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When my wife had surgery and insurance denied part of our claim, hospital billing said it was normal, and it usually doesn't get resolved until one of their law

• lotsofpulp 6y ago
  Is it possible the hospital also has a tendency to over charge? For example, the data for Synagis indicates it only works to prevent RSV in a very narrow set of cases. It's a very expensive medicine. And it's vastly over prescribed based on the efficacy data, so a parent who is already emotional over their premature baby is going to be frustrated if/when the insurance company denies it. The doctor isn't going to into detail and explain that the data doesn't support its use. They're incentivized to "do something", even if it's a shot in the dark.
  • bcrosby95 6y ago
    For my wife's surgery (gall bladder removal - supposedly one of the most common in the country) insurance paid the surgeon, and initially denied the hospital bill and anesthesiologist bill as medically unnecessary. After 8 months of back and forth and dozens of multi-hour-long phone calls insurance finally covered it all. I don't really care whose fault it is, I shouldn't have to play phone tag with two powerful entities over the course of 8 months as they try to figure out if they're going to fuck me over or not. It's a huge waste of time.
    • deleted 6y ago
      [deleted]
    • lotsofpulp 6y ago
      Yes, that’s why Kaiser is a nice model if we can’t get to taxpayer funded healthcare. It’s vertically integrated insurers and provider so there’s no in network and out of network and covered or not covered BS.