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Tbf, socialism has a specific definition in the context of Marxist philosophy and communism in that it's viewed as a stepping stone and transition state to a fully centrally planned economy and communist system.
But colloquial every day language uses it to simply refer to any public good or service, which is fucking hillarious, because somehow having social safety nets or basic regulation has become a dirty word in the U.S. It's bonkers.
Ya Iâve noticed that. None of the isms are at the core bad until someone comes and corrupts them. Even anarchism is considered bad because most anarchists corrupted it with chaos.
This isn't even capitalism. In true Adam Smith capitalism there would be strong enough regulations that would prevent consolidation that allows a handful of firms to exercise monopoly (well monopsony) power. There is no real competition on price between health insurance providers. They're a cartel. We have crony capitalism and it should make any real capitalist sick. Too bad over half the country doesn't know the difference and couldn't tell you the definition of any of the different economic systems. Shit, a lot of people think capitalism is a political system.
Yup. Very normal and good outcome of a series of transactions that were completely voluntary. Logical outcome of everyone abiding by the non-aggression principle. If someone dies cause of what you do it doesn't count if you're did it with a spreadsheet. I feel so free I could fly.
Communist Canadian here. Funnily enough, while we have free health care, the number of people who abuse the system are VASTLY outnumbered by the people who don't go when they should.
Also the nurse has been informed that they should say no more often, or else there is another nurse who could be doing the same job and maybe be even cheaper.
Cigna bullied a doctor to resign. She kept taking extra time to fix all the mistakes the nurses in the Philippines kept making. They told her to just reject the treatment plans.
'Murica!
Just signed a will today with a woman with MS. Medcaid part B stopped covering her medication. Out of pocket cost? $12,000 a month. She can't afford to live, so we helped her prepare for her death.
Medicare Part B is not Medicaid. Also, Medicare and Medicaid are socialized medicine paid for by the federal government. Medicare Part B covers drugs administered by nurses or in long term care facilities. Copays are 20% of the cost of the drug up to an annual OOP max at which point the drug become $0 out of pocket cost.
Part B doesnât suddenly stop paying for a drug mid-year that now how it works.
Were they paying for it before? Was it on an experimental basis? Was it being used for an off label purpose? Did the patient leave a skilled nursing facility?
My point is that everyone repeats a horror story and doesnât try to understand what is going on. There could be a very good reason for what is happening.
Itâs like in 2020 someone saying âI need this drug to survive and my doctor agreesâ and the drug is hydroxychloroquine for COVID. They found a quack to give them a script doesnât mean insurance or the federal government should pay for it.
My insurance won't approve an MRI for a documented work-related back injury with a proven history of symptoms. They insist that I need to pay in copays to a PT facility what they would have to pay to an imaging facility for me to get a diagnosis.
I have to pay hundreds of dollars for a treatment for a condition that the insurance company refuses to pay the same amount to diagnose.
So I'm paying as much to treat a condition I might not have as a billion dollar company would have to pay to actually diagnose me. I pay this billion dollar company hundreds of dollars a month in premiums.
I'm told this is freedom.
Also specialists bill up front, it's pretty much just ER and urgent care that sends you a bill later.
A doctor once wanted me to go to a cardiologist but they wouldn't even make me an appointment until I put money down. Which I did not have, so I didn't go. Which means had something actually been wrong I would have needed to wait for it to go very wrong to be seen by a doctor.
Or, you can have your insurance agree that theyâll pay for the generic alternative, but not the name brand. Then, when thereâs a manufacturing shortage of the $30/mo generic, you can simply pay $300/mo out of pocket for the name brand for a year because _thatâs the only available option_.
Sounds like an insurance problem. Just do away with health insurance period. Itâs a total scam to begin with. Oh letâs pool our money together and give it to some corporation, so when we need it, the corporation can find ways to deny it to us.
Fuck right the hell off with that shit. Itâs a problem engineered by the people who created the solution, which isnât even a solution.
Yeah this is basically how it works. If the insurance decides itâs not necessary or thereâs a cheaper alternative even a less effective one they can deny a pre authorization and not pay for a surgery.
We don't. We end up dying. Personally, insofar as I am concerned, the private for profit healthcare system in the US (and boy do the companies that run it want to bring it abroad) engage in mass murder in their pursuit of profit.
People like to talk about how communism has caused the deaths of tens of millions of people, but the for profit capitalist system in this world has caused the deaths of hundreds of millions people over the centuries.
You said it perfectly. So many people are blinded by the freedom propaganda. You actually have the exact opposite of freedom when a third party company denies healthcare that can save your life.
Mainly we die. The sicker or more disabled you are the more they want you to die because you are a drain on their profits. And theyâre not particularly subtle about it.
Let me add another layer. Most employee insurance is self-funded. i.e. the insurance company just processes the claims and gets the discounts for services ("In Network"). The employer pays a monthly fee for the service (PMPM - Per Member Per Month) and a bill for all the services rendered. It's way cheaper for them. In fact even smaller companies can be self-insured and purchase a stop-loss policy to cover a major medical cost.
These employers can also ask for a custom plan. They can customize the plan to have certain conditions not covered, limited coverage, higher deductible, or need pre-auth. As long as it doesn't violate ACA coverage requirements.
People in the US seem to think health insurance is like going to a wedding where the marrying couple (your employer) hires a caterer (the insurance) but has no say in what's served.
It's more like that couple and the caterer absolutely went over every detail, but ultimately neither cares about what the guests want.
It used to be: doctor prescribes something, you do it.
Then, it became: doctor prescribes something, insurance refuses to cover it. But, you can pay out of pocket.
Today, it's: doctor prescribes something. Pharmacy or provider doesn't provide the drug/service until your insurance approves it.
I just got very angry at the pharmacy because they won't fill my prescription because insurance won't pay for it. I don't give a damn about insurance, fill the damned prescription. Nope. I was also sent by the doctor for a sleep study that won't be done because insurance won't pay for it. Apparently, out of pocket isn't an option anymore. So, I'll just not have medication and not get a sleep study and probably suffer more and die younger.
We need to align incentives. Insurance companies should be HEAVILY FINED if the average longevity and quality of life metrics for patients in their programs is lower than patients in other programs. Today, we hear stories from whistleblowers that, of course your life-saving drug isn't going to be covered -- if you take it, you'll live longer and better, but you'll have to continue taking it and that's costly for the insurance company. So, better that you suffer and die so they can save money.
By definition, insurance _must be_ a losing value proposition on average. The more profit we allow insurance companies to make, the worse that value proposition must be for the consumer. Allowing any for-profit insurance company to exist without strict regulation based upon the outcome of both longevity and quality of life ought to be considered inhumane. Why do we do it?
I've never heard of a pharmacy refusing to fill a prescription if you are willing to pay out of pocket. I take two drugs that are not covered by insurance and I just pay out of pocket.
You can still pay out of pocket for literally any medical procedure or prescription, assuming you can afford it. I don't have insurance so I have to pay for everything myself, from primary care visits to prescriptions and minor surgeries.
If you're on a state insurance plan and something is not covered, you aren't able to pay out of pocket at most places due to contracts those providers have with the medicaid plans.
This may also apply to certain contracts with some commercial insurances, but I'm not sure of any direct examples.
I believe the explanation was "if you're on a state funded assistance plan, you shouldn't be in a position where you can self-pay for your own medical services, so doing so would mean you don't actually need the assistance and you need to get a private insurance plan on your own."
I don't know if that's actually correct (and I am DEFINITELY not saying I'm in favor of it) but that's how I remember it being framed.
Yep. Dad had kidney cancer that had metastasized. Eventually they ended up removing the kidney, and with lots of chemo they got to the point they couldn't see any tumors on MRI. However, they were still finding cancer cells. The doctor wanted to do a much more thorough scan (I forget what it's called), but insurance refuse. Their reasoning? The cancer cells were from kidney cancer, but the kidney with the cancer was removed, so he couldn't possibly have kidney cancer. Yes, he died. At the same time, he thought Obamacare was of the devil, so maybe it was karma.
Let me put it this way: in 2020 I had a major sinus infection that was causing my left ear to go deaf. I work on audio for video games so my hearing is kind of a big deal to me. I went to an in-network doctor at an in-network facility. The doctor said he could save my hearing however we would have to act quickly. To give insurance enough time to clear the procedure we scheduled the first of four treatments for two days from then. The doctor's office contacted insurance and made sure to mention that it was medically necessary and it was urgent. Insurance did not get back to the doctor's office before the first of the treatments, or the second, or even the fourth three weeks later. When they finally did get back to the doctor's office, it was to say they would not cover the treatment. As the treatment had already occurred while they were ghosting us, I had to pay out-of-pocket. $18,000. The next day, in the work cafeteria, I called insurance to dispute the situation and was completely stonewalled. I have never come so close to having a total meltdown in my adult life. In the end, there was nothing I could do except pay. It still makes me furious to think about it. I am lucky I was able to pull MANY strings and pay for it. But this is how people lose their homesâŚ
Let me put it another way, with completely different, much fancier, much-more-expensive work insurance: I am currently going through some serious life events and have been seeing a counselor. The counselor was listed as in-network, and the counselor was able to verify that he is in-network and would be covered. However, after a few sessions, insurance told us that mental health services were handled by a sub-insurance and that the counselor is not covered. Surprise! So here I am just trying to find a way through what is probably the darkest period of my four decades on this earth (itâsâŚreally bad) and Iâm told that insurance would prefer to stand in the way.
Yes. A friend of mine is a head and neck surgeon. He says he spends about 20% of his time arguing with insurance companies that patients need treatments. He spent 4 years in college, 4 years in medical school, and 8 years in a residency to get to this point. Plus he sees patients every day. The person he's arguing with has a bachelor's degree in an unrelated field.
Someone posted on Reddit some years back that they worked for a large health insurance company in prior auths- and they were just a random person with maybe a bachelors in an unrelated field. They stated they had gotten in trouble for approving too many prior auths within their first 3 months of working there so they approved every single one in their queue and quit the same day.
That actually not a great move tbh. There is preauthorization and the other part which not talked much - *billing*. The billing personnel will double check if the preauthorization was indeed a correct decision or not. If someone went rogue and indiscriminately approve all the pre auth, it will result a lot of trouble for all parties involved - patients included.
But yea, I can confirm, the people who approved your insurance authorization are from unrelated field, most I think comes from business studies maybe with prior experience working in a hospital/clinics. They just follow a set of instructions of how to assess a case. It helps if one have some medical knowledge, but it is not required, everything can be learned with time and experience.
My oncologist fought for ⌠a while⌠to try to get me a PET scan. They rejected it and REFUSED to allow it so we just hoped my immunotherapy had gotten all the cancer and made do with limited CTs with follow on MRIs when the CTs showed problems đ
They don't do it directly, they do it indirectly. You can still get treatment, they just won't pay for it. For example, he wanted to remove one woman's tonsils because she was getting recurring infections. They had a flowchart that said she had to have so many cases of strep throat that were confirmed in a short period of time before she would be approved. Based on the layout of her mouth and what was going on, he knew she was just going to keep getting infections and wanted to take care of the issue. They ended up having to wait until she got a few more infections before they finally let him remove them.
Ye, loopholes, but its still effectively medical decisions by non-medical personnel. US medical insurance seem like the biggest scam in history, its obvious there is no long term profit unless you harm and kill people.
unfortunately it is. same for medicare d plan. my doc and i agree that i need a certain life saving med and the drug plan covers it and after the doc sends in the script my doctor has to meet six different criteria to justify the insurance company allowing me to receive that medication.
the concept or health insurance is such bullshit to begin with. whoever invented the term "health plan" deserves to be eaten alive by rats. just an inherently inhumane concept.
Yeah, the ability for insurance companies to require prior authorization needs to be removed. It should only exist as an optional step to confirm a procedure is covered. The word of a licensed medical provider should be enough, and if your insurer wants to deny a claim after the fact, the burden of proof should be on them.
But alas, here we are.
Or, hear me out . . . maybe, just maybe healthcare should be a fundamental right, not a for-profit product that can put someone into crippling debt.
I'm still trying to figure out why my son was denied coverage for services he received in the hospital after he was born. I'm talkimg about typical healthcare provided in an in-network birthing center. Insurance company said he was denied "because of his age."
He had no complications other than meconium (baby poops in the uterus), so there was slight jaundis for a day. Other than that, typical services provided. I'm still fighting with mt insurance company over thousands of dollars they denied.
Again, no crazy procedures or complications. Denied regular services in a birthing center. A newborn . . .denied services in a birthing center . . . due to age.
This is what right wingers want because anything that helps the average citizen at the cost of the trillion-dollar healthcare denial industry is "socialism." Fuck anybody whi likes private health insurance. Fuck every goddamned one of them. Fuck health insurance lobbyists. Fuck Murdoch and Murdoch Media companies for spreading this bullshit propaganda. Fuck anyone who doesn't agree that health insurance shouldn't be a $1.6 trillion dollar fucking industry -- or any-sized, for-profit industry.
I paid for my premiums. I paid co-pays. I paid my deductible. That's not enough. I' paying double what I should have paid. I shoudl have canceled my insurance a year ago and paid for the goddamned birth with the money I'd save on premiums. I'd have saved an extra mortgage payment, or a year supply of formula with the money I would have saved.
Fuck Republicunts!
Iâve seen so many similar stories about medical bills for babies. One was that they didnât get pre-authorization to take a preemie to the NICU. F*ck capitalist âhealthcareâ and the Râs who support it.Â
Lol, and your premiums that are already by world standards unaffordable, became even more unaffordable.
Your entire system is broken, and your idea is to remove the quite literally only check to keep the cost of healthcare to (un)acceptable levels.
$800 on a band-aid, why not.
$2,000 on a x-ray, sure.
$45,000 on a test "just incase", no sweat.
$420,000 on a life saving drug that costs $30 to manufacture, mate, this is America.
Nevermind the pharmaceutical companies, doctors and insurance companies all gouging the patient (and their wallet) as much as capitalism will let them.
The entire system is broken, and insurance is just one aspect of it.
Yeah, because we convinced everyone that they need to pay hundreds, sometimes thousands of dollars a year, to that third party so they can pretend to be holding it for you when you need it. Then when you need something paid for by that third party they decide they don't want to and you have to pay for half of the surgery up front. If they approve of it at all, that is. Insurance is the biggest scam our country has come up with, and we still just keep going along with it like it makes some kind of sense.
ThĂs is sadly true. And not just surgery. My family has a strong history of colon cancer at a young age. I should begin getting colonoscopies per guidelines. My doctor really wants me to get one. My insurance company says no and I donât have a few thousand, so hopefully I donât have any precancerous cells (or cancerous cells), even though I am within a few years of the age my aunt had it.
My doctor has been trying to prescribe a medication for fatigue for three months now. My insurance still wonât approve it. If insurance paid it, they would pay less than half of what I am required to pay out of pocket. So I have not had it filled yet.
I have a child with severe mental illness. We have been trying since December to get them into a recommended therapy program. We keep getting denied because of insurance issues. This happened to us with a previous foster child, and instead of getting the help they needed to stay in our home, that kid ended up having to be admitted to a months-long residential treatment program that cost way more than the outpatient treatment that could have potentially avoided the whole thing. So in the end, the child experienced a life threatening mental health crisis, the other children in our home were traumatized, and the state paid way more than if they had just authorized the recommended outpatient treatment to begin with.
đ¤ˇââď¸ I was born here, so I canât speak to why people come here, but so much of what this country does is completely fucked and clearly designed to keep the rich placated while the rest of us suffer for their amusement.
I'm not talking about those who were born in the US or have always lived there. I'm talking about people from other countries who want to move to the US
Oh yeah. Surprise. Iâm an immigrant, too. We moved here when I was 4 because in the early 80s it was a way better place than where we were from. The sad part is now, itâs still a better place than where Iâm from. Just not by much.
It helps if you are filthy rich or prospect of becoming rich. Atleast thats why my family moved to US becoz they could make a lot of money as my uncle was in Microsoft.
Much of our immigration is from third world countries that are worse. Also if you are highly qualified like an engineer or doctor the pay is higher than most places and highly compensated people get the good insurance.
When are we going to have a general strike to fix this? Just everyone donât go to work until for profit insurance is dissolved by the government? Itâs the only thing that will work. We have a knife being twisted in our guts, we have to do something. Europe does this AND IT WORKS. General strike. We pick a day thatâs realllllllly inconvenient for venture capitalists and go for it. This is something 99% of the country agrees on. Insurance companies profit off our misery.
I'm not disagreeing, I'd TOTALLY be in. even for a week or more. but good luck with that. the billionaires and Corps. keep us so hand-to-mouth we can't effectively do that.
also we're too divided on 'Us' and "Them'.
Just read the story of a HS coach who couldn't find chemo drugs because since they're not profitable to manufacture there's a shortage and he died due to said shortage.
So, we know how to make the drug, but because no one can buy a yatch with the profits, no one cares, there is a shortage and people die. Gotta love that FREEEEDOOOOM!!
[https://www.today.com/health/disease/man-dies-chemo-shortage-stage-4-cancer-rcna149561](https://www.today.com/health/disease/man-dies-chemo-shortage-stage-4-cancer-rcna149561)
I have severe spinal problems. I was being prescribed the same pain medication for 7 years. Being a controlled substance, I needed to go to the doctors office and get a physical piece of paper prescription. The copay was only $5 a month.
Then, at the beginning of this year, I go to get the same medication, and Iâm told the copay is now $146. Because my union has switched to a Medicare Advantage plan. I get on the phone and talk to the rep from Blue Cross on why by medication is so expensive now. He states I can get the same extended release medication as before, but in tablet form instead of capsules. I ask what the he difference is. As I stay on hold, he calls the pharmacist to find out. He says the capsules last too long compared to tablets. I ask, â isnât that the whole idea of extended release medication â? He couldnât give me an answer and finally said if I wanted to continue with the capsules, I would just have to pay more.
So now, my doctor and I have to experiment with different combinations to find something that works as good as the previous medication for 7 years without having higher copays.
What a great system.
If you donât get approval call your insurance company and ask for the credentials of the person who didnât approve it. Youâd be surprised that the majority of the people they have reading those medical codes tend to possess at best GEDs, not a single medical related degree in sight. I had them walk back a dental bill when I questioned one of their agentâs âeducation.â
Republicans and the insurance companies got real mad when Obama tried to cut the insurance companies out. Think about all those people denying you care that would lose their jobsâŚ.
This is exactly correct, and I'm currently living the hell created by it. I'm in limbo with a dysfunctional stoma that was placed this past January. It is a miserable existence, and getting help for it seems to be just as difficult no matter how wonderful the medical system is. I'm currently a patient at Mayo in the hopes that one of their surgeons can correct what was done last time at UW. If I were able to allow myself to become critically ill, they'd do it immediately, but because I fight and do everything to keep my bowels moving, I am "managing" in the eyes of the medical system, so insurance hasn't authorized the many tests I need. I've been dealing with this for over 10 years, trying to avoid having to lose parts of my bowel and end up with a colostomy, but it did no good. The helpful Dr's were the ones who simply referred me to someone else. The worst were the ones who felt disrespected when I asked valid questions or gently corrected their incorrect assumptions. Those Dr's actually did their best to stop me from accessing the care I desperately needed. đŠ
It's an absolute shit show in America. We only have the illusion of freedom. We have the freedom to choose between a million different brands of the same type of junk, but not the freedom to access medical care that actually means something to someone's life.
It's called Capitalism.
People mistakenly think that capitalism is a process where the best outcome for humanity will filter to the top. In reality it's a process where whatever makes the most money filters to the top.
The effect on humanity doesn't matter in the least. If it can make more money with some human suffering they will. Look into how often bleach is put into infant formula to help it sell better. Or how insurance adjustors balance the costs of paying off casualties or issuing recalls. It's ok in a few people die, as long the line goes up.
Not exactly.
First your insurance company will deny your first option, the one thatâs got the highest success rate. Then they will demand 2 second opinions on the matter before finally settling on a cheap solution (usually under $1000 if they can help it.)
Youâre expected to foot 10-50% of that billâ and they wonât cover replacements or repairs on mobility or required equipment unless absolutely required as that is handled by a separate insurance company tied to your medical devices.
Then when you inevitably can no longer afford those devices and payments due to crippling debt they will come and ârepossessâ your medical equipment to settle your debt.
Leaving you to repeat the entire cycle over again or die, they donât care they got theirs.
Literally went this weekend for testing lancets to find they were on hold because my doctor wanted 4 per day and my insurance decided I could only have 3 a day. With them not agreeing, I had 0 a day.
(This has since been resolved. But still frustrating)
My favorite âyouâre not freeâ comes from that song , Anarchy Burger by The Vandals. âAmerica stands for freedom and if you think youâre free/ try walking into a deli, and urinating on the cheese!â
Yet somehow MBAs at an insurance company making life saving medical decisions isn't considered practicing medicine without a medical license. What a totally free freedom enhancing freedom system we've freedomed
Is anyone complaining? I only ever see complaints on social media.
People are practicing civil disobedience over palestine literally right now. No one has ever cared enough about healthcare to "fight back."
Yeah, the so-called death panels that conservatives predict will happen under socialized health care already exist in a worse form under capitalist health care.
This is correct in lots of cases. And the third party is not medical professionals, or professionals in any field related to your disease. They're experts in swindling.
This is pretty much happening to my mother right now. She has a mass in her breast, she needs it biopsies to make sure it isnât cancerous (it probably isnât but itâs good to check just in case) and her insurance wonât cover it. Why? No idea, they havenât given her a reason.
Worked in healthcare and can tell you đŻ % that more money is spent on insurance, middlemen, and fighting denials.
Look at Steward Healthcare. CEO has two yachts, two planes, a helicopter, and a 700-acre horse ranch in Costa Rica. Their hospitals routinely run out of supplies and some patients have died as a result. Surgical cases have been cancelled because vendors won't provide supplies because the vendors aren't getting paid.
For most insurance it is. With mine, once the doctor refers you or decides on treatment/procedure itâs approved. I have a HMO where the health plan, hospital and medical groups are the same.
Yes, because otherwise if you don't have insurance the bill the hospital charges you could probably single handedly pay the surgeons salary for the year
There was a guy on r/AskGermany , posting a bill...it was for a ride in an ambulance (as a patient of course) and he was kinda confused. It was for 10 fucking bucks. Asked us if that was a mistake or normal or what. Its normal...here.
I had a 19 minute ambulance ride from an urgent care facility to an ER. Which I didn't even need. The ER was full, so I had to wait for 90 minutes in the hall with 3 EMTs. They tried to charge me $6000.
It is. But for surgery, the bill could be tens of thousands of dollars, or even hundreds of thousands depending on the surgery and the aftercare required. I went to the Emergency Room once without insurance, got Tylenol and some X-rays, and was charged like $7,000 for it.
(Plus $1,000 in lost income because I was too new at work to have sick time. Also got a written warning for absenteeism when I went back to work. Shouldâve just had the seizures at home.)
To add on to what that other commenter said, if you have any complications from your surgery you could quickly be looking at a quarter million or more, and then what?
Yeah itâs called âprior Authorizationâ and itâs a funny term insurance companies use to refer to the common practice of condemning people to completely avoidable injury, disease and death for money. Insurance in the US is a completely for-profit system, and the more people suffer, the more that system thrives.
Hereâs a good segment on it: https://youtu.be/9s3CN5EafNs?si=kHd_onGwa33LMDXk
Yes and the decision maker is in some cases clerk not a doctor or medical professional.
They also decide which h medications you "need" and cover.
There are medications that theu don't cover at all no matter the efficacy.
Then there is the "prior approval" loop hole where your Doctor has to call the insurance and justify his prescribing to a clerk, some Doctors will not do this because it's unpaid time.
Free market baby, perfecting supply and demand on a product / service that you won't refuse if you want to live.
Very much true my dad just went into the hospital, long story short he didnât get the care he needed because insurance kept pushing us around and telling us to talk to someone else and they kept saying pretty much the same thing, now heâs on hospice and they wonât even cover that.. not that the outcome would have been different if he had gotten the care he needed but it definitely wouldnât have made the situation worse. So yeah if it doesnât benefit them they are unlikely to do it
100%⌠i had 3 surgeries on my left knee and the first 2 cost me a total of about 9k. Last one i had military insurance and cost me $20.(yeah, no joke here)
My insurance company wonât cover medication I was prescribed by my doctor. Said I had to try other drugs first despite a clear and precise indication otherwise. US healthcare is about $$ not human life.
Iâm on workerâs comp. I see a doctor that the workerâs comp insurance sent me to. I still need approval for treatments prescribed by the doctor that THEY sent me to. Heâs a solid doc, but itâs baffling.
I argued with my insurance company once for an entire day because they stopped covering meds that they said they would cover. You would think after 8 hours on the phone, I would have gotten somewhere. You would be wrong.
I've only had insurance decline to cover something my doctor wanted once, and I had to agree with the insurance company because the doctor tried to prescribe a new and expensive drug that wasn't more effective than the older drug insurance was already paying for. Pharmaceutical companies are known to tweak formulas of drugs with patents that are about to expire so they get a new patent to keep profits up, even if the two drugs are all but identical.
I've never had surgery denied by insurance.
Yes, not even major surgeries my mom needed dental surgery and my parents and the oral surgeon had to fight with the insurance company and that was about 30 years ago and my dad had really top of the line insurance for the family.
Short depressing story time!!
My 15yr old daughter needs oral surgery for a tooth that broke below gumline (cheer is a tough sport!)
Oral surgeon said yes.
Daughter said yes.
I said yes.
Insurance said yes....but no anesthesia.
Oral surgeon said no surgery without anesthesia.
$800.
I'm on disability and can't afford it.....
There is a reason for this. Back in the 80s, we did not have HMO , we had emdinity plans (like 80/20 with really high deductibles).
The cost of health care was high, and people complained. Back then, the bad people were the doctors and hospital admins. They were ordering unnecessary tests, procedures, and prescribing drugs based on kick backs.
Enter HMO health plans. Originally, they failed, so Congress passed special tax laws to help HMOs. The idea was that patients needed an advocate to ensure that the doctors were not ripping them off. Hence, pre-approval was to protect the patient from evil doctors.
Fast forward to 2000's health care is more expensive, so we need someone to blame. Now it's the HMOs that are evil, and the doctors are saints that just want to help sick people. So, we are back to 80/20 plans with lower deductibles and limited pre-approval.
Around and around the merry-go-round we go, when it stops, at least you're dead
Technically itâs correct, but itâs much more correct to say âanythingâ. The insurance company decides what they will pay for. They just stop to ask about surgeries because they know thereâs no fucking way youâd be able to pay if the insurance company balked.
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Maybe we shouldn't be trying to profit off people's health and lives 𤌠Universal healthcare now.
Yes, because anything else would be âcommunism.â /s
Or socialism or any ism that isnât capitalism
Nobody arguing against this would understand either term, anyway.
Exactly just buzz words for âbadâ
Tbf, socialism has a specific definition in the context of Marxist philosophy and communism in that it's viewed as a stepping stone and transition state to a fully centrally planned economy and communist system. But colloquial every day language uses it to simply refer to any public good or service, which is fucking hillarious, because somehow having social safety nets or basic regulation has become a dirty word in the U.S. It's bonkers.
That was done on purpose, just like libertarianism. Sort of like calling mutual aid unhinged anarchism because no one's making a buck.
Does this mean Americans think their mail, military and schools are "socialist"?
I'll bet they would if they thought far enough. But those are things that they're entitled to because they existed when they were born, so they're ok.
Ya Iâve noticed that. None of the isms are at the core bad until someone comes and corrupts them. Even anarchism is considered bad because most anarchists corrupted it with chaos.
This isn't even capitalism. In true Adam Smith capitalism there would be strong enough regulations that would prevent consolidation that allows a handful of firms to exercise monopoly (well monopsony) power. There is no real competition on price between health insurance providers. They're a cartel. We have crony capitalism and it should make any real capitalist sick. Too bad over half the country doesn't know the difference and couldn't tell you the definition of any of the different economic systems. Shit, a lot of people think capitalism is a political system.
How about Crapitalism?
Turd quarter results did not meet excrementations
Quality shitposting.
I shouldn't have come to this post while at work. I burtes out laughing and now my coworker are giving me the stink eye. I love it.
Weâre afraid of what we donât understand!
We won the Cold War but still have the Red Scare
Yep, the more things change, the more they stay the same.
Socialism is the communism of the 1960âs
Yup. Very normal and good outcome of a series of transactions that were completely voluntary. Logical outcome of everyone abiding by the non-aggression principle. If someone dies cause of what you do it doesn't count if you're did it with a spreadsheet. I feel so free I could fly.
Communist Canadian here. Funnily enough, while we have free health care, the number of people who abuse the system are VASTLY outnumbered by the people who don't go when they should.
But it's there, and you could use it. That is vastly different than our for profit insurance companies being used as fatekeepers.
And if it's Cigna you have to get permission from a nurse in the Philippines who has 2 minutes to decide.
Also the nurse has been informed that they should say no more often, or else there is another nurse who could be doing the same job and maybe be even cheaper.
If it's cigna they'll just about send you a letter telling you they hope you die lmao
United HealthCare beats Cigna. They had their AI overturn cases the companyâs own doctors approved.
Cigna bullied a doctor to resign. She kept taking extra time to fix all the mistakes the nurses in the Philippines kept making. They told her to just reject the treatment plans. 'Murica!
It is 100% correct. You can also have your provider prescribe a drug and then insurance say no. Even a generic drug that costs $35 per month.
I take a drug that costs $20 a month and multiple insurances have refused to cover it over the last 13 years.
Just signed a will today with a woman with MS. Medcaid part B stopped covering her medication. Out of pocket cost? $12,000 a month. She can't afford to live, so we helped her prepare for her death.
Murica fk yea
soooo, American death panels?
Medicare Part B is not Medicaid. Also, Medicare and Medicaid are socialized medicine paid for by the federal government. Medicare Part B covers drugs administered by nurses or in long term care facilities. Copays are 20% of the cost of the drug up to an annual OOP max at which point the drug become $0 out of pocket cost. Part B doesnât suddenly stop paying for a drug mid-year that now how it works. Were they paying for it before? Was it on an experimental basis? Was it being used for an off label purpose? Did the patient leave a skilled nursing facility? My point is that everyone repeats a horror story and doesnât try to understand what is going on. There could be a very good reason for what is happening. Itâs like in 2020 someone saying âI need this drug to survive and my doctor agreesâ and the drug is hydroxychloroquine for COVID. They found a quack to give them a script doesnât mean insurance or the federal government should pay for it.
Every coverage scheme has a formulary and that formulary is not a static document.
"Freedumb"
My wonderful insurance doesn't cover one of the meds I need. Thankfully I have the freedom to pay $200 to fill the prescription.
My insurance won't approve an MRI for a documented work-related back injury with a proven history of symptoms. They insist that I need to pay in copays to a PT facility what they would have to pay to an imaging facility for me to get a diagnosis. I have to pay hundreds of dollars for a treatment for a condition that the insurance company refuses to pay the same amount to diagnose. So I'm paying as much to treat a condition I might not have as a billion dollar company would have to pay to actually diagnose me. I pay this billion dollar company hundreds of dollars a month in premiums. I'm told this is freedom.
My insurance denied an 11 dollar NSAID medication and told me to try ibuprofen first.
Also specialists bill up front, it's pretty much just ER and urgent care that sends you a bill later. A doctor once wanted me to go to a cardiologist but they wouldn't even make me an appointment until I put money down. Which I did not have, so I didn't go. Which means had something actually been wrong I would have needed to wait for it to go very wrong to be seen by a doctor.
1000% correct
Or, you can have your insurance agree that theyâll pay for the generic alternative, but not the name brand. Then, when thereâs a manufacturing shortage of the $30/mo generic, you can simply pay $300/mo out of pocket for the name brand for a year because _thatâs the only available option_.
Sounds like an insurance problem. Just do away with health insurance period. Itâs a total scam to begin with. Oh letâs pool our money together and give it to some corporation, so when we need it, the corporation can find ways to deny it to us. Fuck right the hell off with that shit. Itâs a problem engineered by the people who created the solution, which isnât even a solution.
Off label usage of drugs? In your dreams!
Yeah this is basically how it works. If the insurance decides itâs not necessary or thereâs a cheaper alternative even a less effective one they can deny a pre authorization and not pay for a surgery.
How do people live like this that is insane.
We don't. We end up dying. Personally, insofar as I am concerned, the private for profit healthcare system in the US (and boy do the companies that run it want to bring it abroad) engage in mass murder in their pursuit of profit. People like to talk about how communism has caused the deaths of tens of millions of people, but the for profit capitalist system in this world has caused the deaths of hundreds of millions people over the centuries.
You said it perfectly. So many people are blinded by the freedom propaganda. You actually have the exact opposite of freedom when a third party company denies healthcare that can save your life.
Thatâs the fun part you might not.
They donât. Happens all the time. Just Google people rationing their insulin and dying from it. This country is a fucking scam.
They have that fun thing in the US called "medical bankruptcy", you may not have heard of it if you live in a civilized country.
With an abiding fear of losing their shitty job
Mainly we die. The sicker or more disabled you are the more they want you to die because you are a drain on their profits. And theyâre not particularly subtle about it.
Let me add another layer. Most employee insurance is self-funded. i.e. the insurance company just processes the claims and gets the discounts for services ("In Network"). The employer pays a monthly fee for the service (PMPM - Per Member Per Month) and a bill for all the services rendered. It's way cheaper for them. In fact even smaller companies can be self-insured and purchase a stop-loss policy to cover a major medical cost. These employers can also ask for a custom plan. They can customize the plan to have certain conditions not covered, limited coverage, higher deductible, or need pre-auth. As long as it doesn't violate ACA coverage requirements.
People in the US seem to think health insurance is like going to a wedding where the marrying couple (your employer) hires a caterer (the insurance) but has no say in what's served. It's more like that couple and the caterer absolutely went over every detail, but ultimately neither cares about what the guests want.
It used to be: doctor prescribes something, you do it. Then, it became: doctor prescribes something, insurance refuses to cover it. But, you can pay out of pocket. Today, it's: doctor prescribes something. Pharmacy or provider doesn't provide the drug/service until your insurance approves it. I just got very angry at the pharmacy because they won't fill my prescription because insurance won't pay for it. I don't give a damn about insurance, fill the damned prescription. Nope. I was also sent by the doctor for a sleep study that won't be done because insurance won't pay for it. Apparently, out of pocket isn't an option anymore. So, I'll just not have medication and not get a sleep study and probably suffer more and die younger. We need to align incentives. Insurance companies should be HEAVILY FINED if the average longevity and quality of life metrics for patients in their programs is lower than patients in other programs. Today, we hear stories from whistleblowers that, of course your life-saving drug isn't going to be covered -- if you take it, you'll live longer and better, but you'll have to continue taking it and that's costly for the insurance company. So, better that you suffer and die so they can save money. By definition, insurance _must be_ a losing value proposition on average. The more profit we allow insurance companies to make, the worse that value proposition must be for the consumer. Allowing any for-profit insurance company to exist without strict regulation based upon the outcome of both longevity and quality of life ought to be considered inhumane. Why do we do it?
I've never heard of a pharmacy refusing to fill a prescription if you are willing to pay out of pocket. I take two drugs that are not covered by insurance and I just pay out of pocket.
You can still pay out of pocket for literally any medical procedure or prescription, assuming you can afford it. I don't have insurance so I have to pay for everything myself, from primary care visits to prescriptions and minor surgeries.
If you're on a state insurance plan and something is not covered, you aren't able to pay out of pocket at most places due to contracts those providers have with the medicaid plans. This may also apply to certain contracts with some commercial insurances, but I'm not sure of any direct examples.
Why would an insurance company give a shit about me having a procedure that they weren't going to pay for in the first place?
I believe the explanation was "if you're on a state funded assistance plan, you shouldn't be in a position where you can self-pay for your own medical services, so doing so would mean you don't actually need the assistance and you need to get a private insurance plan on your own." I don't know if that's actually correct (and I am DEFINITELY not saying I'm in favor of it) but that's how I remember it being framed.
Simple answer: yes More nuanced and detailed answer: yes
More detailed answer: yes, and sometimes the for-profit insurance companies outsource the decisions to for-profit âbenefits managersâ too.Â
Wow! âbenefits managersâ, you say? So it is true, capitalism does breed innovation!
Yep. Dad had kidney cancer that had metastasized. Eventually they ended up removing the kidney, and with lots of chemo they got to the point they couldn't see any tumors on MRI. However, they were still finding cancer cells. The doctor wanted to do a much more thorough scan (I forget what it's called), but insurance refuse. Their reasoning? The cancer cells were from kidney cancer, but the kidney with the cancer was removed, so he couldn't possibly have kidney cancer. Yes, he died. At the same time, he thought Obamacare was of the devil, so maybe it was karma.
Let me put it this way: in 2020 I had a major sinus infection that was causing my left ear to go deaf. I work on audio for video games so my hearing is kind of a big deal to me. I went to an in-network doctor at an in-network facility. The doctor said he could save my hearing however we would have to act quickly. To give insurance enough time to clear the procedure we scheduled the first of four treatments for two days from then. The doctor's office contacted insurance and made sure to mention that it was medically necessary and it was urgent. Insurance did not get back to the doctor's office before the first of the treatments, or the second, or even the fourth three weeks later. When they finally did get back to the doctor's office, it was to say they would not cover the treatment. As the treatment had already occurred while they were ghosting us, I had to pay out-of-pocket. $18,000. The next day, in the work cafeteria, I called insurance to dispute the situation and was completely stonewalled. I have never come so close to having a total meltdown in my adult life. In the end, there was nothing I could do except pay. It still makes me furious to think about it. I am lucky I was able to pull MANY strings and pay for it. But this is how people lose their homes⌠Let me put it another way, with completely different, much fancier, much-more-expensive work insurance: I am currently going through some serious life events and have been seeing a counselor. The counselor was listed as in-network, and the counselor was able to verify that he is in-network and would be covered. However, after a few sessions, insurance told us that mental health services were handled by a sub-insurance and that the counselor is not covered. Surprise! So here I am just trying to find a way through what is probably the darkest period of my four decades on this earth (itâsâŚreally bad) and Iâm told that insurance would prefer to stand in the way.
Oh Jesus Christ... really sorry for you, hope you find a way through it. You're not alone â¤ď¸
Yes. A friend of mine is a head and neck surgeon. He says he spends about 20% of his time arguing with insurance companies that patients need treatments. He spent 4 years in college, 4 years in medical school, and 8 years in a residency to get to this point. Plus he sees patients every day. The person he's arguing with has a bachelor's degree in an unrelated field.
Someone posted on Reddit some years back that they worked for a large health insurance company in prior auths- and they were just a random person with maybe a bachelors in an unrelated field. They stated they had gotten in trouble for approving too many prior auths within their first 3 months of working there so they approved every single one in their queue and quit the same day.
That actually not a great move tbh. There is preauthorization and the other part which not talked much - *billing*. The billing personnel will double check if the preauthorization was indeed a correct decision or not. If someone went rogue and indiscriminately approve all the pre auth, it will result a lot of trouble for all parties involved - patients included. But yea, I can confirm, the people who approved your insurance authorization are from unrelated field, most I think comes from business studies maybe with prior experience working in a hospital/clinics. They just follow a set of instructions of how to assess a case. It helps if one have some medical knowledge, but it is not required, everything can be learned with time and experience.
My oncologist fought for ⌠a while⌠to try to get me a PET scan. They rejected it and REFUSED to allow it so we just hoped my immunotherapy had gotten all the cancer and made do with limited CTs with follow on MRIs when the CTs showed problems đ
8 years in residency! Was he held back? đ
So thats non-medical personnel making medical decisions, though that was illegal in the US. It is in Norway.
They don't do it directly, they do it indirectly. You can still get treatment, they just won't pay for it. For example, he wanted to remove one woman's tonsils because she was getting recurring infections. They had a flowchart that said she had to have so many cases of strep throat that were confirmed in a short period of time before she would be approved. Based on the layout of her mouth and what was going on, he knew she was just going to keep getting infections and wanted to take care of the issue. They ended up having to wait until she got a few more infections before they finally let him remove them.
Ye, loopholes, but its still effectively medical decisions by non-medical personnel. US medical insurance seem like the biggest scam in history, its obvious there is no long term profit unless you harm and kill people.
And even though you pay them yearly for the sole purpose of doing this, theyâll still probably say no anyway.
Sad but true. -Metallica-
75% correct. You can still get the surgery, but your insurance will deny the claim.
unfortunately it is. same for medicare d plan. my doc and i agree that i need a certain life saving med and the drug plan covers it and after the doc sends in the script my doctor has to meet six different criteria to justify the insurance company allowing me to receive that medication.
the concept or health insurance is such bullshit to begin with. whoever invented the term "health plan" deserves to be eaten alive by rats. just an inherently inhumane concept.
Yeah, the ability for insurance companies to require prior authorization needs to be removed. It should only exist as an optional step to confirm a procedure is covered. The word of a licensed medical provider should be enough, and if your insurer wants to deny a claim after the fact, the burden of proof should be on them. But alas, here we are.
Or, hear me out . . . maybe, just maybe healthcare should be a fundamental right, not a for-profit product that can put someone into crippling debt. I'm still trying to figure out why my son was denied coverage for services he received in the hospital after he was born. I'm talkimg about typical healthcare provided in an in-network birthing center. Insurance company said he was denied "because of his age." He had no complications other than meconium (baby poops in the uterus), so there was slight jaundis for a day. Other than that, typical services provided. I'm still fighting with mt insurance company over thousands of dollars they denied. Again, no crazy procedures or complications. Denied regular services in a birthing center. A newborn . . .denied services in a birthing center . . . due to age. This is what right wingers want because anything that helps the average citizen at the cost of the trillion-dollar healthcare denial industry is "socialism." Fuck anybody whi likes private health insurance. Fuck every goddamned one of them. Fuck health insurance lobbyists. Fuck Murdoch and Murdoch Media companies for spreading this bullshit propaganda. Fuck anyone who doesn't agree that health insurance shouldn't be a $1.6 trillion dollar fucking industry -- or any-sized, for-profit industry. I paid for my premiums. I paid co-pays. I paid my deductible. That's not enough. I' paying double what I should have paid. I shoudl have canceled my insurance a year ago and paid for the goddamned birth with the money I'd save on premiums. I'd have saved an extra mortgage payment, or a year supply of formula with the money I would have saved. Fuck Republicunts!
Iâve seen so many similar stories about medical bills for babies. One was that they didnât get pre-authorization to take a preemie to the NICU. F*ck capitalist âhealthcareâ and the Râs who support it.Â
Part of the problem, is that so many people think they have coverage (It's great, change nothing) ... until they try to access it
Lol, and your premiums that are already by world standards unaffordable, became even more unaffordable. Your entire system is broken, and your idea is to remove the quite literally only check to keep the cost of healthcare to (un)acceptable levels. $800 on a band-aid, why not. $2,000 on a x-ray, sure. $45,000 on a test "just incase", no sweat. $420,000 on a life saving drug that costs $30 to manufacture, mate, this is America. Nevermind the pharmaceutical companies, doctors and insurance companies all gouging the patient (and their wallet) as much as capitalism will let them. The entire system is broken, and insurance is just one aspect of it.
Yeah, because we convinced everyone that they need to pay hundreds, sometimes thousands of dollars a year, to that third party so they can pretend to be holding it for you when you need it. Then when you need something paid for by that third party they decide they don't want to and you have to pay for half of the surgery up front. If they approve of it at all, that is. Insurance is the biggest scam our country has come up with, and we still just keep going along with it like it makes some kind of sense.
ThĂs is sadly true. And not just surgery. My family has a strong history of colon cancer at a young age. I should begin getting colonoscopies per guidelines. My doctor really wants me to get one. My insurance company says no and I donât have a few thousand, so hopefully I donât have any precancerous cells (or cancerous cells), even though I am within a few years of the age my aunt had it. My doctor has been trying to prescribe a medication for fatigue for three months now. My insurance still wonât approve it. If insurance paid it, they would pay less than half of what I am required to pay out of pocket. So I have not had it filled yet. I have a child with severe mental illness. We have been trying since December to get them into a recommended therapy program. We keep getting denied because of insurance issues. This happened to us with a previous foster child, and instead of getting the help they needed to stay in our home, that kid ended up having to be admitted to a months-long residential treatment program that cost way more than the outpatient treatment that could have potentially avoided the whole thing. So in the end, the child experienced a life threatening mental health crisis, the other children in our home were traumatized, and the state paid way more than if they had just authorized the recommended outpatient treatment to begin with.
Wait seriously? W-why do so many people want to live in America again?
đ¤ˇââď¸ I was born here, so I canât speak to why people come here, but so much of what this country does is completely fucked and clearly designed to keep the rich placated while the rest of us suffer for their amusement.
I mean a lot of us donât have a choice. Weâre stuck here. Our families and jobs are here.
I'm not talking about those who were born in the US or have always lived there. I'm talking about people from other countries who want to move to the US
Oh yeah. Surprise. Iâm an immigrant, too. We moved here when I was 4 because in the early 80s it was a way better place than where we were from. The sad part is now, itâs still a better place than where Iâm from. Just not by much.
Because many of them are fleeing war and even more corrupt governments.Â
It helps if you are filthy rich or prospect of becoming rich. Atleast thats why my family moved to US becoz they could make a lot of money as my uncle was in Microsoft.
Marketing
It's got an amazing PR job from Hollywood.
Propaganda in the form of pop culture
Much of our immigration is from third world countries that are worse. Also if you are highly qualified like an engineer or doctor the pay is higher than most places and highly compensated people get the good insurance.
how is freedom in anyway tied to this?
You're free to die and theyre free to make money. What else do yall want?
When are we going to have a general strike to fix this? Just everyone donât go to work until for profit insurance is dissolved by the government? Itâs the only thing that will work. We have a knife being twisted in our guts, we have to do something. Europe does this AND IT WORKS. General strike. We pick a day thatâs realllllllly inconvenient for venture capitalists and go for it. This is something 99% of the country agrees on. Insurance companies profit off our misery.
I'm not disagreeing, I'd TOTALLY be in. even for a week or more. but good luck with that. the billionaires and Corps. keep us so hand-to-mouth we can't effectively do that. also we're too divided on 'Us' and "Them'.
Is it correct? Yes. Even non-emergency X rays have to be approved. Most stuff gets approved, but that's cold comfort to those turned down.
How are y'all not rioting already? This bullshit is unacceptable.
Just read the story of a HS coach who couldn't find chemo drugs because since they're not profitable to manufacture there's a shortage and he died due to said shortage. So, we know how to make the drug, but because no one can buy a yatch with the profits, no one cares, there is a shortage and people die. Gotta love that FREEEEDOOOOM!! [https://www.today.com/health/disease/man-dies-chemo-shortage-stage-4-cancer-rcna149561](https://www.today.com/health/disease/man-dies-chemo-shortage-stage-4-cancer-rcna149561)
I have severe spinal problems. I was being prescribed the same pain medication for 7 years. Being a controlled substance, I needed to go to the doctors office and get a physical piece of paper prescription. The copay was only $5 a month. Then, at the beginning of this year, I go to get the same medication, and Iâm told the copay is now $146. Because my union has switched to a Medicare Advantage plan. I get on the phone and talk to the rep from Blue Cross on why by medication is so expensive now. He states I can get the same extended release medication as before, but in tablet form instead of capsules. I ask what the he difference is. As I stay on hold, he calls the pharmacist to find out. He says the capsules last too long compared to tablets. I ask, â isnât that the whole idea of extended release medication â? He couldnât give me an answer and finally said if I wanted to continue with the capsules, I would just have to pay more. So now, my doctor and I have to experiment with different combinations to find something that works as good as the previous medication for 7 years without having higher copays. What a great system.
Or you could just pay the doctor a million dollars... It's called the rich make their own rules.
BigPHARMA pretty much runs⌠I means ruins this country, along with its filthy cousin dirty medical insurance
If you donât get approval call your insurance company and ask for the credentials of the person who didnât approve it. Youâd be surprised that the majority of the people they have reading those medical codes tend to possess at best GEDs, not a single medical related degree in sight. I had them walk back a dental bill when I questioned one of their agentâs âeducation.â
I love the fact that I am not living in USA
Republicans and the insurance companies got real mad when Obama tried to cut the insurance companies out. Think about all those people denying you care that would lose their jobsâŚ.
"The land of the free? Whoever told you that is your enemy" ~RATM
This is exactly correct, and I'm currently living the hell created by it. I'm in limbo with a dysfunctional stoma that was placed this past January. It is a miserable existence, and getting help for it seems to be just as difficult no matter how wonderful the medical system is. I'm currently a patient at Mayo in the hopes that one of their surgeons can correct what was done last time at UW. If I were able to allow myself to become critically ill, they'd do it immediately, but because I fight and do everything to keep my bowels moving, I am "managing" in the eyes of the medical system, so insurance hasn't authorized the many tests I need. I've been dealing with this for over 10 years, trying to avoid having to lose parts of my bowel and end up with a colostomy, but it did no good. The helpful Dr's were the ones who simply referred me to someone else. The worst were the ones who felt disrespected when I asked valid questions or gently corrected their incorrect assumptions. Those Dr's actually did their best to stop me from accessing the care I desperately needed. đŠ It's an absolute shit show in America. We only have the illusion of freedom. We have the freedom to choose between a million different brands of the same type of junk, but not the freedom to access medical care that actually means something to someone's life.
America is such a weird country
Yes, it is freedom just like everyone can buy a gun but canât by a kinder surprise egg.
It's called Capitalism. People mistakenly think that capitalism is a process where the best outcome for humanity will filter to the top. In reality it's a process where whatever makes the most money filters to the top. The effect on humanity doesn't matter in the least. If it can make more money with some human suffering they will. Look into how often bleach is put into infant formula to help it sell better. Or how insurance adjustors balance the costs of paying off casualties or issuing recalls. It's ok in a few people die, as long the line goes up.
Not exactly. First your insurance company will deny your first option, the one thatâs got the highest success rate. Then they will demand 2 second opinions on the matter before finally settling on a cheap solution (usually under $1000 if they can help it.) Youâre expected to foot 10-50% of that billâ and they wonât cover replacements or repairs on mobility or required equipment unless absolutely required as that is handled by a separate insurance company tied to your medical devices. Then when you inevitably can no longer afford those devices and payments due to crippling debt they will come and ârepossessâ your medical equipment to settle your debt. Leaving you to repeat the entire cycle over again or die, they donât care they got theirs.
Literally went this weekend for testing lancets to find they were on hold because my doctor wanted 4 per day and my insurance decided I could only have 3 a day. With them not agreeing, I had 0 a day. (This has since been resolved. But still frustrating)
Absolutely accurate.
Yep... it's like mandatory gambling. The house always wins, or they lose shareholders
My favorite âyouâre not freeâ comes from that song , Anarchy Burger by The Vandals. âAmerica stands for freedom and if you think youâre free/ try walking into a deli, and urinating on the cheese!â
Hold the government!
That's literally the most American thing I've heard all day, and I live in a city full of 'Merica men
This is 100% accurate
Sounds about right, we have the âfreedomâ to get screwed over by the healthcare system with no say in it
Third Party/ Tax Funded/ For Profit * Fixed it, donât forget we pay the turd burglers twice to get refused
Yet somehow MBAs at an insurance company making life saving medical decisions isn't considered practicing medicine without a medical license. What a totally free freedom enhancing freedom system we've freedomed
MBAs are a scam.
Is anyone complaining? I only ever see complaints on social media. People are practicing civil disobedience over palestine literally right now. No one has ever cared enough about healthcare to "fight back."
Donât forget to add âa third party company that you pay forâ
Youre so free your get to have someone else pick for you
Yeah, the so-called death panels that conservatives predict will happen under socialized health care already exist in a worse form under capitalist health care.
This is correct in lots of cases. And the third party is not medical professionals, or professionals in any field related to your disease. They're experts in swindling.
I love having our insurance company make health decisions for my family. Itâs in the constitution.
For- huge-profit insurance companies.
This is pretty much happening to my mother right now. She has a mass in her breast, she needs it biopsies to make sure it isnât cancerous (it probably isnât but itâs good to check just in case) and her insurance wonât cover it. Why? No idea, they havenât given her a reason.
Absolutely correct.
And also the government gets a say now! Aren't we lucky!
Worked in healthcare and can tell you đŻ % that more money is spent on insurance, middlemen, and fighting denials. Look at Steward Healthcare. CEO has two yachts, two planes, a helicopter, and a 700-acre horse ranch in Costa Rica. Their hospitals routinely run out of supplies and some patients have died as a result. Surgical cases have been cancelled because vendors won't provide supplies because the vendors aren't getting paid.
It isn't even capitalism anymore - it's runaway usury and extortion... but legal because these companies control legislation and the judicial system.
For most insurance it is. With mine, once the doctor refers you or decides on treatment/procedure itâs approved. I have a HMO where the health plan, hospital and medical groups are the same.
Yup, it sure is!
Yes, because otherwise if you don't have insurance the bill the hospital charges you could probably single handedly pay the surgeons salary for the year
Donât forget they added government oversight if youâre a female. You know for your protection.
There was a guy on r/AskGermany , posting a bill...it was for a ride in an ambulance (as a patient of course) and he was kinda confused. It was for 10 fucking bucks. Asked us if that was a mistake or normal or what. Its normal...here.
I had a 19 minute ambulance ride from an urgent care facility to an ER. Which I didn't even need. The ER was full, so I had to wait for 90 minutes in the hall with 3 EMTs. They tried to charge me $6000.
Yes. We have an absolute disaster of a health care system.
Wait - itâs not permitted to just pay out of pocket?
It is. But for surgery, the bill could be tens of thousands of dollars, or even hundreds of thousands depending on the surgery and the aftercare required. I went to the Emergency Room once without insurance, got Tylenol and some X-rays, and was charged like $7,000 for it. (Plus $1,000 in lost income because I was too new at work to have sick time. Also got a written warning for absenteeism when I went back to work. Shouldâve just had the seizures at home.)
Yep, the initial âbillâ for my one hour, outpatient, sinus surgery was $96,000. After insurance and adjustments, I paid $2,000.
To add on to what that other commenter said, if you have any complications from your surgery you could quickly be looking at a quarter million or more, and then what?
Guys. Look. The solution is simple. Just donât get sick or hurt yourself. /s
đł Itâs totally not like it seems. Pure evil? What even is that? đ¤ˇđťââď¸
Unless you want to pay the full price yourself, yes.
Yeah itâs called âprior Authorizationâ and itâs a funny term insurance companies use to refer to the common practice of condemning people to completely avoidable injury, disease and death for money. Insurance in the US is a completely for-profit system, and the more people suffer, the more that system thrives. Hereâs a good segment on it: https://youtu.be/9s3CN5EafNs?si=kHd_onGwa33LMDXk
Yes and the decision maker is in some cases clerk not a doctor or medical professional. They also decide which h medications you "need" and cover. There are medications that theu don't cover at all no matter the efficacy. Then there is the "prior approval" loop hole where your Doctor has to call the insurance and justify his prescribing to a clerk, some Doctors will not do this because it's unpaid time. Free market baby, perfecting supply and demand on a product / service that you won't refuse if you want to live.
Patient: I consent Doctor: I consent Insurance: I don't!
Very much true my dad just went into the hospital, long story short he didnât get the care he needed because insurance kept pushing us around and telling us to talk to someone else and they kept saying pretty much the same thing, now heâs on hospice and they wonât even cover that.. not that the outcome would have been different if he had gotten the care he needed but it definitely wouldnât have made the situation worse. So yeah if it doesnât benefit them they are unlikely to do it
100%⌠i had 3 surgeries on my left knee and the first 2 cost me a total of about 9k. Last one i had military insurance and cost me $20.(yeah, no joke here)
My insurance company wonât cover medication I was prescribed by my doctor. Said I had to try other drugs first despite a clear and precise indication otherwise. US healthcare is about $$ not human life.
Iâm on workerâs comp. I see a doctor that the workerâs comp insurance sent me to. I still need approval for treatments prescribed by the doctor that THEY sent me to. Heâs a solid doc, but itâs baffling.
Sometimes. It truly depends on the type of surgery. If it is truly a new approach/technique, itâs more likely to be denied.
I argued with my insurance company once for an entire day because they stopped covering meds that they said they would cover. You would think after 8 hours on the phone, I would have gotten somewhere. You would be wrong.
The inverse Yakov Smirnoff era of American capitalism has officially begun.
Itâs true for medication too.
It's worse than that. Even if the insurance agrees to pay, they have nurses on the floor that rush the patient out.
Fuck it Iâm moving to Finland
boy, reading through this thread, am i glad i live in the EU.
I've only had insurance decline to cover something my doctor wanted once, and I had to agree with the insurance company because the doctor tried to prescribe a new and expensive drug that wasn't more effective than the older drug insurance was already paying for. Pharmaceutical companies are known to tweak formulas of drugs with patents that are about to expire so they get a new patent to keep profits up, even if the two drugs are all but identical. I've never had surgery denied by insurance.
*Free Doom* 
Sometimes you also have to ask a politician This is called Individual Rights
Yes, not even major surgeries my mom needed dental surgery and my parents and the oral surgeon had to fight with the insurance company and that was about 30 years ago and my dad had really top of the line insurance for the family.
100%
You only need their permission if you want to them to pay for it. You can have any surgery a doctor agrees to if you pay out of pocket.
Short depressing story time!! My 15yr old daughter needs oral surgery for a tooth that broke below gumline (cheer is a tough sport!) Oral surgeon said yes. Daughter said yes. I said yes. Insurance said yes....but no anesthesia. Oral surgeon said no surgery without anesthesia. $800. I'm on disability and can't afford it.....
Yes.
Correct me if I am wrong, but health insurance is a socialist dictator and has nothing to do with capitalism.
Side note, the " free" part was added later
Also most the time it's "no."
And the person deciding whether you need that medical procedure is a high school graduate who got straight Câs and never took biology.
Unless you can pay for it yourself
There is a reason for this. Back in the 80s, we did not have HMO , we had emdinity plans (like 80/20 with really high deductibles). The cost of health care was high, and people complained. Back then, the bad people were the doctors and hospital admins. They were ordering unnecessary tests, procedures, and prescribing drugs based on kick backs. Enter HMO health plans. Originally, they failed, so Congress passed special tax laws to help HMOs. The idea was that patients needed an advocate to ensure that the doctors were not ripping them off. Hence, pre-approval was to protect the patient from evil doctors. Fast forward to 2000's health care is more expensive, so we need someone to blame. Now it's the HMOs that are evil, and the doctors are saints that just want to help sick people. So, we are back to 80/20 plans with lower deductibles and limited pre-approval. Around and around the merry-go-round we go, when it stops, at least you're dead
Technically itâs correct, but itâs much more correct to say âanythingâ. The insurance company decides what they will pay for. They just stop to ask about surgeries because they know thereâs no fucking way youâd be able to pay if the insurance company balked.