Fuck private health insurance!

[lastlib]

WHY the hell do we even ALLOW for-profit health insurance in this country?!?

Two years ago, I broke both bones in my lower right leg. (Think Alex Smith, without all the nasty stuff.) With metal rods in the bones, they healed, but the associated swelling in my foot and ankle has never subsided. Orthopedic doctors gave up on it, referred me to my primary care doctor. He sent me to a vein clinic; they determined I had varicose veins, which caused accumulation of fluid in the leg, foot, and ankle. They proposed a venaseal treatment to essentially shut down the affected vein, and applied to my health insurance company for approval.

This afternoon, the day before the scheduled treatment, I get word that the f*cking insurance company has denied the coverage for it! Their reason: I'm not in enough pain to justify it.

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So now the vein clinic has to revise the treatment which will now be less effective, per the doctor, and re-submit it. F*CKING RIDICULOUS!!

Joe/Kamala, PLEASE give us single payer health-care!!

[Moostache]

1. Very sorry to hear of your experiences in "the 'best' healthcare system in the world" (gag)

The only thing in America that is remotely "the best" these days is the line of bullshit running amok in our media and the return on investment that our insurance companies get on their senator auction, err...I guess we still call them campaign donations?

It is well past time to remove the profit motive from healthcare.

Then we need to unleash hell on the food industry and get some answers for why literally EVERYTHING has either corn, corn syrup or straight up sugar in it on our grocery shelves and food supply. I would be totally expecting a rather shockingly large overlap of the for-profit healthcare owners and the food distribution owners too.

[Deuxcents]

2. I'm on Medicare

And have supplemental health insurance.. I wonder why b/c they don’t pay for anything .. nothing compared to my payments to them. We need Medicare for all and get rid of this rip off. Ever check to see what their bonuses are? Be sure to be sitting down

[Ferrets are Cool]

8. Wife has Medicare and a supplemental

She got stage 4 lymphoma 2 years ago this month. Her total insurance costs so far have reached almost one million dollars. Our out of pocket has been around 10K. I guess it is determined by what supplemental you have.

[Deuxcents]

14. O.. my Friend

I have nothing to complain about. Apologies. Thanks for the lesson of being humble. I wish I had words to express my hope for both of you b/c my heart says what I cannot express

[Ferrets are Cool]

23. Thank you for your kind words.

❤

[IcyPeas]

3. Insurance companies determining what treatments we need is a problem.

It's a scam.

[leftstreet]

4. DURec

[róisín_dubh]

5. I will be fighting with my insurance company soon. I'm sorry you're dealing with this.

I have to get an echo-cardiogram, and I know they're going to deny it. My doctor prescribed it because I'm having some weird issues post-covid (I was vaccinated but had a mild breakthrough case).

I hate it.

[The Magistrate]

7. Now That's Just So Cute, Sir

Cute as a button....

[sarcasmo]

9. Brother-in-laws chemo was denied by his insurance. This country is 💩💩💩💩💩💩.

[mvd]

10. Yes, 100%! K&R

I don’t want any system that puts profits over affordable, quality, and necessary health care. Very sorry to hear about your situation and hope it gets better for you.

[TheRickles]

11. Sometimes you have to fail a cheaper form of therapy first.

So if you have a trial of physical therapy (lymphatic drainage) and occupational therapy, and that doesn't help, maybe they'll OK the more expensive surgical approach.

[Auggie]

12. Tell us the insurance company so we can avoid it

[Withywindle]

15. It's not like there are any GOOD ones

They're all crooked as hell and they all have financial incentive to NOT cover treatments.

[lastlib]

16. This one is Medica. They suck, and they're damned expensive on the premiums.

I got their coverage through the ACA exchange, since I don't have employer insurance. It's almost $900/month, and it was the most affordable one on the exchange for me. It has been a rip-off for me.

[Auggie]

24. Thanks

I'm learning to exaggerate everything with my HMO. Your share (about pain) is good to know.

[lastlib]

25. That's a tactic I just might adopt.

I should've remembered that law-school lesson about distorting the facts.

[aggiesal]

13. Since you're steamed and mad, you should not read this article ...

https://www.nytimes.com/interactive/2021/08/22/upshot/hospital-prices.html

There is a paywall, but while loading, just stop the loading.
You may have to do this multiple times.

[Celerity]

17. some pics from that that will make heads explode

The American, for-profit healthcare system is the biggest wealth-transfer, wealth-extraction scheme on the planet

Over the next twenty years, there are literally trillions of dollars in profit at stake, which is which why nothing much that is actually successful at TRUE reform is likely to be done.

The Eichelberger family at home. Last summer Nathan, second from right, was bitten by a stray dog and needed a rabies shot. The family originally received an estimate that it would cost about $800 paying cash, but later received a surprise bill for over $2,000 more.Lindsay D’Addato for The New York Times
Ms. Eichelberger’s plan had a $3,500 deductible, so she worked hard to find the best price for her son’s care.

But neither the hospitals she called nor her insurer would give her answers.

She made her decision based on the little information she could get: a hospital, Layton, that said it would charge her $787 if she paid cash. The price for paying with insurance wouldn’t be available for another week or two, she was told.

But even the cash price didn’t turn out to be right: A few weeks after the visit, the hospital billed her an additional $2,260.

It turns out that the original estimate left out a drug her son would need.

“It was the most convoluted, useless process,” said Ms. Eichelberger, who was able to get the bill waived after five months of negotiations with the hospital.

Daron Cowley, a spokesman for Layton’s health system, Intermountain, said Ms. Eichelberger received the additional bill because “a new employee provided incomplete information with a price estimate that was not accurate.”

The health system declined to comment on prices at its hospitals, saying its contracts with insurers forbid discussing negotiations.

[aggiesal]

19. It's pretty amazing ...

you're going to p1$$ him off.

[DFW]

18. I swear, U.S. private health insurance is the real-life version of John Grisham's "Great Benefit"

I have had thousands of dollars in medical costs this year due to some nasty dental work, as well as my usual annual physicals and cardiac check-ups. Blue Cross's universal reply: denied, denied, denied. The alternative German health insurance has premiums of $35,000 a year, so even with the universal denial in the USA, I'm still ahead of the game, but let no one tell me that U.S. insurance steps in to pick up the tab whenever medical care is required. Maybe they do under some circumstances, but for me, my employer is paying Blue Cross to cover the cost of postage for my printed denials.

[lastlib]

26. That really sucks!

Sorry you're having to go through that, sir! Makes my troubles pale in comparison!

[DFW]

28. I have pretty much given up at this point

Since most of my non-dental care is in Germany, they deny everything as a matter of course. They say "out of network," or can't understand the bills, even though everything there is coded with numbers that are standardized. In other words, if I don't get my medical work done in their "approved" network, which must consist of three doctors spread between Waco and El Paso, and prescriptions filled at some pharmacy in Waxahatchie, all claims are systematically denied. I have pretty much come to terms with it.

Minor consolation--in Germany, you can deduct medical expenses not covered by insurance (for me, to all intents and purposes, that's everything) from your income on the German tax return. Since for me, that rate is turning out to be well over 60%, I take advantage of it as much as I can. As an American citizen resident in Germany, I have to file tax returns in both countries. Despite the existence of a Double Taxation Treaty (Doppelbesteuerungsabkommen), many forms of income are treated differently by the two countries, and are therefore taxed twice. The USA is one of THREE countries on the planet that does NOT recognize residence-based taxation. The other two are Eritrea and some even smaller African country. Some people say this is great because it nails 37 American "millionayahs and billionayahs" who reside on yachts in the Caymans or the harbor of Monte Carlo, but for the other nine million of us Americans Abroad, it sucks royally. Even though we have a population greater than half the states of the union, we have zero representation in Congress, so no one bothers to introduce legislation to lighten the burden. Accountants across the world, of course, prefer the status quo, and are happy for the added business.

[Saffron Walden]

20. Ask your doctor to have a peer to peer review with the insurance co doc.

I was turned down a few days before my major surgery because the insurance company said it was "experimental". My surgeon was livid and had the decision reversed. That was 14 years ago and that 'experimental' surgery allowed me to walk again and has never given me any problems.

[lastlib]

27. They had one

Denial upheld.

[Saffron Walden]

29. Wow.

[Ron Green]

21. One risk pool is a health care system. Multiple risk pools is an investment scheme.

We have enough investment schemes in this country; we need a health care system.

[Laura PourMeADrink]

22. Private Health Insurance, HMOs...all just cocktail napkin talk. "How

can we, the PTB, make more money out of nothing, out of a simple
thing that EVERYONE needs?" Bet martinis were pouring that night.

Actually remember the original pitch at work - HMOs - "They will be
SO great - doctors will care about you and help you stay well and
not get sick. And it's only X dollars per month."

[Chakaconcarne]

30. Vericose veins are tricky... You really need to demonstrate pain or other side effects to get them

Treated since they are considered more a cosmetic issue. Many patients won't accept that so they exaggerate the problem and I believe insurance scrutinizes the case/treatments more heavily as a result. Sometimes if you get the right provider they can write their notes in way to help this along... Best always to use your own words to describe the pain and any other possible issue you can think of.. and they do pretty much always have to titrate up through the different levels of treatment to save on costs. You could always go through another provider.