Our ultimate goal here at MedicalCredentialing.org is to help you fulfill your mission as a healthcare provider: that is providing quality healthcare to your customers. And one action we’re taking to accomplish that goal is gathering current, quality information about the varying insurance companies and programs you deal with each day.
So, we surveyed 10 medical billers to get their honest opinions on popular insurers—such as Blue Cross Blue Shield, Magellan, and UnitedHealth—rooted in their firsthand experiences with said companies. And one of the questions we asked them was: Which insurance company is most likely to reject preauthorization for a medical procedure? You can review the results below, but first, I ask you to remember this: many health insurance companies require patients to meet certain criteria before they preauthorize or preapprove coverage for a medical procedure. And in order to preapprove, typically the patient has to submit a variety of records from notes to lab results. Therefore, if a patient doesn’t present the proper documentation, it’s understandable and common for an insurance company to reject preauthorization.
As you can see above, responses varied all across the board. However, Magellan ultimately received the greatest number of votes, with 30 percent of those surveyed saying Magellan is most likely to reject preauthorization for a medical procedure. Blue Cross Blue Shield and Medicaid weren’t too far behind, as they each received 20% of votes. And the remaining votes were split evenly between Humana, TRICARE, and Medicare—each coming in at 10 percent. More information about these insurance companies can be found below.
Magellan Health (30% of votes)
Again, Magellan was voted as the most likely to reject preauthorization for a medical procedure. This company prides itself on prioritizing its three core values, which include integrity, accountability, and caring. According to them, upholding these values enables them to best serve their customers and fulfill those customers’ needs. Furthermore, the company says, “no matter what health challenges arise, we simply believe that everyone should be able to live their best life.”
Blue Cross Blue Shield (20% of votes)
Blue Cross Blue Shield received 20% of the votes. This company values corporate responsibility by building and sustaining programs that have a positive impact on healthcare all across the country. Additionally, according to their website, “Blue Cross Blue Shield has led the healthcare industry by rising to the challenges that change brings, enabling new discoveries, and continuing to evolve.”
Medicaid (20% of votes)
Tied for second with Blue Cross Blue Shield, Medicaid also received 20% of the votes. Medicaid is an insurance program that provides low-cost—and sometimes even free—healthcare coverage to low-income individuals, families, the elderly, and people with disabilities. In some states, this program covers all individuals below a certain income level.
Humana (10% of votes)
Humana was one of three insurers to receive a portion of the remaining votes—more specifically, 10 percent total. This company takes pride in the fact that they cater to so many different customers, including families, military members, and seniors. In addition, it’s their goal to leave their mark and raise the standard of healthcare by not only improving the wellbeing of those customers, but the entire planet.
TRICARE (10% of votes)
Like Humana, TRICARE received 10% of survey votes. This healthcare program is specifically for uniformed service members, retirees, and their families, who live all around the world. According to TRICARE’s website, their vision is to “be a world-class healthcare system that supports the military mission by fostering, protecting, sustaining and restoring health.”
Medicare (10% of votes)
And to round out the survey results, Medicare also received 10% of the medical billers’ votes. This is a federal health insurance program for the following individuals: people 65 years and older, those with End-Stage Renal Disease, and certain younger people with disabilities. Different parts of this program cover specific services, such as inpatient and outpatient care and medical supplies.
As detailed earlier, health insurance companies have to follow proper protocol and also fulfill their core values—which might mean rejecting preauthorization for medical procedures. Most companies ask for specific documentation that proves the need for a given procedure, and if the patient can’t provide that, the insurer can rightfully reject. That being said, the medical billers who participated in this survey identified the above insurers as those most likely to reject preauthorization for a medical procedure.