4 ms·

I was reading this and it made me sad. Not because of the obvious content but because of the diagnosis being thrown around and how when reading them my immediat

by jetti 14y ago

I was reading this and it made me sad. Not because of the obvious content but because of the diagnosis being thrown around and how when reading them my immediate thought was "I hope it isn't a personality disorder". I say this knowing full well that many insurance companies will NOT cover anything related to personality disorders because they feel that they aren't curable. I still remember when I called my insurance company at my first job after college to see if they would cover an exam to diagnose an autism spectrum disorder for myself. Their response was as follows: they would cover it if I was found not to have autism and they would not cover it if I did have autism. I remember taking time in the private room I was in at work and just crying. It was just so backwards. In fact, I have been putting off going back for further testing solely because the official diagnosis won't benefit me but could only harm me. At least now if I go see a therapist, the individual symptoms would be listed as reason for the visit instead of possibly something that no insurance company would cover.

commanda 14y ago
My heart really goes out to you. Can you imagine replacing "autism" with "type 1 diabetes" in your story and any health insurance company acting that way? Unthinkable. I hope our culture gets to the point where it stops regarding some illnesses as unworthy of care.
- jetti 14y ago
  Thank you. I am just baffled that an insurance company would pay for an unnecessary test instead of one that was deemed necessary. It seems completely contradictory to how they want to make money.
  - Mz 14y ago
    I am sorry about your situation but also curious as to how you think insurance companies work (if you don't mind me asking).
    - jetti 14y ago
      They negotiate a rate with providers in the network and pay out based on that. My point (and I don't think it was very clear) is that the system currently is set up (for at least that one company) so that if you don't have autism they will pay for the exam (which isn't cheap). Since there is no barrier to getting an exam, everybody could go and get the exam and for the majority of the people the insurance company would pay because they would (most likely) not be diagnosed with autism. The insurance company would pay out for all of these people for a useless test. Granted that this is only if a bunch of people wanted to waste their time and the time of the doctor(s), but it would still not be beneficial to the insurance company.
      - Mz 14y ago
        I am sorry, I don't really get what you think they do here. I worked for an insurance company for five years. The longer I worked there, the more policies I canceled. I am sure they won't go extinct just because I think what they do makes Darth Vader look warm and fuzzy, but their test policy is exactly in line with their goal: If you are diagnosed with autism, they don't want to cover treatment. If you actually need treatment, they want to find a way to limit their liability. They want most people paying in to need little or nothing from them. They work like Las Vegas in that they design the game so the house wins much more often than it loses. It is the only way to pay the employees and keep the doors open. But at least Las Vegas has the redeeming value that you can view any small gambling losses as the cost of entertainment, as no different from buying, say, a movie ticket to be entertained for the evening. Edit: But thank you for replying and have an upvote for indulging my curiosity. Edit2: This is a criticism specifically of health and life insurance. Car insurance is another ball of wax and I think has more redeeming value.
        jetti 14y ago
        "They want most people paying in to need little or nothing from them." Exactly. I'm not conveying my thoughts very well. The way it is setup would allow people to treat the autism diagnosis exam as preventative care. If they know they don't have autism or suspect they don't, they can go get the exam done and insurance will cover it, even though there may have never been a valid reason for that person to take the exam. Granted, this isn't going to be something that many people (if anybody) would do for fun or to make the insurance company suffer, but it is an option the way they have it setup. I hope that makes more sense on my end.

by jetti 14y ago

commanda 14y ago

My heart really goes out to you. Can you imagine replacing "autism" with "type 1 diabetes" in your story and any health insurance company acting that way? Unthinkable. I hope our culture gets to the point where it stops regarding some illnesses as unworthy of care.

jetti 14y ago
Thank you. I am just baffled that an insurance company would pay for an unnecessary test instead of one that was deemed necessary. It seems completely contradictory to how they want to make money.
- Mz 14y ago
  I am sorry about your situation but also curious as to how you think insurance companies work (if you don't mind me asking).
  - jetti 14y ago
    They negotiate a rate with providers in the network and pay out based on that. My point (and I don't think it was very clear) is that the system currently is set up (for at least that one company) so that if you don't have autism they will pay for the exam (which isn't cheap). Since there is no barrier to getting an exam, everybody could go and get the exam and for the majority of the people the insurance company would pay because they would (most likely) not be diagnosed with autism. The insurance company would pay out for all of these people for a useless test. Granted that this is only if a bunch of people wanted to waste their time and the time of the doctor(s), but it would still not be beneficial to the insurance company.
    - Mz 14y ago
      I am sorry, I don't really get what you think they do here. I worked for an insurance company for five years. The longer I worked there, the more policies I canceled. I am sure they won't go extinct just because I think what they do makes Darth Vader look warm and fuzzy, but their test policy is exactly in line with their goal: If you are diagnosed with autism, they don't want to cover treatment. If you actually need treatment, they want to find a way to limit their liability. They want most people paying in to need little or nothing from them. They work like Las Vegas in that they design the game so the house wins much more often than it loses. It is the only way to pay the employees and keep the doors open. But at least Las Vegas has the redeeming value that you can view any small gambling losses as the cost of entertainment, as no different from buying, say, a movie ticket to be entertained for the evening. Edit: But thank you for replying and have an upvote for indulging my curiosity. Edit2: This is a criticism specifically of health and life insurance. Car insurance is another ball of wax and I think has more redeeming value.
      - jetti 14y ago
        "They want most people paying in to need little or nothing from them." Exactly. I'm not conveying my thoughts very well. The way it is setup would allow people to treat the autism diagnosis exam as preventative care. If they know they don't have autism or suspect they don't, they can go get the exam done and insurance will cover it, even though there may have never been a valid reason for that person to take the exam. Granted, this isn't going to be something that many people (if anybody) would do for fun or to make the insurance company suffer, but it is an option the way they have it setup. I hope that makes more sense on my end.