A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims
If you're a tech entrepreneur, it's the first story in here that should alarm you the most. It's about denying coverage altogether, not about denying individual claims. Outside of the "guaranteed issue" 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're looking for reliably diagnosed conditions like diabetes. No. They'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'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'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'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.