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Speed over accuracy: probe focuses on VA claim denials

On Behalf of | Oct 10, 2017 | Denied Insurance Claims

“[P]ick-n-click and get them moving.”

Sadly, that description relates to what a health care claims processor with the U.S. Department of Veterans Affairs says has long been the process by which he and fellow employees have evaluated disabled veterans’ medical claims following received care.

According to a recent media investigatory report, many vets across the country who were convinced — in many cases, told by VA employees — that their care was covered and that their emergency claims would not incur personal liability ultimately experienced a post-care reality marked by far different circumstances.

Like staggeringly large bills from third-party providers they were referred to by the VA. Like recurrent and harassing phone calls from collection agencies.

A VA whistleblower says that he was deemed an “exceptional” employee for hitting a review target off 22 claims per hour. And that under-three-minutes-per-claim assessment related to emergency visits that the above investigatory story notes required him in each instance to “make a series of determinations.”

And that is simply not possible, he recently told reporters, adding that it has routinely led to quick denials and subsequent uncovered bills sent to veterans who were actually covered for the care they received.

“We are accountable for speed,” says the whistleblower.

Stories forthcoming from care-entitled vets who are ultimately denied coverage are not dissimilar from complaints routinely made by legions of non-military individuals and families across the country.

Frustration and even great fear mark the emotions of claimants every day who know they have coverage entitlements and yet encounter delay tactics or outright denials from insurers, subsequently receiving punishingly high medical bills.

In the above story, some veterans have seen a reversal of their situations, with the VA reportedly engaging in “a sudden about-face” in the wake of a formal probe into the agency’s claim processing and inaccurate denials.

A strong and timely response from proven claimants’ rights insurance attorneys can yield a similarly positive result in the wake of bad-faith or other questionable conduct from insurers that fails to properly address a legitimate claim demand.

Policyholders who fully honor the terms of their insurance contracts fully expect insurers to act the same way.

When they don’t, a diligent and aggressive legal response can often change their minds.