Ray Goldenberg wrote:
> On Sun, 20 Jun 2004 07:15:37 -0400, " H. Huntzinger" wrote:
>
> >Regardless of the source of the insurance, a claim can almost always be
> >contested in some way if the insurer so chooses.
>
> Hi,
>
> I have seen many claims over the years and I don't recall seeing any
> denied that were legitimate.
Of course they were, since payment isn't the hard part: the hard part
was the prior determination of claim legitimacy.
For example, in your recollections, what happened to those claims where
the legitimacy was in dispute, or could not be resolved?
Similarly, what are your recollections for what percentage of the time
that this occurs?
The blunt reality that not all insurance claims are paid.
Sure, we can all agree that those claims that were not legitimate
shouldn't be paid, but the problem is in determining legitimacy: this
process isn't perfect and probably never can be.
So there will be claim "errors" made where people who should have been
determined legitimate weren't paid, as well as claims that shouldn't
have been paid, are paid.
These "rejected good" and "accepted bad" errors are a risk in any
process. Some people will be more familiar with the descriptions of
Alpha/Beta Risk, Type I/Type II Risk, and/or Producer/Consumer Risk; the
concept is the same throughout: the risk of making a mistake in
judgement. When you study sampling plans (http://tinyurl.com/2usya),
you'll find out that it is not unheard of for these sorts of "error"
risks to sometimes be 10% or more.
-hh |