Denying Your Medical Care is Big Business in America
Denying Your Medical Care is Big Business in America
Insurance companies have weaponized a seemingly benign process to protect their profits, and it’s putting patients at risk.
My spouse struggled with a medical condition for years and was lucky to finally get a prescription for something that actually resolved the problem. The medication was expensive ($1000+ a month), but since we literally tried everything else, insurance would “let” it be covered.
Then I lost my job and had to move over to a new company’s insurance plan. And they won’t cover it.
The fact that your employment in the US determines what medical care you can get is absolutely bonkers.
126A medication being more expensive usually indicates rarity. This means the instance of required coverage by insurance companies is also rare. The fact any medication, needed to mitigate the risk of simply being born, might not be covered by “insurance” is bonkers.
I think we need to start a new industry to take it to insurance companies every time they deny coverage. Bury them in complaints and legal actions. Go so hard on every case that they give in immediately upon seeing the letterhead.
31I think insurance companies are useless parasites that should all have been outmoded by single payer decades ago.
38My medicine is $1,500 a month without insurance. It’s a bipolar medication. It doesn’t indicate rarity, it indicates greed. They could easily sell it for half the price and still make money.
15It’s important to keep in mind that this rarity is often artificial scarcity by the pharmaceutical companies. There are some conditions which are rare, but have treatments that have been available for decades now with generics on the market for years. They simply don’t produce much of those meds, even though it’s cheap to do so, in order to artificially inflate the market price.
Insurers are complicit in this scheme because they don’t push back on this practice at all. Without single payer, we have no negotiating force to get pharmaceuticals to produce drugs in an affordable way, so they can manipulate the market however they please. It’s absolutely depraved.
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They did that to prevent people from being able to shop for insurance. They promote capitalism, but they suppress competition which is, in theory, supposed to be part of a "healthy" capitalist economy.
The ACA helped a tiny bit, but it didn't go nearly far enough. And then they tried a zillion times to revoke even that.
It's never been about healthcare, it's always been about making a small number of people very wealthy.
16Seriously. My wife lost her job because of medical conditions (depression and adhd) before we were married. Getting her treatment was part of why we got married
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We do stings in restaurants (for servering underagers) all the time. The fines are significant for the server and the restaurant. I wish they would do stings on mechanics, dentists, and most importantly health care. Wrongfully denied claims should be devastating to the company.
74Oh yeah dentists for sure. The dentist who removed my wisdom teeth was a total quack. He did it in two sessions, used novocaine even though I told him it didn't work well on me, and actually crushed a tooth to get it out. And yes, I felt the pain of him crushing a tooth. We should have sued him.
This was when I was 19. I'm 46 now. A few months ago, I had a terrible pain back where my wisdom teeth were and it got worse and worse. I have some nerve issues, so scheduling a dentist is a big deal right now because I need to be totally out. So we scheduled it, but a few days later, a little sliver of tooth from the space where he crushed the wisdom tooth worked its way out and the pain stopped.
14That's a twofold issue. Original dentist for sure, but also, that sliver of tooth should have been picked up over the years in routine x-rays you should have had during routine exams, as well.
5Oof I feel for you friend. When I was in my early 20s I had to get all four wisdoms out as they came in crooked, all four had to be crushed and removed, but at least they knocked me out for it and gave me percocets afterwards...
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Paywall removed: https://archive.is/CXm5f
Here's the corresponding video: https://youtu.be/9s3CN5EafNs
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The fact that whether or not I get medical care is almost completely determined by whatever insurance company I have at any given time is so depressing.
I have thankfully been pretty healthy in my life but the few times I've actually needed help I have been told to go fuck myself pretty much every time by my insurance and since I'm not a millionaire I can't afford anything that's not covered. Don't even get me started on the Russian roulette at the doctor's office where anything can cost seemingly any amount at any time and no one has any damn clue until the bill's arrived.
So whether or not I need the help really doesn't matter at the end of the day most times. All that matters is if the insurance company is feeling nice or not.
52My doctor diagnosed me with a b-12 deficiency. Something easily fixed with a shot she prescribed.
The pharmacist looked at me like I was a drug addict when I asked where the needle for the injection was when I picked up the scrip. "Just have the doctor do it".
Fee for randomly showing up to my doctor to get the shot? $0
Fee for getting the shot done when I was actively at a scheduled check up? $130
I take an oral supplement instead now that's not quite as effective.
21Needles are legal over the counter in my state as they should be. But I’ve had so many pharmacists pull shit about me buying them. Like first of all motherfucker you just saw me buy a vial of estradiol, but even if you didn’t I know I’d rather addicts shoot up with new needles on a purely selfish basis of it prevents disease from spreading. Anyways I buy online in bulk from a medical supplier now, it’s just easier
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Remember all the hysteria over "death panels" during the ACA debates? Fooled you, they were already here, invented by insurance companies.
37They paired that with a ton of bullshit about "corporate efficiency" vs " government corruption". It was one of the biggest Anarcho-Capitalist PR coups in my life.
12That’s why I’m very open about who decided when my mom died. The government didn’t choose, her doctor didn’t choose, and neither her nor her family chose. You get three resurgences of cancer, that’s what the insurance company decided.
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The insurance companies use computer algorithms to deny claims and most people won't fight it.
25Most people can't fight it. Fighting a claim, depending on insurance, requires multiple different Doctors recommending the same thing. Sometimes the insurance requires prior steps taken that are unavailable to individuals (I was required to take antibiotic that I'm allergic to before a surgery). Getting into a specialist can take months, and the costs of seeing a specialist are not often covered at all (goes towards deductible), and unless you live in or near a city you may not be able to find specialists you don't need to get a hotel to see (travel expenses and time off work are not covered). Not to mention, if fighting a denied claim rolls over to the next year, everything starts over, even if you have the same insurance it's considered a new policy because it's a new year.
Unless you have unlimited time and money, fighting a denied claim is pretty difficult and goes nowhere fast. That's how the system was designed.
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Someone let me know if the article has any value beyond what is already heavily studied and known — that the profit motive and racketeering between all middlemen (insurers, big pharma, banking/finance sector, and health care providers) is a calculated effort to dramatically inflate the profits of each at the expense of the most vulnerable. Insurers don't make money by paying claims. They make money deny them, so do everything in their power to deny as many claims as possible.
22They got their Death Panels, they just wanted to make sure they were profitable and not socialized.
Conservatives: ranting about OMG there will be government death panels…
Medical insurance industry: that’s a great idea!
14My coworker needed to have a heart monitor replaced and the fucking
parasitesinsurance company said no, he didn't have a stroke yet...The fucking
parasitesinsurance companies are literally telling you fuck off and have a stroke, if you survive then we'll cough upyour money you've been paying us foreverenough for a replacement...5
This isn't news, but I'll accept that there are people who still haven't learned this and suppose that it's still worth publishing.
14What is the point of this comment then?
Of course there are people that haven't heard of this or don't understand this. The world didn't freeze and people didn't stop being born, new humans growing up and becoming adults and just learning about various parts of the world everyday don't know about these sorts of things.
Education and information is a perpetual struggle and a perpetual effort.
12It's getting worst though. A lot worst. They keep adding more and more layers to make it so difficult and convoluted you give up. Last year my insurance started using an external pharmacy for my meds. Fine. But my meds to need to be administered by a nurse in a hospital. So I need to get prior authorization from my doctor to my insurance who then approves the pharmacy to do the meds. But there are 30% copays now so I use a third party company that works with the company that makes the meds to comp the 30%. Then I need to get the hospital to call the pharmacy to order meds on my behalf and send it to the hospital, not me. Then I can finally schedule my appointment to actually get the shot in the hospital. I do this circus once a year, every year because they change one layer every year and so I have to figure out the new rules. It's pure madness.
10This is exactly me trying to get ahold of immunosuppressants to treat my Crohn's Disease. I have to go through a specialty pharmacy owned by the insurance company. They bill to SaveOn, an assistance program, because my 30% copay works out to over $8K. They additionally bill against a discount/coupon program. If anything gets screwed up between the five systems of record I have to keep my data in (via phone calls, of course, because the self-service web portals are designed to give you incorrect data and accomplish nothing), then I spend weeks trying to correct everything and wind up getting my meds late.
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I call it practicing medicine without a license, and it should be treated as such
-signed, someone who's family is stuck in that system
12Does anyone have a non-paywalled version of this
7Paywall removed: https://archive.is/CXm5f
Here’s the corresponding video: https://youtu.be/9s3CN5EafNs
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For-profit insurance is itself a conflict of interest and unethical. How can one expect an organization with a profit motive behave in the interests of the people they claim to insure (other than dead people dont pay them anymore)?
Im of the opinion that a government should run some form of medical insurance for this exact reason. Private corporations should not be allowed to comodify modern essentials of life and I feel like this should extend health care.
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