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Sure we could save lives by listening to doctors! But who will save our dollars, huh? The REAL value!
My $7000/mo medication has a bunch of “cost relief” programs so they can pretend that they give a shit about affordability, then when you actually try to use them they make you do like 20 phone calls over the span of several months until they finally let you enroll and when you do it only lasts for a short amount of time before they kick you off and you have to start the process all over again. I’ve had to miss multiple doses of the medication which is dangerous for my physical health because I don’t have the money to pay for it and this process takes so fucking long.
Recently, they signed me up for some super shady thing where I pay for the medication upfront and then they pay me back after showing me the receipt. What they didn’t tell me is that it has a limit for how much it will pay for, so I pay for the medication, and what a surprise, they rejected my claim and now I lost $5000 to the medication, which could have paid for a car or a semester of community college. Our healthcare system does a great job at making dying sound like a decent alternative to healthcare.
I work for a neurologist practice, and the amount I have to argue with insurance (and inevitably have to get the neurologist on the phone to directly request something for many) is insane. A good chunk of my job isn’t providing care, but arguing with insurance that the care is necessary. These companies are actively delaying patient care, and try to blame the physician whenever possible.
Wildly infuriating, especially when the denials are worded along the lines of “we reviewed this, and don’t consider it medically necessary”. Motherfucker, a doctor said it was necessary and listed the clinical reasons why this test or procedure would be beneficial. Nothing has radicalized me for universal healthcare more than working in healthcare.
People love to shit on the VA, because they’re the largest American healthcare provider in the country so there’s a lot of bad stories
But my last MRI went like this:
Doctor: you need an MRI, let me check if it’s open. (Less than a minute on laptop). Ok, go down to room ____ and they can get you in now.
There’s a huge up front cost for that machine, so for profit hospitals went everyone to use it to make the money back, and insurance wants no one to use it so they don’t have to pay.
Take insurance out of the picture, take the hospital trying to make money out of the picture. And it’s really that easy. No one pushes for unnecessary tests, no one tries to prevent necessary tests. And there’s a huge push towards preventive medicine, because it’s cheaper to catch shit early.
We already pay more than what it would cost, it’s just the healthcare industry donates to both parties, so as long as both standards are “at least they’re not the other team” shits never going to get fixed.
If we hold higher standards than that, it won’t take many election cycles to get change to actually happen
It’s cheaper to catch shit early.
This is a huge takeaway. Insurance doesn’t care about your longevity, health, quality of life or even long term costs.
People hop insurance providers all the time so the companies are literally focused on profits quarter by quarter.
Hospitals should unionize and sue the the ever-loving shit out of insurance companies for lost time. Not like our neoliberal politicians are going to do anything about it.
How is that even legal? How is someone who hasn’t examined the patient and isn’t their physician allowed to make treatment decisions? If they even have the necessary qualifications.
They’re technically not making treatment decisions, they’re making payment decisions about treatment decisions. Effectively it’s a distinction without a difference though. And it’s usually a “doctor” working for the healthcare company rubber stamping the denials. It’s a thoroughly shitty system.
Specifically, it’s the doctors who technically passed med school, but only just. They’re not going to practice medicine anywhere else, but they can make good money writing up legally protected reports that say “in my professional opinion, this patient’s lack of arms does not prevent him from going back to his roofing job”.
Because of money!
Every time you see something that feels illegal but isn’t, or that makes no sense in general, look for the money trail. There’s always one, and it always leads to the explanation.
In this case, insurance companies have made such an absolute ass ton of money by killing off their customers that they have become a political entity. They now use their deep pockets to lobby politicians to keep their scam legal.
This is 100% the answer
I feel like we’re getting to the point that this needs to be an election deciding issue. It won’t be this upcoming election, but probably the one after where the presidency isn’t on the line. We need to ignore republican/democrat talking points and elect based on a will to completely revamp the system. Obama tried but it didn’t go far enough. Once its bad enough that people are willing to cross party lines to fix it, then you’ll see change, and I (probably too optimistically) think we’re almost there.
On the flip side, I can’t imagine being the person arguing for the insurance companies makes them a better or happy person in the long term. Being a devil’s henchman, over time it must destroy important parts of them like empathy, trust in people, and their basic human decency. Virtues that are needed now more than ever in society.
I expect it’s like any call center - the computer spits out a result and they have a script to follow, and are not allowed to stray from the script
This part isnt brought up enough. You can take more severe examples, folks working in slaughter houses, military translators marking targets based on vague phrasing, and they have well documented negative effects on people who work those jobs in general.
Theres no reason to think someone working an insurance claims job might not develop the same type of problems if they feel they are helping cause harm, even if to a lesser degree.
Well yeah that’s why they keep doing it
And some doctors themselves will be hesitant to give care that might not be provably required beyond all doubt but is objectively prudent.
Universal health care? I don’t want government making my health care decisions! We have for-profit companies for that.
Do people believe that there? I can assure you the government has no roll in our health care decisions, and what the doctor wants the patient can always get.
Far too many, yes.
Oh yeah, it was a major propaganda position back in the 00s and it’s part of how obamacare got that way.
Yep. The two main arguments were that the ACA would create death panels and that people would no longer have a choice in their healthcare providers. But both of those were, and still are, the status quo with private, for profit health insurance providers being involved in care.
Death panels?
Believe it or not, that’s also Frank.
Feank is a busy man. Denying medical treatments, sitting on death panels. Is there nothing Frank can do?
Oh yeah, Frank can’t approve medical treatment.
Fun fact, he was named after the health insurance industry’s inspiration, 1789 France.
Don’t be so sure it would be different. I collapsed, nearly drove off the road 3 times in one week and decided that it was enough and went to the doctor. He sent me home, wrote me in as extreme burnout (completely true, I had to sleep at work for every coffee break to make it through the day and 30 mins before driving home to actually make it). So I thought Great, I will rest for a few months and go back to work after that! Nope. The state heath insurance office said Our specialists decided, that you are perfectly fine. No sick pay. Get back to operating the industrial concrete blender. The health center doctors signed a letter, but no, I was fucked. So on top of this I got extreme financial stress. We got out of this crap by renting our cabin and starting going full into an outdoor adventure business. What a great time. Where was this? In Sweden in January 2019.
Sounds like a flaw in the system. I fail to see how health insurance should ever be involved between patient and doctor in a “universal” health care system. Sure doesn’t happen where I live.
Sounds more like an intended feature
Well, they got denied by Försäkringskassan, “Swedish Social Insurance Agency”. Basically wouldn’t be able to get sick-pay, but that’s about it. Which is a bit weird, as nearly all first-time requests get approved, but of course it happens.
So it’s not really the same thing as American insurance denying; they’re still able to seek care, just that the suggested treatment for burnout (pause from working) wouldn’t be economically comfortable if Försäkringskassan denies their sick-pay.
It’s cute that you expect Americans to feel sympathy because your employer didn’t take your burnout seriously
Yum… crab bucket.
I knew someone that literally went blind due to stress and still had to go in for work lol
Oh, most of us do, we’re just too burnt out ourselves to do much but grunt out, “sorry, bub. I know it sucks.”
That’s how I end almost every conversation.
Sometimes the Frank is an AI that is wrong 90% of the time. That’s fine, because reasons.
Sometimes the Frank is an AI that is wrong 90% of the time. That’s fine, because
reasons$$$.I fucking wish. At least then I wouldn’t have to be put on hold for 30 min just to have to eventually explain to a person who was hired 3 weeks ago how to do their job.
Private insurance always has you speak to an actual adjuster for authorization, mainly because they know any sort of automated system would be more accurate and faster than having you talk to their undertrained and understaffed employees.
Private insurance’s goal is to erect as many barriers between the provider and the patients as possible, and then blame the provider for all the barriers. It works every time.
“I have the best insurance, they told me it would be covered”. Nope, Medicare is the best insurance and you traded that away for a privatized Medicare supplemental that lies to you about your coverage.
Prior authorization should 100% be outlawed. It’s either insurance adjusters practicing medicine without a license, or insurance doctors making diagnoses without examining a patient, both of which are unethical or illegal.
Though I think the real solution is a system where every time a prior authorization denial is overruled by the DOO or a court, the insurance company has to pay punitive damages of at least $200,000 to the patient.
Maybe if you can’t afford to pay premiums that allow you to have an IRM, just
don’t indulge in expensive illnessesdie already.Think we could make Lemmy a household name by having the C suite of companies that do this SWATed? The government doesn’t work so we’re going to have to do this ourselves.
don’t joke about that, you might cut into their profits if it happened. /s
i have a friend who’s a transplant patient and has been taking the same meds for over 10 years post transplant-- every year it’s a furious battle with insurance who, every year, decides the meds are no longer “medically necessary” and drops coverage for it. fucking helloooo these are anti-rejection pills, the textbook definition of “medically necessary.”
it’s not that insurance companies are stupid, it’s that they’re saving money on people dying when those people don’t get what they needed to live.
insurance is the biggest fucking scam of all time
I have a chronic condition that requires expensive medication. Every. Single. Year. I have to fight insurance to renew the prescription. I went without for months the first time and ended up needing a far more expensive surgery to fix the damage it caused. I was already pretty left-leaning before my diagnosis, but now I don’t believe there is any justification for private anything in healthcare. It’s a completely morally bankrupt business to be making money off of people’s unavoidable suffering.
The insurance system does not work in the medical field, it would never work because insurance is for managing risks that are unknown, like a house flooding or your car getting hit in an intersection.
In medical “insurance” it is often dealing with known issues, and the insurance system is just not set up to deal with preventative care, annual check ups, mammograms, blood tests, or pre-existing conditions. It would be like trying to use car insurance to pay for an oil change, which is just as ridiculous as it sounds in your head.
That’s exactly why the term “insurance” should be used when discussing a single payer system, it’s not really insurance, it should be a collective action group that works together with the medical community to find a middle ground where hospitals can still exist and pay wages to their staff, the people can get the medical care they need without getting thrown into poverty for daring to get sick, and the government benefits from having a healthier population as a whole.
Too bad theres way too much money in the short term in keeping this all private, and having a sicker population, so we have decades of insurance company propaganda to work against, and a huge population of people that don’t understand that by doing single payer health care your taxes would go up, but you also wouldn’t be paying out the nose for medical insurance & medical care (because they don’t cover anything). Also think of a world where your health care isn’t beholden to your employment, all the different choices you’d make in your life.
But insurance companies said that if everyone paid for insurance, especially the people who don’t need it, that costs would go down
I don’t get it why americans still put up with this if I suffered from that in France I would just leave my country.
The health insurance company has little motivation to care about your health, but doctors have little motivation to care about money and money is actually important too. Ultimately you end up paying for all that unnecessary testing and there has to be some mechanism for controlling cost.
With that said, one time I was appealing a rejection of home care for my grandfather and I mentioned that his condition had declined and he was currently in the hospital. The guy from the insurance company said that clearly someone in a hospital doesn’t need home care and so my appeal should be rejected and I should file a new claim (which can take months) after my grandfather was home again. The arbitrator didn’t agree with that (although she said that she could postpone the hearing until he was discharged if that was what the insurance company wanted) but I was still so angry.
That study is idiotic. It’s literally an embodiment of the joke: “You could have found it faster if you looked in the last place first”.
Standardized triage testing has been shown over and over to save many more lives than doctor intuition alone. Just because a test rules out a diagnosis doesn’t make it “unnecessary”.
Frank didn’t even look at it. He just fed your claim into their computer and it spat out a rejection.
Bold to assume he bothered to feed it to a computer when you can just reject without having to do that. Feeding something to a computer takes time, and time is money y’know.
Everything is filed electronically, having a person step in will always be more work and money dude…
And leaves a nasty paper trail!
Frank bought a self-inking stamp that says “REJECTED” and saw a 70% productivity increase.
Frank has management written all over him!
Nonsense. Frank was replaced with an AI years ago. It only took a half hour to train on a Raspberry Pi.
Everyone should also remember that it’s going to get worse. People, especially nurses, are leaving the medical field. GPs are becoming scarce, and boomers are taking more and more of the medical resources available as they age. It’s going to get harder and harder to get timely medical care at all, let alone getting it without bankruptcy.
American health insurance in a nutshell: https://youtu.be/llx-SaGq4Fs?si=eDIny0fqcGYFkB2a
And before non-Americans ask, yes, that’s actually how it is. The humor in this video isn’t from exaggeration, the comedy derives from the unexpectedly clear way the absurdity of the system is explained.
it seriously blows my mind that the overwhelming majority of my fellow americans tolerate this system, that is if they don’t downright approve of it. The issues mentioned in that video are not isolated incidents. They are common, everyday, business-as-usual practices that almost all of us deal with.
Yep! The last bit is more of a joke, but the rest is pretty spot on with how the stupid system works. Here’s another example of a video explaining US Healthcare.
The episode of South park where they walk into this 22nd century insurance building and ask to make a claim. They get sent to the “claims office” and it’s like they went back in time to the 1980s with dot matrix printers, rotary dial phones, and fax machines.
Here is the link if anyone is interested: https://www.youtube.com/watch?v=VAfy26xs6e0
I love BDG, everything he makes is fantastic
20 years of experience believes
What are ‘experience believes’? Is this sentence missing some punctuation?
I’m a grammar nerd, but come on. This doesn’t help anything.
There should be a comma after experience.
No it’s fine as is. That person just read it wrong, that’s all.
No, there shouldn’t.
Oof man. Reread the entire sentence.
I’m drunk in the back of the car and I’m crying like: a baby coming home from the bar.
Had surgery to correct an underbite a few years ago after prepping for it with braces for years. For context, I was still young enough to be on my parents’ insurance. The surgery involved moving my upper jaw forward and my lower jaw back because the underbite was so severe. The insurance denied the claim. My parents (I love them so much for this) decided beforehand that, if the claim and the appeal were denied, they would instead “gift” me the money out of their own retirement savings and have me pay for it. The procedure alone cost, I believe, $16k out of pocket. (I don’t remember the specific reason why they gifted me the money instead of paying for it outright.)
It might be that you HAD to be the one to pay for it. When I hit a certain age, all the insurance cheques were made out to me, and I had to deposit them and transfer the money to my parents.
(Though this was insurance for therapy, so maybe it’s different?)
Insurance wasn’t involved when it came time to pay for the surgery. By then, they’d already denied the claim and the appeal, so they were paying completely out of pocket for the surgery.
Right, but it might still have to be you paying, insurance or no.
