That might be the case if you got to talk to someone with the ability to do anything about it. Customer service is just able to tell you what happened, not really make any change. You can file an appeal, but you can’t really ask for much during that process. It’s mostly automated and the people who process those have very specific criteria for overriding an initial decision and have a very short period of time they’re allowed to spend on each appeal.
So the only way you’d get to someone who might be able to access any of this information is through a lawsuit. Trying to intimidate a worker with no power, no access to information, and a very high quotas is unlikely to have much effect. And these companies all have more lawyers on staff and/or retainer than any of us could afford in a hundred lifetimes. And those people aren’t going to give that information anyway. Nor would they give it to any lawyer you might hire in most cases. Proprietary information has way more legal protections than consumer rights, even in healthcare. You’d need to get a judge to order that release of confidential information about an employee or proprietary algorithm in most states, unless you convince someone to sacrifice their job, their freedom, and possibly their life to become a whistleblower.
So unless your claim is in the hundreds of thousands at least, it’s unlikely you’ll spend less on lawyers just to get your case in front of someone who can answer these questions much less compelled them to give it. Otherwise, they’d have an incentive to pay claims in good faith in the first place. So there’s no intimidation felt on their end by things like this. It just makes them get I to a defensive posture if anything, and likely reduces your likelihood of getting an appeal approved in a timely manner.
Your best bet if your claim is denied and appeal fails and you actually have a case is to hope you live in a somewhat progressive state that funds their insurance commission and has more consumer-friendly laws, and go to them for help. Federal laws aren’t going to help much unless you have evidence of fraud or you understand all the details of the case and can point to specific contract language or laws they violated already. But in that case the appeal should be all that’s needed.
That might be the case if you got to talk to someone with the ability to do anything about it. Customer service is just able to tell you what happened, not really make any change. You can file an appeal, but you can’t really ask for much during that process. It’s mostly automated and the people who process those have very specific criteria for overriding an initial decision and have a very short period of time they’re allowed to spend on each appeal.
So the only way you’d get to someone who might be able to access any of this information is through a lawsuit. Trying to intimidate a worker with no power, no access to information, and a very high quotas is unlikely to have much effect. And these companies all have more lawyers on staff and/or retainer than any of us could afford in a hundred lifetimes. And those people aren’t going to give that information anyway. Nor would they give it to any lawyer you might hire in most cases. Proprietary information has way more legal protections than consumer rights, even in healthcare. You’d need to get a judge to order that release of confidential information about an employee or proprietary algorithm in most states, unless you convince someone to sacrifice their job, their freedom, and possibly their life to become a whistleblower.
So unless your claim is in the hundreds of thousands at least, it’s unlikely you’ll spend less on lawyers just to get your case in front of someone who can answer these questions much less compelled them to give it. Otherwise, they’d have an incentive to pay claims in good faith in the first place. So there’s no intimidation felt on their end by things like this. It just makes them get I to a defensive posture if anything, and likely reduces your likelihood of getting an appeal approved in a timely manner.
Your best bet if your claim is denied and appeal fails and you actually have a case is to hope you live in a somewhat progressive state that funds their insurance commission and has more consumer-friendly laws, and go to them for help. Federal laws aren’t going to help much unless you have evidence of fraud or you understand all the details of the case and can point to specific contract language or laws they violated already. But in that case the appeal should be all that’s needed.