Eh, we're currently fighting to get some claims covered. Before a certain date, all the claims are denied; after a certain date, all the claims are approved. The claims are all for the same thing, related to the same procedure (physical therapy after a joint replacement).
Could the claims have been rejected due to a simple human error? Sure, it's plausible. Was there another human error that caused the claims to be rejected after we appealed? Maybe, but probably not. Could a third human error cause the claims to be rejected again after our second appeal? Seems pretty unlikely.
Yeah, in your case it seems reasonable that the denials are malicious.
I guess I'm not seeing why the poster I was replying to declared that getting access to the claims file was useless. Wouldn't getting access to that file make it easier to prove that claims were wrongfully denied?
Could the claims have been rejected due to a simple human error? Sure, it's plausible. Was there another human error that caused the claims to be rejected after we appealed? Maybe, but probably not. Could a third human error cause the claims to be rejected again after our second appeal? Seems pretty unlikely.