinical records from the first authorization, the second authorization, EVERY PAID CLAIM related to his condition, AND EVERY RX CLAIM FOR PAIN MEDS the company paid for to demonstrate medical necessity. 4 hours of work. The appeals team denied it in 15 minutes later, it was absolutely not reviewed. This is the straw that broke the camel’s back and made me rage quit Fidelis.