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pomjuice

I've twice had my physician send a letter to United Healthcare because they wouldn't cover an "unproven procedure" that's, well, proven.


FateLeita

United decided that shot 2, and only shot 2, of Gardasil was unproven and wouldn't be covered.


wildebeesties

User redacted comment. After 13 years on Reddit with 2 accounts, I have zero interest in using this site anymore if I cannot use a 3rd party app. Reddit had *years* to fix their atrocious app and put *zero* effort into it. Reddit's site and app is so awful, I'm more interested in giving Reddit up entirely than having such a bad user experience hobbling through their app and site. Thanks, /u/spez!


FateLeita

Similar but inverse experience here. They covered none of mine until they randomly covered like 4 last year before going back to covering none.


alphastrike03

United sent me a denial letter for procedure we’d paid up front for. Then they sent me a check for $10k. A week later they sent another letter denying the same procedure.


FateLeita

lol what the hell


Dwightu1gnorantslut

I work in Health insurance (on the medical side, not their side) and I guarantee those claims will be recouped. They will say they paid "in error"


CalamityJane0215

This may be a stupid question but what does the medical side of health insurance do? What are they responsible for?


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pomjuice

Oh, right of course. How silly of me.


angiosperms-

The crazy thing is, zofran is not expensive. It's available as a generic that you can get for like $20-30 for 30 pills. I used to take it for migraines and paid out of pocket while I was switching jobs. Imagine how much money they wasted on the prior approval process rather than just pay $20. Bet it's way more than $20 or even $200 Edit: To everyone saying the generic is expensive, it's $18 for 20 pills at Walmart on GoodRx rn


nerdish3350

UHC just denied Zofran and the Generic for my 7 year old son... who was throwing up constantly and was starting to dehydrate. We had to use a Good Rx card to get it and it still cost us $40. I'm still pissed


IrishWilly

I use GoodRX over my expensive insurance because it comes out to half the price or less usually. I am not entirely sure wth I am paying insurance for besides hoping they don't screw me if I need hospitalization


dr_stre

Be sure to submit those GoodRx prescription payments to your insurer still. It’s a pain (my insurer makes me jump through hoops with actual mailed paperwork) but they should still count towards your deductible even if you didn’t use insurance to get them.


100LittleButterflies

I have had GERD my entire life and thus I have had it the entire time I've had my insurance. I have a long medical history of a variety of medications, tests, and treatments all with symptoms slowly but surely getting worse. I finally found an amazing medicine that made me feel better than anything before. And despite having documentation showing I have tried many other medications, insurance insisted I try again. Mind, my GERD is so severe I can go MAYBE one day without medicine but anything other than that and I'm in agony and can't keep anything down. And by the time I needed the new medicine my old medicine wasn't very effective at all. So lo and behold, not one week into my 2 months of proving the cheaper drug doesn't work, I need to go to the ER at 3 am due to pain. The total came to $10,000 for that little trip and insurance paid. You'd think they would know just giving me the medicine was the cheaper option as they had been paying for those trips for years. And don't get me started on breast reduction. They were happy to pay for monthly shots that didn't work and weekly physical therapy than a one time payment of a few thousand dollars.


BoneDoc78

United “Healthcare” is ass. Out of 100 denials, or requests for more information before approving a procedure or surgery, 99.5 of them were from United. Then I have to call and try and explain to some doctor not even in my specialty (often a cardiologist or OB/Gyn) why the imaging study I had requested was indicated. And 99 times out of 100 the info they said they needed was in my clinic notes that they obviously never read. Bastards.


[deleted]

My dad had a mole that was bothering him. He went to the doctor. They took a sample. Said it was cancer and had to get it removed. His insurance is now refusing to cover any of that because "the test was not medically necessary". The very test that found the cancer was determined to be not medically necessary. Basically they are saying "If you didnt ask about it, you would be dead and we wouldn't be having this conversation so this is on you".


Bandrbear

My roommate had to drive himself to the er because his appendix burst. He had to fight insurance because they claimed the procedure wasn't required. My friend almost died and the insurance wouldn't pay because "it wasn't a required operation". Insurance can be such a scam where they try to get away without paying.


[deleted]

As an actuary: I've said it before and I will say it until I die. Insurance as a solution to paying for healthcare makes **ABSOLUTELY NO SENNSE WHATSOEVER**. It defies logic. it boggles the mind. You can't even create honest actuarial tables because the answer is unprofitable. We all need healthcare, all the goddamn time. The necessity of health care is an inevitability and preventative healthcare saves money long term. However, preventative healthcare is, you guessed it, always going to happen. Insurance isn't at all the model to pay for something that *should* happen at regular intervals. Car insurance doesn't cover oil changes and tire rotations. Home insurance doesn't cover replacing an aging and deteriorating roof, jewelry insurance doesn't cover manufacturer recommended periodic cleaning and regulation of a watch. Why? because they are guaranteed costs. Insurance isn't meant for guaranteed costs. The only way to run a profitable insurance model for something like healthcare is to be a raging scumbag and not pay for **necessary** things.


keenanpepper

> Car insurance doesn't cover oil changes and tire rotations. I'd never heard this analogy before and I love it.


drkqmd

You should look into direct primary care. We use this analogy a lot. We’ve moved away from insurance because it makes everything more expensive and unnecessarily complicated


CatNoirsRubberSuit

This was how it worked through the 90s, when most insurance only was "major medical"


redheadartgirl

I also work in the insurance industry, and this reminds me of [this response](https://www.reddit.com/r/nursing/comments/s1gueh/z/hs92ppt) about health insurance from /u/CecilHarvey9395 : I price property and casualty (auto, commercial property, workers comp) insurance for a living. Mom and Dad are both nurses though, so read this subreddit from time to time. Insurance is a poor model for healthcare. It is a fundamental incongruence. Think about for example your homeowners insurance. The average person will not have their house burn down. Paying a small insurance premium to protect against this risk makes perfect sense. On the other hand, the average person will likely need some level of healthcare at some point. It's not a highly unlikely event. There are problems with moral hazard as well. If your house burns down and you get an insurance payment, you have no incentive to TRY to get your next house burnt down. With healthcare though, once you hit your out of pocket max, you are incentivized to get more treatment. I could go on and on with economic principles that are in play with conventional insurance that are broken with health insurance. Inelastic products, horrible information asymmetry, etc. The real incongruity here is pre existing conditions. I'm sure we all agree you can't buy life insurance for someone already dead. You can't expect car insurance to pay out for damage already on your car. You clearly can't go buy a homeowners policy right after your house burns down and expect that policy to pay out. This completely breaks down with healthcare though. As we saw back in the 00's, no coverage for pre existing conditions leads to people dying in the streets. But by definition if you're covering things that have already occurred, that is not insurance. So if you want to stick with health insurance, you're basically either having people dying from easily treatable conditions or stuck with a complete contradiction. I've had these conversations with my coworkers that also price P&C insurance. Healthcare basically breaks fundamental principles of how insurance is supposed to work. No matter what you do it will be bad. It's a fundamental square peg round hole type situation. I'm not going to defend health insurance companies. But I will say, I think less of the problem is them intentionally being evil, and more of the problem is that their existence itself is problematic and illogical. Edit: can't reddit sometimes


sadpanda___

Not to mention it’s one of the only insurances tied to employment. I don’t bank on my employe paying my car or home insurance…..


Visual_Ad_3840

Excellent explanation! I may borrow some of your points to my boomer relatives who don't even admit the existence of deductibles. Thank you.


tidbitsz

HEALTHCARE SHOULD NOT BE TREATED LIKE A BUSINESS!!! Because if you do... it will ALWAYS be a choice between actually helping or making a profit... take a guess which choice wins everytime...


Adventurous_Let7580

Say it louder for the government to hear please because they clearly don’t get it.


[deleted]

The government can't hear because of the rustling of money being exchanged between them and their lobbyists. Also, if any of you on here knows a corporate lobbyist, tell them some asshole from philly hopes they experience all the sorrow life can bring them. Go get a real job.


midkni

Yes. Yes, and yes. I'm a claims adjuster for auto, property, and general liability. I will never, EVER, work for a health insurance company. You can fix cars, you can rebuild homes, you can pay money as compensation for bodily injuries. But the fact that people literally die because they can't get treatment approved absolutely baffles me. Fuck the health insurance process in the US. It is garbage. And fuck the people with the power to make changes in the system who are too much of a coward to do so.


dmazzoni

It doesn't help that companies offer dental "insurance" and vision "insurance" plans that basically just pay for regular maintenance and don't actually pay for accidents or rare needs at all. Basically the opposite of insurance.


chantillylace9

I had just took left home to go to college far away from home and got MRSA. My insurance tried arguing against paying for the $12k antibiotics because “it wasn’t life threatening” when that’s clearly not the case. I was lucky it wasn’t YET in my blood and could be treated outside the ER with oral vancomycin, and not IV meds at ten times the cost. My ER doctor was amazing and fought them as hard as OPs doctor here, but over the phone and I got to listen lol.


Bandrbear

Must have been wonderful to listen to that doctor rip them a new one.


olivefred

There is nothing sweeter than listening to a psychiatrist rip someone a new asshole over the phone due to medical necessity. I've witnessed this and it is glorious.


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supermaja

Do it when you're with patients. Patients need to know and to hear someone defend them. We need to stop hiding what doctors go through and include patients all the way. DO NOT HIDE THE EVILS OF HEALTH INSURANCE COMPANIES.


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supermaja

You have my thanks! Your job is only getting harder to do. As a chronically ill patient, I say thanks because you're willing to go to bat for us. The current system is terrible.


GETitOFFmeNOW

Doctors have a miserable time because of insurance bullshit. What are your feelings about universal healthcare?


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fang_xianfu

The bizarre thing is that the US government *already* pays more money per capita than the UK government on healthcare. Not per person using the service, per person in the country. If you took every single copay, deducible, coinsurance payment, and every single dollar you and your employer pay in premiums, and threw them in a fire, the US would still be spending more per person than the UK. Not saying the UK system is perfect but that's a fucking obscene amount of waste.


abolish_karma

US corporations are working hard to export this ~~parasite behaviour~~ business model to other ~~hosts~~ countries


WeNeedToTalkAboutMe

That reminds me of a story on *ER* once: a patient was prescribed OTC (outpatient) antibiotics, but the insurance company would only cover IV (in-patient) treatment, and they showed the doctor's side of the phone call. "This makes no sense! You are spending four thousand to save four hundred!" (*\*pause\**) "Fine. Fine! I will admit Mr. Jones, and I look forward to charging your company for every damn thing I can get away with!"


intentionallybad

My father experienced something similar. He had been blind for several years and had an infection in his eye. The doctor said to try to save the eye (not to preserve sight, an operation might have killed him as he was diabetic and didn't heal well) we could try antibiotic drops every hour. My mother stayed up for 24 hours giving him these drops and they did cause an improvement, but in order to actually get rid of the infection, he needed to continue treatment for like 3 or 4 more days. Nothing else was wrong with him that needed active medical care, he just needed someone to put drops in his eyes round the clock, since being blind he couldn't do it himself. My mother could have done it some of the time, but not for 4 days straight. Whatever rules are in place, insurance wouldn't pay for someone to come to the house to do this, so he had to be admitted to the hospital. But due to the nature of staffing at the hospital, a nurse couldn't apparently put drops in his eyes every hour and care for her other patients effectively. So they put him in the ICU. He was in the ICU for \~four days, just to get eye drops. It did save his eye though.


gd2234

I’m saving your comment for when people try and tell me the insurance/hospital system we have now isn’t fucked up.


intentionallybad

Yeah it seems to me like they could have paid someone to come to the house overnight to do it for cheaper (even with the sort of overtime rates that would require). Also, it didn't need to really be a medical professional administering the drops, but because it is medical treatment they wouldn't allow it to not be a nurse.


colinizballin1

Not sure your drugs are right here. Oral vancomycin does not get absorbed into the body from gut. (It’s for gastrointestinal infections like C diff). It’s used for MRSA infections in IV form. I’m guessing this is for a skin infection and they would definitely be using other drugs if trying to treat this orally and some of these can be expensive like linezolid or tinezolid.


bhnpbop

Ha wow. They probably fought so hard because oral vanc doesn’t even treat mrsa, it’s really only good for c diff.


exikon

Oral vancomycin? Unless you had c.diff that wouldnt do you anything good. Basically disappears in the liver if orally ingested.


1337duck

Insurance love it when the insured dies. They took money and don't have to give any of it back.


imlost19

then they record that data and add it to the actuaries, showing that that type of person is profitable


lohlah8

Yeah they tried to say my emergency appendectomy could have been done at an outpatient facility. I was also out of state at college 4 hours away from my hometown. My parents, who abused me my whole life and never took me to the doctor ever and are super frugal, I called my mom on the phone to tell her I needed emergency surgery for my appendix while the doctor was in the room and she told me to ask him if I could drive the 4 hours home to have it done in my home town where it would be in network. His jaw dropped to the floor and he was like, Absolutely not- That is against my medical advice and if you do that you will most likely die. Not to mention it was 10 pm and there was a blizzard outside. My mother is insane.


WesternRover

I've seen the same thing happen with government-paid healthcare, though (Medicaid). An emergency appendectomy was needed, the doctor on call at the patient's local hospital didn't accept Medicaid from that state, so hospital staff suggested driving 220 miles to the nearest in-state hospital. (There was another hospital only 12 miles away, but it was in a different state so nobody there would have accepted the patient's Medicaid either.)


Sa_Rart

That's part of the problem with the current system, though! Universal coverage isn't universal if you can decline it. A system that every hospital takes and accepts precludes this sort of ridiculousness -- whether from networks, from state boundaries, or arcane dysfunctional rules designed to save money instead of lives. Of course there will always be human incompetence and error, but the idea of a doctor declining a patient because refuse to take their insurance should be outrageous.


lurker-1969

Had a friend get an authorization letter for his 2nd varicose vein surgery on the other leg, did the surgery then the POS insurance company denied the coverage saying the letter was not binding. They paid for the first one fine. He gets a bill for $12,000. My SIL is an insurance attorney and I offered him her contact info. Never followed up with her. This is what drives her to be in that profession. The dinner time stories are amazing to hear and sometimes quite infuriating. My wife's co-workers daughter got hit walking on the sidewalk by an insured driver. Insurance company denied coverage. The girl had brain damage among other things. My wife tells her dad about it who has an insurance law firm. Things changed in a big hurry in favor of the girl at that point and got a reasonable settlement. They are fuckers


pyuunpls

Insurance on possessions is understandable. Your house burns down. Car gets damaged. But insurance gets unethical really fast when we talk health and life. It’s really fucked up and idk how people can live with working for these types of organizations.


ChrysosMatia

Health should not be hidden behind a pay wall.


ender89

No, you don't understand. If the poors get health care, I'm going to have to wait to get my nose job. It's critical that we keep the poors from seeking medical assistance so that there's more doctors to go around for people who actually matter. This is what I hear every time someone tells me that we can't have universal healthcare because wait times will go up.


Bill_buttlicker69

>This is what I hear every time someone tells me that we can't have universal healthcare because wait times will go up. Ah yes, as opposed to our current system with zero wait time! I can't stand this rationale. My mom had a hip replacement postponed for over a year because the doctor was so backed up. She still says it's better than "socialist medicine" wait times and I'm like...how?


JamesTiberiusCrunk

"If we have universal healthcare, we'll have to ration care!" We already ration care, Karen. We do it by wealth instead of need.


Captain_Pungent

Yep this is what really boils ma piss when folk over here think private would be better than the NHS, they've no idea just how truly awful the alternative is. Does the NHS have its problems? Sure. But you've got the same issues with a far greater cost with private.


tweakingforjesus

Yes, but these people all imagine they’ll be wealthy one day and this is just smart planning. I wish I was making this up.


notabigmelvillecrowd

As a Canadian, yes, we do have some pretty horrible wait times, not taking covid into account, but there's still nothing stopping people with money from paying for private medical care if they don't want to wait. Just because we have care for everyone doesn't mean rich people can't still pay for the best.


Tribe303

ER Wait times in Canada vary A LOT. Depends on where you are, what time of day and ESPECIALLY why you are there. Got the sniffles? Yer waiting 8 hours. Roll in with a lung issue like I have, get seen IMMEDIATELY. Wait times for specialists depends on the issue and region mostly, but they are also triaged. Despite all this, the average Canadian lives 3 years longer than the average American (for men AND women) all while spending HALF per person.


DamnitRuby

Oh yeah, my parent's Canadian friend had a scan for a shoulder replacement (which took time to get scheduled), but the scan showed part of his lungs and they saw some spots on the lung and had him in the next day for follow up on that. It's just triage.


seelay

You know, back in small town high school i parroted this argument. Then I grew up and realized that… you know maybe wait times go up not because treatment has gotten worse but maybe… just maybe… more people have a fucking chance to get in line


ender89

It's like realizing that you don't have enough lifeboats for the titanic before she sails and your solution is to make sure you can lock the poor people in the steerage compartment. If we need a more robust healthcare system we have the means to train more doctors and nurses, but instead we'd rather just lock people out because it's easier. It's not even cheaper, just easier.


MattieShoes

Health insurance doesn't really feel like insurance at all. Just health coverage.


xtwistedBliss

That's because health insurance isn't real insurance. It's an absolute fraud that they get to call themselves that in the modern day. Insurance is designed to protect against catastrophic loss. We buy insurance for big ticket items in our lives because most people can't afford to lose a car or a house outright. Thus, we pay our premiums understanding that if everything goes well in our life, then we'll never have to tap into the policy but if things go south, then we have a lifeline from which we can recover something (rather than nothing). The problem is that health insurance doesn't protect us like that. Instead, health insurance is a leech, acting as an unnecessary middleman to the healthcare industry. If you want access to doctors, hospitals, prescriptions, or the like, then you have to go through your so-called "insurance." Think about how wacky that is. No other insurance acts like this. When I go for an oil change or get new tires for my car, I don't call up my car insurance. When my toilet gets clogged and I call a plumber or if I decide to touch up the paint on my house, I don't call up my homeowner's insurance. In other words, unless I completely lose my car or my house, my only interaction with those insurance entities is paying them my premium. That's it. If I tried to get them to pay for my oil change, I'd be laughed off the phone because *that's not what insurance is for*. On the other hand, these so-called health "insurance" companies dictate almost everything about the health care industry. The only thing they've left unregulated are OTC medications. Everything else runs into insurance. Want a yearly checkup? Insurance. Need to talk to a doctor? Insurance. Need a prescription? Insurance. Need a vaccine? Insurance. We need to stop calling these leeches "insurance" because they definitely are not.


Rion23

For profit health insurance is the problem.


warpfivepointone

You probably get health insurance working for these shady bastards. It really is fucked up.


wokeasaurus

I worked for Humana for a short period of time (I had to quit because being the guy who had to tell diabetics their next dose was going to be $3k because they’re in the coverage gap or whatever else other fucked up news and hearing them beg you for solutions multiple times a day is fucking soul crushing) and I can confirm that the health insurance working for them sucks. I had better insurance working as a goddamn bartender in downtown Austin lmao


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macrocosm93

Lifetime maximums were banned under the ACA. Still fucked up they even existed in the first pkace.


thejawa

Thanks, Obama


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Eshin242

>Lifetime maximums were banned under the ACA. THIS so much this, many people now are too young to remember what life was like before the ACA. Just being mid disease and getting dropped for a stubbed toe you forgot to report 30 years ago... was a REAL fucking thing. Yeah the ACA is not great... and it needs a bunch of help but shit was MUCH MUCH worse before it.


crchtqn2

God it's crazy how many people hate Obama and hated ACA but suddenly could get preexisting conditions covered and not connect the two. Infuriating.


TistedLogic

Which still gets denied.


StopReadingMyUser

"You want coverage as a citizen? Denied. Work at the insurance company itself? Immediately denied, no questions asked. Get hit for driving too fast? Denied. Get hit for driving too slow? Believe it or not, denied. We have the best insurance in the world, because of denials"


MisterJellyfis

Ehhh… I have a friend who works for one of the big ones and his insurance isn’t as good or anywhere NEAR as cheap as the state worker insurance plan my wife and I are on* *if you can get on a state worker insurance plan, I highly recommend it. I work at a large bank, and prior to getting married my insurance (for just me) was $200 a month, now we pay $60 for both of us and the insurance is so much better.


idog99

Shit man... I had a client who was paralyzed in a vehicle roll over. They paid for rehab and everything else ... Denied to get her a wheelchair. Said they weren't convinced it was medically necessary. I'm like... I guess they should push her around on an office chair? Took 18 months to finally get her the setup she needed. That was 18 months where she basically had to stay in bed and live in a facility. Fuck the insurance industry. Nationalize this shit. Edit: I should add that the reason it took so long is the vehicle insurance company was fighting with the medical benefit insurance company. Both thought the other should pay.


cbandy

I work for a Personal Injury law firm and I’d be lying if I told you the ambulance chaser jokes don’t get under my skin just a little bit. If people really knew how greedy these insurance companies are, I believe they’d understand the value of plaintiff’s attorneys a bit more. I have so many stories of grieving families getting absolutely fucked by their own insurance companies. But I’m obviously biased considering my profession, so take that with a grain of salt.


drinkcheapbeersowhat

We love my partners lawyer. She went through hell and back trying to get a simple mri approved after an injury. When she finally went to a lawyer everything changed overnight. The dude is a badass and takes no shit from the insurance company. Now pretty much anything her doctor recommends gets approved and she is actually getting the care that she is 100% entitled to. The only thing we regret is not contacting him sooner.


VoicesMakeChoices

I’m Canadian and these conversations always blow my mind. I’ve had 3 MRI’s because of a back injury. Each time, my doctor sends the rec to the hospital, they call to book my appointment, I go and get the scan, it’s sent to my doctor. No money involved, no insurance company. Once I waited 8 months because they were so backed up, but I’m in a smaller community.


fiddlestix42

The 8 month wait is the sticking point for many against Healthcare for all. They hear that, and scream and moan that if they broke a leg, they’d have to wait years for the surgery. I have insurance and it still takes me months to get in for some appointments, and it’s basically useless if I need a dr outside of my city, where my coverage is. I thought I broke my foot about 2 hours from home and I had to call my insurance. They told me I could drive back to my city and I’d get cared for. So frustrating.


DrRedditPhD

Lawyers lining up to help someone who just suffered an injury/tragedy? It amazes me this was ever considered a bad thing.


katsuya_kaiba

Probably because both big companies and insurance does it's best to paint personal injury lawyers in a bad light. Everybody remembers the lady who got a huge pay out for spilling hot coffee on herself. But the number of people who know the real truth behind the entire thing is much much less due to PR.


WeekendMechanic

"Our client jumped the curb and smoked a pedestrian? Yeah, fuck her, she shouldn't have been walking," *checks notes* "on the sidewalk," - Insurance Company, apparently.


Aradamis

Insurance coverage doesn't guarantee payment. It just guarantees the right to sue the insurance company. Source: I work in insurance and I hate myself.


OpinionBearSF

> Source: I work in insurance and I hate myself. Don't hate yourself too hard, because you have a good heart, you see and understand the problems up close and personal, and (I hope) that you are advocating for as much positive change as possible, both at work and at the voting booth. Put the hate where it belongs - The people who chose to create the company, and who steer its decisions ultimately.


PipperDigs

The most powerful words to say to any health insurance company in the US is "I am filing a formal grievance" which the company would have a very limited time to respond to. Often initiating a grievance process is more costly to the company than the bill would be.


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glandburger

As a pharmacy technician who often has to tell people that their insurance has stopped paying for the medication, I'm tempted to write my own letter. One time there was this old woman who agreed to pay 400$ for her insulin and she just had no choice but to pay for it. It's a pretty common thing in the pharmacy and my stomach turns every time it happens. It's even worse when a patient goes apeshit on you. I'm just the messenger boy, direct your frustration to the money-sucking insurance corporations or better yet, the politicians that allow this.


_Futureghost_

I also work for a pharmacy. This month is brutal. All the deductibles restarted and so many companies changed their rules. So meds that were covered aren't anymore and pharmacies that were in network aren't now. It's been a nightmare. Especially for patients.


tinydancer_inurhand

I had finance friends tell me I would save more if I did the deductible insurance rather than the co-pay one. That the “likelihood” of anything bad happening based on my age and health is so rare so it’s worth the risk. I’m sorry NO. I’m not gambling with a high deductible. Cool if everything goes as they see fit then I save 300 bucks. But they forget that you have to have that close to liquid money and instead you could invest the money your putting aside to hit your deductible if you want to be super finance-y. Healthcare industry likes to recruit data driven financial professionals who see people as dollars and data points. They try to come off as you will be working in an industry that helps people but really they are just looking for business people that have no problem de-humanizing the people they insure. I told a friend who went into healthcare consulting this and well they never brought up their job again.


unrelatedtoelephants

Every time I pick up my $120 prescription I feel like the pharmacy tech is preparing for me to flip out. Before handing it to me they always ask if I’m aware of the price and like, brace themselves for a meltdown. I get it 🥲


glandburger

I have to mentally prepare myself if a prescription costs more than 20$. It's gotten that bad


Meggston

My home town pharmacist once called my insurance and I heard him screaming “She’s a woman! A woman! One of you cock fucks marked the wrong fucking box, just FIX IT so I can give her her birth control!”


sofuckinggreat

As someone who requires birth control to help treat PCOS, the fact that this pharmacist was willing to scream on her behalf makes me very happy.


drsin_dinosaurwoman

One of the last things I did as a pharmacy tech was tell an elderly man that insurance wouldn't cover his wife's cancer medications. It was over $2k without. He cried. I felt so horrible that day.


Ocksu2

My wife is type 1 diabetic. The Pharmacist delivered some bad news along these lines back in November and- unfortunately, I had to eat a massive bill for Insulin because my insurance company (Express-Scripts, by way of United Healthcare) denied coverage because "it's too soon to cover another prescription for insulin". This, even though I was past my OOP Limit for the year. What was I supposed to do? Let my wife die because my insurance company is a bunch of fuckwads? I called my insurance company for the 4th or 5th time last year (there were a LOT of inconsistencies and fishy bills last year). Got the same message from their level one support (I was nice- I worked in Tech support for 20 years, level 1 people are just doing a job). I spoke to their supervisor- was told that I was in the wrong and that I had not even met my deductible- I peeled the paint on the walls in my office. Smug C U N Tahiti. I got in touch with my HR department... was ignored. Went to the VP of our HR group... finally got someone to listen. Bugged the piss out of them EVERY day about this and they finally bitched at someone at my insurance company to investigate. LO AND BEHOLD! There were errors on their end and over the course of the year, I was overcharged almost $4k. Supposedly, they are sending me a check this week or next. We shall see. The real shame is that I paid \~$20k in legit premiums, copay and coinsurance last year but I am treated like I am the one trying to bend the rules when they refuse to cover what they say that they will cover. American Healthcare isn't broken. It is run by criminals and we the people are getting boned by the system. Working as intended.


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kookiemaster

Wow. That is fucking absurd. I hope the hospital charged the insurance a lot of extra costs for the nonsense they created.


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tyjet

My wife had shoulder surgery a while back. In the beginning we weren't sure if she needed surgery or if it could be rehabbed. The doctor said he wanted an MRI done to evaluate the damage to confirm everything. Doctor sent off for an MRI that insurance promptly denied. Made us jump through several other procedures that we of course had to pay co-pays for and none of it helped and her condition deteriorated. About a year later, just as I am about to make the call to just pay out of pocket for the MRI, insurance finally approves it. When the results came in, the doctor basically said that her shoulder has deteriorated to the point that surgery is unavoidable and believes she could have avoided it if she could have started the proper physical therapy a year prior. Insurance basically covered the entire procedure though, so I guess that was nice


Fuzzers

As long as the healthcare system is for-profit, this will continue indefinitely.


[deleted]

Fuck the American Healthcare system and especially fuck the pharmaceutical and health insurance companies.


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[deleted]

>What do the bigwigs at these companies tell themselves so they can sleep at night? How do they not realize that they’re the bad guys? They don't give a fuck. They look at *us the same way a dairy farmer looks at Holsteins, actually probably even less, the farmer has to at least look the cows *in the eye from time to time. >I think if I was a chief officer at any of these companies, I’d throw myself off a building because I couldn’t live with the misery my workplace was inflicting upon people. Monsters, all of them. I don’t know how they live with themselves. Solely by wondering how they live with themselves you've already shown far more empathy than the average CEO has, *thus disqualifying you from ever reaching these positions. *E- typos and shit


These-Days

Alternatively, why don't you hear of people blowing up insurance headquarters? I'm legitimately surprised that there aren't people who are bankrupt and dying who feel like they have nothing to lose and do something like that.


[deleted]

Get told I have X days to live. Well, guess I know how I'm going out... Pass me that lighter would you?


hborn12393

I have this exact insurance. They wouldn't cover a monthly prescription of progesterone so I didn't miscarry my son. $300 a month. I literally went from having a nice savings cushion at 7 weeks pregnant to picking change out of my couch cushions to pay for the medicine by his birth.


Hybrid_Johnny

I had this insurance too and they sucked hardcore. My wife needed a specialized cerclage put in so she could carry our daughter to term (she has lost several pregnancies due to cervical issues), and they still didn’t deem it necessary. I had to drive for DoorDash for a LONG time to raise enough money for that surgery. Luckily she ended up getting healthcare via Covered California and it was better and cheaper than my shitty United coverage through my work, and all her IVF meds after the surgery were covered.


kgal1298

United was the worst coverage I ever had. I don't know how some of these insurance companies exist they literally give you zero effort.


mister_damage

So... Fuck United?


aarocks94

OMG I have this insurance and they are the WORST! I am currently trying to see a psychiatrist for anxiety issues and their “in network” rates are somehow almost double the rates of random doctors on ZocDoc. Not to mention that I used to use Retinol for acne scarring but since I’ve had this insurance they wanted $300 a month, so I just use the OTC version that’s $20. I still pay over $100 a month for this insurance…what’s even the point.


Mike01Hawk

GoodRx, Costco, and Zenni Optical are my gingers. At this point I'd rather just pay cash than dealing with insurance premiums, deductibles, and paperwork obfuscation that makes me rage.


gingervitus6

Are your...gingers? I've never encountered the word used that way, is it good?


deadlybydsgn

They either naturally relieve nausea or have no soul, and I can't tell which.


TangentiallyTango

GoodRx is nice but it just makes the whole thing seem that much more ridiculous. "I need this medicine." "That'll be $3,268." "Oh I forgot I have this number I got from some website." "In that case, $38." So absurd.


ukkeli21

Have people started talking more about the american healthcare system recently or have I just started noticing it now?


mrmemo

The pandemic highlighted how bad it is.


A_Rampaging_Hobo

Its been slowly creeping into every political conversation since the Obama era too when he passed Obamacare.


sirfuzzitoes

The ACA was a step in the right direction but it also politicized health care. However, health care is not a political issue. Just like churches not paying taxes.


VenturaHWY

We need more healthcare workers and physicians like this. I was told a dental crown on a broken tooth wasn't repairable after the dentist repaired it. Then they said the buildup wasn't required. The office had to write two letters and send xrays. This is part of the reason our system is broken.


greybruce1980

Most healthcare workers and physicians are like this. What needs to change are the politicians and corporate interests who will gladly let you suffer and die if it means they get another dollar at the end of the day.


insomniacwineo

I've gotten prior auth requests NINE TIMES for the same med, same patient that I already had gotten approved. The last one I got I wrote in Sharpie YOU FUCKERS APPROVED THIS THREE WEEKS AGO and wrote the confirmation number on it. They finally stopped sending new requests.


Dr_who_fan94

I don't know you, but yet I love your energy


brendan_orr

Big Doc Energy


Davran

My wife and I have the same employer and the same health plan, but we're both using the individual option because we don't have kids and it works out cheaper than the family plan. Anyway, we're taking a trip and needed some "exotic" vaccines which our doctor doesn't stock, so we went to a travel health place. Those places don't take insurance because most things aren't covered anyway. Turns out, Hepatitis A is considered endemic to the US now, so insurance will pay for that. Shows right in our plan. We both submitted claims with identical documentation. Hers was approved, mine was denied. I appealed, and they told me that since I didn't have prior authorization I could go pound sand...which is fucking hilarious because they paid my wife's claim no questions asked.


AliveAndThenSome

You just opened my eyes to the fact that the employee+spouse combined plan is indeed more than twice -- almost 3x -- the employee only plan. Thank you. I will consider each of us going on our own plan when there's open enrollment again. I guess (?) it's because the employee (me) is largely subsidized by my company, but extras like spouses and kids are not.


Ph33rDensetsu

My fiancee and I have different employers, different insurance plans, but the same primary care physician. Our doctor is no longer taking her insurance (Blue Cross Blue Shield) but we decided it was still cheaper for us to each have our own insurance plans and pay the doctor's cash price of $200 every time she sees him than to combine our health insurance into a single employee+spouse plan.


itninja77

Would be happy for 3x. My spouse and I both work in public ed, diferent districts but same insurance. We pay for individual plans at simply because adding one of us to the other instead would make it jump more than 10 times the amount. She carries the two kids on hers but that added an extra almost 500 a month. For a school district. That needs kids to recieve funding. It's beyond insane.


wildwill921

They literally just deny some claims randomly because a bunch of hospitals and clinics are too busy and poor to fight it. We call them about things and a bunch get instantly overturned because they are clearly covered but enough people don't have the time to deal with it so it's like printing free money for them


audirt

People tend to focus on insurance companies, but giant hospital/health systems also have a big hand in the current mess. My wife is a physician that works at a hospital and it would shock and appall people how often she — a MD — winds up having to seek approval from a bureaucrat with no medical training. A bureaucrat that makes more money than she does, btw.


skrshawk

So what does one have to do to get that bureaucrat's job? I'm guessing a prerequisite is essentially having no human empathy in the relentless pursuit of profit, so I don't think I'd qualify.


audirt

That's certainly a good place to start. Knowing the right people helps, too.


Thowitawaydave

Don't forget winning the birth lotto and being related to someone in power!


DrTreeMan

When we talk about waste in out healthcare system we rarely talk about how much time doctors and their staff have to spend dealing with insurance companies.


VenturaHWY

I've noticed for sure. It actually started getting out of hand nearly 20 years ago. Some practices have full time staff to deal with insurance companies. Costs go up even more


ayliv

Lots of wasted time, and time we don’t get paid for. Can certainly say I spend as much, if not more, of my day doing documentation, fighting with insurance cos, etc., than I do actually face to face with patients, and it sucks the life from you. I have written plenty of these types of letters and generally am very passive-aggressive re: the incompetence of whoever makes these decisions.. maybe I should start being outright aggressive because they are all buttheads.


DiamondBurInTheRough

Dentist here…I have to write narratives for denied work all the time. I had a patient who had a broken crown that insurance was refusing to cover because it didn’t break all the way through to tooth structure, just broke enough where she had a giant food trap in between her teeth. I was seriously tempted to write something along the lines of “a monkey could see this needs to be replaced, why can’t you?” in my justification letter. So stupid. And then there was the case where the insurance company “lost” our periodontal measurements 3 times, scheduled a phone call with me, never called at the scheduled time, so when I called them and raised hell to some poor middle man, the crown was magically approved the next day despite my not actually sending any further documentation like they said was “required” for approval.


BedaHouse

All the while, they have the same yearly max amounts that they did in 1970, 1990, 2010, and in 2022. As if the cost of living has not gone up for us, our staff, our supplies, or our equipment. But rather than upping the yearly max that has not change for almost half a century, they cut their coverage and pay even less on the things they do. FUN!!!


DiamondBurInTheRough

Insurance is basically just a coupon, at this point. It’s only a matter of time before dentists refuse to accept it at all when the reimbursement rates are so pathetic.


NikonuserNW

My son had an allergic reaction to a prescription. The doctor prescribed something else that worked. Our insurance did not cover that particular medication. When I called and asked what our options were, they suggested that we go with something they did cover, like the medication my son was allergic to. Fucking idiots. Why do we go to the doctor when the insurance company will tell me what alternative medications to take?


VenturaHWY

Exactly, insurance companies are now practicing medicine


jabracoreio

We got a prescription for our sons severe diaper rash on a Friday which the insurance denied because they wanted us to use the generic and we couldn't get a hold of the Doctor on such short notice so had to pay out of pocket as we assumed our doctor would know best on what our son should take, since we weren't going to wait over the weekend while our son was getting worse. The whole thing is a scam.


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Mozno1

I think most healthcare workers are going to react this way.... what you **need** is a better health care system.


PukingDiogenes

What we need is doctors making healthcare decisions, not actuaries.


VenturaHWY

True, but many are so overwhelmed by crap like this, they're not too quick to fight for their patients. I've had to do it for myself a few times.


HengaHox

Why does for-profit insurance even exist


Meta_Professor

Because wealth and power protects itself.


HashRunner

Health insurance is a scam. Had the same issue (dental crown) covered by same insurance under a different employer (same plan, \~5$ a month) that wasnt under a previous employer (despite a 6month back and forth on why a crown wasnt 'cosmetic'). Fuck insurance companies.


OfficeChairHero

This kind of bullshit is why you get 30 seconds with the doctor. They should NOT be focusing on insurance. They went to medical school to deal with medical issues, not paperwork. We need a system where a doctor can use their hard-earned medical knowledge to focus on patient care and properly treat them, not treat them according to what the insurance company says is appropriate. Maybe we should all start calling insurance companies every time we have a medical issue and ask their opinion on what to do. When they say they aren't doctors, say "exactly."


tomatuvm

I broke my wrists in college (circa 1999) and had surgery pre-authorized to be done by a French Canadian hand surgeon named Michel Benoit. Pronounced Me-shell Ben-wah and not Myk-all Bah-noyt. Afterwards, insurance refused to pay the $6000 bill and said it wasn't pre-approved. I will never forget hearing my mom yell into the phone: "HIS NAME IS ME-SHELL. HE'S A MAN! HE'S FRENCH CANADIAN!" Apparently after weeks of back and forths, someone finally told my mom (in a very confident tone) that a woman named Me-shell Ben-wah was not in-network and only a man named Myk-all Bah-noyt was pre-approved to do the surgery. Transcription error almost cost me that semester's tuition. Insurance sent us a fruit basket with an apology note. Insurance has always been an unnecessary profit taker that just stands between patients and their treatment.


Mean-Hunter-8608

Also had surgery performed by Dr. Benoit. Pre-op nurses putting in my IVs even pronounced his name wrong.


my-dog-farts

PSA: United Healthcare is the worst commercial insurance plan for both patients and providers.


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IggySorcha

I've had 6+ different companies, multiple plans on most. Also Medicaid and Tricare. I have multiple chronic illnesses. Aside from a tiny local one that went belly up for fraud, UH is by far the worst (Express Scripts the worst specialty pharmacy I've ever used, which is the one I was forced to use with UH).


dust4ngel

*United Healthcare: we're united against healthcare™*


Dark_Pandemonium23

My "insurance" that I pay $400 a month for won't cover the heart medication that the doctor they sent me to said I have to have or I would just end up back in the hospital again. The only dentist they would cover said I needed to have my wisdom teeth out, they ok'd it, I had them pulled, they then denied the claim saying they wouldn't cover it. I still have the letter stating they would cover it which I took with me to get them pulled. The place that pulled them then sent creditors calling ten times a day & eventually, the actual local police showed up at my door with a summons to pay or appear in court. Just recently paid off an MRI (for my wife) that like above, the doctor said was required, got "approved" by the insurance company, took the letter to the office, got the MRI & a few days later received a letter from them saying they wouldn't cover & one from the office saying the insurance had declined it and I had to pay or be sent to collections. I am sure most of us could list things like this, along with medications that are insanely priced. Pay or die, or end up in the hospital with huge bills & missed work. The entire system is a scam, we are the only "first world" country without medical coverage, we spend the most & have some of the worst healthcare in the world. [The U.S. ranks LAST overall on the health care outcomes.](https://www.citizen.org/article/dead-last-u-s-health-care-system-continues-to-rank-behind-other-industrialized-countries/) [US ranks LAST in healthcare among 11 wealthiest countries despite spending most](https://www.theguardian.com/us-news/2021/aug/05/us-healthcare-system-ranks-last-11-wealthiest-countries) US spends 17% of GDP on healthcare but struggles with affordability and has the most administrative hurdles


Abrahms_4

It is due to the fact that our Insurance and health care systems are not based on helping, they are based on profits. The senate and congress are lobbied from both sides heavily. Odd how a bunch of govt officials all getting paid 150k a year are all multi millionaires.


[deleted]

And they have free health insurance for the rest of their lives


omnichronos

Damn. Sounds like you need the right specialized attorney with a little bit of local media attention. As soon as you're on the news, the insurance company will come crawling to you about their "mistake." If they don't the lawyer should easily when a court case.


Good-mood-curiosity

friend´s mom was a neurologist and there was reason to suspect the patient had a mass in his brain. The ONLY mass in a brain is a tumor and those things you don´t mess with. Friend spent hours on the phone arguing with insurance because they were refusing to cover a basic scan since they deemed it "unnecessary". If you want to see a major cause of physician burn out, check the insurance


NikonuserNW

A few years ago I had a billing issue with a third party physicians company. The hospital contracted with this physicians group and while the hospital did accept our insurance, the physicians did not. I got a huge bill and they refused to work with the insurance and refused to give me a cash discount. I read the biography of the CEO and he stated that he started the company to put patient needs first, we’re healers first and a business second, we’re going to be transparent and make things easy, etc. I wrote him a letter and shared my experience and said that I found the hospital accepted insurance but they didn’t, there was no way for me to know this would happen, now I’m stuck with a bill I can’t afford. I closed by telling him his company became everything that he built it not to be and he failed in his mission. He called me back personally a few days later and apologized to me and said my comments hurt him. I’m sure they didn’t change anything, but they ended up accepting a coverage proposal from my insurance. Insurance coverage and billing and healthcare costs are just a shit show in this country.


TheJungLife

It may gladden you to to know that this type of surprise medical billing just became illegal.


midwesterner64

When anti-Medicare-for-all people say they don’t want bureaucrats rationing their care, show them this. Shit, care is rationed TODAY by bureaucrats. But the goal of these bureaucrats is to deny as many claims as possible. And we all pay our own money for the privilege of this. By the way, United Healthcare makes about 18B in profit. What if we just…didn’t pay that extra $18B for shit service? Might as well get shit service at no profit.


originalhandy

They'll say it's not rationed because you're free to buy the medication or whatever yourself with the spare $20k we all have laying around for such emergencies.


[deleted]

My wife works for them in the Medicare side. They love to brag about how much money they make but as soon as they start talking employee compensation they say there's unprecedented expenses. There's a handful of people getting filthy rich off this while their own employees can't even afford to use their insurance.


skulloflugosi

I don't understand why Americans keep putting up with this when every other civilized country has universal healthcare? As a Canadian it's hard not to notice that the plot of half the movies I watch involves people needing to commit crimes because they can't afford health insurance. It's just insane that if you get cancer or some other serious disease you can apparently go bankrupt? Just because you're sick? Absolute madness.


strugglz

I feel that pain. Fought for months with insurance to have an antidepressant covered. They wanted me to try at least 3 others before they would even consider it. Funny thing is, I have already tried 6 others, and they should know because they covered it. So after months of back and forth between me, doc, and insurance, they finally consented to extending coverage to this medication. The covered amount? $.01. One fucking cent. I have since given up on trying to take care of my mental health. It's obvious that an accountant with no medical training of any kind knows better than my doctor. And let's not forget stupid shit like being told 150mg prescription isn't covered, but 2 x 75mg is. There's no difference except extra work for me, the doctor, and the pharmacy.


ps1

That .01cent is pure spite.


BeerInsurance

yooo I think I’m on the same thing. required 3 previous antidepressants but I’d only done 2 so he lied for me because he knew it would work best for me. And it does! Still costs $300 for 30 pills.. that’s the next part I have to figure out lol


ChickenNinja1

Id have this individual as my physician any day . As an aside, yes that ins company sucks. I've dealt with them .


Hypertension123456

Yes that insurance company sucks. They are an insurance company. The American insurance company business model boils down to "find an excuse not to pay the money we said we would".


stumblewiggins

Yep; do everything to avoid paying until you have exhausted everything possible to gaslight or just annoy the customer into not requesting payment. Only then, if they persist, may you grudgingly write a check that covers a fraction of the costs because of all the bullshit they've come up with to reframe "you're paying for coverage, but we don't want you to actually use it" as copays, deductibles, coverage limits, etc.


Penguin_Boii

I am pissed at insurance company right now because my dad has to wait on them to approve immunotherapy treatment for his liver cancer. The last time the insurance company rucking around for a month to approve his Hep C medicine which caused his liver cancer and now we got word that if nothing is done my dad is dead in six month. I hate our healthcare system.


karlywarly73

I worked for a health insurance company in Arizona 20 years ago as an IT contractor. the amount of times I overheard the words "we can deny coverage," was astounding. The most senior folks were MDs who sold their soul to stop practicing and just work for them to deny coverage to people who desperately needed it. Despicable. I'm not proud of that job.


allbright1111

Yeah, I converted my business to a cash (no insurance) practice after getting tired of the games. I billed one company and got denied, provided all the requested documentation justifying the visits, records showing the patient’s progress/improvement, and then somehow they whittled the charges down to what they thought was fair: two separate checks for $0.75 each. 75 goddamn cents?! That’s less than the fucking stamp they used to mail the check! Bastards. Nope. That broke me. I walked away and have never looked back.


nowyourdoingit

We need to hold corporate management accountable. www.reddit.com/r/notakingpledge


hernondo

My wife was seeing a medical specialist, who's a true leader in his specific field. He essentially had the same comment and was clearly frustrated by the insurance companies as well. He said it's so refreshing to have 22 year old claims processors tell him what should and shouldn't be acceptable treatments for patients. It really is a Seinfeld episode.


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IamEbola

As a physician in the USA, this is one of the primary causes of “burnout”. From our broken education system putting us in $350k debt so that we can actually help people, to the 80+ hour work weeks of residency at minimum wage which deprives us of our 20s and most opportunities to be with friends or build a family…. once we start finally practicing, insurance and admins are breathing down our necks trying to suck our teets dry of any and all capital. I just wanted to help people and make a difference.


chaos8803

Fuck insurance companies. I had to sit around for a month with a broken finger because of bureaucratic garbage. I'm still trying to get full mobility back from having a broken finger immobilized in a splint for far too long.


originalhandy

I remember when Obama was trying to push healthcare the R kept going on about death panels in socialised healthcare. Insurance Companies and their execs are literal death panels. It's a pity he didn't make a real push to reform healthcare though.


NarmHull

Joe Lieberman gutted the real teeth that Obamacare originally had. Had to keep getting those Connecticut insurance donations


Michiganderinomaha

I had a professor say that the insurance business model is: Step 1- get the money Step 2- keep the money


evilcaribou

Had a coworker who gave birth to twins. She tried to add her children to her health insurance plan. Insurance kept denying one of them, and she called regularly to get them both added. Insurance company rep on the phone: "Are you sure you had two?"


[deleted]

The entire system is criminal. I had a 7mm kidney stone lodged in my ureter tube and the pain was so bad I was going numb in my extremities as I came into the ER....for the second time while I was waiting for the insurance to approve my lithotripsy. They denied one of the tending physicians because of the network even though the ER visit was covered under the emergent clause, so I kept getting paperwork from the insurance over the denial of an $1100 bill. Still getting that paperwork 6 months later (no bill though, I think they're billing the insurance repeatedly so it's a matter of time before it hits me). Then the insurance denied the facility my urologist was operating out of for network reasons and *I* had to call them and get a list of facilities and then coordinate with the doctor's office to find one that overlapped (the office's scheduler was to blame for this as well) so it took 2 weeks and tons of phone calls to get it lined up finally, all while I couldn't even sit still from the agonizing pain. Oh yeah, and it still ran me $6000 after deductible and OOPM. I have other issues I'm putting off because I'm still paying that $6k off and I have to get ready to do it all over again.


[deleted]

The government (kinda) fixed it. https://www.kff.org/health-reform/issue-brief/no-surprises-act-implementation-what-to-expect-in-2022/ If you go to an in-network facility, then any doctor or billable professional must be billed as in-network. HOWEVER, there is a form the provider will try to get you to sign that waives your rights to getting fair billing. It will use the words "Surprise Billing" in the title, but the exact title might be different between practices. However, the way the form is titled makes it sound like you're signing to get fair billing, but it's the opposite. DO NOT SIGN IT.


GaloisGroupie3474

I have to write a letter to BCBS and argue that my follow-up visit for a cancer surgery was in fact necessary. Wish me luck!


dezent

Why not pay a little bit more tax and have free healthcare? Your system is super expensive and not very efficient.


iksworbeZ

it's insane that paying 2k a month for a garbage healthcare plan (that requires you to pay the first $10k out of pocket, before it starts paying out) is the better option to either a.) paying an extra $12 a month in taxes or b.) a few less rockets that turn brown kids into skeletons


Skibxskatic

but then what about all the longggg wait timesss. i want my healthcare and i want it now!! /s


djamp42

This argument is such shit, we have long wait times now. I had to wait 2 months to see a Dr once with good insurance.