3 ms·

I’m 51 and had this conversation too many times to indulge this. All I can say is that I wish you luck if you or your loved ones ever have a serious medical iss

I’m 51 and had this conversation too many times to indulge this. All I can say is that I wish you luck if you or your loved ones ever have a serious medical issue in the US. And you may be lucky. Or you may spend years on telephone calls trying to get a pharmacy benefits manager to send you the prescription your doctor prescribed. Or calls with your insurance company to get them to pay what they are supposed to pay.

throwaway173738 3y ago
Yeah been there with my partner. She spent at least two days a week on the phone with the insurance company from 2021 to January of this year. Private insurance is the worst, and open enrollment is terrible. We should’ve outlawed employer-provided insurance but required employer stipends for insurance and forced everyone to buy through the marketplace with open enrollment once a month. As a patient you have zero control over your insurance while your employer has no incentive to get good insurance.
nerdponx 3y ago
I have a close family member who has had multiple significant surgeries, and it was all covered, and they didn't pay a penny over their annual out-of-pocket maximum. Maybe the difference is that it was all "elective" and therefore planned out weeks or months in advance, with ample time for insurance pre-approvals? I've had a harder time getting reimbursed for psychotherapy than they had getting covered for their surgeries.
- projectileboy 3y ago
  Interesting, I’ve had somewhat similar experiences. Big one-time events were handled no problem. But chronic illnesses have always been a nightmare - for my daughter to get her meds, she pretty much has to have the same chain of conversations once a quarter with doctor, pharmacy benefits manager, and insurance. PBMs are the worst though, by far.

3 ms·

I’m 51 and had this conversation too many times to indulge this. All I can say is that I wish you luck if you or your loved ones ever have a serious medical iss

by projectileboy 3y ago

throwaway173738 3y ago
Yeah been there with my partner. She spent at least two days a week on the phone with the insurance company from 2021 to January of this year. Private insurance is the worst, and open enrollment is terrible. We should’ve outlawed employer-provided insurance but required employer stipends for insurance and forced everyone to buy through the marketplace with open enrollment once a month. As a patient you have zero control over your insurance while your employer has no incentive to get good insurance.
nerdponx 3y ago
I have a close family member who has had multiple significant surgeries, and it was all covered, and they didn't pay a penny over their annual out-of-pocket maximum. Maybe the difference is that it was all "elective" and therefore planned out weeks or months in advance, with ample time for insurance pre-approvals? I've had a harder time getting reimbursed for psychotherapy than they had getting covered for their surgeries.
- projectileboy 3y ago
  Interesting, I’ve had somewhat similar experiences. Big one-time events were handled no problem. But chronic illnesses have always been a nightmare - for my daughter to get her meds, she pretty much has to have the same chain of conversations once a quarter with doctor, pharmacy benefits manager, and insurance. PBMs are the worst though, by far.