> The TennCare Connect system—built by Deloitte and other contractors for more than $400 million—is supposed to analyze income and health information to automatically determine eligibility for benefits program applicants. But in practice, the system often doesn’t load the appropriate data, assigns beneficiaries to the wrong households, and makes incorrect eligibility determinations, according to the decision from Middle District of Tennessee Judge Waverly Crenshaw Jr.
Not at all surprised to see the name of a big consulting firm like Deloitte in something like this. How much money and productivity is lost to these leeches across our entire economy?
Leaving aside this particular case: how can potential recipients of benefits even know how or why they were denied to bring such lawsuits in the first place? Especially if they are forced into arbitration? For example I feel like private health insurance companies, particularly Aetna, deny many claims falsely as a typical approach to avoid having to pay out as much. And patients are then subjected to a long drawn out process with hours of wait times, hours of calls, and constant vigilance. This method of avoiding payouts by creating expenses for patients should be illegal. But how can anyone see what’s happening and be in a position to challenge it without even a basic level of transparency?
> how can potential recipients of benefits even know how or why they were denied to bring such lawsuits in the first place? Especially if they are forced into arbitration?
You get a letter in the mail, with a review of the decision they made. There is a section where they have to explain why they denied you. It is a direct, "We don't think you meet this criteria" statement.
IMHO, the state should be the one to approve/deny claims (except if they're duplicate claims within a time-period specific to the code). Leaving it to the insurance company to process the claim is akin to letting robbers play cops.
Not at all surprised to see the name of a big consulting firm like Deloitte in something like this. How much money and productivity is lost to these leeches across our entire economy?
Leaving aside this particular case: how can potential recipients of benefits even know how or why they were denied to bring such lawsuits in the first place? Especially if they are forced into arbitration? For example I feel like private health insurance companies, particularly Aetna, deny many claims falsely as a typical approach to avoid having to pay out as much. And patients are then subjected to a long drawn out process with hours of wait times, hours of calls, and constant vigilance. This method of avoiding payouts by creating expenses for patients should be illegal. But how can anyone see what’s happening and be in a position to challenge it without even a basic level of transparency?