And “manual scrub”, in practice, meant “find any reason to deny”.
> Some 60% of the claims weren’t reimbursed at all.
The article gives examples of very normal billing errors that were used as the pretext for this.
It’s very clear they knew they didn’t want to pay the claims. Even in advance of the procedures.
> Then, a week or so before her surgery, Arch was wrangling child care and meal plans when she got a call from the insurer. The representative on the line was trying to persuade her to have the surgery elsewhere. She urged Arch to seek a hospital that, unlike the center, was in network and charged less.
>> Some 60% of the claims weren’t reimbursed at all.
>The article gives examples of very normal billing errors that were used as the pretext for this.
Are you talking about this blurb?
"Blue Cross did not accuse the center of any intentional miscoding — but the sloppy billing led to additional scrutiny, the company’s witnesses said. "
I'm not sure what the alternative is. Are they supposed to pay even though the are errors? Are they saying, "you only have one chance to file a claim, and there's a typo in it so we won't reimburse you a dime?". It's not clear from the article why exactly they're denying the claim, aside from maybe the place being overpriced.
> Some 60% of the claims weren’t reimbursed at all.
The article gives examples of very normal billing errors that were used as the pretext for this.
It’s very clear they knew they didn’t want to pay the claims. Even in advance of the procedures.
> Then, a week or so before her surgery, Arch was wrangling child care and meal plans when she got a call from the insurer. The representative on the line was trying to persuade her to have the surgery elsewhere. She urged Arch to seek a hospital that, unlike the center, was in network and charged less.