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'I Don't Want to Die.' He needed mental health care. He found a ghost network

207 points by jameslk 2y ago

wantsanagent 2y ago
I've encountered this in the Pittsburgh area with AHN. Trying to get a provider results in printed lists of outdated numbers, practices not accepting patients, etc. Frankly I think we need to start breaking laws. A startup needs to offer straight up good care and fuck the web of infinite regulations which support America's for profit health failure. Doctors can lose their licenses pretty easily so it's going to have to be a straight tech play. Offer as-good-as-possible care entirely outside of the medical profession. AIs are getting good enough that despite the obvious errors they make they are still better than the nothing-burger of care we get here.
- dgoldstein0 2y ago
  I don't see how the law is the problem here. The problem sounds like insurance companies that dodge their duties. We need them to be held accountable. We likely also need the general cost of doing business in healthcare to go down - which they are partly responsible for due to throwing up so many barriers for them to actually pay for anything.
  - bumby 2y ago
    Steelmanning the OP (which I’m not sure I agree with), it’s possible they are alluding to regulatory capture, implying the laws are crafted to benefit for-profit companies first and patients second. However, I’m not sure going in the direction of less regulation would help. It’s like saying “The for-profit healthcare companies have too much power, so let’s just give them more power.”
    - jfengel 2y ago
      It's not so much a capture as a hodgepodge. There are a great many interests, and even in a good faith environment it would be a challenge to get everything right. Add to that the fact that it's not a good faith environment. There are many forces, not even connected to the industry, who fight to lower prices at any cost. Even if it means finding out too late that you're not actually buying anything at all. The laws and regulatory environment are "the best compromise people were able to get at the time" rather than any kind of cogent plan.
  - akira2501 2y ago
    > We need them to be held accountable. We likely also need the general cost of doing business in healthcare to go down These two statements are at odds with each other. > responsible for due to throwing up so many barriers To me, it's obviously lack of competition that's the problem, you don't want to punish crappy providers, you want to subsidize new ones so the market is flooded with options. Which can be done right after we solve the monopolization problem in health care service providers, medical equipment providers, and "pharmacy benefit managers."
  - xtracto 2y ago
    My dream project is a non-profit smart-contract based insurance system: with double blind analysis of claims by doctors who have nothing to win from approving/rejecting a specific claim, a system were there is no asshole middleman insurance racket company. I know this tech is disliked in HN, but I am positive that it is possible build something like that, due to the "trustlessness" capabilities.
- antisthenes 2y ago
  > Frankly I think we need to start breaking laws. Who's stopping you? I don't pay my medical bills by default, unless it's my dentist or my primary care provider. Everyone else can go to hell until the system breaks.
  - bumby 2y ago
    Most large systems can absorb a certain level of free-loaders and remain stable by shifting that burden to other people. What you’re advocating is a collective action problem and will just make matters worse for everyone else. Unless you have a way to create a critical mass of similar behavior, it’s tantamount to a selfish action that benefits you to the expense of others.
    - antisthenes 2y ago
      Unless the system gets worse, there will never be enough willpower to change it for the better. As it stands, the system is already awful for the majority of people, with outcomes like this that become commonplace. > it’s tantamount to a selfish action that benefits you to the expense of others. Not unlike having great insurance paid for by your company, while others (just at the cutoff of govt subsidy for the plan) suffer the most and have to pay thousands of dollars for routine care. It's the ultimate "fuck you got mine", only applied to something that most people can't live without. And while "fuck you got mine" is okay in the context of luxury items, it is not in the case of medicine/housing/food. So maintaining the status quo is just as, if not more, selfish than protesting the system with a non-payment. But again, keeping the status quo is just letting the wound fester at this point.
      - bumby 2y ago
        >maintaining the status quo is just as, if not more, selfish than protesting the system with a non-payment. The point was that your approach won’t change the status quo, just makes it a little more expensive for everyone else.
        2y ago
- jfengel 2y ago
  It's not like starting up a food truck. A health care operation is vast, and no existing providers are going to break the law and risk losing their licences. You would need to create an entire parallel network. It would cost tens of billions, possibly hundreds.
- insane_dreamer 2y ago
  > offer straight up good care and fuck the web of infinite regulations which support America's for profit health failur they'd get immediately sued out of existence by the large vested interests
dgoldstein0 2y ago
This is messed up. Feels ripe for a wrongful death lawsuit at the minimum, and likely some regulatory enforcement against this scam insurance
- anjel 2y ago
  Perhaps you've never attempted to sue your once and former insurer for contract breach... You probably get the implied frustration and futility, but remember to include the impact of same on your yet-to-be treated illness.
  - dgoldstein0 2y ago
    No I have not sued anyone. But my point is now that he's gone, maybe his family could sue. Not sure that'll really fix anything though. Laws and regulations with real enforcement could though.
    - anjel 2y ago
      1st true anecdote: multi year stop > start > offer settlement, revoke settlement > stall some more > offer a little less than last time > revoke 2nd settlement offer can delay what they have already acknowledged to themselves is a valid claim. But the interest income on your settlement for 4 years accrues to them, and wears you down so you'll be more disgusted, tired, and malleable for the final settlement negotiation. 2nd anecdote: Atty Wraps up a slip-and-fall, and pays out settlement. Client says "I'm using this as a down payment on a house." Atty replies "Hey, if you're happy with my services, let me handle your closing for you? Client: "Why not?" missing the fact that the legal work fell outside of their practice specialization. Meanwhile, Seller takes a third mortgage out during closing and pockets 50k without reporting it. (Buyer's) atty fails to find this, and buyer gets a notice of delinquency 1 month after move-in. Seller is in another state. Atty: "aww heck, I missed this but my malpractice insurance will take care of it for you." Then stalls for more than two years to initiate the claim. Client finally realizes atty is trying to run out the clock and goes to directly insurer and is told we only pay claims if you sue your atty for malpractice and prevail. They needed a new lawyer, plus new litigation funds, plus it turns out (in NJ at least) there are precious few legal malpractice attorneys because lawyers hate that kind of work. “I never was ruined but twice; once when I gained a lawsuit, and once when I lost it.” -quote attributed to Voltaire
keybored 2y ago
I almost teared up.
- _dark_matter_ 2y ago
  I did as well. My cousin passed away in his early 30s from alcoholism - this story hit close to home.
xyst 2y ago
It’s beating a dead horse at this point, but private health insurance is quite possibly the worst middleman I have ever dealt with. They not only make the patients life worse but the doctors and hospitals as well. Dealing with insurance means small practices need a dedicated office staff to file the right paperwork and get paid for each patient visit.
- yieldcrv 2y ago
  I’m curious about why it wasn’t considered to switch insurers, the article has do many details on many processes and I felt this one was not investigated It’s definitely hard to cancel them and the expense adds up to pay premiums for two Was it a possibility?
  - siliconwrath 2y ago
    I obviously don’t know the specifics, but US healthcare plans only let you change during specific enrollment periods or qualifying life events. It’s possible he wasn’t able to. Additionally, it sounds like he picked what appeared to be the best rated plan available to him on the market. Others may have been even worse or prohibitively expensive.
    - yieldcrv 2y ago
      Yes I know it’s hard to cancel outside of enrollment periods, you can still have multiple Adding in the last minute flights and commitments throughout this article, I would say for other people that at some point the calculus can be re-evaluated to find that paying the premiums would be worth it. The loved ones can pay for that instead of last minute flights and time off
      - bumby 2y ago
        The man in the article was living in a studio apartment. I doubt he was in a position to be paying the equivalent of a mortgage for many insurance options. Even if he could, I’m not sure that’s the system/solution we’d want.
yieldcrv 2y ago
> what good another detox would do if it didn’t help him combat the root causes of his addiction through therapy that’s how I feel about suicide hotlines and the random placement of suggesting people call them
- None4U 2y ago
  People are not going to therapy if they're dead, and those hotlines are for helping people find local resources
  - yieldcrv 2y ago
    Yeah and I acknowledge now that a large subset of suicides are totally impulsive, so any momentary disruption of the thought process is enough I think for a different subset that none of the resources are fixing the underlying stressor or interest in ending self preservation
EMM_386 2y ago
I've never heard of them. Then I read the bring in more revenue then "Disney, FedEx or PepsiCo". Wait, what? Oh, right, subsidaries. And, of course, a giant in Medicare Advantage. That company sounds ... very bad and needs to start doing what they are supposed to be doing and stop playing games. People are looking for help and they are looking for ... well, how to squeeze out more money I suppose. "You need psychiatric care? Sorry, we're a bit busy trying to make more money. Priorities and all." "Someone died due to our lack of caring about any of that? Sorry to hear that. Listen, gotta go. (click)" Sue them into the ground.
- aziaziazi 2y ago
  > bring in more revenue then "Disney, FedEx or PepsiCo". > Sue them into the ground Good luck with that :-)
  - EMM_386 2y ago
    True, they are too big and have their tentacles in too many things to make them go away. However, when you are dealing with people who are supposed to be helping people, and they are staring at how much money is currently coming instead, just do what needs to be done. Any single law they broke? Sue them. People are asking for serious help, and they aren't helping them. And people are dying. That is beyond unaccepable. I hate these types of companies. It's like the companies that buy the land under hospitals, make them pay to stay on what is no longer their land, squeeze out as much as they can, bankrupt the hospital, and do it again to another one. Especially brutal when they do that to rural hospitals where now patients are pretty far from the other one still standing. I have a very strong dislike for any companies in that category. The people don't matter, as long as we can extract the money, we're going to do it. Greed on steroids.
- lotsofpulp 2y ago
  I don’t think the article is right. >One of the 25 largest corporations in America, Centene brings in more revenue than Disney, FedEx or PepsiCo, but it is less known because its hundreds of subsidiaries use different names. https://companiesmarketcap.com/largest-companies-by-revenue/ https://companiesmarketcap.com/largest-companies-by-revenue/ By what measure is Centene one of the US’s 25 largest corporations? Its way down at #519 in global market cap rankings, which means it is nowhere near top 25 in the US by market cap. It has $157B in revenue, so maybe that gets it close to top 25, though I still doubt it. It has less than 70k employees, which is not near top 25 either. And there are 5 other managed care organizations (aka health insurers) doing more business than Centene (UNH, Elevance, CVS, Cigna, and Humana). It has miniscule profit margins (1.56%) because it is paying out almost all of its revenue to healthcare providers (90% medical loss ratio). https://www.macrotrends.net/stocks/charts/CNC/centene/profit-margins https://www.macrotrends.net/stocks/charts/CNC/centene/profit... https://www.healthcaredive.com/news/centene-medicaid-redeterminations-second-quarter-earnings/689278/ https://www.healthcaredive.com/news/centene-medicaid-redeter... If this business approved more claims or paid more for the claims, it would either go out of business or become a charity. Or it would have to increase premiums.
olalonde 2y ago
Health insurance in the US sounds like such a scam. Is it not possible to pay for a psychiatrist directly or to renew prescriptions without seeing one?
- wepple 2y ago
  The former, yes, but they’re far more expensive. The latter, kind-of. You have to have regular check-ins, dependent on the type of medication
  - olalonde 2y ago
    It's crazy that you can't get a prescription for under 379$. Something is seriously broken with that system. I'm pretty sure I could get one for 1/10 that price where I live, without insurance.
    - GuinansEyebrows 2y ago
      When I first moved to the Netherlands, I had to visit a pharmacy to purchase insulin. I was prepared to spend nearly half my paycheck on a months supply and deal with the headache of not having a prescription on file before I’d established insurance. I walked out the door with a box of Lantus pens having spent 80€. That would have cost me about $600 in the US at the time, if they’d even dispense to me without a prescription.
      - rafram 2y ago
        It only would’ve cost you $600 if you paid the list price, which no uninsured patient should ever have to do. GoodRx has a coupon that takes it down to $35 per 30-day supply - significantly cheaper than in the Netherlands - and any decent pharmacy should offer you their “store discount,” which will be about the same.
        olalonde 2y ago
        Why is there a "list price" and an actual price? What's the point? Do pharmacies not compete with each other? Imagine if you went to a McDonald and the Big Mac was 300$ but it really was 10$ if you asked for a discount. So many questions...
Bengalilol 2y ago
This is so bad : we can measure a country's strength by its weakest link. There are some major loopholes here.
knodi123 2y ago
I've dealt with ghost networks too, with BCBS of CA. They provide you a directory with a thousand options, and I was already planning to go with the first provider that would have me. Had to call 15 before I got one that wasn't out of business, not accepting new patients, or not actually accepting the provider that gave me their number. So I can only assume that roughly 6% of their providers are actually real.
- ipaddr 2y ago
  I wouldn't assume based on your sample. Most people start at the top so more of those would be filled. Businesses that add AAA to their name to appear at the top of the yellow pages are more likely to close.
  - knodi123 2y ago
    It's not a phone book. The search results were based on distance from my exact address.
    - ipaddr 2y ago
      Your location is not random.
      - knodi123 2y ago
        what a bizarre statement. You're right. My location is also not alphabetical.
- robodan 2y ago
  I assume BCBS is Blue Cross Blue Shield; which is one of the largest insurers. Can I ask how big is the city you live in (or near)? It seems like big cities have options, but small towns starve for medical help.
  - knodi123 2y ago
    It's a capital city. In the end, there were options. Their directory had 200 providers, so even with that dismal accuracy, I bet could even find another provider if I didn't like my current one. I'm just providing supporting anecdata about how provider directories are vastly inflated with unusable results.
Apocryphon 2y ago
Not to get too ideological, but libertarian proponents tend to claim that businesses with poor service will just naturally be outcompeted. Those who go as far as to suggest that fraud need not be prosecuted by statist regulation will say that dishonest companies will have bad reputations and customers will naturally not patronize them. Makes me wonder what trying to build such a reputation system would look in practice. Consumer Reports manages to hang on as a publication but not everyone consults it, and there are so many more review sites these days of varying quality, impacted by AI/outsourced copywriting. And when you deal with an industry as dominated by a few monolithic oligopolies like health insurance or phone service- what is more bad publicity going to do to AT&T? You can’t even boycott that, especially when they lock in customers to prevent them from easily switching away.
- klabb3 2y ago
  Right you could go against the rest of the world and continue with privatized care. I’m sure it could work much better if free markets were enforced, but it’s very much the opposite. US markets are extremely entrenched, especially in highly regulated sectors. Markets are cornered by PE, by acquisitions, by frivolous lawsuits, any means possible to get dominance. And there’s no functioning anti-trust law, so you get the opposite of free markets. Even Milton Friedman claimed that governments have a necessary obligation to interfere to preserve free markets.
  - BirAdam 2y ago
    “Interfere to preserve free markets” is odd. The entire issue in the USA is regulatory capture and bribery of the government. The government has such tremendous lucre from taxing and such authoritarian power that every entity that can exploit it will exploit it. The government’s money and power is the one ring. The idea that the government should interfere is the entire problem. Just things like preventing insurance, a financial product, from being sold across the nation or around the world gives insurers undue power. Don’t get me wrong, in this case, breach of contract is a legal issue and the insurance company should be prosecuted, but Milton Friedman was off on this one by a mile. A government that has been purchased by banks, insurance companies, drug companies, and defense companies cannot act in the market fairly and therefore should not act at all.
ars 2y ago
It's easy to blame the insurance companies, but doing so misses the more important detail: There aren't enough providers. No amount of complaining or regulating the insurance companies is going to change this.
- Apocryphon 2y ago
  They should still be blamed by misrepresenting the lack of supply in their network. But certainly, medical professions probably need reform to alleviate supply, then of course you get into knock-on effects ranging from malpractice suits/tort reform to medical school tuitions. On the subject of mental health, it almost feels like we need a Manhattan Project of sorts to deal with the mounting crisis.
- LorenPechtel 2y ago
  Any longstanding shortage is either a resource limit or because the price is too low.
  - binfalse2 2y ago
    [flagged]
bryan_w 2y ago
The leaders at ambetter should be in jail. The world would be better off if they didn't exist.
hedora 2y ago
It's common to hit similar road blocks when trying to get a primary care physician around here (and the in-network specialists won't see you without a referral from a primary care physician, rendering your health insurance worthless for non-emergency care). The US really needs to get rid of the health insurance industry. Single payer would work as would standardized pricing combined with "if the doctor is licensed the insurance company must accept the bill". Barring that, there should be SLAs regarding for one-shot online searches or one phone call lookup of in-network care providers. For example, there could be a guarantee that the top three hits of at least 99% of such attempts each contain the phone number of a doctor's office that is accepting new patients and provides relevant care. If the insurance company falls below that bar, then it should have to refund all the premiums they collected that month (since there's no way to know which customers deferred care due to this bullshit), or be hit with some other fine that'd actually be material to their earnings.
- paulryanrogers 2y ago
  Afraid single payer system would just be hollowed out by conservatives (funded by PE), as it has been in the UK. Doubtful the US has the buy in and the discipline to maintain such a system. Sadly our private insurance market is an oligopoly that can obscure pricing and collude to increase prices. So it's the worst of both worlds.
- LorenPechtel 2y ago
  We have three UHC systems in America. Medicare, Medicaid and Tricare. All are typically worse than the private system. You want people to support UHC, fix the system first! What I would like to see is a SLA requirement that you can submit a request for a doctor who does X and is taking new patients. If you go through that list without finding one that can actually take you in a reasonable period they have 24 hours to remedy the matter or they have to cover at in network rates any doctor you select--and that remains in effect so long as you see that doctor (they can't force you to switch doctors.) Say $100/day + costs if they fail. They don't need more than a very short period because it shouldn't happen very often in the first place.
NeuroCoder 2y ago
Working in a psych unit trying to improve this process is really eye opening. Some key doctors have put in the effort to turn the inpatient floor from weeks of being trapped to identifying these situations where people simply need actual support established. There's even a special 72 hour turn around program recognizing this situation where the system has failed and what we need is rapid stabilization and setting up the proper support for the person to have therapists, medicine, and support groups while still living their lives. It still has flaws, but there are people that care and are working overtime to fix the system. It's just a very slow process.
todfox 2y ago
I once had an insurance plan with a grossly inaccurate provider directory. This cost me a bit as the doctor they suggested to me, verbally on the phone, turned out to be out of network. They later told me it was the doctor’s responsibility to remove themselves from the directories and they often fail to do that. If they’re so incapable of maintaining an accurate list of providers on their own, how did the insurance company know to reject that claim so quickly? They are simply liars and fraudsters. I began calling random doctors in the directory and one even told me he tried to get his name removed for three years. Anybody at the insurance company could clean up the directory once a quarter. They know the directories are inaccurate. It makes their network look bigger. Health insurance middlemen need to be eliminated already.
- prepend 2y ago
  It seems like insurance companies don’t care about things that burden the customer or provider. Lots of onerous forms and weird processes that are wrongly documented. I had infuriating situations where their directory showed a provider, their phone service confirmed they were in network, but the claim was rejected as out of network. They said they made a mistake and the only way to know is to try to submit a claim. I asked the same thing “if you know to review a claim why don’t your reps or your web site know?”
  - Reason077 2y ago
    It sounds like something that would be very easy to fix if the government mandated that insurance companies have a responsibility to keep their provider directories up-to-date. Software should be able to very easily identify providers that have not accepted any claims in a given time period, so that they can be flagged for removal.
    - mu53 2y ago
      You are giving me flashbacks back to 2008. "THeY aRe Gonna KILL GrandMA" Healthcare companies are entrenched politically with expansive lobbying efforts and advertising dollars.
copx 2y ago
Man, American healthcare sucks. Who came up with this "network" idea? I hope they are burning in hell. Here in Germany I can just go to any doctor/care provider. The insurance companies don't have networks I need to worry about. I have always considered that normal, and think the American system is horrible and perverse.
- pas 2y ago
  How do you know if someone is a care provider or they just say so? ... and that's the problem with the patchwork of states, certification boards, semi-regulated honor systems interconnected with a fuckton of money. And instead of sufficiently driving out scams[1] from the whole country (or at least from states) there are these mythical "allowlists". [1] but then muh freedom! and MLMs and religious crazies and spiritual-woo-whatever crazies masquerading as religious crazies, and ...
  - copx 2y ago
    >How do you know if someone is a care provider or they just say so? We have central authorities for that and as a patient I don't have to worry about it. In the case of public insurance (which over 80% of Germans use) the care provider bills the insurance company, not you. And people can't just pretend to be medical professionals because the insurance company can easily check if you actually have a valid license to practice medicine in Germany. Again there are central authorities for that which maintain registries.
- zajio1am 2y ago
  Really? Here in Czechia, we have similar public healthcare system based on public health insurance providers, and there is still a concept of non-contract doctor/care provider. It is unusual, as most care providers have contracts with most insurance providers, but it exists.
- MrDrMcCoy 2y ago
  You Germans really have it figured out. Social market economy is a great and well proven system. It's a pity that my fellow Americans conflate it with socialism, which is one of the few things that would be worse than what we have now.
more_corn 2y ago
Weaponized incompetence
taurath 2y ago
Ghost mental health networks are a thing. If you need a specialist therapist you will probably not even be able to get a single available provider who takes insurance. The best you can do, if you don't have a bunch of cash on hand or an HSA is get on a waiting list for literal years. People on medicaid, those who would proportionally probably need more mental healthcare, have the least amount of access (very very few therapists can financially afford to take medicaid), and the worst care (those that do are almost always new grads trying to finish the requirements of an independent license). It is one of the ways that our society deeply punishes the poor. Many many people especially here will never have experienced this - but some who've say lost a job due to a mental health reason quickly find that as their job goes away so does their ability to access care. Then they have to decide between at minimum $400 a month (more likely $700) for food/rent or for therapy. There is frequently nobody there to help you at the bottom. It can't happen to you until it does.
LeroyRaz 2y ago
This isn't normal. No other developed country has these issues. How can any American be proud of their country?
- mu53 2y ago
  what country are you from?
howard941 2y ago
Know what else sucks? A provider in your network at the beginning of the year and then dropping out partway through the year. Now I'm stuck for the rest of the year with insurance that I can't change that doesn't cover the provider it was chosen for. Recourse?
hackable_sand 2y ago
This is chilling. It lines up with my experience except I made it out with scars. People still judge me for them so I wear them openly and talk about them openly.
xtracto 2y ago
This reads so fucked up... pardon my language . But after every paragraph I was shouting "why don't you go to a private psychiatrist, even if it is out of the insurers network!!!!" Of course I already know the amswer: apparently in the US the cost of that is prohibite. Over here I can go to doctoralia.com.mx and book a next day specialist for at most $100 for the first consultation. Just to get my message, and the ask him to help him refer to whoever takes my insurance, if needed. US health system keeps beeing THE reason why I would never think to migrate to that country. No matter how pretty the American Dream sounds like.
chriscappuccio 2y ago
Maybe at the point when this guy figured out that drinking a fifth a day was bad, and his insurance company was a piece of shit, he could have thought, I'll do something else. Jujitsu ? AA ? Heck, go to a church. Try one of those cheap ketamine clinics if you have to...come on, there are so many ways... I get it, you have insurance and it would be nice to use it but many, many medical interventions are flawed and the services are not going to fix your life for you. As this poor guy unfortunately discovered when he thought that his plan was going to help. No, it probably won't, and even a good provider may not be of much help.
- 0xcde4c3db 2y ago
  I think it's worth seriously considering the possibility that that he felt like he was at the end of his rope partly because he did try a bunch of other things and none of them substantially helped. Especially considering that he moved out of downtown Austin, where there was presumably no shortage of options. The article mentions that he hadn't found a "new" AA group in Phoenix, which wouldn't make sense unless he had one previously.
tareqak 2y ago
I’ve had a similar experience with an insurance provider with similarly outdated providers when I was in Arizona. One of the care providers that was listed was one that I had previously seen in California (the education/ alma mater, name, etc. were all the same). I did end up calling to make sure, and found that my hunch at the time of this information being horribly stale was correct.
hut8 2y ago
https://www.timesunion.com/health/article/attorney-general-says-n-y-insurers-ghost-18537213.php https://www.timesunion.com/health/article/attorney-general-s... We have a huge problem with this in New York.
39896880 2y ago
What is most horrifying about this story is it is not about a person who is poor, or stuck in their ways and refusing help. It is about a person with both the will to get better and a caring family member advocating for him. If that kind of person can't get help, what chance does anyone else have?

207 points by jameslk 2y ago

I've encountered this in the Pittsburgh area with AHN. Trying to get a provider results in printed lists of outdated numbers, practices not accepting patients, etc. Frankly I think we need to start breaking laws. A startup needs to offer straight up good care and fuck the web of infinite regulations which support America's for profit health failure. Doctors can lose their licenses pretty easily so it's going to have to be a straight tech play. Offer as-good-as-possible care entirely outside of the medical profession. AIs are getting good enough that despite the obvious errors they make they are still better than the nothing-burger of care we get here.

dgoldstein0 2y ago
I don't see how the law is the problem here. The problem sounds like insurance companies that dodge their duties. We need them to be held accountable. We likely also need the general cost of doing business in healthcare to go down - which they are partly responsible for due to throwing up so many barriers for them to actually pay for anything.
- bumby 2y ago
  Steelmanning the OP (which I’m not sure I agree with), it’s possible they are alluding to regulatory capture, implying the laws are crafted to benefit for-profit companies first and patients second. However, I’m not sure going in the direction of less regulation would help. It’s like saying “The for-profit healthcare companies have too much power, so let’s just give them more power.”
  - jfengel 2y ago
    It's not so much a capture as a hodgepodge. There are a great many interests, and even in a good faith environment it would be a challenge to get everything right. Add to that the fact that it's not a good faith environment. There are many forces, not even connected to the industry, who fight to lower prices at any cost. Even if it means finding out too late that you're not actually buying anything at all. The laws and regulatory environment are "the best compromise people were able to get at the time" rather than any kind of cogent plan.
- akira2501 2y ago
  > We need them to be held accountable. We likely also need the general cost of doing business in healthcare to go down These two statements are at odds with each other. > responsible for due to throwing up so many barriers To me, it's obviously lack of competition that's the problem, you don't want to punish crappy providers, you want to subsidize new ones so the market is flooded with options. Which can be done right after we solve the monopolization problem in health care service providers, medical equipment providers, and "pharmacy benefit managers."
- xtracto 2y ago
  My dream project is a non-profit smart-contract based insurance system: with double blind analysis of claims by doctors who have nothing to win from approving/rejecting a specific claim, a system were there is no asshole middleman insurance racket company. I know this tech is disliked in HN, but I am positive that it is possible build something like that, due to the "trustlessness" capabilities.
antisthenes 2y ago
> Frankly I think we need to start breaking laws. Who's stopping you? I don't pay my medical bills by default, unless it's my dentist or my primary care provider. Everyone else can go to hell until the system breaks.
- bumby 2y ago
  Most large systems can absorb a certain level of free-loaders and remain stable by shifting that burden to other people. What you’re advocating is a collective action problem and will just make matters worse for everyone else. Unless you have a way to create a critical mass of similar behavior, it’s tantamount to a selfish action that benefits you to the expense of others.
  - antisthenes 2y ago
    Unless the system gets worse, there will never be enough willpower to change it for the better. As it stands, the system is already awful for the majority of people, with outcomes like this that become commonplace. > it’s tantamount to a selfish action that benefits you to the expense of others. Not unlike having great insurance paid for by your company, while others (just at the cutoff of govt subsidy for the plan) suffer the most and have to pay thousands of dollars for routine care. It's the ultimate "fuck you got mine", only applied to something that most people can't live without. And while "fuck you got mine" is okay in the context of luxury items, it is not in the case of medicine/housing/food. So maintaining the status quo is just as, if not more, selfish than protesting the system with a non-payment. But again, keeping the status quo is just letting the wound fester at this point.
    - bumby 2y ago
      >maintaining the status quo is just as, if not more, selfish than protesting the system with a non-payment. The point was that your approach won’t change the status quo, just makes it a little more expensive for everyone else.
      - 2y ago
jfengel 2y ago
It's not like starting up a food truck. A health care operation is vast, and no existing providers are going to break the law and risk losing their licences. You would need to create an entire parallel network. It would cost tens of billions, possibly hundreds.
insane_dreamer 2y ago
> offer straight up good care and fuck the web of infinite regulations which support America's for profit health failur they'd get immediately sued out of existence by the large vested interests

dgoldstein0 2y ago

This is messed up. Feels ripe for a wrongful death lawsuit at the minimum, and likely some regulatory enforcement against this scam insurance

anjel 2y ago
Perhaps you've never attempted to sue your once and former insurer for contract breach... You probably get the implied frustration and futility, but remember to include the impact of same on your yet-to-be treated illness.
- dgoldstein0 2y ago
  No I have not sued anyone. But my point is now that he's gone, maybe his family could sue. Not sure that'll really fix anything though. Laws and regulations with real enforcement could though.
  - anjel 2y ago
    1st true anecdote: multi year stop > start > offer settlement, revoke settlement > stall some more > offer a little less than last time > revoke 2nd settlement offer can delay what they have already acknowledged to themselves is a valid claim. But the interest income on your settlement for 4 years accrues to them, and wears you down so you'll be more disgusted, tired, and malleable for the final settlement negotiation. 2nd anecdote: Atty Wraps up a slip-and-fall, and pays out settlement. Client says "I'm using this as a down payment on a house." Atty replies "Hey, if you're happy with my services, let me handle your closing for you? Client: "Why not?" missing the fact that the legal work fell outside of their practice specialization. Meanwhile, Seller takes a third mortgage out during closing and pockets 50k without reporting it. (Buyer's) atty fails to find this, and buyer gets a notice of delinquency 1 month after move-in. Seller is in another state. Atty: "aww heck, I missed this but my malpractice insurance will take care of it for you." Then stalls for more than two years to initiate the claim. Client finally realizes atty is trying to run out the clock and goes to directly insurer and is told we only pay claims if you sue your atty for malpractice and prevail. They needed a new lawyer, plus new litigation funds, plus it turns out (in NJ at least) there are precious few legal malpractice attorneys because lawyers hate that kind of work. “I never was ruined but twice; once when I gained a lawsuit, and once when I lost it.” -quote attributed to Voltaire

keybored 2y ago

I almost teared up.

_dark_matter_ 2y ago
I did as well. My cousin passed away in his early 30s from alcoholism - this story hit close to home.

xyst 2y ago

It’s beating a dead horse at this point, but private health insurance is quite possibly the worst middleman I have ever dealt with. They not only make the patients life worse but the doctors and hospitals as well. Dealing with insurance means small practices need a dedicated office staff to file the right paperwork and get paid for each patient visit.

yieldcrv 2y ago
I’m curious about why it wasn’t considered to switch insurers, the article has do many details on many processes and I felt this one was not investigated It’s definitely hard to cancel them and the expense adds up to pay premiums for two Was it a possibility?
- siliconwrath 2y ago
  I obviously don’t know the specifics, but US healthcare plans only let you change during specific enrollment periods or qualifying life events. It’s possible he wasn’t able to. Additionally, it sounds like he picked what appeared to be the best rated plan available to him on the market. Others may have been even worse or prohibitively expensive.
  - yieldcrv 2y ago
    Yes I know it’s hard to cancel outside of enrollment periods, you can still have multiple Adding in the last minute flights and commitments throughout this article, I would say for other people that at some point the calculus can be re-evaluated to find that paying the premiums would be worth it. The loved ones can pay for that instead of last minute flights and time off
    - bumby 2y ago
      The man in the article was living in a studio apartment. I doubt he was in a position to be paying the equivalent of a mortgage for many insurance options. Even if he could, I’m not sure that’s the system/solution we’d want.

yieldcrv 2y ago

> what good another detox would do if it didn’t help him combat the root causes of his addiction through therapy that’s how I feel about suicide hotlines and the random placement of suggesting people call them

None4U 2y ago
People are not going to therapy if they're dead, and those hotlines are for helping people find local resources
- yieldcrv 2y ago
  Yeah and I acknowledge now that a large subset of suicides are totally impulsive, so any momentary disruption of the thought process is enough I think for a different subset that none of the resources are fixing the underlying stressor or interest in ending self preservation

EMM_386 2y ago

I've never heard of them. Then I read the bring in more revenue then "Disney, FedEx or PepsiCo". Wait, what? Oh, right, subsidaries. And, of course, a giant in Medicare Advantage. That company sounds ... very bad and needs to start doing what they are supposed to be doing and stop playing games. People are looking for help and they are looking for ... well, how to squeeze out more money I suppose. "You need psychiatric care? Sorry, we're a bit busy trying to make more money. Priorities and all." "Someone died due to our lack of caring about any of that? Sorry to hear that. Listen, gotta go. (click)" Sue them into the ground.

aziaziazi 2y ago
> bring in more revenue then "Disney, FedEx or PepsiCo". > Sue them into the ground Good luck with that :-)
- EMM_386 2y ago
  True, they are too big and have their tentacles in too many things to make them go away. However, when you are dealing with people who are supposed to be helping people, and they are staring at how much money is currently coming instead, just do what needs to be done. Any single law they broke? Sue them. People are asking for serious help, and they aren't helping them. And people are dying. That is beyond unaccepable. I hate these types of companies. It's like the companies that buy the land under hospitals, make them pay to stay on what is no longer their land, squeeze out as much as they can, bankrupt the hospital, and do it again to another one. Especially brutal when they do that to rural hospitals where now patients are pretty far from the other one still standing. I have a very strong dislike for any companies in that category. The people don't matter, as long as we can extract the money, we're going to do it. Greed on steroids.
lotsofpulp 2y ago
I don’t think the article is right. >One of the 25 largest corporations in America, Centene brings in more revenue than Disney, FedEx or PepsiCo, but it is less known because its hundreds of subsidiaries use different names. https://companiesmarketcap.com/largest-companies-by-revenue/ https://companiesmarketcap.com/largest-companies-by-revenue/ By what measure is Centene one of the US’s 25 largest corporations? Its way down at #519 in global market cap rankings, which means it is nowhere near top 25 in the US by market cap. It has $157B in revenue, so maybe that gets it close to top 25, though I still doubt it. It has less than 70k employees, which is not near top 25 either. And there are 5 other managed care organizations (aka health insurers) doing more business than Centene (UNH, Elevance, CVS, Cigna, and Humana). It has miniscule profit margins (1.56%) because it is paying out almost all of its revenue to healthcare providers (90% medical loss ratio). https://www.macrotrends.net/stocks/charts/CNC/centene/profit-margins https://www.macrotrends.net/stocks/charts/CNC/centene/profit... https://www.healthcaredive.com/news/centene-medicaid-redeterminations-second-quarter-earnings/689278/ https://www.healthcaredive.com/news/centene-medicaid-redeter... If this business approved more claims or paid more for the claims, it would either go out of business or become a charity. Or it would have to increase premiums.

olalonde 2y ago

Health insurance in the US sounds like such a scam. Is it not possible to pay for a psychiatrist directly or to renew prescriptions without seeing one?

wepple 2y ago
The former, yes, but they’re far more expensive. The latter, kind-of. You have to have regular check-ins, dependent on the type of medication
- olalonde 2y ago
  It's crazy that you can't get a prescription for under 379$. Something is seriously broken with that system. I'm pretty sure I could get one for 1/10 that price where I live, without insurance.
  - GuinansEyebrows 2y ago
    When I first moved to the Netherlands, I had to visit a pharmacy to purchase insulin. I was prepared to spend nearly half my paycheck on a months supply and deal with the headache of not having a prescription on file before I’d established insurance. I walked out the door with a box of Lantus pens having spent 80€. That would have cost me about $600 in the US at the time, if they’d even dispense to me without a prescription.
    - rafram 2y ago
      It only would’ve cost you $600 if you paid the list price, which no uninsured patient should ever have to do. GoodRx has a coupon that takes it down to $35 per 30-day supply - significantly cheaper than in the Netherlands - and any decent pharmacy should offer you their “store discount,” which will be about the same.
      - olalonde 2y ago
        Why is there a "list price" and an actual price? What's the point? Do pharmacies not compete with each other? Imagine if you went to a McDonald and the Big Mac was 300$ but it really was 10$ if you asked for a discount. So many questions...

Bengalilol 2y ago

This is so bad : we can measure a country's strength by its weakest link. There are some major loopholes here.

knodi123 2y ago

I've dealt with ghost networks too, with BCBS of CA. They provide you a directory with a thousand options, and I was already planning to go with the first provider that would have me. Had to call 15 before I got one that wasn't out of business, not accepting new patients, or not actually accepting the provider that gave me their number. So I can only assume that roughly 6% of their providers are actually real.

ipaddr 2y ago
I wouldn't assume based on your sample. Most people start at the top so more of those would be filled. Businesses that add AAA to their name to appear at the top of the yellow pages are more likely to close.
- knodi123 2y ago
  It's not a phone book. The search results were based on distance from my exact address.
  - ipaddr 2y ago
    Your location is not random.
    - knodi123 2y ago
      what a bizarre statement. You're right. My location is also not alphabetical.
robodan 2y ago
I assume BCBS is Blue Cross Blue Shield; which is one of the largest insurers. Can I ask how big is the city you live in (or near)? It seems like big cities have options, but small towns starve for medical help.
- knodi123 2y ago
  It's a capital city. In the end, there were options. Their directory had 200 providers, so even with that dismal accuracy, I bet could even find another provider if I didn't like my current one. I'm just providing supporting anecdata about how provider directories are vastly inflated with unusable results.

Apocryphon 2y ago

Not to get too ideological, but libertarian proponents tend to claim that businesses with poor service will just naturally be outcompeted. Those who go as far as to suggest that fraud need not be prosecuted by statist regulation will say that dishonest companies will have bad reputations and customers will naturally not patronize them. Makes me wonder what trying to build such a reputation system would look in practice. Consumer Reports manages to hang on as a publication but not everyone consults it, and there are so many more review sites these days of varying quality, impacted by AI/outsourced copywriting. And when you deal with an industry as dominated by a few monolithic oligopolies like health insurance or phone service- what is more bad publicity going to do to AT&T? You can’t even boycott that, especially when they lock in customers to prevent them from easily switching away.

klabb3 2y ago
Right you could go against the rest of the world and continue with privatized care. I’m sure it could work much better if free markets were enforced, but it’s very much the opposite. US markets are extremely entrenched, especially in highly regulated sectors. Markets are cornered by PE, by acquisitions, by frivolous lawsuits, any means possible to get dominance. And there’s no functioning anti-trust law, so you get the opposite of free markets. Even Milton Friedman claimed that governments have a necessary obligation to interfere to preserve free markets.
- BirAdam 2y ago
  “Interfere to preserve free markets” is odd. The entire issue in the USA is regulatory capture and bribery of the government. The government has such tremendous lucre from taxing and such authoritarian power that every entity that can exploit it will exploit it. The government’s money and power is the one ring. The idea that the government should interfere is the entire problem. Just things like preventing insurance, a financial product, from being sold across the nation or around the world gives insurers undue power. Don’t get me wrong, in this case, breach of contract is a legal issue and the insurance company should be prosecuted, but Milton Friedman was off on this one by a mile. A government that has been purchased by banks, insurance companies, drug companies, and defense companies cannot act in the market fairly and therefore should not act at all.

ars 2y ago

It's easy to blame the insurance companies, but doing so misses the more important detail: There aren't enough providers. No amount of complaining or regulating the insurance companies is going to change this.

Apocryphon 2y ago
They should still be blamed by misrepresenting the lack of supply in their network. But certainly, medical professions probably need reform to alleviate supply, then of course you get into knock-on effects ranging from malpractice suits/tort reform to medical school tuitions. On the subject of mental health, it almost feels like we need a Manhattan Project of sorts to deal with the mounting crisis.
LorenPechtel 2y ago
Any longstanding shortage is either a resource limit or because the price is too low.
- binfalse2 2y ago
  [flagged]

bryan_w 2y ago

The leaders at ambetter should be in jail. The world would be better off if they didn't exist.

hedora 2y ago

It's common to hit similar road blocks when trying to get a primary care physician around here (and the in-network specialists won't see you without a referral from a primary care physician, rendering your health insurance worthless for non-emergency care). The US really needs to get rid of the health insurance industry. Single payer would work as would standardized pricing combined with "if the doctor is licensed the insurance company must accept the bill". Barring that, there should be SLAs regarding for one-shot online searches or one phone call lookup of in-network care providers. For example, there could be a guarantee that the top three hits of at least 99% of such attempts each contain the phone number of a doctor's office that is accepting new patients and provides relevant care. If the insurance company falls below that bar, then it should have to refund all the premiums they collected that month (since there's no way to know which customers deferred care due to this bullshit), or be hit with some other fine that'd actually be material to their earnings.

paulryanrogers 2y ago
Afraid single payer system would just be hollowed out by conservatives (funded by PE), as it has been in the UK. Doubtful the US has the buy in and the discipline to maintain such a system. Sadly our private insurance market is an oligopoly that can obscure pricing and collude to increase prices. So it's the worst of both worlds.
LorenPechtel 2y ago
We have three UHC systems in America. Medicare, Medicaid and Tricare. All are typically worse than the private system. You want people to support UHC, fix the system first! What I would like to see is a SLA requirement that you can submit a request for a doctor who does X and is taking new patients. If you go through that list without finding one that can actually take you in a reasonable period they have 24 hours to remedy the matter or they have to cover at in network rates any doctor you select--and that remains in effect so long as you see that doctor (they can't force you to switch doctors.) Say $100/day + costs if they fail. They don't need more than a very short period because it shouldn't happen very often in the first place.

NeuroCoder 2y ago

Working in a psych unit trying to improve this process is really eye opening. Some key doctors have put in the effort to turn the inpatient floor from weeks of being trapped to identifying these situations where people simply need actual support established. There's even a special 72 hour turn around program recognizing this situation where the system has failed and what we need is rapid stabilization and setting up the proper support for the person to have therapists, medicine, and support groups while still living their lives. It still has flaws, but there are people that care and are working overtime to fix the system. It's just a very slow process.

todfox 2y ago

I once had an insurance plan with a grossly inaccurate provider directory. This cost me a bit as the doctor they suggested to me, verbally on the phone, turned out to be out of network. They later told me it was the doctor’s responsibility to remove themselves from the directories and they often fail to do that. If they’re so incapable of maintaining an accurate list of providers on their own, how did the insurance company know to reject that claim so quickly? They are simply liars and fraudsters. I began calling random doctors in the directory and one even told me he tried to get his name removed for three years. Anybody at the insurance company could clean up the directory once a quarter. They know the directories are inaccurate. It makes their network look bigger. Health insurance middlemen need to be eliminated already.

prepend 2y ago
It seems like insurance companies don’t care about things that burden the customer or provider. Lots of onerous forms and weird processes that are wrongly documented. I had infuriating situations where their directory showed a provider, their phone service confirmed they were in network, but the claim was rejected as out of network. They said they made a mistake and the only way to know is to try to submit a claim. I asked the same thing “if you know to review a claim why don’t your reps or your web site know?”
- Reason077 2y ago
  It sounds like something that would be very easy to fix if the government mandated that insurance companies have a responsibility to keep their provider directories up-to-date. Software should be able to very easily identify providers that have not accepted any claims in a given time period, so that they can be flagged for removal.
  - mu53 2y ago
    You are giving me flashbacks back to 2008. "THeY aRe Gonna KILL GrandMA" Healthcare companies are entrenched politically with expansive lobbying efforts and advertising dollars.

copx 2y ago

Man, American healthcare sucks. Who came up with this "network" idea? I hope they are burning in hell. Here in Germany I can just go to any doctor/care provider. The insurance companies don't have networks I need to worry about. I have always considered that normal, and think the American system is horrible and perverse.

pas 2y ago
How do you know if someone is a care provider or they just say so? ... and that's the problem with the patchwork of states, certification boards, semi-regulated honor systems interconnected with a fuckton of money. And instead of sufficiently driving out scams[1] from the whole country (or at least from states) there are these mythical "allowlists". [1] but then muh freedom! and MLMs and religious crazies and spiritual-woo-whatever crazies masquerading as religious crazies, and ...
- copx 2y ago
  >How do you know if someone is a care provider or they just say so? We have central authorities for that and as a patient I don't have to worry about it. In the case of public insurance (which over 80% of Germans use) the care provider bills the insurance company, not you. And people can't just pretend to be medical professionals because the insurance company can easily check if you actually have a valid license to practice medicine in Germany. Again there are central authorities for that which maintain registries.
zajio1am 2y ago
Really? Here in Czechia, we have similar public healthcare system based on public health insurance providers, and there is still a concept of non-contract doctor/care provider. It is unusual, as most care providers have contracts with most insurance providers, but it exists.
MrDrMcCoy 2y ago
You Germans really have it figured out. Social market economy is a great and well proven system. It's a pity that my fellow Americans conflate it with socialism, which is one of the few things that would be worse than what we have now.

more_corn 2y ago

Weaponized incompetence

taurath 2y ago

Ghost mental health networks are a thing. If you need a specialist therapist you will probably not even be able to get a single available provider who takes insurance. The best you can do, if you don't have a bunch of cash on hand or an HSA is get on a waiting list for literal years. People on medicaid, those who would proportionally probably need more mental healthcare, have the least amount of access (very very few therapists can financially afford to take medicaid), and the worst care (those that do are almost always new grads trying to finish the requirements of an independent license). It is one of the ways that our society deeply punishes the poor. Many many people especially here will never have experienced this - but some who've say lost a job due to a mental health reason quickly find that as their job goes away so does their ability to access care. Then they have to decide between at minimum $400 a month (more likely $700) for food/rent or for therapy. There is frequently nobody there to help you at the bottom. It can't happen to you until it does.

LeroyRaz 2y ago

This isn't normal. No other developed country has these issues. How can any American be proud of their country?

mu53 2y ago
what country are you from?

howard941 2y ago

Know what else sucks? A provider in your network at the beginning of the year and then dropping out partway through the year. Now I'm stuck for the rest of the year with insurance that I can't change that doesn't cover the provider it was chosen for. Recourse?

hackable_sand 2y ago

This is chilling. It lines up with my experience except I made it out with scars. People still judge me for them so I wear them openly and talk about them openly.

xtracto 2y ago

This reads so fucked up... pardon my language . But after every paragraph I was shouting "why don't you go to a private psychiatrist, even if it is out of the insurers network!!!!" Of course I already know the amswer: apparently in the US the cost of that is prohibite. Over here I can go to doctoralia.com.mx and book a next day specialist for at most $100 for the first consultation. Just to get my message, and the ask him to help him refer to whoever takes my insurance, if needed. US health system keeps beeing THE reason why I would never think to migrate to that country. No matter how pretty the American Dream sounds like.

chriscappuccio 2y ago

Maybe at the point when this guy figured out that drinking a fifth a day was bad, and his insurance company was a piece of shit, he could have thought, I'll do something else. Jujitsu ? AA ? Heck, go to a church. Try one of those cheap ketamine clinics if you have to...come on, there are so many ways... I get it, you have insurance and it would be nice to use it but many, many medical interventions are flawed and the services are not going to fix your life for you. As this poor guy unfortunately discovered when he thought that his plan was going to help. No, it probably won't, and even a good provider may not be of much help.

0xcde4c3db 2y ago
I think it's worth seriously considering the possibility that that he felt like he was at the end of his rope partly because he did try a bunch of other things and none of them substantially helped. Especially considering that he moved out of downtown Austin, where there was presumably no shortage of options. The article mentions that he hadn't found a "new" AA group in Phoenix, which wouldn't make sense unless he had one previously.

tareqak 2y ago

I’ve had a similar experience with an insurance provider with similarly outdated providers when I was in Arizona. One of the care providers that was listed was one that I had previously seen in California (the education/ alma mater, name, etc. were all the same). I did end up calling to make sure, and found that my hunch at the time of this information being horribly stale was correct.

hut8 2y ago

https://www.timesunion.com/health/article/attorney-general-says-n-y-insurers-ghost-18537213.php https://www.timesunion.com/health/article/attorney-general-s... We have a huge problem with this in New York.

39896880 2y ago

What is most horrifying about this story is it is not about a person who is poor, or stuck in their ways and refusing help. It is about a person with both the will to get better and a caring family member advocating for him. If that kind of person can't get help, what chance does anyone else have?