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Up and down the board this is the game insurance companies are playing. For example, I had need for a medical device. My doctors office submitted the claim fo
by cogman10 3y ago
Up and down the board this is the game insurance companies are playing.
For example, I had need for a medical device. My doctors office submitted the claim for that device with documentation of it's necessity 5 times over 6 months before it was finally approved. The prior 4 times it was "You didn't include all the required information" even though each submission was identical.
There's simply far too little oversight on insurance agencies. They are perversely incentivized to give the worst outcomes for everyone which being to command high premiums because of the relatively low amount of competition or threat of "switching" (After all, you are using your employer's insurance. You didn't get to pick it, HR did. And they picked it based on who's cheapest. How did they become the cheapest? A race to the bottom in terms of service).
All of this burdens the whole system with cost and delay.
I'm all for universal healthcare, but if we can't get that can we at least get stronger regulations and punitive measure against insurance companies for playing these games? It's crazy that everyone has stories, regardless of agency, of illegitimate claim denials.
And to be clear, they do this because it saves them money and costs them nothing. By denying by default, a certain percentage of the population and doctors offices will ultimately just go away because of the headache it takes to convince the agency to provide the product you pay for.
- Loughla 3y agoIt's astounding that the care plan created by myself and my team of doctors is regularly denied by a statistician at Blue Cross Blue Shield. This means my care is ultimately in the hands of someone with zero medical training. Astounding.
- cmckn 3y agoI think this is the most infuriating thing about US healthcare. Your doctor thinks you need a diagnostic test to make sure you don’t have cancer? Sorry bud, random bureaucrat at Premera thinks not! But you’re welcome to spend hours of your time filing and following-up on an appeal with absolutely zero chance of a different outcome!
- polygamous_bat 3y agoCraziest thing is if you tried to institute the rules of health insurance on credit card fraud (where banks have full liability) heads would roll. However no one bats an eye when it’s for something as crucial as people living or dying.
- gymbeaux 3y agoOn that note, why do I have to pay $200 to see a specialist who misdiagnoses me? Any other field, they’d be fired, sued, or at least not get paid for the service.
- briffle 3y agoI would love, love for it to become a thing for Employers to put your money in a special type of account (similar to a Roth 401k) where the only thing you can do with it is buy insurance on the open market. Heck, even have a list of 2-3 'preferred' plans that employees can choose from, if they don't want to do all the research. But seeing all that money go into their pay-stub, and then right back out for insurance is going to be very, very eye opening to people who currently just have their employer pay it, and they ever see it in their check.
- cogman10 3y agoYeah, I'd do that with a public option that insurance companies have to compete with.
- akhosravian 3y agoThe problem here is the open market insurance is all garbage compared to basically any employer plan. Especially for those of us in tech.
- dessimus 3y agoIt might not be if health insurance companies actually had to compete to consumers directly rather than only to CFO/CHROs, who in turn provide 2 or 3 "choices" from a single carrier.
- distract8901 3y agoThat's exactly what my current job does. I buy a policy on the government marketplace, submit my premium statements, and I get reimbursed every month. My allowance is quite generous, and it pays for 100% of the cost of the most comprehensive insurance I could find for both me and my husband. The platform is called PeopleKeep. It's really, really nice to pick my own policy. Now I never, ever have to deal with CVS Caremark ever again.
- nradov 3y agoThe CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P) may solve some of those problems starting in 2026. https://www.cms.gov/priorities/key-initiatives/burden-reduction/policies-and-regulations/cms-advancing-interoperability-and-improving-prior-authorization-proposed-rule-cms-0057-p https://www.cms.gov/priorities/key-initiatives/burden-reduct...
- giantg2 3y agoYep, I've submitted for prescription reimbursement for compounded medication. I submitted photocopies with just the dates and signatures changed - the formula and everything was the same. One time they gave me the full $45 in reimbursement. The next time it was $17 (cost of the prescription med without the other ingredients or compounding). The third time they gave me $1. I tried asking why each was different. They had no explaination but were emphatic that they paid the correct amounts.
- FireBeyond 3y ago> My doctors office submitted the claim for that device with documentation of it's necessity 5 times over 6 months before it was finally approved I have had a profoundly deviated septum since childhood. A couple of years ago I went to an ENT to get it fixed. "Yup, 90% deviated on the right side." "Great, when do we schedule surgery?" "Well, first, I prescribe you these two nasal sprays so that you can come back in four weeks and tell me they didn't fix your breathing, so I can tell the insurer that so they can approve surgery."