How and why health insurance claims are denied and appealed

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Much national discussion about our health insurance system has been sparked by the terrible murder of UnitedHealthcare CEO Brian Thompson in New York earlier this month. Among major health insurance, UnitedHealthcare has the greatest rate of claim denials, according to Lending Tree and Value Penguin study, which has sparked Americans to share terrifying tales about denied claims.

The wisdom of having companies with subsidiaries that sell health insurance and provide healthcare, respectively, has also been questioned. The Kelsey-Seybold clinics in Greater Houston, for example, are owned by Optum, a division of UnitedHealth.

With the assistance of Dr. Vivian Ho, a health economist at Rice University and Baylor College of Medicine, we go over the intricacies of health care insurance and the claims process in the Houston region in the audio above.

We also speak with Dr. Miranda Yaver, who has been studying coverage denials for a book and is an assistant professor of health policy and management at the University of Pittsburgh. Additionally, she is the author of the Substack “Rationing by Inconvenience.”

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