A little more to this.
I processed medical claims for 7 years. Never once was I instructed or guided or led to believe it was okay to wrongly deny a claim. Claims processors were constantly reviewed and tested, harped-on for accuracy. Signs on every supervisor's door, showing how 99.9 % accuracy is not good enough. If you process one million claims at 99.9 % accuracy, that's still 1000 errors. From what I saw, they do not do anything wrong on purpose.
But, claims can be complicated. Especially big hospitalization claims. Crazy intricate. So, errors are made. People just don't talk about all the claims handled correctly. Everybody (including me) has horror stories about health insurance.
In order for a claim to be processed correctly though, it has to be submitted correctly. The hospitals, clinics, dr's offices have to be accurate too.
And of course, there is always the random person who is trying to pull a fast one, and get something for nothing. The patient who pisses and moans about how things aren't done the way they think it should be done, and wants everything covered or paid for.
Was getting an oil change last week, and an old woman had an absolute shit-hemorrhage because they wouldn't give her one more free oil change with the car she bought several years ago, or something. The poor woman behind the counter had to go get two managers, and in the end the old lady made a fool of herself. Prime example of people who expect things they're not due.
