21 ms·

I fought insurance over this past summer after they declined covering a life saving surgery for my 6-year-old child at the last minute. We were in despair that

I fought insurance over this past summer after they declined covering a life saving surgery for my 6-year-old child at the last minute. We were in despair that my child's life was at risk each day we waited because of insurance incompetence. ChatGPT literally guided me through the whole external appeal process, who to contact outside of normal channels to ask for help / apply pressure, researched questions I had, helped with wording on the appeals, and yes, helped keep me pushing forward at some of the darkest moments when I was grasping for anything, however small, to help keep the pressure up on the insurance company. I didn't follow everything it suggested blindly. Definitely decided a few times to make decisions that differed from its advice partially or completely, and I sometimes ran suggested next steps by several close friends/family to make sure I wasn't missing something obvious. But the ideas/path ChatGPT suggested, the chasing down different scenarios to rule in/out them, and coaching me through this is what ultimately got movement on our case. 10 days post denial, I was able to get the procedure approved from these efforts. 21 days post denial and 7 days after the decision was reversed, we lucked into a surgery slot that opened up and my child got their life saving surgery. They have recovered and is in the best health of the past 18 months. This maybe isn't leveling the playing field, at least not entirely. But it gave us a fighting chance on a short timeline and know where to best use our pressure. The hopeful part of me is that many others can use similar techniques to win.

nmz 11mo ago
> incompetence No, that's the goal. Denying coverage is how insurance companies make money. The less money they give, the more money they keep.
miki123211 11mo ago
This is why AI is an equalizing force. Eventually, we'll just have a free (or at least much cheaper) psychiatrist in our pocket. Sure, AI advice is workse than the advice of a competent professional, but it's very often better no advice, and that's what you get if you can't afford the professional.
- ASalazarMX 11mo ago
  I shudder to think when insurance companies use AI to counteract customers using AI to navigate through their system. They'll eventually catch up, and people who don't use any kind of AI will be disadvantaged. That is, until someone sells them a turnkey AI service to do insurance claims... and decides to play both teams so resolutions come back at pre-AI levels, and the free market(TM) is happy because a new equilibrium has been reached. Maybe I just need more sleep.
  - itissid 11mo ago
    I am not sure it's that simple. Thing is many costs are due to information assymetry: you not knowing something that they do. For example them counting on you to big hire a lawyer for collecting medical debt or mortgage debt your spouse or parent owes. As a general rule you aren't responsible for it. There are exceptions. e.g. Filial laws(children responsible for parent's debts) exist in many states, but are difficult to invoke. Community property laws https://www.irs.gov/publications/p555#en_US_202502_publink1000168755 https://www.irs.gov/publications/p555#en_US_202502_publink10... in 9 states that can link your income to your partner, when the state you were domiciled in with your partner in a home/condo you bought together. So in general, adverserial use of AI cannot bring claims "back to pre-AI" levels. Much more likely is the fact is reduced debt collection activity and illegal billing will reduce to a new baseline.
benmw333 11mo ago
A few of the sentences don't make sense to me. Who is "they" and "their" in the last two paragraphs?
- apparent 11mo ago
  Seems like GP is trying to refer to the child without reference to sex.
  - chrisgeleven 11mo ago
    Bingo. It's not important.
horns4lyfe 11mo ago
Insurance companies have become cartoonishly evil. It’s going to get really nasty out there at some point.
brightball 11mo ago
In that same vein, I used a public adjuster once after a small electrical fire torched a room in my house. The insurance adjuster was great, his manager was awful and made a difficult experience much worse. Without getting into details, the moment I realized that he was being intentionally obtuse I started looking into options. First contacted an attorney who essentially said, “Yes, I can do it but I’m going to cost a lot and the insurance company won’t reimburse you for my time.” Kept looking and discovered public adjusters were a thing. Did some research, found one who was reputable and he took me on for free. Pretty sure we used net, about 2-4 hours of his time. He told me exactly what was going to happen, how the insurance company was going to react and it played out exactly as he said. 1. He requested a process to take the valuation of everything damaged in the fire to a 3rd party arbiter. 2. Insurance company will send you a letter saying it’s not time for that yet. We will proceed anyway. And we did. 3. He will nominate 3 arbiters and the insurance company will nominate 3 arbiters. Neither will select either of the others nominees and an independent 3rd party will select one instead. 4. The moment the insurance company realizes the valuation of your things will be outside of their control, they will become extremely agreeable. And they did. And honestly the only thing I really wanted was another week in a hotel for my family because the company cleaning my house of smoke was short staffed over the holidays. Would have cost them likely $1,000 but instead he escalated the situation dramatically.
- DesiLurker 11mo ago
  thank you for this comment, learnt a new defensive trick today.
Sincere6066 11mo ago
(this thread paid for by OpenAI)
itissid 11mo ago
A pharmacist once told me that big insurance companies have call centers out in other countries whose job it is to call everyone who has medication approved and any one with misleading line of questioning:"Did you get or approve medication worth $$$$$$..?". Calling 100's of people Ofc the find one poor guy never heard of such a sum denies this kind of line of questioning. Then the insurance company uses this to deny all claims made by the pharmacy for ALL their patients for that given drug/medication. The pharmacist told me the mountain of documentary evidence they have to collect to rebut these denials is very large. Once a customer at their pharmacy said he did not want to sign off on a paper that he got a medication, the pharmacist got the customer's ok though to video record his consent, just so he does not have to deal with this mess. He also mentioned to me that a pharmacist should NEVER pay any kind of reimbursement to an insurance company on a claim that was denied cause that somehow legally can let the insurance company deny future claims. Not entirely sure what exact legal procedure allows them to do that.
IlikeKitties 11mo ago
I'm glad you were able to use these tools to help your family though such tough times! > The hopeful part of me is that many others can use similar techniques to win. And the realistic part in me says that these tools will be used to deny appeals without a human ever looking into them and making sure you will never get to talk to a human or get approval for anything ever again.
phyzix5761 11mo ago
I'm curious, where do you live that denies a child a life saving surgery just because insurance won't cover it? Because in the US there's laws against that.
- lelanthran 11mo ago
  > I'm curious, where do you live that denies a child a life saving surgery just because insurance won't cover it? Because in the US there's laws against that. Maybe I'm just too skeptical, but a) This is a very new account with exactly 1 other posting 3 months ago, and b) They don't refer to their child with any sort of gender. They even used slightly awkward sentence construction just to avoid gender. Few parents think of their child as an "it". So either this is a sleeper bot, or the surgery in question was gender reassignment. Or this poster routinely refers to their child as an "it", not a "he" or a "her".
  - Nevermark 11mo ago
    Or they value privacy? Especially regarding their children? Many people nondescriptly don’t gender themselves in online discussions.
    - lelanthran 11mo ago
      > Or they value privacy? Especially regarding their children? Could be, but they made only a single other posting and are effectively not even pseudo-anonymous, but completely anonymous.
  - chrisgeleven 11mo ago
    I usually read Hacker News, not comment...this story just grabbed my attention because of my kid's situation and wanting to maybe give others hope fighting a similar battle. You know, when you deal with the past 18 months where your kid has 6 hospitalizations due to illness, 2 minor surgeries, 3 major surgeries (this last one was spine related, others heart), countless appointments, multiple feeding tube feedings a day to sustain nutrition, nearly $2 million lifetime billed do insurance (as a 6 year old)...who the fuck cares about what gender I decide to write about or the reason I might not share it?
heavyset_go 11mo ago
The other side of this is that your LLM interaction can be leveraged to train adversarial models that find ways to still deny or delay your claim despite your LLM-advised actions. Insurance companies, or the companies they pay to launder their involvement, would pay a lot more for that than the public would be able to.
- chrisgeleven 11mo ago
  I know, that is a worry I have.
egorfine 11mo ago
[flagged]
- tboyd47 11mo ago
  It's not a democracy. You were told wrong, it's a republic.
  - galangalalgol 11mo ago
    Well it was a democratic republic. Now it is an electoral autocracy. He fixed it so good those christians will never have (or be able) to vote again. Just like he said he would. A Republic where the representatives are chosen by a popular vote are still democracies.
    - tboyd47 11mo ago
      The representatives are chosen by the Electoral College, not the popular vote. The U.S. is not a democracy.
      - galangalalgol 11mo ago
        Representatives are chosen directly by the voters of their districts and senators directly by the voters of their state. Electors are selected however their state decides, so yeah, the president isn't necessarily democratically chosen. Neither are judges. In practice though the electors are chosen based on the state vote. Saying the us wasn't a democracy is narrowing the definition of democracy quite a bit.
        tboyd47 11mo ago
        It's a constitutional republic. Democracy is optional. We'll either discover it now or discover it later.
- zarmsdos 11mo ago
  Decades of right-wing propaganda, unfortunately. They tend to have an emotional reaction against any sort of socialized anything, including healthcare.
lotsofpulp 11mo ago
I was under the impression that if you were to go to an emergency room, life saving surgery would be scheduled regardless of who is paying (or not paying), due to EMTALA. I can't imagine a hospital waiting for an insurance company's approval to pay for a procedure to schedule a child's life saving surgery. Is this incorrect?
- chrisgeleven 11mo ago
  This wasn't an immediate ER situation, at least directly (yet). More of a if this procedure doesn't get done now, at some point in the relatively near future, there will be multiple ER situations, almost certainly multiple hospitalizations, and one of those might go past the point of no return. And the insurance still played games. Like, it's in your best interest to pay once and get this situation resolved in a scheduled/controlled manner than wait for multiple emergency hospitalizations AND have to pay for this in an emergency situation...you're probably talking at least 2x cost if not more.
- kiitos 11mo ago
  > Is this incorrect? yep because "life-saving" isn't a single well-defined boolean condition that can be determined by ER staff as part of triage > I can't imagine a hospital waiting for an insurance company's approval to pay for a procedure to schedule a child's life saving surgery. then I guess you've never dealt with major health issues like cancer, blood disease, etc. etc. because what you're describing here happens all the time
- dboreham 11mo ago
  Presumably parent is describing a non-emergency situation.
  - tptacek 11mo ago
    Good reminder that "life saving" and "elective" are orthogonal.
- evan_ 11mo ago
  if the kid has a steel spike through his abdomen then they will perform that surgery. If he's having seizures because of a brain tumor all they're required to do is stabilize and release.
dweekly 11mo ago
I am so glad to hear your child got the care they needed. I've found that people often forget to call their state senator or assemblyperson. It has consistently amazed me how quickly a large company that's sitting on their butts about a topic will move lickety-split once their Government Affairs and/or PR teams are on the thread... Another tip from having worked at a regulated entity: a physical letter to the CEO mailed to HQ creates a mandatory-response paper trail that will produce a very, very different (better) outcome than e.g. asking to talk to a supervisor while on a call that's not going well.
lanfeust6 11mo ago
Great story, and encapsulates what I find most powerful about LLMs.
Brainfood 11mo ago
Thank you for sharing. I can personally say this same process has driven me to the brink of sanity. 10 years of managing a chronically ill child’s healthcare with multiple surgeries. Being a developer with the ability to navigate complex problems, social engineer people who have turned into robots, and enough income to make it through unforeseen lump sum payments - I cannot fathom how the average person deals with this. I made more $ than I ever did before to cover the costs and afford the best healthcare possible but the system is designed so we still get screwed and have nothing left. Thankful for the people who dedicate their lives to helping others. To everyone else who can justify profiting off of someone else misery, while being the richest and most advanced society on every other level? I have nothing nice to say to you.
bmurphy1976 11mo ago
How comfortable are you with naming and shaming the company? I don't think things are going to change if we don't call this stuff out loudly and publicly. That's awful but I'm glad you were able to figure this out. I've had my own problems with insurance companies, but nothing to this level. I can't imagine the frustration, especially with YOUR CHILD'S HEALTH on the line. Five years back I ended up getting surgery for a herniated disc. I was in immense and crippling pain. Before having the surgery, we decided to go through a round epidural shots. I had done that 20 years previously and it resolved the problem, so why wouldn't I? Turns out my insurance company (who I will name: BCBSIL) delegated the approval for the epidurals through some kind of extra bureaucratic process with a 3rd party. It took days and additional effort on our end to get approved. I remind you, I was in crippling pain at the time. The delays getting this approved lead to me taking more Ibuprofen than I would otherwise have taken, which in turn lead to signs of internal bleeding. I had to ease off the Ibuprofen and significantly increase the amount of codeine (a drug which does not sit well with me) just to get by. Now not only did I have to wait for the approval, but I then had to wait for the signs of internal bleeding to go away before the doctor would give me the shot (which was the right call, even though it sucked). Delays, compounding delays, compounding delays, all while I was absolutely miserable. Anyway, I finally got approved and got the shot and it kinda helped, but didn't fix the issue. I had a second shot, got worse, and then decided we had no choice but to schedule the surgery. The most frustrating thing (but something I am glad for) is that the surgery was approved immediately. It's so maddening how inconsistent the whole thing is.
- like_any_other 11mo ago
  > How comfortable are you with naming and shaming the company? Don't forget about the individuals responsible. Both the ones that made the denial decision, and the ones that instituted the internal system that incentivizes such denials.
- chrisgeleven 11mo ago
  It was Anthem Blue Cross. You know, it is one thing if it is you or I as terrible as that is. But this was a 6-year-old.
magicalhippo 11mo ago
Relative recently had their baby come several months early. The baby needed intensive care for a couple of months, and breathing support (CPAP) for another two. Mom lived at the hospital hotel for the duration. Baby got regular inspections of the heart, lungs and eyes (too much oxygen in the blood can lead to problems with the cornea or something), including after checkout. They got billed exactly zero. Both parents even got full pay during the hospital stay, so didn't have to worry about the economy. Ok, so I pay a fair bit of taxes here in Norway, and some of it is used on stupid stuff. But overall I like knowing my life won't be ruined because of some random event forced me into insolvency.
- ksclarke 11mo ago
  The whole time I was reading this, as someone from the U.S., I was wondering what country the writer was from, because it sure as #$@! wasn't written by someone in the U.S. When I got to that part, I was, "Oh. Okay. That makes sense."
  - thatfrenchguy 11mo ago
    In the US, you'll be billed the maximum out of pocket for your health insurance whether your little one is in the ICU for months or whether it was a easy delivery though, so at least birth is a predictable medical expense.
    - t0mas88 11mo ago
      If you have health insurance... Which is not automatically a thing for many Americans, and it seems even more with current political trends.
      - trollbridge 11mo ago
        If someone doesn’t have health insurance in my state, they get sent to financial counselling/assistance and signed up for Medicaid, CHIP, or HCAP. I asked one of their counsellors once if they ever have any ultra wealthy people who don’t have insurance and also don’t qualify for any assistance. (This was at a children’s hospital with a Level IV NICU.) She said she was unaware of that ever happening, other than very wealthy foreigners who would prepare in advance, arrange payment in advance, fly in, and have a special procedure done. Overall, in many states, it is logistically impossible to have an unaffordable bill and also not qualify for assistance. The worst situation actually is the person who has insurance but has high deductibles and copays.
game_the0ry 11mo ago
Happy to hear this all worked out. Have you thought about reaching out to local news to get the word out? That insurance company should be called out.
ethbr1 11mo ago
Amazingly happy to hear you were able to drive the process! FWIW, surgical centers usually have to do the exact same thing for their patients (typical role: coordinator), and they do it the same way you did (plus knowing a few counterparties because they work together regularly). The lack of data standardization in health insurance is atrocious. (In the US, CMS/Congress pushing what it can, but at a glacial pace) The strongest argument for single payer is that a diverse marketplace has demonstrated a fundamental inability to interoperate.
Cub3 11mo ago
Man that’s terrifying. I can’t imagine going through that due to admin incompetence The US healthcare system sounds horrific

nmz 11mo ago

> incompetence No, that's the goal. Denying coverage is how insurance companies make money. The less money they give, the more money they keep.

miki123211 11mo ago

This is why AI is an equalizing force. Eventually, we'll just have a free (or at least much cheaper) psychiatrist in our pocket. Sure, AI advice is workse than the advice of a competent professional, but it's very often better no advice, and that's what you get if you can't afford the professional.

ASalazarMX 11mo ago
I shudder to think when insurance companies use AI to counteract customers using AI to navigate through their system. They'll eventually catch up, and people who don't use any kind of AI will be disadvantaged. That is, until someone sells them a turnkey AI service to do insurance claims... and decides to play both teams so resolutions come back at pre-AI levels, and the free market(TM) is happy because a new equilibrium has been reached. Maybe I just need more sleep.
- itissid 11mo ago
  I am not sure it's that simple. Thing is many costs are due to information assymetry: you not knowing something that they do. For example them counting on you to big hire a lawyer for collecting medical debt or mortgage debt your spouse or parent owes. As a general rule you aren't responsible for it. There are exceptions. e.g. Filial laws(children responsible for parent's debts) exist in many states, but are difficult to invoke. Community property laws https://www.irs.gov/publications/p555#en_US_202502_publink1000168755 https://www.irs.gov/publications/p555#en_US_202502_publink10... in 9 states that can link your income to your partner, when the state you were domiciled in with your partner in a home/condo you bought together. So in general, adverserial use of AI cannot bring claims "back to pre-AI" levels. Much more likely is the fact is reduced debt collection activity and illegal billing will reduce to a new baseline.

benmw333 11mo ago

A few of the sentences don't make sense to me. Who is "they" and "their" in the last two paragraphs?

apparent 11mo ago
Seems like GP is trying to refer to the child without reference to sex.
- chrisgeleven 11mo ago
  Bingo. It's not important.

horns4lyfe 11mo ago

Insurance companies have become cartoonishly evil. It’s going to get really nasty out there at some point.

brightball 11mo ago

In that same vein, I used a public adjuster once after a small electrical fire torched a room in my house. The insurance adjuster was great, his manager was awful and made a difficult experience much worse. Without getting into details, the moment I realized that he was being intentionally obtuse I started looking into options. First contacted an attorney who essentially said, “Yes, I can do it but I’m going to cost a lot and the insurance company won’t reimburse you for my time.” Kept looking and discovered public adjusters were a thing. Did some research, found one who was reputable and he took me on for free. Pretty sure we used net, about 2-4 hours of his time. He told me exactly what was going to happen, how the insurance company was going to react and it played out exactly as he said. 1. He requested a process to take the valuation of everything damaged in the fire to a 3rd party arbiter. 2. Insurance company will send you a letter saying it’s not time for that yet. We will proceed anyway. And we did. 3. He will nominate 3 arbiters and the insurance company will nominate 3 arbiters. Neither will select either of the others nominees and an independent 3rd party will select one instead. 4. The moment the insurance company realizes the valuation of your things will be outside of their control, they will become extremely agreeable. And they did. And honestly the only thing I really wanted was another week in a hotel for my family because the company cleaning my house of smoke was short staffed over the holidays. Would have cost them likely $1,000 but instead he escalated the situation dramatically.

DesiLurker 11mo ago
thank you for this comment, learnt a new defensive trick today.

Sincere6066 11mo ago

(this thread paid for by OpenAI)

itissid 11mo ago

A pharmacist once told me that big insurance companies have call centers out in other countries whose job it is to call everyone who has medication approved and any one with misleading line of questioning:"Did you get or approve medication worth $$$$$$..?". Calling 100's of people Ofc the find one poor guy never heard of such a sum denies this kind of line of questioning. Then the insurance company uses this to deny all claims made by the pharmacy for ALL their patients for that given drug/medication. The pharmacist told me the mountain of documentary evidence they have to collect to rebut these denials is very large. Once a customer at their pharmacy said he did not want to sign off on a paper that he got a medication, the pharmacist got the customer's ok though to video record his consent, just so he does not have to deal with this mess. He also mentioned to me that a pharmacist should NEVER pay any kind of reimbursement to an insurance company on a claim that was denied cause that somehow legally can let the insurance company deny future claims. Not entirely sure what exact legal procedure allows them to do that.

IlikeKitties 11mo ago

I'm glad you were able to use these tools to help your family though such tough times! > The hopeful part of me is that many others can use similar techniques to win. And the realistic part in me says that these tools will be used to deny appeals without a human ever looking into them and making sure you will never get to talk to a human or get approval for anything ever again.

phyzix5761 11mo ago

I'm curious, where do you live that denies a child a life saving surgery just because insurance won't cover it? Because in the US there's laws against that.

lelanthran 11mo ago
> I'm curious, where do you live that denies a child a life saving surgery just because insurance won't cover it? Because in the US there's laws against that. Maybe I'm just too skeptical, but a) This is a very new account with exactly 1 other posting 3 months ago, and b) They don't refer to their child with any sort of gender. They even used slightly awkward sentence construction just to avoid gender. Few parents think of their child as an "it". So either this is a sleeper bot, or the surgery in question was gender reassignment. Or this poster routinely refers to their child as an "it", not a "he" or a "her".
- Nevermark 11mo ago
  Or they value privacy? Especially regarding their children? Many people nondescriptly don’t gender themselves in online discussions.
  - lelanthran 11mo ago
    > Or they value privacy? Especially regarding their children? Could be, but they made only a single other posting and are effectively not even pseudo-anonymous, but completely anonymous.
- chrisgeleven 11mo ago
  I usually read Hacker News, not comment...this story just grabbed my attention because of my kid's situation and wanting to maybe give others hope fighting a similar battle. You know, when you deal with the past 18 months where your kid has 6 hospitalizations due to illness, 2 minor surgeries, 3 major surgeries (this last one was spine related, others heart), countless appointments, multiple feeding tube feedings a day to sustain nutrition, nearly $2 million lifetime billed do insurance (as a 6 year old)...who the fuck cares about what gender I decide to write about or the reason I might not share it?

heavyset_go 11mo ago

The other side of this is that your LLM interaction can be leveraged to train adversarial models that find ways to still deny or delay your claim despite your LLM-advised actions. Insurance companies, or the companies they pay to launder their involvement, would pay a lot more for that than the public would be able to.

chrisgeleven 11mo ago
I know, that is a worry I have.

egorfine 11mo ago

[flagged]

tboyd47 11mo ago
It's not a democracy. You were told wrong, it's a republic.
- galangalalgol 11mo ago
  Well it was a democratic republic. Now it is an electoral autocracy. He fixed it so good those christians will never have (or be able) to vote again. Just like he said he would. A Republic where the representatives are chosen by a popular vote are still democracies.
  - tboyd47 11mo ago
    The representatives are chosen by the Electoral College, not the popular vote. The U.S. is not a democracy.
    - galangalalgol 11mo ago
      Representatives are chosen directly by the voters of their districts and senators directly by the voters of their state. Electors are selected however their state decides, so yeah, the president isn't necessarily democratically chosen. Neither are judges. In practice though the electors are chosen based on the state vote. Saying the us wasn't a democracy is narrowing the definition of democracy quite a bit.
      - tboyd47 11mo ago
        It's a constitutional republic. Democracy is optional. We'll either discover it now or discover it later.
zarmsdos 11mo ago
Decades of right-wing propaganda, unfortunately. They tend to have an emotional reaction against any sort of socialized anything, including healthcare.

lotsofpulp 11mo ago

I was under the impression that if you were to go to an emergency room, life saving surgery would be scheduled regardless of who is paying (or not paying), due to EMTALA. I can't imagine a hospital waiting for an insurance company's approval to pay for a procedure to schedule a child's life saving surgery. Is this incorrect?

chrisgeleven 11mo ago
This wasn't an immediate ER situation, at least directly (yet). More of a if this procedure doesn't get done now, at some point in the relatively near future, there will be multiple ER situations, almost certainly multiple hospitalizations, and one of those might go past the point of no return. And the insurance still played games. Like, it's in your best interest to pay once and get this situation resolved in a scheduled/controlled manner than wait for multiple emergency hospitalizations AND have to pay for this in an emergency situation...you're probably talking at least 2x cost if not more.
kiitos 11mo ago
> Is this incorrect? yep because "life-saving" isn't a single well-defined boolean condition that can be determined by ER staff as part of triage > I can't imagine a hospital waiting for an insurance company's approval to pay for a procedure to schedule a child's life saving surgery. then I guess you've never dealt with major health issues like cancer, blood disease, etc. etc. because what you're describing here happens all the time
dboreham 11mo ago
Presumably parent is describing a non-emergency situation.
- tptacek 11mo ago
  Good reminder that "life saving" and "elective" are orthogonal.
evan_ 11mo ago
if the kid has a steel spike through his abdomen then they will perform that surgery. If he's having seizures because of a brain tumor all they're required to do is stabilize and release.

dweekly 11mo ago

I am so glad to hear your child got the care they needed. I've found that people often forget to call their state senator or assemblyperson. It has consistently amazed me how quickly a large company that's sitting on their butts about a topic will move lickety-split once their Government Affairs and/or PR teams are on the thread... Another tip from having worked at a regulated entity: a physical letter to the CEO mailed to HQ creates a mandatory-response paper trail that will produce a very, very different (better) outcome than e.g. asking to talk to a supervisor while on a call that's not going well.

lanfeust6 11mo ago

Great story, and encapsulates what I find most powerful about LLMs.

Brainfood 11mo ago

Thank you for sharing. I can personally say this same process has driven me to the brink of sanity. 10 years of managing a chronically ill child’s healthcare with multiple surgeries. Being a developer with the ability to navigate complex problems, social engineer people who have turned into robots, and enough income to make it through unforeseen lump sum payments - I cannot fathom how the average person deals with this. I made more $ than I ever did before to cover the costs and afford the best healthcare possible but the system is designed so we still get screwed and have nothing left. Thankful for the people who dedicate their lives to helping others. To everyone else who can justify profiting off of someone else misery, while being the richest and most advanced society on every other level? I have nothing nice to say to you.

bmurphy1976 11mo ago

How comfortable are you with naming and shaming the company? I don't think things are going to change if we don't call this stuff out loudly and publicly. That's awful but I'm glad you were able to figure this out. I've had my own problems with insurance companies, but nothing to this level. I can't imagine the frustration, especially with YOUR CHILD'S HEALTH on the line. Five years back I ended up getting surgery for a herniated disc. I was in immense and crippling pain. Before having the surgery, we decided to go through a round epidural shots. I had done that 20 years previously and it resolved the problem, so why wouldn't I? Turns out my insurance company (who I will name: BCBSIL) delegated the approval for the epidurals through some kind of extra bureaucratic process with a 3rd party. It took days and additional effort on our end to get approved. I remind you, I was in crippling pain at the time. The delays getting this approved lead to me taking more Ibuprofen than I would otherwise have taken, which in turn lead to signs of internal bleeding. I had to ease off the Ibuprofen and significantly increase the amount of codeine (a drug which does not sit well with me) just to get by. Now not only did I have to wait for the approval, but I then had to wait for the signs of internal bleeding to go away before the doctor would give me the shot (which was the right call, even though it sucked). Delays, compounding delays, compounding delays, all while I was absolutely miserable. Anyway, I finally got approved and got the shot and it kinda helped, but didn't fix the issue. I had a second shot, got worse, and then decided we had no choice but to schedule the surgery. The most frustrating thing (but something I am glad for) is that the surgery was approved immediately. It's so maddening how inconsistent the whole thing is.

like_any_other 11mo ago
> How comfortable are you with naming and shaming the company? Don't forget about the individuals responsible. Both the ones that made the denial decision, and the ones that instituted the internal system that incentivizes such denials.
chrisgeleven 11mo ago
It was Anthem Blue Cross. You know, it is one thing if it is you or I as terrible as that is. But this was a 6-year-old.

magicalhippo 11mo ago

Relative recently had their baby come several months early. The baby needed intensive care for a couple of months, and breathing support (CPAP) for another two. Mom lived at the hospital hotel for the duration. Baby got regular inspections of the heart, lungs and eyes (too much oxygen in the blood can lead to problems with the cornea or something), including after checkout. They got billed exactly zero. Both parents even got full pay during the hospital stay, so didn't have to worry about the economy. Ok, so I pay a fair bit of taxes here in Norway, and some of it is used on stupid stuff. But overall I like knowing my life won't be ruined because of some random event forced me into insolvency.

ksclarke 11mo ago
The whole time I was reading this, as someone from the U.S., I was wondering what country the writer was from, because it sure as #$@! wasn't written by someone in the U.S. When I got to that part, I was, "Oh. Okay. That makes sense."
- thatfrenchguy 11mo ago
  In the US, you'll be billed the maximum out of pocket for your health insurance whether your little one is in the ICU for months or whether it was a easy delivery though, so at least birth is a predictable medical expense.
  - t0mas88 11mo ago
    If you have health insurance... Which is not automatically a thing for many Americans, and it seems even more with current political trends.
    - trollbridge 11mo ago
      If someone doesn’t have health insurance in my state, they get sent to financial counselling/assistance and signed up for Medicaid, CHIP, or HCAP. I asked one of their counsellors once if they ever have any ultra wealthy people who don’t have insurance and also don’t qualify for any assistance. (This was at a children’s hospital with a Level IV NICU.) She said she was unaware of that ever happening, other than very wealthy foreigners who would prepare in advance, arrange payment in advance, fly in, and have a special procedure done. Overall, in many states, it is logistically impossible to have an unaffordable bill and also not qualify for assistance. The worst situation actually is the person who has insurance but has high deductibles and copays.

game_the0ry 11mo ago

Happy to hear this all worked out. Have you thought about reaching out to local news to get the word out? That insurance company should be called out.

ethbr1 11mo ago

Amazingly happy to hear you were able to drive the process! FWIW, surgical centers usually have to do the exact same thing for their patients (typical role: coordinator), and they do it the same way you did (plus knowing a few counterparties because they work together regularly). The lack of data standardization in health insurance is atrocious. (In the US, CMS/Congress pushing what it can, but at a glacial pace) The strongest argument for single payer is that a diverse marketplace has demonstrated a fundamental inability to interoperate.

Cub3 11mo ago

Man that’s terrifying. I can’t imagine going through that due to admin incompetence The US healthcare system sounds horrific