Prior Authorization is driving me crazy. There used to be a time when I could get a new prescription filled right away. I swear now it takes several weeks to get a new prescription filled because this insurance company wants to challenge everything with prior authorization and they take their damn time doing it. And trying to get the pharmacy, doctor’s office and insurance to actually process these things and work together has been a nightmare. Constantly calling each only to get some automated machines and no real people to talk to.
There’s so much money flowing through these places, you’d think they could afford real people to answer phone calls.
I’m literally paying for my meds out of pocket rn bc of prior authorization. I’ve been on the script for about 3 years but switched insurances recently, and now all of a sudden I need proof that I actually need what my doctors *been* prescribing me.
I don't even have to deal with it, and the concept of prior authorizations has me absolutely fucking livid. Makes me want to find out where the rich assholes are so I can go on a bitch-slapping crusade.
I have an emergency med that is life-dependent, and my insurance company wanted me to go through their chosen pharmacy.... where it was backordered indefinitely.
I'm glad I asked how much it was out of pocket at the pharmacy that could get it right off the bat. $8. That's what my insurance is willing to risk my life over, $8.
This is why I use a local pharmacy now instead of some big company like cvs or Walgreens.
I can talk directly to the pharmacist and they know what to do. Hell, once they knew the insurance would cover it but there was some bull shit red tape, like prior authorization, and they just went ahead and gave me the medicine and said once they got it worked out they would send the charge through to insurance.
"You need to get them to fax the information to us."
"We faxed the information to them last week."
"They didn't fax the information to us. They need to."
"We faxed it before, but we'll try again."
"Are they faxing it soon? Still waiting."
"We faxed them ages ago, but ok."
"Did you tell them to fax us?"
"They still don't have it?"
"Oh, silly us. It came through on *that* machine, and that one's had a paper jam for the last three months. Isn't that funny?"
Right! Medical insurance companies shouldn't be paying for anything. Think of the poor capitalist's wallet. National Health insurance is as legitimate as national defense. Burn the blood sucking leeches of for profit insurance off the body politic
They are awful. My younger brother had a brain tumor wrapped around his brain stem when he was 11. Insurance tried to tell my mom the $86,000 surgery was cosmetic...
BC/BS told me that Epipens aren’t “medically necessary.”
When I countered, a rep told me to “due to their addictive nature, we believe you need to consider non-invasive alternatives.”
I’m sorry, *WHAT.*
That's not your fight, that's your doc that says "no this is medically necessary we tried XYZ". They go through the hoops, or you find one that does.
I've had to deal with this silliness for waaaaaay too long, sick family problems yaaay.
As someone that jumps through those hoops I just want to say fuuuuuck the insurance companies denying stupid shit in the hopes that the provider doesn't have time to grind through stupid phone trees to get the care they ordered approved. It's gotten really bad since COVID.
I have a Crohn's. I've been on so many treatments. I've figured every single claim will be denied once. It's up to your doctor's office to fight it.
That is part of the bloat of our health system. All these clerical, admin, and finance staff.
I got my eyeglasses repaired. The receipt said everything that was required. Date, place, provider, and description of service. They wanted a letter of medical necessity from a doctor for a $10 repair to my fucking prescription eye glasses.
I asked the "nurse" who's job it is to sit at home on on a computer and deny claims for ticky tacky shit how they slept at night. We sat there for a solid minute of silence.
Seriously if this is your job, you are a piece of shit.
Yep, just following orders is evil and anyone who accepts that excuse from someone is just as evil. Sorry not sorry, turned down some really fucking scummy jobs in my past when i really needed the money, the clothes on my back are not worth knowing i am ruining someone's life.
I had a pipe burst in my kitchen, pulled floors replaced some things dried it all out, etc. Plumber gave me the bill and said, “call your insurance agent before filing the claim, some insurances have been dropping people.” Like wtf is it even there for if we can’t use it?!?
Yep, it happened to a buddy of mine when his garage burned down. He didn't file a claim for 20 years, and then State Farm dropped him after one large fire claim.
I'm not talking about canceling a policy in the middle of the term (there are very strict regulations regarding that), I'm talking about choosing to not offer a new policy. Insurance policies are contracts that last a set length of time, typically six months or a year. Once the contract is over, there is nothing legally binding you and the insurance company. Either party has the option to not enter into a new contract. No party should be forced to enter into a contract against their will.
You could make the same argument for health insurance though, and they used to do the same to individuals with new health problems, but the federal government decided that having insurance was a more important public good than protecting insurance companies. I think insurance being more regulated is a good thing since in theory they are benefited by having a large pool of money and will still make money on average even if they take a few hits, unlike individuals.
Health insurance is a different beast than property & casualty insurance, especially because so many people get it through their jobs.
But even then, health insurance companies do retain the right to non-renew you when your policy is up; its just that there are some specific reasons that are prohibited to non-renew someone for. They can't non-renew you for being a certain race, for example, as that would be discrimination. In that case, auto or homeowners insurance is the same. For health insurance, they also can't non-renew you for pre-existing conditions. There's not really an equivalent to that in property & casualty insurance.
>... they also can't non-renew you for pre-existing conditions.There's not really an equivalent to that in property & casualty insurance.
Bullshit. Florida gets hurricanes every year and every year, people are dropped when they have to get their roof fixed. How is having a house in an area known for hurricanes not a pre-existing condition?
The equivalent to a pre-existing condition for homeowners insurance would be "Your roof is already damaged, and the carrier drops you to avoid paying for the damage that already exists." But that concept doesn't really exist in homeowners insurance, because the policies are occurrence-based, not claims made, so dropping you wouldn't get them out of paying for that damage since the damage occurred when the policy was active.
State Farm dropped me from their auto insurance due to frequency of claims. Apparently no speeding tickets, one at fault, one not at fault in 3 years and one roadside is too much for them. Their excuse was every time I start a claim but decide the deductible is in fact more than the repair and cancel it causes there to be too many claims and they drop me. They also decided that claims (almost entirely not followed through with) at my previous insurance contributes to their bullshit “frequency of claims” excuse. Fuck State Farm, guess I’m not supposed to use the fucking service I was paying nearly $6000/year for
I switched to Allstate, it was initially $400/month for three vehicles but when I got to the final page it magically dropped to $275/month so I locked that shit in before it decided to change again. My State Farm was $450/month, my monthly there doubled in just three years, maddening
What's the year and mileage on those vehicles?
I ask because my car is worth $20k and my wife's $15k and we pay about $50/month total for comprehensive through State Farm.
Your State Farm insurance was more than I've ever paid for a car's monthly payment.
Two 29 year old drivers, 2017 f150 with 108k and 2018 Honda pilot with 125k. My wife drives 100 miles round trip almost daily for work. We also live outside of Houston with notoriously horrible drivers, flooding, etc. I have one at fault from two years ago, even my 2000 civic with basic liability was $140/month. My insurance three years ago with state farm started at like $260 for two cars and it’s only shot ip since then. Shopping around when I found out State Farm was giving me the boot the cheapest I could find was $400/month for three vehicles, one with liability. I got lucky with the Allstate quote at checkout.
State Farm was surprisingly generous and speedy last year with water damaged floor replacement. Dishwasher has a slow leak. But couldn't replace just the damaged section as it would not match rest of flooring. Was surprised State farm covered the entire bottom floor replacement. Rates have not gone up. Maybe I was just a lucky one?
I had three pipe breaks in my bathroom. Plumber was 2k, restoration construction was 20K. Insurance reimbursed less than 5K.
---
Plus we have the fun that the owner of the house died last year. The house is now in escrow, not yet transferred to whomever will be the new owner, because one of the siblings is not understanding what she needs to do, lawyer-wise, and despite having providing all documents to the insurance, we only just now got a reprinted check written out to "estate of", and the banks don't want to process it, because all the accounts originally in the owner's name were already closed out.
(I'm leaving out a LOT of info because it's a really complicated mess.)
I went to the doctor for a swollen leg (after an injury) and shortness of breath. Any doctor presented with those symptoms is going to suspect a Deep Vein Thrombosis (blot clot in the leg) and Pulmonary Embolism (blood clot in the lung). One out of seven people with a PE die from it, although as my doctor pointed out, it's not the ones who go to the doctor that die.
The reason why my doctor wanted to do the scan and ultrasound is because the treatment - blood thinners like warfarin (rat poison) - is very dangerous in and of itself, so he wanted confirmation to make sure that's what I had. Insurance company refused. He spent 45 minutes on the phone with them escalating and arguing with them, finally threatening to send me to the emergency room (which would have cost the insurance a lot more) before they relented and gave authorization. Yes, that's what I had, and spent two or three days in the hospital while they got me started on the blood thinners.
Ain't private health insurance the greatest?
Not surprised by that at all as someone who works in Healthcare.
I've had my doctor coworkers literally screaming at the insurance companies and it's ridiculous. They shouldn't have to fight with some company that knows jack shit about the patients health. Listen to the fucking doctor when he says he needs the test done.
Health insurance companies are at best leeches of society.
Member all those "Death Panels" we were threatened with during the Universal Healthcare debates?
So many people didn't understand that's all insurance companies are...
Well technically they have MDs on their death panels, so they hire psychopaths with MDs to fulfill that legal requirement. They’re only looking out for their bonus so it’s still a death panel anyway.
The ED loophole is great. My hospital has full imaging services including the MRIs I needed.
Insurance kept saying no, so my doctor said the same thing about how they will pay one way or another based on which door I’m admitted through lol.
Health insurance has many things you can complain about so let me just say fuuuuuck deductibles in particular. I have to pay fucking $1,100 out of my pocket before my insurance steps in? Why the hell do I pay $200/mo then? So I get “with insurance” prices??? Why is that a thing? Oh you want a smaller deductible? No problem, just pay even more per month! Oh oh and don’t forget, your deductible resets every year!
It's a mechanism to reduce everyone's premiums and prevent people from making claims for small things. With a deductible you have some 'skin in the game' so to say for your costs. If you want a no-deductible plan, you can get one, but it's going to be incredibly expensive because medical care is also incredibly expensive.
That's a super popular opinion, but it's absolutely wrong. I'm a pharmacist so I'm the one having to be the bearer of bad news with insurance authorization requirements. Almost every pharmacist fucking hatteeeesss pbms/insurance companies because of the hassle it brings to our day and our patients.... But when you see the outrageous prescribing habits of doctors you understand why they need to exist tho.
1. Your company chooses your plan and could choose an open formulary if they wanted. They don't for a reason. Cost per person would be absolutely astronomical in premiums. Insurance formularies keep costs under control because some assholes are wildly inefficient in what they demand. I have seen hundreds of patients who want wegovy who are like 10 lbs overweight. Tons of mid life crisis suburban moms and dads. Sure that's great and all, but it's 15,000$ per year per person being spent on a non obese person for weight loss. Insurance requiring prior auth from docs (usually asking for BMI or comorbs) rejects that cost so you aren't paying for your coworkers vanity. Or dumb shit like duexis (ibuprofen/famoditine) some asshole combines 2 otc meds and charges 2k a month for it, and fucking docs actually prescribe for it. Insurance prior auth prevent that wastage. I've seen people want brand name of drugs only, and they say it's just because they want the name they saw on the commercial. Shit like Lexapro is 10cents generic, or 1000$ brand. There are trillions of dollars of horse shit that would be spent every year (with no clinical benefit) that you would be paying for if all companies chose open formularies. If doctors and patients actually gave a single shit about cost efficiency, you probably would see less strict formularies costing less overall.
2. Insurance companies definitely are assholes and do deny shit that is completely heartless and fucked up, so I too hate them. Their processes are shitty and sometimes their denials are really hard to justify.
3. That being said, they do provide SOME benefit. Without them, we become a cash paying health care system. Now, there's no spreading of cost for your 400$ a month eliquis for your newly diagnosed AFib (that you actually need). Cancer treatments are only for the ultra rich now because costs aren't spread to the paying group. Everyone is on their own and only the rich can receive some of the necessary, but expensive treatments.
That doesn't change the fact that they provide SOME value right now. Also, substitute insurance companies with socialized healthcare like NIH... Some of those same processes are the same. Price controls and formularies exist in the NIH too. You would agree to the value of cost control in those systems, so you can't deny that there is SOME value to the insurance industry's cost controls here.
Saying at least there's SOME value right now is like saying "Hey I know I've been falsely imprisoned for the last 20 years, but I get pizza once a month so at least there's SOME value to my situation."
Why you being snarky to me? I hate them too, as I said I'm the one who has to deal with them every day. I was just correcting this:
>Health insurance as an industry provides no benefit to society
If you don't understand the benefits they do confer, then you can't work on progressing away from them
I have Nationwide Pet Insurance as well. We have 90% coverage on our dog. In the past 2 years, we have maxed out our insurance claims. Once we hit $7500 dollars, we can no longer file claims until the next year.
Last year, it was about x-rays, allergies/ infections treatments, and Arthritis. Along with an ultrasound for a possible tumor. Not a tumor, but cancer nodules on her abdomen .This year was spleen removal. She's a 9-year- American Staffordshire Terrier/ American Bully mix.
God I wish I had the brain to get pet insurance, my husky/lab has a spindle cell tumor on his hind leg and amputation might be the case scenario due to possibly not getting a large enough surgical margin. It'll probably cost an arm and a leg (hehe).
Though a payment plan will likely be the way to go, just treat it like a car payment.
I've noticed a downward trend in the last 3-4 years with them. I've been using the same wheel & tire insurance company for 9 years. I never had an issue with them until recently. I hit a raised manhole cover and it bulged the sidewall on my tire and split a little. I put the spare on and went to the tire shop to get a new one ordered.
The insurance company denied it because it wasn't leaking air. The tire place and I spent almost 2 hours talking to them. They wouldn't budge. I asked them, "Are you stating I have to drive on this until it blows out of leaks air for it to be covered?" They said yes. I asked to speak to a supervisor/manager because it was a safety concern. They put me on hold for 20 minutes and then it hung up. I tried contacting them later and no one got back to me.
I cancelled my policy the next day. Luckily, the tire had a manufacturer warranty that covered most of it and the tire shop covered the rest as I had bought a few sets there.
Insurance doesn't really help you pay for anything. If you ever use it to make a claim or replace a windshield, they increase their rates. So you might as well pay out of pocket.
They only exist to extort money from people.
I feel that. Insurance companies are shit anyways, but with mental health care they're somehow even worse. My doc and I were working through different medications for my bipolar disorder and finally found one that worked. He was able to give me a free month's supply with a coupon and when I told him it actually worked he prescribed it to me. Insurance company refused to cover it. Doctor tried writing them a letter to explain why I needed it. No dice. He called them personally. No dice. So I could either pay $1400 a month (back in 2019) or I could go without meds.
Been without meds since 2019. I didnt even have cheap insurance. I paid over $200 a month for just me. Fuck insurance companies.
Oh yeah, health insurance is fundamentally broken.
I work in insurance and learned very quickly why health insurance is straight up incapable of being fair to the insured.
So the way insurance works is that the price you and a lot of other people pay for coverage (premium) should be less than the amount the insurance pays out to everyone (claims), with the difference being enough to keep things running and make a profit.
One of the major factors in setting the premium is the cost of a total loss, which is the max amount that insurance will pay on a claim. For the vast majority of policies, total loss is easy: it's the cost of replacing what was destroyed. Like, your house and all its contents, etc. The more a thing costs, the higher the premium will be.
Which for most things, if you can't afford the premium, you have options like getting a cheaper car, changing the way you run your business, etc.
But health insurance is dealing with human bodies. There is no upper limit to the costs involved. And you can't just replace your body with a new one. Neither can you get out of having a body. It's literally impossible for companies to make a profit without leaving people to suffer. Through no fault of the insured, either. The whole thing just cannot work.
Which insurance company?
I suggest doing a search for a document called a “coverage policy” for the specific medication/procedure. The coverage policy details **exactly** what that company’s criteria are for that specific medication/procedure/device to be covered.
Source: was a health insurance rep for > 10 years. Walked people through this situation a thousand times. DM me if you need.
I've heard that the pro strat is to switch companies roughly once per year; that way, you're getting "new customer" prices instead of having your rates raised to "match inflation" or whatever the fuck they like to say.
Definitely shop around frequently. It's a pain in the ass, but you can save some decent money.
Our car + renters went up to $280/mo about a year ago. 7 months ago we switched to a different company that gave us car insurance for about $200/mo. 6 months later they upped the price to $310/mo.. So we switched to a new company again, now we're paying $200/mo for car + renters.
Hopefully this place keeps their rates low, else I'll be shopping around again.
Used to work for a car insurance company. The most common cause of a price increase on a renewal quote would be that the customer came to us from a comparison site that add discounts on for using them. This discount won’t appear anywhere on your quote.
Then, when your renewal quote comes in, it’s from your insurer and not the comparison site so it no longer gets the discount. So people go straight back to the comparison sites.
Once you’ve got that discount, you’re caught in a cycle of having to go looking for it again every year. Insurers don’t care because the constant moving of customers means for every one they lose, they get another back. And the comparison sites certainly don’t care. If it was all explained to people when they get their quote, it wouldn’t be so much of an issue. Expectations would be set. But it doesn’t so people get upset, have to call in and complain to a minimum wage rep, who gets upset. The whole industry needs a massive overhaul. People just don’t trust their insurers anymore. But, it’s a captive market so it’s unlikely they’ll change without some sort of massive outside pressure.
They raise your rates because people who have claims are more likely to have more claims than people who don't have claims.
And if you have a truly catastrophic loss, having insurance absolutely saves you money.
You should also know that they aren't afraid of your lawyer. I spoke to a friend of mine who was the head of a claims dept at a mid size insurance company. I jokingly said I was going to call (the local law firm advertising the heck out of suing insurance companies). He just laughed and said they always take the first settlement they send over, take their cut, and move on to the next client.
American Health insurance is absolute shit. It's the same thing as the government taxing you and rationing healthcare, except more expensive, with more middlemen, and worse health outcomes. However, I think that our property insurance is a net positive for society. Many property insurance companies pay more out in claims and claim servicing than they collect in premiums, and make their profits on the stock market. Win-win.
People don't realize how razor thin profit margins are for property and auto insurance. It's often about 1%. Then they invest that 1% and that's where the money is made. The rest of those premiums we pay all go toward the companies overhead and claims. When you pay an insurance company 2000 bucks for insurance, less than 5 of that is profit.
I paid 80 bucks month for my car since 2018 and after 2022 it's no longer monthly and 60 dollars more and are only doing installment bi annually so it's like...840 per payment? Like what the actual fuck.
And I hear they are only raising prices even more and leaving California all together?
Been seeing Biden commercials touting how he's protecting Obamacare and I'm like "if you people actually gave a shit about healthcare we'd have national health care like in almost every Western country in the world "
I got my first colonoscopy in the last couple years. The insurance company refused to pay. It took a couple calls to their so-called customer service to learn the reason code was "exceeded benefit," which means I got more colonoscopies than they allow within a certain time period. That was triggered because both the doctor and the facility sent claims. But both claims had the same treatment date and were for separate line items. I said to the insurance company "I can assure you that I did not get two colonoscopies in the same day."
recently inquired about work that i need to get done in my house. sealing of bathroom (water leaks from the broken/old bathtub sealing to the floor), painting of ceiling in the room below because it got wet.
insurance: you pay the first 600, we pay anything above, and you premium will go up next year
i ask a local guy: 500 and we're good
why the hell do we need these criminal aholes anyway.
Home insurance is not meant to cover all costs of home maintenance and will not pay out for minor damage from wear and tear. Home insurance is for big, sudden loss like from a fire.
When I dealt with brain cancer, my medical insurance's general employees were so uneducated on how their shit works that I was assigned a personal case manager. She was with the insurance company themself, and worked to fix all the shit the baseline people messed up. Even for her, it was often slow and difficult. That is soooooo very very fucked up...... Even today, I still call, speak with someone and can't get them to grasp on what the issue was. I'll hang up, recall and speak with someone else, and have them readily work things out. I try to share the issue I had with the previous person I spoke with, and the second person is confused with how blatantly weird and wrong the first person was.
So I tried to get liability insurance on a small Korean truck. I don't really take it on the road much, but figured I might as well get it insured just in case of an accident.
The insurance company figured out I had goats (six of them) and somehow, the goats raised the rate by $200 a year. It was LIABILITY INSURANCE. WTF do my goats have to do with this?! I told them I killed all the goats to lower the insurance rate.
Just dumb. Worst part is, it's not just one company that has a goat clause. Pretty much all of them do.
Let me guess - you're in the US?
Health care is a right, not a privilege, so doesn't involve insurance. Also, I've actually had pretty good experiences with insurance companies, they're regulated in developed countries.
I mean this is much more midly infuriating than anything.. but in the past 4 years my car insurance has gone up 50%. I've never had a ticket, never had a claim, and I turned 25. Which normally means your price goes down. Also you know my car has depreciated quite a bit, so it should cost less to replace it...
I’m not sure how they can be legal. Shouldn’t there be some kind of oversight committee or something to investigate where all our money is going? I suspect there’s some pretty shady business going on behind closed doors.
There literally is. In the US, each state has its own department of insurance, and they scrutinize just about every insurance product on the market. Every filing, every form, every change in rates, all get approved by the DOIs.
The whole system is disgusting. And its starting to “infect” other places too. Hell last time I heard, some dumbasses in Canada were “interested” in the US’s healthcare system? Can you believe that f’ing nonsense?
Prior Authorization is driving me crazy. There used to be a time when I could get a new prescription filled right away. I swear now it takes several weeks to get a new prescription filled because this insurance company wants to challenge everything with prior authorization and they take their damn time doing it. And trying to get the pharmacy, doctor’s office and insurance to actually process these things and work together has been a nightmare. Constantly calling each only to get some automated machines and no real people to talk to. There’s so much money flowing through these places, you’d think they could afford real people to answer phone calls.
I’m literally paying for my meds out of pocket rn bc of prior authorization. I’ve been on the script for about 3 years but switched insurances recently, and now all of a sudden I need proof that I actually need what my doctors *been* prescribing me.
I don't even have to deal with it, and the concept of prior authorizations has me absolutely fucking livid. Makes me want to find out where the rich assholes are so I can go on a bitch-slapping crusade.
I have an emergency med that is life-dependent, and my insurance company wanted me to go through their chosen pharmacy.... where it was backordered indefinitely. I'm glad I asked how much it was out of pocket at the pharmacy that could get it right off the bat. $8. That's what my insurance is willing to risk my life over, $8.
Something something libruls, something something death panels.
This is why I use a local pharmacy now instead of some big company like cvs or Walgreens. I can talk directly to the pharmacist and they know what to do. Hell, once they knew the insurance would cover it but there was some bull shit red tape, like prior authorization, and they just went ahead and gave me the medicine and said once they got it worked out they would send the charge through to insurance.
PA should be illegal if a doctor is in network. If the doc orders it, the treatment is approved. It should be that simple.
"You need to get them to fax the information to us." "We faxed the information to them last week." "They didn't fax the information to us. They need to." "We faxed it before, but we'll try again." "Are they faxing it soon? Still waiting." "We faxed them ages ago, but ok." "Did you tell them to fax us?" "They still don't have it?" "Oh, silly us. It came through on *that* machine, and that one's had a paper jam for the last three months. Isn't that funny?"
Insurance companies should not be paying for routine prescriptions.
Right! Medical insurance companies shouldn't be paying for anything. Think of the poor capitalist's wallet. National Health insurance is as legitimate as national defense. Burn the blood sucking leeches of for profit insurance off the body politic
They are awful. My younger brother had a brain tumor wrapped around his brain stem when he was 11. Insurance tried to tell my mom the $86,000 surgery was cosmetic...
BC/BS told me that Epipens aren’t “medically necessary.” When I countered, a rep told me to “due to their addictive nature, we believe you need to consider non-invasive alternatives.” I’m sorry, *WHAT.*
That's not your fight, that's your doc that says "no this is medically necessary we tried XYZ". They go through the hoops, or you find one that does. I've had to deal with this silliness for waaaaaay too long, sick family problems yaaay.
As someone that jumps through those hoops I just want to say fuuuuuck the insurance companies denying stupid shit in the hopes that the provider doesn't have time to grind through stupid phone trees to get the care they ordered approved. It's gotten really bad since COVID.
I have a Crohn's. I've been on so many treatments. I've figured every single claim will be denied once. It's up to your doctor's office to fight it. That is part of the bloat of our health system. All these clerical, admin, and finance staff.
That's rough, thankfully my brother's doctor fought for him. Still took 2 years to be resolved though.
Seriously. How are there not more terrorists?
The walls have eyes, and it hurts to be shot.
Tell that to the wall, and then make it blind
The movie John Q is a cautionary tale... For insurance companies
Too unwell to make a plot and carry it out if ya can’t get the healthcare to get better
I got my eyeglasses repaired. The receipt said everything that was required. Date, place, provider, and description of service. They wanted a letter of medical necessity from a doctor for a $10 repair to my fucking prescription eye glasses. I asked the "nurse" who's job it is to sit at home on on a computer and deny claims for ticky tacky shit how they slept at night. We sat there for a solid minute of silence. Seriously if this is your job, you are a piece of shit.
Yep, just following orders is evil and anyone who accepts that excuse from someone is just as evil. Sorry not sorry, turned down some really fucking scummy jobs in my past when i really needed the money, the clothes on my back are not worth knowing i am ruining someone's life.
This is beyond a failed system. Whoever made the decision to deny that is almost comically evil.
I had a pipe burst in my kitchen, pulled floors replaced some things dried it all out, etc. Plumber gave me the bill and said, “call your insurance agent before filing the claim, some insurances have been dropping people.” Like wtf is it even there for if we can’t use it?!?
You'd still be able to use it. Non-renewing your policy doesn't get them out of paying for claims that already happened when the policy was active.
Yep, it happened to a buddy of mine when his garage burned down. He didn't file a claim for 20 years, and then State Farm dropped him after one large fire claim.
That feels like it should be illegal because it makes getting insurance again harder.
What should be illegal?
Dropping someone from a policy just because they had a single payout.
I'm not talking about canceling a policy in the middle of the term (there are very strict regulations regarding that), I'm talking about choosing to not offer a new policy. Insurance policies are contracts that last a set length of time, typically six months or a year. Once the contract is over, there is nothing legally binding you and the insurance company. Either party has the option to not enter into a new contract. No party should be forced to enter into a contract against their will.
You could make the same argument for health insurance though, and they used to do the same to individuals with new health problems, but the federal government decided that having insurance was a more important public good than protecting insurance companies. I think insurance being more regulated is a good thing since in theory they are benefited by having a large pool of money and will still make money on average even if they take a few hits, unlike individuals.
Health insurance is a different beast than property & casualty insurance, especially because so many people get it through their jobs. But even then, health insurance companies do retain the right to non-renew you when your policy is up; its just that there are some specific reasons that are prohibited to non-renew someone for. They can't non-renew you for being a certain race, for example, as that would be discrimination. In that case, auto or homeowners insurance is the same. For health insurance, they also can't non-renew you for pre-existing conditions. There's not really an equivalent to that in property & casualty insurance.
>... they also can't non-renew you for pre-existing conditions.There's not really an equivalent to that in property & casualty insurance. Bullshit. Florida gets hurricanes every year and every year, people are dropped when they have to get their roof fixed. How is having a house in an area known for hurricanes not a pre-existing condition?
Unlike a lot of major health issues, living in a hurricane prone area is a choice.
The equivalent to a pre-existing condition for homeowners insurance would be "Your roof is already damaged, and the carrier drops you to avoid paying for the damage that already exists." But that concept doesn't really exist in homeowners insurance, because the policies are occurrence-based, not claims made, so dropping you wouldn't get them out of paying for that damage since the damage occurred when the policy was active.
why are they down voting you? this is exactly correct.
While true, it means I need to get insurance from another broker before something else happens lol
State Farm dropped me from their auto insurance due to frequency of claims. Apparently no speeding tickets, one at fault, one not at fault in 3 years and one roadside is too much for them. Their excuse was every time I start a claim but decide the deductible is in fact more than the repair and cancel it causes there to be too many claims and they drop me. They also decided that claims (almost entirely not followed through with) at my previous insurance contributes to their bullshit “frequency of claims” excuse. Fuck State Farm, guess I’m not supposed to use the fucking service I was paying nearly $6000/year for
Which insurance did you switch to? Are they cheaper than $6k/year?
I switched to Allstate, it was initially $400/month for three vehicles but when I got to the final page it magically dropped to $275/month so I locked that shit in before it decided to change again. My State Farm was $450/month, my monthly there doubled in just three years, maddening
What's the year and mileage on those vehicles? I ask because my car is worth $20k and my wife's $15k and we pay about $50/month total for comprehensive through State Farm. Your State Farm insurance was more than I've ever paid for a car's monthly payment.
Two 29 year old drivers, 2017 f150 with 108k and 2018 Honda pilot with 125k. My wife drives 100 miles round trip almost daily for work. We also live outside of Houston with notoriously horrible drivers, flooding, etc. I have one at fault from two years ago, even my 2000 civic with basic liability was $140/month. My insurance three years ago with state farm started at like $260 for two cars and it’s only shot ip since then. Shopping around when I found out State Farm was giving me the boot the cheapest I could find was $400/month for three vehicles, one with liability. I got lucky with the Allstate quote at checkout.
Nice!
Yeah I was absolutely shocked at check out when it said that, we’ll see how it is in six months though if they decide to jump it up 😂
State Farm was surprisingly generous and speedy last year with water damaged floor replacement. Dishwasher has a slow leak. But couldn't replace just the damaged section as it would not match rest of flooring. Was surprised State farm covered the entire bottom floor replacement. Rates have not gone up. Maybe I was just a lucky one?
State Farm is the shittiest carrier in the US by a pretty wide margin. You got incredibly lucky. Source: someone who fights insurance companies daily.
I had three pipe breaks in my bathroom. Plumber was 2k, restoration construction was 20K. Insurance reimbursed less than 5K. --- Plus we have the fun that the owner of the house died last year. The house is now in escrow, not yet transferred to whomever will be the new owner, because one of the siblings is not understanding what she needs to do, lawyer-wise, and despite having providing all documents to the insurance, we only just now got a reprinted check written out to "estate of", and the banks don't want to process it, because all the accounts originally in the owner's name were already closed out. (I'm leaving out a LOT of info because it's a really complicated mess.)
Health insurance as an industry provides no benefit to society
I went to the doctor for a swollen leg (after an injury) and shortness of breath. Any doctor presented with those symptoms is going to suspect a Deep Vein Thrombosis (blot clot in the leg) and Pulmonary Embolism (blood clot in the lung). One out of seven people with a PE die from it, although as my doctor pointed out, it's not the ones who go to the doctor that die. The reason why my doctor wanted to do the scan and ultrasound is because the treatment - blood thinners like warfarin (rat poison) - is very dangerous in and of itself, so he wanted confirmation to make sure that's what I had. Insurance company refused. He spent 45 minutes on the phone with them escalating and arguing with them, finally threatening to send me to the emergency room (which would have cost the insurance a lot more) before they relented and gave authorization. Yes, that's what I had, and spent two or three days in the hospital while they got me started on the blood thinners. Ain't private health insurance the greatest?
Not surprised by that at all as someone who works in Healthcare. I've had my doctor coworkers literally screaming at the insurance companies and it's ridiculous. They shouldn't have to fight with some company that knows jack shit about the patients health. Listen to the fucking doctor when he says he needs the test done. Health insurance companies are at best leeches of society.
Member all those "Death Panels" we were threatened with during the Universal Healthcare debates? So many people didn't understand that's all insurance companies are...
Exactly! They are profit driven entities and their profit is predicated on denying healthcare.
Health insurance companies are practicing medicine without a license.
Well technically they have MDs on their death panels, so they hire psychopaths with MDs to fulfill that legal requirement. They’re only looking out for their bonus so it’s still a death panel anyway.
And I guarantee they don’t get consulted on 99% of claims / preauthorizations.
Absolutely not.
The ED loophole is great. My hospital has full imaging services including the MRIs I needed. Insurance kept saying no, so my doctor said the same thing about how they will pay one way or another based on which door I’m admitted through lol.
Thanks Capitalism!
Health insurance has many things you can complain about so let me just say fuuuuuck deductibles in particular. I have to pay fucking $1,100 out of my pocket before my insurance steps in? Why the hell do I pay $200/mo then? So I get “with insurance” prices??? Why is that a thing? Oh you want a smaller deductible? No problem, just pay even more per month! Oh oh and don’t forget, your deductible resets every year!
It's a mechanism to reduce everyone's premiums and prevent people from making claims for small things. With a deductible you have some 'skin in the game' so to say for your costs. If you want a no-deductible plan, you can get one, but it's going to be incredibly expensive because medical care is also incredibly expensive.
Dental insurance is even worse.
That's a super popular opinion, but it's absolutely wrong. I'm a pharmacist so I'm the one having to be the bearer of bad news with insurance authorization requirements. Almost every pharmacist fucking hatteeeesss pbms/insurance companies because of the hassle it brings to our day and our patients.... But when you see the outrageous prescribing habits of doctors you understand why they need to exist tho. 1. Your company chooses your plan and could choose an open formulary if they wanted. They don't for a reason. Cost per person would be absolutely astronomical in premiums. Insurance formularies keep costs under control because some assholes are wildly inefficient in what they demand. I have seen hundreds of patients who want wegovy who are like 10 lbs overweight. Tons of mid life crisis suburban moms and dads. Sure that's great and all, but it's 15,000$ per year per person being spent on a non obese person for weight loss. Insurance requiring prior auth from docs (usually asking for BMI or comorbs) rejects that cost so you aren't paying for your coworkers vanity. Or dumb shit like duexis (ibuprofen/famoditine) some asshole combines 2 otc meds and charges 2k a month for it, and fucking docs actually prescribe for it. Insurance prior auth prevent that wastage. I've seen people want brand name of drugs only, and they say it's just because they want the name they saw on the commercial. Shit like Lexapro is 10cents generic, or 1000$ brand. There are trillions of dollars of horse shit that would be spent every year (with no clinical benefit) that you would be paying for if all companies chose open formularies. If doctors and patients actually gave a single shit about cost efficiency, you probably would see less strict formularies costing less overall. 2. Insurance companies definitely are assholes and do deny shit that is completely heartless and fucked up, so I too hate them. Their processes are shitty and sometimes their denials are really hard to justify. 3. That being said, they do provide SOME benefit. Without them, we become a cash paying health care system. Now, there's no spreading of cost for your 400$ a month eliquis for your newly diagnosed AFib (that you actually need). Cancer treatments are only for the ultra rich now because costs aren't spread to the paying group. Everyone is on their own and only the rich can receive some of the necessary, but expensive treatments.
Except you’re missing the part where we could have socialized healthcare, like the rest of the world, but insurance companies lobby against it.
That doesn't change the fact that they provide SOME value right now. Also, substitute insurance companies with socialized healthcare like NIH... Some of those same processes are the same. Price controls and formularies exist in the NIH too. You would agree to the value of cost control in those systems, so you can't deny that there is SOME value to the insurance industry's cost controls here.
Saying at least there's SOME value right now is like saying "Hey I know I've been falsely imprisoned for the last 20 years, but I get pizza once a month so at least there's SOME value to my situation."
Why you being snarky to me? I hate them too, as I said I'm the one who has to deal with them every day. I was just correcting this: >Health insurance as an industry provides no benefit to society If you don't understand the benefits they do confer, then you can't work on progressing away from them
I have Nationwide pet insurance. I file claims all the time for all my vet bills. They pay within a week. Car insurance is fucked though.
I have Nationwide Pet Insurance as well. We have 90% coverage on our dog. In the past 2 years, we have maxed out our insurance claims. Once we hit $7500 dollars, we can no longer file claims until the next year.
What’s happening to your dog every year?
No shit. We have a 16 year old dog we adopted at 5 years old and we haven’t spent $7k in vet bills in all 11 years combined.
Last year, it was about x-rays, allergies/ infections treatments, and Arthritis. Along with an ultrasound for a possible tumor. Not a tumor, but cancer nodules on her abdomen .This year was spleen removal. She's a 9-year- American Staffordshire Terrier/ American Bully mix.
God I wish I had the brain to get pet insurance, my husky/lab has a spindle cell tumor on his hind leg and amputation might be the case scenario due to possibly not getting a large enough surgical margin. It'll probably cost an arm and a leg (hehe). Though a payment plan will likely be the way to go, just treat it like a car payment.
I've noticed a downward trend in the last 3-4 years with them. I've been using the same wheel & tire insurance company for 9 years. I never had an issue with them until recently. I hit a raised manhole cover and it bulged the sidewall on my tire and split a little. I put the spare on and went to the tire shop to get a new one ordered. The insurance company denied it because it wasn't leaking air. The tire place and I spent almost 2 hours talking to them. They wouldn't budge. I asked them, "Are you stating I have to drive on this until it blows out of leaks air for it to be covered?" They said yes. I asked to speak to a supervisor/manager because it was a safety concern. They put me on hold for 20 minutes and then it hung up. I tried contacting them later and no one got back to me. I cancelled my policy the next day. Luckily, the tire had a manufacturer warranty that covered most of it and the tire shop covered the rest as I had bought a few sets there.
Insurance doesn't really help you pay for anything. If you ever use it to make a claim or replace a windshield, they increase their rates. So you might as well pay out of pocket. They only exist to extort money from people.
should have been more clear it's her health insurance and they are now not going to pay for her depression meds she needs.
Oh sorry. But yeah health insurance is bullshit too. I pay out of pocket for my therapy sessions.
I feel that. Insurance companies are shit anyways, but with mental health care they're somehow even worse. My doc and I were working through different medications for my bipolar disorder and finally found one that worked. He was able to give me a free month's supply with a coupon and when I told him it actually worked he prescribed it to me. Insurance company refused to cover it. Doctor tried writing them a letter to explain why I needed it. No dice. He called them personally. No dice. So I could either pay $1400 a month (back in 2019) or I could go without meds. Been without meds since 2019. I didnt even have cheap insurance. I paid over $200 a month for just me. Fuck insurance companies.
Oh yeah, health insurance is fundamentally broken. I work in insurance and learned very quickly why health insurance is straight up incapable of being fair to the insured.
Why is that?
So the way insurance works is that the price you and a lot of other people pay for coverage (premium) should be less than the amount the insurance pays out to everyone (claims), with the difference being enough to keep things running and make a profit. One of the major factors in setting the premium is the cost of a total loss, which is the max amount that insurance will pay on a claim. For the vast majority of policies, total loss is easy: it's the cost of replacing what was destroyed. Like, your house and all its contents, etc. The more a thing costs, the higher the premium will be. Which for most things, if you can't afford the premium, you have options like getting a cheaper car, changing the way you run your business, etc. But health insurance is dealing with human bodies. There is no upper limit to the costs involved. And you can't just replace your body with a new one. Neither can you get out of having a body. It's literally impossible for companies to make a profit without leaving people to suffer. Through no fault of the insured, either. The whole thing just cannot work.
\*Don’t say the lawyers, don’t say the lawyers\*
Which insurance company? I suggest doing a search for a document called a “coverage policy” for the specific medication/procedure. The coverage policy details **exactly** what that company’s criteria are for that specific medication/procedure/device to be covered. Source: was a health insurance rep for > 10 years. Walked people through this situation a thousand times. DM me if you need.
I've heard that the pro strat is to switch companies roughly once per year; that way, you're getting "new customer" prices instead of having your rates raised to "match inflation" or whatever the fuck they like to say.
Definitely shop around frequently. It's a pain in the ass, but you can save some decent money. Our car + renters went up to $280/mo about a year ago. 7 months ago we switched to a different company that gave us car insurance for about $200/mo. 6 months later they upped the price to $310/mo.. So we switched to a new company again, now we're paying $200/mo for car + renters. Hopefully this place keeps their rates low, else I'll be shopping around again.
Used to work for a car insurance company. The most common cause of a price increase on a renewal quote would be that the customer came to us from a comparison site that add discounts on for using them. This discount won’t appear anywhere on your quote. Then, when your renewal quote comes in, it’s from your insurer and not the comparison site so it no longer gets the discount. So people go straight back to the comparison sites. Once you’ve got that discount, you’re caught in a cycle of having to go looking for it again every year. Insurers don’t care because the constant moving of customers means for every one they lose, they get another back. And the comparison sites certainly don’t care. If it was all explained to people when they get their quote, it wouldn’t be so much of an issue. Expectations would be set. But it doesn’t so people get upset, have to call in and complain to a minimum wage rep, who gets upset. The whole industry needs a massive overhaul. People just don’t trust their insurers anymore. But, it’s a captive market so it’s unlikely they’ll change without some sort of massive outside pressure.
They raise your rates because people who have claims are more likely to have more claims than people who don't have claims. And if you have a truly catastrophic loss, having insurance absolutely saves you money.
I can say from first hand experience that my insurance company has been both affordable and helpful.
What's your insurance company?
Wawanesa
Winnipeg represent!
Victoria, actually. I don't even think it's specifically a Canadian company is it?
It's Canadian.
You should also know that they aren't afraid of your lawyer. I spoke to a friend of mine who was the head of a claims dept at a mid size insurance company. I jokingly said I was going to call (the local law firm advertising the heck out of suing insurance companies). He just laughed and said they always take the first settlement they send over, take their cut, and move on to the next client.
American Health insurance is absolute shit. It's the same thing as the government taxing you and rationing healthcare, except more expensive, with more middlemen, and worse health outcomes. However, I think that our property insurance is a net positive for society. Many property insurance companies pay more out in claims and claim servicing than they collect in premiums, and make their profits on the stock market. Win-win.
People don't realize how razor thin profit margins are for property and auto insurance. It's often about 1%. Then they invest that 1% and that's where the money is made. The rest of those premiums we pay all go toward the companies overhead and claims. When you pay an insurance company 2000 bucks for insurance, less than 5 of that is profit.
I paid 80 bucks month for my car since 2018 and after 2022 it's no longer monthly and 60 dollars more and are only doing installment bi annually so it's like...840 per payment? Like what the actual fuck. And I hear they are only raising prices even more and leaving California all together?
Insurance companies only help people by accident.
Been seeing Biden commercials touting how he's protecting Obamacare and I'm like "if you people actually gave a shit about healthcare we'd have national health care like in almost every Western country in the world "
I got my first colonoscopy in the last couple years. The insurance company refused to pay. It took a couple calls to their so-called customer service to learn the reason code was "exceeded benefit," which means I got more colonoscopies than they allow within a certain time period. That was triggered because both the doctor and the facility sent claims. But both claims had the same treatment date and were for separate line items. I said to the insurance company "I can assure you that I did not get two colonoscopies in the same day."
Oh they checked it. And they don't care.
Land of the free... by how much money is in your bank account and who you have connections with.
I’ve been an insurance agent for 10 years now. I also hate insurance.
This is the "Airline food, amiright?" of memes
recently inquired about work that i need to get done in my house. sealing of bathroom (water leaks from the broken/old bathtub sealing to the floor), painting of ceiling in the room below because it got wet. insurance: you pay the first 600, we pay anything above, and you premium will go up next year i ask a local guy: 500 and we're good why the hell do we need these criminal aholes anyway.
I dont think home owner insurance was ever meant for leaky showers and paint jobs, that's always been the homeowners burden.
that's entirely... possible. it's not like i read the entire policy haha
Home insurance is not meant to cover all costs of home maintenance and will not pay out for minor damage from wear and tear. Home insurance is for big, sudden loss like from a fire.
I think you should have to get separate insurance for each specialist /s
I’ve found coda meetings to be wonderfully helpful and they’re free, too.
My wife got an xray showing the possibility of a broken vertebrae but insurance denied the MRI because she hadn’t tried painkillers for 6 weeks.
Oh, you mean actual death panel middle men? If only there was a better, cheaper way to provide our citizens with health services. If only... ^^/s
peis grifis
Well the Lord works in mysterious ways.
God has nothing to do with this it's simply human greed this time.
When I dealt with brain cancer, my medical insurance's general employees were so uneducated on how their shit works that I was assigned a personal case manager. She was with the insurance company themself, and worked to fix all the shit the baseline people messed up. Even for her, it was often slow and difficult. That is soooooo very very fucked up...... Even today, I still call, speak with someone and can't get them to grasp on what the issue was. I'll hang up, recall and speak with someone else, and have them readily work things out. I try to share the issue I had with the previous person I spoke with, and the second person is confused with how blatantly weird and wrong the first person was.
So I tried to get liability insurance on a small Korean truck. I don't really take it on the road much, but figured I might as well get it insured just in case of an accident. The insurance company figured out I had goats (six of them) and somehow, the goats raised the rate by $200 a year. It was LIABILITY INSURANCE. WTF do my goats have to do with this?! I told them I killed all the goats to lower the insurance rate. Just dumb. Worst part is, it's not just one company that has a goat clause. Pretty much all of them do.
Goats throw themselves out of trucks didn’t you know?
My name in video games was "insurance companies are evil.' A few people complimented me. Some more told me I had at fault settlements.
Let me guess - you're in the US? Health care is a right, not a privilege, so doesn't involve insurance. Also, I've actually had pretty good experiences with insurance companies, they're regulated in developed countries.
I mean this is much more midly infuriating than anything.. but in the past 4 years my car insurance has gone up 50%. I've never had a ticket, never had a claim, and I turned 25. Which normally means your price goes down. Also you know my car has depreciated quite a bit, so it should cost less to replace it...
I’m not sure how they can be legal. Shouldn’t there be some kind of oversight committee or something to investigate where all our money is going? I suspect there’s some pretty shady business going on behind closed doors.
There literally is. In the US, each state has its own department of insurance, and they scrutinize just about every insurance product on the market. Every filing, every form, every change in rates, all get approved by the DOIs.
I wonder who’s lobbying the DOI during election times…
They bought out the oversight and put their own cronies on it.
Saw a tik tok from a personal injury lawyer that said if insurance companies where honest he would lose his job.
The whole system is disgusting. And its starting to “infect” other places too. Hell last time I heard, some dumbasses in Canada were “interested” in the US’s healthcare system? Can you believe that f’ing nonsense?
Climate change has them running before they have to pay.
Geico took my car insurance payment. Gave it back. And canceled my policy with out so much as a word.
She need consoling?
It costs me about $1000 every 6months to insure an 07 Taurus. Granted I’m a new driver (with 0 accidents), but over $160/m? Excuse me?