Can't I just get care? I got a whole grown ass person's life to live, and i can't be an expert in everything.
Are you rich? Then yes. If you're not rich, then you need to suffer and struggle for needing to use valuable resources that could be used on people more deserving; like the wealthy.
You could but half the country voted for the guy who hates poor people
In most countries you can, yes.
You can get whatever you want, but you have a $37,849.45 bill because you used the wrong door.
See, that door you used was operated by Attenya Healathus, not the Hospital, which is operated by Wellmeat (formerly Agape Plalauthis) so your care was not covered. If you had entered through the door (as outlined in your EOB) to the right, it would’ve only been an $800 copay for your splinter removal.
Oh ya, you can get care. And then you fight with insurance about whether or not that was the right doctor to use or if it was really necessary in the first place. But insurance won't talk to the hospital and the hospital won't talk to insurance so you have to talk to each of them in turn while waiting on hold every time. It's a wonderful system.
It must be exhausting to be an american
it most certainly is.
Gestures Broadly at Everything
Man, you got that right.
Anyone taking refugees yet?
I need to immigrate
I need to emigrate.
They (Americans) deserve it honestly.
- They worship capitalism
- Gleefuly joke about killing communists (via helicopters)
- Do not bat an eye when US govt invades 3rd world countries
- Rig international organizations in their favor
- Impose their will & turn other countries into a puppet states
- Fund Coups & Terrorists & bomb & sanctions on other emerging (As in developing) countries to destabilize them
- Stage Regime-change operations
- Greedy & Resource-Hoarding Nation with a mostly Selfish & Solipsistic Population
- & you rescued Nazis
- Not to mention how willing people are in joining the Military-industrial complex
I could go on & on
We 100% do.
My christian mother can't wait for society to burn and Jesus to come back.
Let it. Fucking hell. I'm so tired of protecting these fucking idiots. Good riddance.
I do not. Many of my friends don't either. Do we still "deserve it"?
I do not. Many of my friends don't either. Do we still "deserve it"?
And your doctor will have to fight with the insurance company over the phone for an hour to do a pre-auth. When my doctor wants to perform something or give a certain treatment not covered, he assures me he will make this long and stressful call. I really wonder what they are discussing and what goes on in these conversations...
What doctor has time to do that? I'm in Canada and I can never trust my doctor to have any conversation with anyone, at any time longer than five minutes at a time for anything.
The best tactic I've found if you want to get anything done for yourself or someone close to you is for you to do the legwork and make calls, contacts and literally hound people to do their job. If no one is there to push things along, no one is going to magically appear to help you ... that is a fantasy that seldom and rarely happens, even in our publicly funded system.
You or someone who is capable should advocate for you every step of the way, otherwise you will just get lost and forgotten in the system ... whether you are in the US or Canada.
I’m in Canada and I can never trust my doctor to have any conversation with anyone, at any time longer than five minutes at a time for anything
The best tactic I’ve found if you want to get anything done for yourself or someone close to you is for you to do the legwork and make calls, contacts and literally hound people to do their job.
This is my experience in the US as well. Also nobody knows anything about anything.
Doctor A puts you on a medication, doctor B doesn't know until you tell them and then he says "he put you on that!? You shouldn't be on that, I'm taking you off it."
You go to have a surgery and say "hey guys, did you know that I'm difficult to intubate? Because I could die if you don't take that into account", they didn't know.
"Hey guys, I have reason to believe that the insurance card I was issued in the mail isn't completely correct, can anyone help me with this?", 4 different people at the company that issued the card have no idea what's going on, don't even know about the policy tied to the card in question and think you must have accidentally called the wrong company (you didn't).
"Hey guys how much is this going to cost?" it is literally impossible to say.
Do you think your health record got that black mark before you took control of your health journey, or after?
(Mine is "surgery seeking", apparently, as my old region has the mitigation history and the new region doesn't; and one surgery every 15 years seems to be too many for them!)
I have a doctor that actually cares. If I had one that didn't, I would not stop until I found one that did. It's mostly getting the insurance to cover medications that they don't. The doctor usually spends the last hour of his day doing this, for me and other patients. You have to find a local doctor outside of a major city with less client base so they DO have the time. I am in the US. My deductible is very high but the medication I take is life sustaining and I can never pay for it. I have to do this every 6mo to a year: make an appointment and hope the doctor gets their way. Once they didn't and that is why I am at my current doctor. There is not much negotiating a patient can do calling the insurance themselves. They will just look and see you don't know what you are talking about. No matter how you complain about the symptoms, your financial burden, your family, or the fact of it being life-sustaining. Best to have a medical professional advocate. I have even tried with doctor letters and emails forwarded before calling. That is why I wonder what the doctor actually says that gets through.
What you are saying is generally true. The only real oversight in ensuring things are moving forward is us ourselves as patients. It's our responsibility as patients to take charge of our health.
That being said, P2P is sadly a standard aspect of American medical practice. Essentially anyone in a direct patient contact position position has done them. In the clinic or hospital, it may be your primary clinician handling it but it doesn't necessarily have to be. It can be handled by other clinical staff or a group of nonclinical doctors also.
You dont have to worry about P2P since it will get taken care of (whether the service will be covered by insurance is another story). Instead I'd focus on keeping disconnected parts of the system abreast of your medical conditions and current list of medications. Because health information is protected there really isn't a great solution for centralizing this data yet so if you go to a clinic that's on a different EMR, they're not going to have all of the necessary information available to them.
Agree I feel fortunate to have found a doctor(and their PA, and their staff) who feels like my own personal swat team to get my treatments. I am not wealthy and don't have gold plated coverage, I just found a winner.
It's so much paperwork and phone tag.
When I was a clinic assistant in a cancer-focused plastic surgery clinic, it was my job to fight with the insurance companies. I did prior authorizations for every surgery and they would do shit like approve the removal of a melanoma without requiring prior authorization, but performing the skin graft to repair the 10cm diameter hole required a prior authorization because the procedure code falls under the "Plastic Surgery" heading and they wanted to make sure you're not getting skin grafts for cosmetic reasons.
I've had doctors lead me to make certain statements so they can more readily justify a given treatment that they know I need.
It's a bit of a wink-and-a-nod situation.
It's even worse if you're part of an HMO, because the doctors are beholden to the business side, unlike independent doctors who don't have a management overhead telling them how many times a year they can prescribe a treatment, becuase they're doing it more frequently than other doctors in the system.
This demonstrates the major issue with socialized care, because it's also managed this way. I've been in both HMO and PPO systems - overall they both cost about the same despite HMOs acting like they cover more day-to-day stuff. It's just with PPO (independent doctors), I get care that's more tailored to me and my wishes, I don't get pushback from corporate, because there's no corporate involved. I may have to discuss with my doctor how to present things so my insurance won't push back, but at least the insurance company doesn't directly control my doctor's salary, bonus, etc.
All this crap started in the 80's as business management orgs started taking over healthcare organizations and consolidating them, and turning them into profit centers.
cause of death: not knowing the cheat code to getting treated like a human being that exists for some reason
It's hard as one having free (state paid) healthcare in EU, to imagine anything but just going to the doctor, and the doctor seeing to it, that you get the correct treatment.
No paperwork, no hassle, no bill.
I can't imagine why USA hasn't introduced something similar yet, but prefer all that bureaucracy that only makes the whole process way more expensive. Just to make sure some unemployed poor guy doesn't get free treatment!!
USA is a psychopathic society.The US isn't a country.
It's a business dressed up as a country.
(More like 50 countries dressed up as a business dressed up as a country, but then even that gets more complicated)
"We" have been heavily propagandized into this. As a nation we're a masterclass in being brainwashed against our own interests
Once upon a time, I thought the arrival of the internet would mean ordinary people would be better informed. But Trump being elected twice has proven me wrong.
It's not used as much for information as it is used for misinformation and propaganda.In the 70's I thought better information would end religion, it's insane how quickly we are getting absolutely nowhere.
I have come to realize, that I'm VERY naive in some respects. Hard not to turn into a cynic.
I can’t imagine why USA hasn’t introduced something similar yet, but prefer all that bureaucracy that only makes the whole process way more expensive. Just to make sure some unemployed poor guy doesn’t get free treatment!!
(concepts stolen from a very insightful reddit post from years ago) Nearly all modern conservative positions can be explained with two idea.
- Society is zero-sum. For someone to gain something, someone else must lose something.
- Class is defined and there should be no mobility for lower classes to ascend to higher classes in society.
So apply this to healthcare:
Most arguing against medical-treatment-for-all view it as zero-sum. So for most its not just because they don't want some unemployed poor guy getting free treatment, but rather, "if the unemployed poor guy gets free treatment, then treatment won't be available at some point in the future when I need it". This is silly of course.
For others arguing against medical-treatment-for-all, the suffering is the point. The unemployed poor guy should suffer because that is his station in life. A life of comfort is reserved for those of higher classes. They believe, alleviating his suffering would go against the class he's in and should in. This is, of course, also silly.
It's pure lobbying.
That CEO's company made $22 billion in profit or something. Put just $1 billion of that in lobbying and you got a whole army of people manipulating the results in favor of the current status quo, and you'll have your $21 billion instead of $0.
Right, but what do you do when someone who works less, or isn't as talented or smart, as you gets the same or better healthcare!?
Edit: /s
Same not better. And that's the thing, when equal healthcare is the norm, it becomes surprisingly normal. Nobody gives it a second thought.
Because the CEOs of healthcare companies keep pushing to lobby against anything like that which would hurt their profits
It's money. It's specifically a video of a white man with an expensive suit dancing in a rain of hundred dollar bills while the chorus to Money Money Money plays.
Politicians know the system is broke but they benefit from the money and have government sponsored top tier healthcare.
It’s hard as one having free (state paid) healthcare in EU
Your health care is neither free nor "state paid", you pay for it, the government just takes the money before it ever arrives in your bank account. You should know how much you pay, and how the service compares to a comparable commercial health plan.
Oh for fucks sake, I wrote state paid exactly to prevent this bullshit. Obviously we pay the state through taxes.
This is such a tired argument, and doesn't change that single payer or whatever words Americans use to describe what we in Europe merely call healthcare, but healthcare for all is so much cheaper to run, that the money saved easily cover the poor that can't afford to pay if they had to.Your moronic parroting of extreme right wing talking points have zero impact on a reality that is way different from what you try to manipulate people into thinking.
It's wild that Americans accept this idiotic healthcare system.
Unfortunately there are people here in Canada who think it's a better system. 😕
From an American: I'm so sorry our idiocy is bleeding into our neighbors up North. Learn from our mistakes!
Tell everyone you know that our healthcare literally bankrupts our working class, and that we still have crazy wait times for appointments due to our staffing shortages! Tell them there is absolutely zero upside to using anything remotely like our system!
The first card fell last week
There's too much to get into but the short version is we literally aren't given a choice. People here idiotically vote against their own self interests and nothing anyone has tried to fix the problem has worked.
The sad part is that it doesn't seem to matter who's voting for who. I was a lead HIPAA security engineer at Blue Cross Blue Shield, and I architected some of the new EMR access auth systems. But I also got to see how ugly the inside of the insurance industry is. It was so depressing that even though they offered me a generous 6 figure salary, I had to quit for my own mental and emotional health. Their lobbyists have way more money than votes matter to begin with, that's why I had to leave the industry for my own sanity.
We don't accept it. We were born into it, and the powers that be are bought and paid for. Tis bullshit.
Hey now, we have some of the best healthcare in the world if you can afford it, and healthcare stats that demonstrate just how few people that actually is.
I don't think persuasion Checks are a good way to determine who lives and who dies in real life 🥲
Go ahead and roll for persuasion on your motion to abolish persuasion checks in healthcare.
- carve the word "deny"
- carve the word "delay"
.
.
.
Good luck getting them to give you an answer at all to any of those questions. You're going to need to get a lawyer and spend a lot of money and time getting any response at all from anyone who actually works for the company, since the customer service doesn't have access to any of that information and they wouldn't be allowed to reveal it even of they did. It's an insurance system, not a social service system where you have some kind of rights.
Insurance companies are designed to find any reason possible not to pay a claim, whether it's homeowner's insurance, liability insurance, or any other type of insurance. And they have plenty of lawyers on staff so they're happy to make the lawsuit take long enough to cost you more than the claim is worth to you and it barely costs them anything.
The reason why this would work is because it makes it appear as though you may get lawyers involved. Yeah, they don't want to pay out claims, but they also don't want to get sued and lose. This is an intimidation check to make them either back down and pay out or risk potentially going to court with someone who appears to know what's up. They'd rather just pay the bill at that point, at least as long as this doesn't become common.
That might be the case if you got to talk to someone with the ability to do anything about it. Customer service is just able to tell you what happened, not really make any change. You can file an appeal, but you can't really ask for much during that process. It's mostly automated and the people who process those have very specific criteria for overriding an initial decision and have a very short period of time they're allowed to spend on each appeal.
So the only way you'd get to someone who might be able to access any of this information is through a lawsuit. Trying to intimidate a worker with no power, no access to information, and a very high quotas is unlikely to have much effect. And these companies all have more lawyers on staff and/or retainer than any of us could afford in a hundred lifetimes. And those people aren't going to give that information anyway. Nor would they give it to any lawyer you might hire in most cases. Proprietary information has way more legal protections than consumer rights, even in healthcare. You'd need to get a judge to order that release of confidential information about an employee or proprietary algorithm in most states, unless you convince someone to sacrifice their job, their freedom, and possibly their life to become a whistleblower.
So unless your claim is in the hundreds of thousands at least, it's unlikely you'll spend less on lawyers just to get your case in front of someone who can answer these questions much less compelled them to give it. Otherwise, they'd have an incentive to pay claims in good faith in the first place. So there's no intimidation felt on their end by things like this. It just makes them get I to a defensive posture if anything, and likely reduces your likelihood of getting an appeal approved in a timely manner.
Your best bet if your claim is denied and appeal fails and you actually have a case is to hope you live in a somewhat progressive state that funds their insurance commission and has more consumer-friendly laws, and go to them for help. Federal laws aren't going to help much unless you have evidence of fraud or you understand all the details of the case and can point to specific contract language or laws they violated already. But in that case the appeal should be all that's needed.
I guess I get hung up on the whole:
Everyone knows this is true; it's not a secret in any way. But it's a violation of a number of regulations
bit.
So it seems like we could very easily stop these corporations from literally killing people with already existing regulations we are just choosing not to. COOL.
Bold assumption that "we" (meaning the government) includes anyone actually reading this, because as far as I can tell the only "we" the government considers is capital owners. Unless you're proposing some alternate method of behavior alteration.
Tell me you're American without telling me you're American.
I remember when Michael Moore’s “Sicko” came out a long time ago and the country was just as riled up as they are now. History repeats. After a while they will arrest the shooter and this will all die back down.
Ok let me try: bulletproof backpacks.
Semi related, recently I was referred to what I thought was a “specialist” from my doctor for a thing but I couldn’t myself determine if they were in-network with my insurance. Turns out what was implied to be a specialist was actually just a company that determines where to send people for this specific service, so we’re at the point that a primary care provider is working with a 4th party to deal with the 1st party and the 5th party is running services at the 2nd party and I am 1) the person responsible to figure out this insanity and 2) will likely be billed an obscene amount of money for something that should’ve been a 1:1 convo with a doctor and a hospital because one or five of the likely 30 people across 8 companies missed an email. (And you know all those people are they themselves dealing with the same nightmare and probably being paid a paltry $15/hr.
The free market is so much more efficient than the government!
Yeah, that sounds about right. After a heart attack scare, a night in the hospital and all the cardiac testing that went with it, I received a letter in the mail from some company I've never heard of that determined my tests were necessary and would be covered. Weeks later. Like, motherfucker, what was the other option? We all thought I was dieing... ER had me admitted in less than 2 hours. It was bad ...... And someone needed to contact a fifth fucking party to make sure I deserve to live?
Fuck me. I wish I could leave this place and get my family someplace sane, where they are safe.
I jump straight to filing a complaint with the Department of Insurance. The insurance company immediately gives me the authorization every time.
Can they respond to the DOI that I haven't followed proper escalation procedures? Sure. But they just fold because they know they're in the wrong and I am clearly willing to escalate matters.
So the Hippocratic oath is essentially meaningless in America?
It was always meaningless. It never had any legal repercussions if it was broken, just like ethics agreements politicians get to waiver.
This is more than mildlyinteresting.
I tells ya it’s a situation awful enough to drive a man to stay in a hostel.
No idea how effective this would be, I think the doctor would have to request this themselves. When I worked for an insurance company, member services didn't even have access to authorization details.
Usually this is a tactic some doctors do for a peer to peer, but generally you ain't getting a peer to peer as a patient. Peer to peers use unqualified doctors to question treatment at a time convenient to the insurance company in the hope that your doctor decides "this isn't worth my time, the patient needs to figure their own shit out." Importantly, you can't bill for the time spent on this shit. If they made it legally required to allow billing, it would disappear.
This is advice for doctors, not patients.
Usually doctors do the peer to peer and then the patient can appeal once services are denied (which is almost always the case if you've reached the peer to peer stage).
I've used this before with mild succees. It's far from reliably effective. You're more likely to get the decision over turned at the appeal stage, the problem being that precious time is lost while going through that process.
I do like to schedule an appointment so that patients are part of the peer to peer call. That way they can tell the doctor, nurse, PA, NP or whichever other service reimbursement bouncer the insurance company has hired that they're putting a curse on them and their family.
Its only illegal once you are prosecuted for it. That is how businesses operate. Its not just regulation we need but a justice system that has some teeth
Thank you. This is directly relevant to me. And yeah, I'm an American.
There are also advocates who can help you navigate the insurance nightmare. We had to do it when I needed surgery a few years ago.
The tragedy, in my opinion, is that Americans have to do this stuff at all. You need a tactic to get the service you're literally paying for out of your own pocket.
I hate how useful this is.
This is what I want to see.
Beat them back at their own game.
It is like when police say they wish that policing was like in The Andy Griffith Show. Tell them that everyone knew where sheriff Andy Taylor lived. Why don't you tell everyone where you live, sheriff ?
Saved this advice for future reference - thank you!
This has big soviergn citizen energy. "Say these magic legal words and they have to pay your bill".
It’s basically the same tactic, convince them that you’re too much of a pain in the ass to deal with and they should just give you what you want to get you to go away. Only it’s for accessing your own fucking healthcare that you pay them money for and not, you know, avoiding paying child support or truck payments.
Absolutely, the only difference from sovcits is that the bogeyman we believe in is real - it's the insurance companies and billionaires.
