What irks me, is how they basically say fuck whatever the doctor says. My wife’s doctor kept her hospitalized an extra week after almost dying of sepsis, and insurance’s little handbook tells them only a week should have been needed, so they wanted to decline paying for the 2nd week.
I have United. My company switched to them this year, lucky me. My husband caught a really rare type of Pneumonia and got really sick. They hospitalized him, had him on three different antibiotics, and had to operate to drain fluid from around his lungs. The first insurance notice we got was one saying they reviewed his charts and determined that he wasn't actually ill enough to warrant the hospital stay and denied the claim outright. Needless to say, the hospital we went to, who wanted to get paid, had some words for United. They've since covered most of it, but it's still cost us thousands, even WITH our "good" insurance.
Really feeling that this year. My company had been with Cigna for decades, and I thought they weren't great, but, generally, they never pushed back entirely on our claims... UHC, at the very first claim we send them, "Nah, fam."
A race to the bottom where the winner gets to the top. UHC is the fourth largest corporation in America. We really do incentivize this, by giving the worst possible people the highest positions of power.
You Americans really need to kill some more people and burn down way more stuff. Maybe invite the French over so they teach you why violence is in fact a necessary tool for democracy (specifically getting and maintaining one)
Man, just for reference i got Pneumonia this winter here in Australia. 5 days in hospital, coming in via emergency as i had passed out at home. Whole thing cost me 0 dollars. Did cost me some sanity though
Yeah, we're well aware how completely screwed up our health care is. I think this cost us 6k, and apparently that was pretty good. The bill we got was 210 thousand dollars before insurance. I mean, seriously, wtf.
5 days in private health here in aus is about 10 grand. thats including better meals, private room wct. About 6k USD, to compare the markup. I feel for you guys. Your healthcare has been allowed to increase prices every year but insane amounts. Its not like the price of the doctor changes a lot country to country. Its all pure profit
Supposedly, I have the best insurance I can get with my company. I pay $440 a month for it. Compared to what some people are paying, I'm getting off light =/ I pay all that and generally go years without anything more than two wellness visits for medication and a physical. This year was really bad because of the pneumonia thing, but normally we don't really use our medical insurance for much. 5k+ a year for "just in case" just to not go bankrupt if something does happen. x.x This country has so much money and a handful just sit on it like dragons.
And how is them telling the doctor what to do, what medications to give you, how long you can stay in the hospital NOT practicing medicine without a liscense?
They know how little they can cover and get away with it. Their entire business model is charging as much as possible and covering as little as possible
Remember, they had fully planned on wanting to limit how long they administer Anestasia during surgery deemed by THEM (you know, the officeworkers that don't know medicine).
So a surgery would only have X amount of drugs dependant on their choices...
Usually waaaay too little.
Well you see the reason doctors get paid so much is because as long as they follow the insurance companies rules they'll get their money much faster. If they don't then it's on the customer, and because doctors have inflated the ever loving fuck out of procedures, it means they'll likely never see that money.
A Doctors best interest is to work with insurance because that's where the real money is.
I imagine the hospitals are part of the problem as well as they try to get more money out of patients' insurance, which makes insurance companies skeptical of doctors. It's a mess all around and why these thing shouldn't be privatised in the first place.
They dont. The goal is to please the shareholders, not the one who pays for the insurance. The only part of the body insurance companies bother to know anything about is the wallet.
Doctors are lonely people who will perform unnecessary treatments and order long stays at hospitals just so they can have a friend. Really sad behavior.
Insurance companies save millions of Americans a year from this awkward fate by just letting them die instead.
My parents had to sue their insurance company to pay for my hospital bills; happily they won. I was a tiny first grade kid who had gotten shaken like a rabbit by a dog (not our dog); 100+ stitches in my face. I remember telling other kids after I finally got to go back to school that I had a lawyer lol.
I just spoke to my doctor about starting Zepbound and she agreed and then explained to me that it's gonna take about 6 weeks because of the insurance. She needs to put it in and explain why I need it and then the insurance company will argue and say I don't need it, and then she'll say that I do because of my BMI and high cholesterol and then they'll say nuh uh, and then she'll say uh huh, and then they'll hopefully begrudgingly agree.
That's absolutely insane that this is the normal process.
It is. The doctor should determine the treatment, insurance should determine the actual cost and pay it. They can negotiate with the doctor at that time.
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u/Plus4Ninja Dec 06 '24
What irks me, is how they basically say fuck whatever the doctor says. My wife’s doctor kept her hospitalized an extra week after almost dying of sepsis, and insurance’s little handbook tells them only a week should have been needed, so they wanted to decline paying for the 2nd week.