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Rejected, Disallowed, Denied, Refused

Rejected, Disallowed, Denied, Refused

I'm receiving notices from Blue Cross's “claims administration” as to why they won't pay for certain dental procedures, or why they'll only pay partially. Dentists in Rhode Island are leaving the state because of horribly low reimbursements compared to other states in the northeast.

I'm wondering who becomes a health claims adjustor. I understand people going into the mortuary business, or cesspool cleaning, or mold removal. After all, once effectively completed, people are better off and a tough job (emotionally or physically) has been done well, an important service provided. Auto and property claims adjustors are needed to control excessive claims and also to protect their customers from fraud.

But do people aspire to be health claims adjustors? I've met doctors, bragged about by spouses, only to learn that they sit at a desk all day approving and rejecting claims, never having had a patient or hospital privileges in their careers. I've saved more lives than they have.

I think Waylon Jennings and Willie Nelson sang a song, “Don't Let Your Babies Grow Up to Be Cowboys.” Don't let them grow up to be health claims adjustors, either. Anyone who loves denial that much has some serious issues.

 

Written by

Alan Weiss is a consultant, speaker, and author of over 60 books. His consulting firm, Summit Consulting Group, Inc., has attracted clients from over 500 leading organizations around the world.

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