[1171]

A study of 50,000 claims in 18 states:
https://www.workcompwire.com/2018/07/gue...s-process/

A study of 273,000 claims:
http://riskandinsurance.com/70-percent-d...-and-paid/
***Unfortunately there is no link to the study itself and it does not indicate whether it includes an estimate of savings from denied claims that were dropped or not pursued.

Does this mean that stopping claim denials will lower employer costs overall?
The high cost of claim denials & litigation have been known for decades yet employers and carriers continue at a escalating rate.
Why???

[Shadow]

(07-13-2018, 05:12 PM)1171 Wrote: A study of 50,000 claims in 18 states:
https://www.workcompwire.com/2018/07/gue...s-process/

A study of 273,000 claims:
http://riskandinsurance.com/70-percent-d...-and-paid/
***Unfortunately there is no link to the study itself and it does not indicate whether it includes an estimate of savings from denied claims that were dropped or not pursued.

Does this mean that stopping claim denials will lower employer costs overall?
The high cost of claim denials & litigation have been known for decades yet employers and carriers continue at a escalating rate.
Why???

Good question ?

Baffles me personally when I see a simple prescription for an anti inflammatory denied through UR 80.00 ,and then denied through IMR 390.00.So it cost 470.00 to deny a 35.00 script.

I have had several things denied that cost more to deny than to approve.

Maybe there is a tax incentive some how?

[1171]

You might be interested in submitting comments/questions to the DWCs new Pharmacy advisory committee :
https://www.dir.ca.gov/DIRNews/2018/2018-56.pdf

There are probabably many factors that motivate persistent denials even with the knowledge of higher costs.
For carriers there is always the “Pass thru” effect. Carriers bill the employer for most of their costs including denials so they rarely have to eat any of the increase out of profits. Also appearing to be “tough on claims” appeals to many employers and can be a marketing advantage.
Human motivations are sometimes counter intuitive so paying more to stop a claim is perceived as being acceptable; especially if you think you are being taken advantage of.