Welcome to Incremental Social! Learn more about this project here!
Check out lemmyverse to find more communities to join from here!

Why do we have to do the health insurance company's job for them?

Just so tired of almost every time a doctor submits stuff to insurance, we have to be the ones to make multiple phone calls to both the doctor's office and insurance to iron everything out, figure out what the issue is (it's always a different issue), and basically be the go-between for the office and insurance. What am I paying $500+/month for?! It's like paying for the privilege of having an exhausting part-time job.

And yes, I understand that insurance wants to weasel out of paying anything, but this isn't even shadiness, just straight up incompetence and lack of communication/following procedures. The amount of emotional energy we have to spend untangling this stuff leaves us drained.

psmgx ,

The amount of emotional energy we have to spend untangling this stuff leaves us drained.

That's the point. Take a look at the Fortune 500 and Global 500, and notice how many of them are US healthcare companies. No company gets that big doing all the work themselves...

Blackmist ,

Come on now. If you really had to do your insurance company's job for them, you'd have to think of your own reason why they won't pay up.

IamAnonymous ,

Another post to feed America Bad and EU Good circlejerk on Lemmy.

Yes, the system is bad and we should have universal healthcare but I never had to call anyone to figure anything out in the past 15 years. The hospital sends me the bills after getting it through insurance. Not sure who your insurance provider is but this issue is not common.

realitista ,

Living in Europe with single payer health care, this sounds crazy. I just go to the doctor, leave, pick up my drugs, etc. It's all handled by the insurance except maybe a few bucks on some drugs. Worst case I have to show my insurance card but that rarely even happens.

IamAnonymous ,

It is crazy because OPs case is not very common, at least in my experience. The hospital sends the bills to the insurance and later I get a bill for what I owe. I don’t need to make any calls.

yessikg ,
@yessikg@lemmy.blahaj.zone avatar

Oh no, it's very common, especially with large bills

IamAnonymous ,

Not sure how large but I recently got a bill for $3000 without having any issues. It took a while for it to get through the insurance but I didn’t have to make any calls. If you are disputing each charge and getting them to reduce the bill, then that’s a different story.
Again, maybe only my experience has been good.

ArtVandelay ,
@ArtVandelay@lemmy.world avatar

The amount of inefficiencies in the healthcare system is staggering. Like, you almost wouldn't believe it kind of staggering. I can't go into much detail without doxing myself, but it's bad.

jdf038 ,

Same with HSA cards. I quit paying into mine because they wanted proof I got work done after using at a dentist.

Yeah, because dentists usually sell fun things. Fuckin morons

kuraitengai ,

I never had an issue with my HSA card. Paid into one from 2016-2020 when I had a state job. Then switched off a high deductible to a standard plan with an FSA. Left the state job in August 2021 to go private. finally burned through the last of the HSA money in June 2023. Switched jobs back to the state last August and started paying into the FSA. They hassled me over every charge that wasn’t a copay. Go go the eye doctor. Prove it. Buy contacts. Prove it. Go to a chiropractor. Prove it. They deactivated my FSA card over $1.60 that the insurance said was over the standard amount.

Sorry, I pay into the account for medical purposes. I go to a doctor and you pay it. You have no business knowing WHAT the doctor did to me. They were demanding stuff as documentation from my wife that was a blatant privacy violation.

jdf038 ,

Similar issue with me! In our case both were HSAs and my employer changed companies. The first was awesome (and super helpful considering it was pre tax) and the second was horrible.

ikidd ,
@ikidd@lemmy.world avatar

It's the first time they've ever done a claim. Take it easy on them.

afraid_of_zombies ,

I don't know if I should say this but I will.

The last time it was an issue for my kids I conferenced called the insurance and the doctor's office. I then laid into the insurance adjuster saying things that were truly revolting with as much profanity as I could cram into it.

Haven't had an issue since. Turns out the system only works if they think you are unstable enough to make it work.

Pulptastic ,

This happened to me today. Dreading the hold times tomorrow.

toiletobserver ,

Vote for a single payer system (Medicare for all) if you want out

Hildegarde ,

How? Who do I vote for to make that happen?

uis ,
@uis@lemm.ee avatar

Doesn't USA have referendums?

Etterra ,

Yep. The powers that be routinely ignore the ones they don't like.

Jakeroxs ,

In some states lol

uis ,
@uis@lemm.ee avatar

I mean national

Jakeroxs ,

Afaik, no there isn't a federal referendum as a option in the US, could be wrong but given I'm pretty sure it's illegal in some states (can't have those pesky citizens making their own rules)

psmgx ,

Nope. Given how many Americans are obese as shit, believe in angels, and are obliterating public education... That's probably a good thing.

uis ,
@uis@lemm.ee avatar

That explains why so many politicians from America I hear about sound like idiots obliterating literacy. But I disagree with this being good thing. Lack of national referendum gives loud idiots more power.

ikidd ,
@ikidd@lemmy.world avatar

No, but there's a pile of guns.

Sam_Bass ,

Poor souls are weighed down by the egregious amounts of money they have to take in and hand out. Leaves little time to do much else

gamermanh ,
@gamermanh@lemmy.dbzer0.com avatar

My favorite is pre-authorization.

I need a pre-auth before my insurance will cover the Adderall for my ADHD. Every year I must renew this pre-auth or I will not get covered for my prescription.

What is a pre-auth, exactly? It's a Dr. Promising that yes, this medicine they prescribed is medically necessary. No, prescription alone does not count. Yes, it can come from the same Dr. who prescribed it.

And yes, I have to do it yearly to "ensure it's still medically necessary" because my ADHD could magically go away one day, apparently

spaghettiwestern ,

It's beyond belief, but insurance companies do the same thing to amputees.

gamermanh ,
@gamermanh@lemmy.dbzer0.com avatar

Oh I know, I had a family member make the joke about suddenly regrowing a limb

It's disgusting and absolutely should result in anyone who's ever approved that being put against the wall for their pure evil

s_s ,

Any hassle they can create to manufacture a reason to deny coverage.

It's not "beyond belief" it's disgustingly evil.

Sam_Bass ,

It means they have to compare your request to a list of allowances that change annually at the whim of Corporate

AlecSadler ,

I have to do it quarterly for some reason. Annually would be...better, but still stupid. My doctor even thinks it's dumb, so he usually just asks me all the rote questions...

...no he doesn't, he usually goes blahblahblah you've been doing this for 10+ years we know the routine. Unfortunately I still have to make an appointment, have an appointment, pay the deductible for said appointment, just to get 3mos of a medication that, thus far, I have a medical need for.

uis ,
@uis@lemm.ee avatar

Wow. This is similar to what disabled people have to deal with in Russia. Like arm will grow back.

PM_Your_Nudes_Please ,

Oh don’t worry, disabled vets deal with it all the time in America too. Oh, that leg you lost during your deployment? Gotta prove it’s still missing, and that you’re still disabled every year. And if you fail to get personal copies of everything in triplicate, the VA will magically “lose” your paperwork and you’ll be stuck without benefits until you start the entire process all over again.

nul9o9 , (edited )

Same with my MS. It's frustrating to know that if they fuck around and drag their feet one year, i could be getting further brain damage without my meds.

spaghettiwestern , (edited )

We have all become unwilling, unpaid employees of every company in their pursuit of higher profits. It's a feature, not a bug.

Corporations have discovered that there is no real downside (for them) when they don't function. Customer satisfaction no longer has much of an impact on their profits because the few companies left in each sector are doing the exact same thing.

IMO this is yet another side effect of unchecked corporate power. It's the same reason prices have risen so rapidly and corporate profits have reached 70 year highs. We are dealing with near monopolies and the billionaire class who created them. Until our government addresses the problem it's not going to get any better.

In other words it's not going to get better in our lifetimes.

aesthelete ,

In one example of this, during one job interview / recruitment process I essentially had to do all of the background check company's work for them.

That makes literally no sense at all, and I'm not surprised when there's cases of people just pretending to be doctors or whatever for decades. The "doctors" probably verified their own employment history and credentials.

jordanlund ,
@jordanlund@lemmy.world avatar

I tore an achilles tendon last year. Doc wanted me in physical therapy, but PT wouldn't take me because they needed an MRI showing the position and size of the tear.

PT was very clear. Tendons don't show up on xrays.

Doctor was very clear. Tendons don't show up on xrays.

Podiatrist was very clear. Tendons don't show up on xrays.

Aetna: "You didn't do an xray first, MRI denied."

repungnant_canary ,

They try to spend less so aggressively that they end up actually spending more

jordanlund ,
@jordanlund@lemmy.world avatar

Fought them for a month, meanwhile I'm in pain, limping with a busted tendon.

Finally we just gave in and did the xray, which - surprise! - showed nothing! Then they approved the MRI.

repungnant_canary ,

I hope you don't have any long term consequences of that

jordanlund ,
@jordanlund@lemmy.world avatar

Once I got into PT things seemed to go well, it was just a month of suck getting there.

aesthelete ,

Corporations are all about stepping over dollars to pick up pennies.

terminhell ,

https://lemmy.dbzer0.com/pictrs/image/5c3aa2f5-839d-4d0c-b68c-615e4dad050e.png

Klanky OP ,
@Klanky@sopuli.xyz avatar

Haha exactly! I mean, I know this is how it works, it just feels like it’s gotten way worse in the last few years.

Boozilla ,
@Boozilla@lemmy.world avatar

What you really need on top of that insurance is supplemental insurance! That way you can pay two insurance companies and they can both say no!

  • All
  • Subscribed
  • Moderated
  • Favorites
  • •
  • mildlyinfuriating@lemmy.world
  • incremental_games
  • meta
  • All magazines
    •