here's a reason the healthcare industry is one noticing one of their CEOs is recently buried... Anthem Blue Cross kept insisting a woman pay 65k for a helicopter ride when she was unconscious, that saved her life, because they claimed it wasn't preapproved (get permission before a heart attack?) but instantly insisted that was an error, once she got the local news involved to give them bad publicity

As Boley was reviewing all the medical bills paid by her insurance company, she found the bill for the helicopter transport.

“They were denying the claim because it didn’t get preapproved,” she explained.

Boley showed 13 Investigates an explanation of benefits (EOB) from Anthem Blue Cross and Blue Shield that said the insurance company would not pay for the air ambulance because “This service requires preapproval. Your plan doesn’t cover this service without it. You are responsible for this amount.”

“I do not agree with this decision. I want an independent external review,” Boley wrote. “I am certain my diagnosis will be on the list where preapproval is not required. The transport via helicopter was medically necessary and transport any other way would have posed a threat to my survival or seriously endangered my health.”

Anthem turned down her appeal — not once, but twice.

The insurance company doubled down on its preauthorization requirement, insisting “Your claim was processed correctly. Air ambulance services are subject to medical necessity reviews by us and will only be covered when approved in advance (before services are performed). There is no preauthorization on file approving this service.”

“That night I was dead and then I was unconscious. I don’t know how I’m supposed to get preapproval,” Boley said as she looked at her denial letters.

After battling her insurance company for months with no success, Boley contacted 13 Investigates to explain her struggle with the insurance company. 13News then contacted Anthem on Boley’s behalf, requesting that the company further explain its denials and reverse its decisions.

Jeff Blunt, Anthem’s senior director of corporate communications, told 13 Investigates:

"Emergency treatment never requires prior authorization, and our members can access emergency services 24/7 at any facility, regardless of network status. In this case, coverage decisions were made without the necessary information from the provider to recognize that this was an emergency. Once we became aware of the circumstances, we should have acted immediately to obtain that documentation and approve the claim—but we did not.

Jeff Blunt, Anthem’s senior director of corporate communications, told 13 Investigates:

"Emergency treatment never requires prior authorization, and our members can access emergency services 24/7 at any facility, regardless of network status. In this case, coverage decisions were made without the necessary information from the provider to recognize that this was an emergency. Once we became aware of the circumstances, we should have acted immediately to obtain that documentation and approve the claim—but we did not.

13 Investigates also requested clarification about Anthem’s prior authorization policy. While the company insists “emergency treatment never requires prior authorization,” Anthem repeatedly sent Boley EOBs and appeal denial letters stating the opposite.

“It doesn’t even make sense,” said Patricia Kelmar, senior health care campaign director at the U.S. Public Interest Research Group (PIRG), which tracks public health issues affecting consumers.

“We know right now that insurance companies are using AI [artificial intelligence] to deny claims,” Kelmar said.

https://www.wthr.com/article/news/investigations/13-investigates/denied-insurance-company-unconscious-patient-failed-to-get-preapproval-life-saving-air-ambulance-emergency-medical/531-4ae8b22e-ee71-48f6-891a-2c858a8de5de

What's this got to do with cars? Nothing. But a helicopter was the issue, and I cover those. And it's important that you know how fucked up one of the biggest health care insurance companies is in treating it's customers.