A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims
If you&#x27;re a tech entrepreneur, it&#x27;s the first story in here that should alarm you the most. It&#x27;s about denying coverage altogether, not about denying individual claims. Outside of the &quot;guaranteed issue&quot; ACA market, there is virtually no due process for coverage denial. You can be denied on a whim, with little recourse.<p>The list of conditions for which insurance outside the ACA will be denied is long and opaque. The story makes it sound as if they&#x27;re looking for reliably diagnosed conditions like diabetes. No. They&#x27;re looking for <i>indicators</i> of a long list of <i>potential</i> conditions. If you or your spouse has a functioning female reproductive system, the chance of your family being denied is high, even without a diagnosed or treated condition. We were denied for something like that, and also because my daughter had an unexplained seizure when she was 4 (she&#x27;s now 16 and just fine). To get insurance for the first couple years of Matasano, my wife had to take a crappy full-time job with group coverage.<p>Without insurance, a typical working family is one major medical incident away from zeroing themselves out. My daughter has never met a pickleball net that didn&#x27;t break her ankle (she has met one pickleball net). Even with insurance, the cost of that injury was high single-digit thousands of dollars. Without it? The cost of a pretty decent car.  Find a friend who&#x27;s had an appendectomy some time and try to find out how much the insurance company was (nominally) billed for it. A down payment on a house.<p>If you work in this industry, intend ever to start your own business and potentially have a family at the same time, you should be extremely alarmed at the prospect of guaranteed issue regulated health insurance (the ACA) being replaced.