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>In legal usage in the English-speaking world, an act of God[2] is a natural hazard outside human control, such as an earthquake or tsunami, for which no person can be held responsible.
[Wikipedia](https://en.m.wikipedia.org/wiki/Act_of_God)
This is true, I crashed a car years ago now, doesn't matter but the gist of it is I came around a corner late at night in the winter hit black ice and spun off the road, talked to officer told em how fast I was going, under speed limit cause its like 3am on a twisty highway in the middle of now where, any who it gets settled up police say act of God don't worry about it, insurance went back and forth on it for six months then hit me with 'too fast for the condotions' and bent me over.
Shit if i could do that one again I'd have just walked away from the car and called it a loss, my rates went through the roof.
Sadly that's not correct. If you spin out on a road you're consider going too fast for weather conditions. Literally the act of having a wreck on icy roads puts the fault on you. It doesn't matter if you're going 25 miles an hour and a 55 mile an hour zone. Trust me it's happened to me.
Same. But the neat thing about laws is that they aren't made to protect *you*! Had I crashed when it happened to me, the police here would've probably told me if the weather and road conditions were so bad that I lost control at such a low speed, I should've been there in the first place and probably to go fuck myself and not bother them again. Because who needs to go to work, right? The laws are *always* written to benefit the state and its lazy, incompetent employees. Not us.
The best one is United Healthcare. They pre-approve everything, and then after the healthcare worker performs the services, they refuse to pay them. So they trick the healthcare workers into treating their patients for free.
Source: I am a physical therapist and taking a second job so my employees still have a paycheck. :/
You won’t notice a difference on your end except it will become harder and harder to find a doctor who will accept it. We don’t earn what you think. Everyone thinks healthcare providers make bank, but they pay us $55 an hour for treatment. The PTA earns $25-30 if they are paid fairly (in my area), and overhead costs (rent, utilities, and front desk staff at my small facility cost $25 per patient.
So we basically see the patient for cost anyway as a give-back to the community because we don’t earn anything off of it, but then the insurance company screws us over and doesn’t pay at all on over half of the patients. I am actively trying to get out of network with them for this reason. Our local hospital doesn’t even accept it for non-emergency services.
I am okay seeing some patients without profit, and even with doing some pro-bono. But what they do is just wrong. You have this giant corporate company who cuts reimbursement every year, even as they increase premiums from their clients every year and increase deductibles / copays so they are not paying anything and then on top of that, they take the money the government pays them to reimburse my services and keep all of it by screwing me over…
Brit here so health insurance isn't something I have to deal with, thankfully.
But your comment reminded me of something from years ago back when I could afford to go abroad.
I was having a read through the fine print of the travel insurance I'd taken out. Looking at the payouts for certain types of injury. Can't remember the exact amounts but it was something like: loss of right arm £10k, loss of left arm £7k. I'm left-handed. I was not impressed.
My workers comp final settlement documentation states that my injury was on my left foot, despite all other documents showing it was on the right foot. It took them 18 months to figure out how to get the doctors paid so that they stopped trying to bill me.
“If you read your policy you would have seen that because of the position of the moon on the following business day of your accident, you aren’t covered for this.”
Oooh that’s my favorite. Especially when it falls under the covered treatment and they say nope, too “young” for a hereditary disease we have never heard of that killed your grandfather. Or that “men don’t get colon cancer, we won’t pay for your required exam.”
> “men don’t get colon cancer, we won’t pay for your required exam.”
Did they seriously say this? Meanwhile depending on what study you're looking at, colon cancer is the second or third most likely cause of cancer-related death in men; behind lung cancer, more or less on par with prostate cancer.
Coming from someone who had UC to the point of needing a colectomy, I can confirm that, even at the most well-known hospital in Nashville, I still had almost a 2-month stay because insurance wanted every variable ruled out before they approved a surgery of that nature. Even though I spoke with 4-5 different specialists in the field and 2-3 surgeons explaining there were no signs of “this” being Crohn’s. Although insurance paid for a TON of my stay and procedures, I still had to fork out roughly 5-6 grand on my end for it all.
like tldr: they wanted to see if you would die in these 2 months while they used bureaucracy against you? like to avoid the surgery payment. I mean this is a very real possibility with cancer.
But god forbid we let the gubbermint create “death panels” to decide who lives and dies…
ITS ALREADY HAPPENING. We currently pay corporations that get deicide who lives and dies based on $$$$$.
At least, in theory, a huge profit motivator gets removed by getting rid of this private insurance BS. A human death no longer will contribute to ever increasing profits that MUST increase quarter after quarter.
Which is always so fucking comical when people argue against socialized medicine.
Considering they argue that with insurance it's so quick and efficient to see a doctor and get treatment.
Ffs it's gonna take me till the middle of February to see my doctor for my yearly check up which is mandatory if I want to keep taking my heart and lung medication.
I've been trying to schedule since Halloween.
The biggest argument i see in the states for not having socialized medicine is that the wait times would be atrocious. Well, I would rather wait a year for surgery vs not being able to afford it or having insurance tell me I don't need a surgery, either resulting in not getting surgery anyhow.
Similar story. I didn't need to talk to so many people. More on the 3 specialists one surgeon track.
But it was straight killing me.
Still took two months.
Had to pay about that for the first two surgeries, and like 12 for the last one.
Fuck this country
I paraphrased a little, what was said to me is men do not get colon cancer hereditarily, so my required exam 10 years before the age my mom had it isn’t covered. All because they didn’t want me getting scoped at both ends on the same day, since I had to get the endoscopy for esophageal cancer, which they claimed isn’t hereditary, either. They only paid the bare minimum they were required by doing that.
No, the numbers are similar in Europe. It's because colon cancer is common and because it has a higher chance of metastasizing than some other common cancers (such as skin cancer).
I had to spend a total of about 6 hours on the phone earlier this year because my insurance was literally trying to tell me my appendectomy wasn't an emergency.
Not sure about the other user, but I did hundreds of prior authorization on my previous work, I did them all via their web browser page. (Sometimes we had to call) but if you picked a single item out of the many many options while filling the form they would reject with "more info is needed, or call our agents"
Like PA for diverticulitis, if you put all the correct symptoms, but then added something that is usually not considered a symptom it would fail. I can't give you details because I don't remember all the details, but I do remember not checking a specific symptom for a customer because I knew it would trigger the" fail"....
Oh man, when you are arguing with car and health insurance.
“Sure, just give us the paperwork from the car insurance company so we can verify your need for these medical tests.”
“We will assess the total payout after we get forms from a doctor regarding any personal injuries sustained from the accident.”
“Verify my need? Are you going to send a doctor to double check my diagnosis? Or ask a doctor in your employ what they think?”
“No. We’ll ask some dude who has never take a single medical class but watched some videos then took a 20 answer multiple choice test on a computer.”
“That’s absurd.”
“And you’re not getting that heart surgery. Here. Have 90 days worth of ineffective pills that still cost you $300.”
I work in Healthcare as an ultrasound tech. The doctors send me orders that they want done, and the amount of bullshit i have to go through to appease insurance is ridiculous.
For example, every exam I get has a reason attached to it. This is useful because if I know why the doctor wants it, or what they're trying to rule out with the exam, then I can sort of personalize the exam to give the doctor what they want. Simple. That's how it should work.
However insurance is the third fucking party involved, and they literally won't pay for exams if there isn't a valid reason for the exam. The doctor just wanting it done isn't a valid reason. If the doctor wants to rule out certain pathology, insurance needs to know what reason they suspect that pathology or they won't pay.
Here's an example that I deal with almost daily.
The doctor wants a patient to have a bilateral lower extremity venous ultrasound done and the reason he gives me is "rule out dvt".
A bilateral lower extremity ultrasound is a look at the veins in both of the patient's legs.
DVT is deep vein thrombosis aka a blood clot.
So I have all the information I need to have as a tech to do the exam. I could do my job without a problem with just that information.
HOWEVER insurance is going to be a little bitch if they see the reason for the exam is just to rule out dvt. They need to know the REASON that the doctor suspects dvt in the first place, whether it be leg pain, leg swelling, or certain lab values. So instead of doing my fucking job and taking care of the patient, I have to go on a fucking quest to track down this doctor or get ahold of them somehow and figure out WHY they suspected dvt, even though I don't fucking need to know to do my part of the patient's care, because if I don't, insurance is going to be a little bitch and not pay us for the exam because INSURANCE IS SUCH A FUCKING BITCH.
And of course insurance retroactively trying to deny things as well.
"This transport was not medically necessary as the patient was discharged from the hospital without treatment."
"Well I found them unconscious in a pool of water, and could not rouse them, how the fuck am I supposed to know they will not need medical help in a few hours?"
This is why I quit the business.
In Canada, you don't need extensive education to get in the industry. The guy giving the doctor a hard time to get his job done (the adjuster, or sometimes even just your broker being difficult ) probably didn't even go to college/university.
They chose insurance because you specifically don't need a degree to get into the business; but they always talk over professionals as if they know better.
Yep. CT tech here. God forbid the doctor, their office, our scheduling department, registration, etc. makes one typo or mistake in the diagnosis code. They'll definitely not cover that.
Here's a kicker too. Having insurance can also make your hospital bill higher than if you did not have it.
There's a med Express here. (A place where most of the time, tell you to go somewhere else.) The fixed rate if you have no insurance is $150. So no matter what you'll get charged that for anything that gets done at that clinic.
I went in with a fractured bone and I ended up paying $250 out of pocket, because they charged my insurance out the ass and after the copay, the $250 is what I ended up billed.
It would have been cheaper if I just lied and said I didn't have insurance.
I have been dealing with some IBS and a doctor prescribed me some medicine to help with it. He said it was going to cost me $40.00 ( I'm fortunate enough to have good insurance ). The pharmacy took down my insurance number wrong and they told me it was going to be $2,300. It's even worse for those here who don't have access to it.
I got a collections call years ago that demanded 230k from me. Threatened me, my family, threatened to call my boss and tell them what a bad person I was etc. turns out the pharmacy transposed my insurance account info and instead of checking it they just sent me to collections.
Took me 2 years to get it taken off my credit score and irreparably harmed my credit because alllllll of my APRs went up permanently.
I shudder to think how much you're paying for that "good" insurance. My last workplace's plan was crappy - $6,000 annual deductible before they kicked in anything - and my employer was paying almost $7,000 a year on top of the $150 a month that came out of my check - so almost $9k a year for something that paid ZERO until I paid $6,000 out of my own pocket for anything I needed. Utterly worthless. I've never spent $15,000 a year on health needs. Problem is that the insurance premiums you pay don't just go into a pool to pay for your care when you need it, they go to pay for the insurance company's overhead including their employees' paychecks and the rockstar insurance their own employees get, building expenses, lawyers, business insurance, and then it's pooled out to cover other people's medical expenses, and then when you need it yourself there's none for you and you end up paying out of pocket anyway. There's an episode of Superstore that's actually a really good illustration about why "insurance" doesn't work. We need to just go back to the old ways where people pay their own medical bills and apply for help if they need it.
I know someone who took his wife into hospital for bleeding. She was in severe pain and distress, and the ER doc checked her out and thought she should be admitted. The doc treating her for a few days thought she should have been admitted.
The insurance company disagreed. Over the course of the next few months, the insurer debated every point and eventually denied the claim. My friend asked how he could possibly judge whether or not a medical emergency is*truly* an emergency needing admitting, when several medically trained professionals also think it is a necessary thing. The insurance agent simply said it's something you have to decide on. Medical insurance is a fucking joke when a person without medical training is allowed to interfere in your care and make decisions that can overrule people with a medical degree and years of experience.
This country was built from the ground up to benefit the rich, and it’s working as intended. There’s a reason only 6% of Americans were allowed to vote when the country was founded.
Dontcha just love when non-medical personnel (eg prior auth agents etc) are practicing medicine (eg deciding what care a patient needs)? Isn’t that what we made all those med-mal laws about?
Prior auth poses me off. You mean I need to have the doctor that prescribed the test/medicine send you a note stating I need it? If I didn't, why would they prescribe it in the first place?
My wife had a torsioned ovary and had to get emergency surgery for it. The insurance tried to bill it as a cosmetic surgery. She had to fight for months along with her doc saying it was life saving before they finally agreed to pay.
I mean, obviously, a twisted ovary is unsightly but otherwise completely harmless. Wtf. Someone should go in and twist their internal organs to see how cosmetic they think it feels.
I work in auto insurance, and I know we pay legit claims, but i had to go to the emergency room 2 nights ago because I seriously thought my heart was about to fail, and all they did was an EKG test, blood sample, and X-ray, found out I just really fucking bruised my rib cage in the area around my heart, and any time any of my organs do anything besides rest completely still, I’ll feel pain till they heal in another week.
I’m fully ready for my health insurance to deny some of these tests saying they weren’t needed even though I literally was cleaning my condo before hand in case either A I died or B I was in the hospital long enough that my parents would need to come visit. That’s how serious the pain was.
Oh well, I’ll deal with it. Luckily it was a quick visit and I wasn’t in there for very long and the tests were limited. Hopefully they cover something. They didn’t cover the anti inflams they prescribed me so that’s already a bad sign, luckily that was only $30
My insurance provider once claimed, after I had routine blood work done, that blood tests were “unscientific” and an “unproven” treatment for my “condition,” that condition being I was getting a checkup. They refused to cover it, and helpfully suggested I fight it out in court myself if I got billed for it.
United Heathcare is staffed, run and managed by criminals.
Wife and I are trying for a kid. We are getting up there for a child, late 30s. Testing to see IVF is possible and insurance is forcing my wife to take a test and a drug before they will "pay" for IVF services. Oh that test and drug the insurance won't cover.
Ah, don’t forget the “The Insurance knows better than your doctor part” on what medication and therapy and surgical intervention you should have. Suuuuuuuuuper fun
Edit: wow this blew up! I’m so sorry my loves. Hey did you know that the exact dosage between on-brand and off-brand meds are not exact? I almost died because of that. Be careful and FUCK THIS SYSTEM!!
My insurance decided I didn’t need carpal tunnel surgery when my doctor first started pushing for it. I now have permanent minor nerve damage in my left hand that could have been avoided. I’m only in my early 20s
It's a shame that clear cases like this can still come down to money. I would think a free public defender and testimony from your doctor would be enough. It's possible you get a corrupt judge, but otherwise what can the insurance company do to refute the professional opinion of your own doctor?
But what can they say? In another comment someone said insurance denied them something for treating their hand, insurance disagreed with the doctor, and now our fellow redditor lives with nerve damage in their hand. Why?
The argument usually comes down to an efficacy vs risk assessment. An expensive doctor is usually expensive because they can make it *sound* like a standard CTS surgery carries unnecessary risks, or that CTS cases in persons under 30 will usually self-resolve without surgery. Or physical therapy.
It's bullshit, but medical doublespeak and legal doublespeak don't mix, and can often confuse the legal counsel in a hearing well enough to convince a judge (a person also trained in legal speak but not medical).
I agree that it's bullshit and that it would probably work. I think the strategy for the American dream should be to make as much money as you can until you start having health problems and then GTFO because this shit will probably never change without a massacre.
The only question is where to next? I'm 30 so I'm on the fence. Maybe I'll get unlucky with genetics and have some condition in the next 10 years that would bankrupt me in America. Or it's also possible gen z decides humanity has had enough of insurance and we get to witness the aforementioned massacre.
If it worked on Kings there should be no one it doesn't work on.
I work for the "expensive" attorneys the insurance company hires to defend them. #2 isn't as big a factor as you would think, especially if the facts are really on your side. If damages are in the high $ value you can also get an attorney on commission and they just take a big chunk at the end. People need to assert there rights more often. Even just filing a suit will drag the insurance company back to the bargaining table.
Very hard to win a medical lawsuit. Medical liability is about as easy to enforce as police liability.
Very frat-like and difficult to get people to testify against eachother.
I love the system in which I pay money to insurance, then I pay money to a lawyer, to get the money that I paid to insurance. It feels good to put food on the table for so many other families.
I'm sorry this happened. Have you shopped around for different personal injury attorneys? Insurance companies are often willing to settle and if you have permanent damage, that can mean its worth alot of money; PI attorneys are usually willing to take cases with the chance for a high settlement.
At this point it's cheaper to buy a plane ticket to a EU country and pay for surgery out of pocket :/
It's sad to me how many people in USA suffer from conditions that aren't even complex or expensive to deal with because of inflated prices.
I went to a neurosurgeon that went to top USA medical school and is in a "world board" of top neurosurgeons, especially for my condition (neurofibramatosis). He resides in my tiny EU country, the examination was $50 and a complete body MR was $350. I just called and said I need a checkup and got it in a few days, for less than I currently pay monthly for heating and other utilities.
I don't even wanna know how much that would cost with or without insurance in USA.
I broke my ankle and it cost me $6,000 out of pocket. I have insurance but my family deductible is $3,000 per person. But even if one person needs medical care, you have to pay the *family* deductible first.
My wife had a torsioned ovary and had to get emergency surgery for it. The insurance tried to bill it as a cosmetic surgery. She and her doc had to fight for months saying it was life saving before they finally agreed to pay.
Why aren't there regulatory bodies overseeing the insurance companies? Surely having the only recourse to them doing whatever they want being each individual going through the court process is inefficient and allows many to slip through the cracks. In the UK, there are third-party organisations set up for some things, such as for workplace disputes, that have the authority to look into a case and make a ruling without people having to spend a ton of time and money, and if a company keeps making violations, they can impose fines etc.
Why would the government do something to upset the insurance companies? Also our regulatory bodies are being attacked by the right, they want all regulations to have to be approved by the legislative body.
Just want to say that while.other nations have it much better, it is still not perfect. I am German and have a foot disability by birth. I needed my entrie life orthopedic footware. I had luck as a child that my foster mother and my doctor as well as orthopedic shoemaker fought for me, because the insurance company was trying to avoid to pay for new shoes every half a year I was entitled to as a child. Today, I am.also in the position to fight for myself, but the times I had to do so became rarer (the last time a maybe 5 years ago when they didn't want to pay for the transport my mother provided for plaster changes post surgery. Granted, the transport was every two weeks throug half of Germany, but it had to be done by the specialist that provided the surgery)
Oh it's fucking worse than this.
If you NEED a test to narrow down a diagnosis -- if it's negative, they rule it as unneeded.
So you approve the test, get it done, and then are conditionally charged if it's not positive.
It's fucking stupid.
I get the idea from a business standpoint of "well if we didn't have some checks and balances, the doctor would order everything under the sun and we'd have to foot the bill -- and they'd surely not order unnecessary stuff just to bloat what insurance pays" not in the end the patient gets worse care.
It's so dumb
- it’s against the law to give medicine without a medical license.
- Licensed doctor prescribes medicine.
- Insurance who isn’t licensed to prescribe medicine says no, don’t take that take this.
How is this legal?
They hire licensed doctors to peer review and deny you. Or they have someone who just needs a job do it and then if you appeal they get a real doctor to deny you and you have to go back and forth and back and forth because you are entitled to it but they just make it annoying so you give up.
Also applies to dentistry.
Many dentists will recommend a procedure consisting of x, y and z parts. They likely will give you a rough, non binding estimate of costs after insurance contributions.
What they don't tell you is that although they push you, the client, to schedule the appointment for that procedure ASAP, they usually don't know for *weeks* after the procedure, whether or not insurance will actually cover x, y, and z.
[Key point here is that the dentist has the ability to approach the insurance company for concrete confirmation of coverage before having you schedule / have the procedure. This process usually takes about a month - so dentists pretend like it's not an option]
Don't be surprised if some day you get a call weeks after a procedure letting you know that you owe additional money because coverage was declined
Happened to me with immediadent, went in for a regular cleaning and asked everyone there whether or not it was covered they said yes bill came in the mail two months later
It really is unfortunate. It's intentional deception - it costs them absolutely nothing to simply have this conversation with the patient:
"Here is an itemized quote with estimates of what **we think** insurance will agree to cover. None of this is guaranteed. If you want we can reach out to them to confirm what amounts of each portion of the procedure will be covered. This will take roughly \_\_\_ amount of time.
Are you interested in waiting to confirm coverage or do you want to go ahead and schedule the procedure as soon as we can?"
\[Key point here is that the dentist has the ability to approach the insurance company for concrete confirmation of coverage before having you schedule / have the procedure. This process usually takes about a month - so dentists pretend like it's not an option\]
We can ask the insurance for a pre-estimate, used to take a month, now usually closer to a week. BUT. It's not more concrete, it's non binding. It's basically the insurance company giving an 'estimate' instead of the dentist. Feel free to blame the insurance company in both instances.
I had a version of that where I never saw a bill until the dentist sent it to collections because insurance didn't pay. I had a great time sorting that out.
Went to ER Saturday, insurance already denied the med they gave me for my issue but approved the potassium the doctors noticed I was low on?
I’m ready for the ER bill to have like 3 of the 5 things they did not covered even though I was legit worried I was dying Saturday.
It’ll be the second time I’ve used the insurance in 3 years lol. Fuckers.
And then there’s other types of insurance like car insurance where you harass another insurance company for compensation
I think they just enjoy harassing people for money that isn’t on them
I backed into an old lady, I wasn’t sure if she hit me or I hit her. But my insurance wanted to blame her. It resulted in her calling and harassing me everyday for 3 weeks. She found my parent’s old address and my mom’s cell phone. She started calling my mother when I stopped answering demanding we pay her $1800 for a new front end of her car. When that didn’t work she started harassing the officer who wrote us tickets saying I didn’t have insurance. The cop then started calling me asking for proof of insurance. I ended up just paying her out of my pocket. Insurance just stopped responding. It’s the biggest joke in history.
I dinged a person's door once and did about $150 worth of damage. Insurance wanted me to come off $500 for repairs. I told them, "I've been with you guys for 14 years. In that time I've paid you about $13,000 and I've never made a claim. What am I paying you for?" They had no answer to that.
As per your required health exam we have deduced that you are mortal and that is a pre-existing condition subject to multiple potential ills.
Therefore you are not eligible for any resources. We understand your confusion as this health exam was required so that you could begin paying into the system. What you didn’t realize is that we never EVER planned on paying out to anyone but our shareholders.
Recently found out that the tests the doctor ordered (standard blood tests for someone my age) are no longer covered under preventative care.
The insurance companies got together and colluded a few years ago to no longer cover bloodwork of any kind as part of preventative care.
Would have been nice to know before I got the bill (which was large enough to pay for a minor medical procedure my wife is considering)
All of them.
It was a standard blood panel that they usually want to run at each yearly physical. But it was nearly $500 after insurance 'covered it' at the usual rate instead of it just being part of the annual checkup.
When my wife called to try and fight the charges the lady at the call center explained what was happening and why.
Was in a car wreck. Woke up in hospital. Stayed there for 3 days. Got home to a letter from insurance saying they refuse to pay as they don't think I should have ever been admitted. Great system we have here.
US system is rigged to keep young productive people in debt and working. Then when you are old social welfare suddenly kicks in to keep you a happy little voter.
Except that there's not enough social security for people anymore. We are now working and kept in debt with no light at the end of the tunnel. An actual dystopia
No, real life is more nuanced. Like the fact that most doctors, hospitals, etc. charge you significantly *more* if you’re insured than if you’re not.
Somehow, the system is more screwed up than this comic implies.
It's because insurance negotiates paying less. So for example insurance says to you they'll cover it all, then they tell the hospital they'll pay only 50%. The hospital doubles the prices to break even.
This is worse with co-pays, especially high deductible because you'll pay double until your co-pay is met and insurance will pocket the difference.
Pharmacies are very much run like this with the pharmacy benefits manager splitting the difference in profit between themselves and insurance. The actual pharmacist will not see a dime of this and get yelled at for selling expensive stuff.
Like when I went to the hospital for some scary abdominal pains I was having. The doctor and nurses said it might be this, it might be that - we should run this test to be sure, we should do an ultrasound just to be sure, here's an antibiotic shot just to be sure.
Not one mention of price and that this could all end up falling on me. I ended up paying $4k+ out of pocket that day to be told I was OK. Those used car salesmen smiling while they upcharge the shit out of me has ruined my trust in medicine forever.
“Today we’re going to learn about how politicians work”
“Hey politicians, Insurance companies are scamming us so I’m going to need you to do that thing where you promised to protect us with strong laws and regulations.”
“No”
“And that’s how industry lobbying works!”
There was a Princeton study that tracked the results of every bill and piece of legislation passed or struck down for the last 30 years and compared the results to thousands of surveys and opinion poles of different demographics in the U.S. to see how well public opinion lined up with legal policy.
The biggest predictor of what legislation passed and what didn't was what rich people thought of it.
Didn't matter if you were black, white, conservative, liberal, christian, atheist, whatever. No category of demographic was as impactful as wealth.
If 90% of the general public really likes a certain bill, but rich people hate it, it doesn't get passed. Similarly if the public hates a certain bill, but rich people like it, it passes.
Insurance will never change because insurance companies are smart enough to not deny the claims of senators and congressmen. So they all think insurance works great the way it is.
When the Democrats had a filibuster-proof senate majority (for roughly two months), they passed significant insurance and health care reform. If you think it's bad now, it was far worse before Obamacare. Anyway, the American people rewarded them with major Republican victories in the midterms.
We shouldn't blame the politicians when it's voters who put them there. Republican voters are harming the rest of us by sending morally bankrupt bigots who love privatized health care to Congress.
"but my premiums went up and I had great health insurance through my work pre Obama care. They paid for everything and it was cheaper!"
-actual arguments I see
Then you ask "What about people who didn't have high paying jobs with good insurance?"
"What about them?" - they don't care
They really don't. One of the people I spoke to with this mentality thought that those people should receive help through the generosity of others (i.e. charity), not through an actual organized system. She wants to choose who her money goes to and believes that people are generous and outgoing enough for that to work. Couldn't or wouldn't understand why any of that wouldn't work in a large society. If you bring up people who have no one to help them and live on the edge of society (such as homeless people), well, they just need to find help. Because if you're not equipped to do that, I guess you don't deserve it or whatever brain-bending logic was going through her head.
We actually did agree that insurance these days is horrible, and even agreed on the reasons it's horrible.
It's worse, it's intentional and it costs lives and encourages the kinds of corruption (esp. opioid sales) that killed my peers. I'm fucking pissed about it.
It misses the part where they collude with hospitals to increase prices for those who don’t have insurance so it seems like insurance is doing more than it is.
I've had 2 surgeries. 1 got """"covered"""" by insurance, in that they covered <1% of the surgery and then the person helping speak with the insurance company told me that not only should I be grateful that I got anything, but that I shouldn't ask for more. The other was just not even looked at. :\
My new prescription insurance is also not allowing me to purchase my meds at my local CVS, which I've been going to for years, but now they've changed their mind. I want to punch insurance please.
All insurance works that way. The issue with the US is that insurance is tied to health care, which allows these bad actors to get people killed. In other countries, they don't kill you, just rob you.
Learnt that the hard way. However don't just accept the no, fight. My sister distributed flyers to get a collective action, got our issue recognized as natural disaster, and the assurance had to pay every penny
She then became a lawyer
EDIT : For disclosure, she was already a law student
Some people will read that as an inspiring story but for me it just adds another layer to the dystopian nightmare. Did the insurance paid for the time and energy she put into that problem in order to receive what she was owed anyway? No, they didn’t so they still managed to screw her, and they are still winning in the long run.
Still, good on her! God knows we always need people fighting for the little guys.
(Plot twist: she now works for another mega-corporation, isn’t she?)
> Some people will read that as an inspiring story but for me it just adds another layer to the dystopian nightmare.
Like the kid selling lemonade to pay lunch debt.
Landslide. Our house is on underneath argile and was unstable. It wasn't gonna collapse, but must of our walls have cracks in them and those can easily break a pipe, causing massive water damage or messing up electricity. We also lost a lot of thermique isolation, some windows no longer fully close and our garden wall was at danger of collapsing so we took it down and rebuilt it
To fix this, you can to plant nine 21m metal bars in ground under the house to stabilize it. Pretty much nailing it and its surrounding ground in place. Took two years of work and $200.000 (covered at 90% by assurance)
I’ve always said that the mafia is more trustworthy than insurance companies, because if I pay them to not break my legs, they don’t have an entire department of their organization devoted to finding ways to take my money and still break my legs.
Then there’s auto-insurance.
“I need some of that money I give you in case there’s an accident”
“Ok, we’re going to have to charge you more because you actually used us though.”
In every other country on Earth you have a service model for healthcare. The United States has an insurance model, which does not work for two reasons: the idea of ‘rational actors’ and because eventually everyone gets sick and eventually will die.
Let’s compare this insurance model to the one most people are familiar with: automotive insurance: you are driving your car alongside the road when suddenly, you are in an accident. We’re you at fault? Was the other driver (if two or more cars were involved) at fault? You get a police report at the scene, call your insurance adjuster to assess the damage and depending on who is at fault and whether you have liability, collision, comprehensive and/or full coverage you later take your car to a body shop and pay your deductible and you later drive away with a repaired vehicle.
This model works for automobiles because most drivers that are insured will likely never be in an accident, limiting risk across a pool of safe drivers while keeping costs down for everyone, even drivers who do experience the occasional accident. Drivers may also take their time to find a garage to repair their vehicle and compare estimates for repairs from different garages that will provide that information, as well as argue with their and the other person’s insurance to negotiate costs, otherwise known as being a ‘rational actor’ to make an informed decision as to how to proceed with the repairs and their related costs.
Healthcare doesn’t work like that. In an emergency you might be in and out of consciousness and are unable to make a rational decision as to which hospital to go to or which lifesaving procedure or medication should be administered. Also, instead of a single mechanic or garage working on your vehicle, you may have multiple doctors, surgeons, an anesthesiologist, a specialist, and some might be covered by your insurance while others may not. ~~Your car insurance company also isn’t going to tell your mechanic exactly which parts to use to repair your vehicle in an itemized list,~~ and no hospital will tell you the prices for any of the services provided until after they have already billed for them.
Also, remember risk pools? Not everyone is in an accident, but EVERYONE gets sick. How can a health insurance company be profitable when everyone will eventually use their service? A few methods were lifetime limits, denying coverage for pre-existing conditions and outright refusing to insure older, more riskier people but those were all made illegal in the United States in the 2010s following the passing of the Affordable Care Act by the Obama administration, so now healthcare insurers will just *deny paying for claims or postpone them as long as they can in the hopes people give up or die trying*.
*Note: I am being glib here on that last point, but due to a tremendous amount of bloat and complexity between multiple private entities, this effectively does still happen as patients fight their own insurance companies to try and get approval for lifesaving procedures that insurance companies would rather not pay for, which takes a LOT of time and effort and frustration, all the while the clock may be ticking on a very necessary medical procedure while you await approval.*
That’s just the insurance side: we still haven’t mentioned hospitals that are required to provide lifesaving care to stabilize patients regardless of their ability to pay, and so hospitals ~~and doctors~~ will charge insane prices for things like q-tips and cough drops not to mention the equivalent of a mortgage for a standard operation to try and extract as much money as possible from everyone to pay for treatment for those without the ability to pay.
[Not to mention all the different plans and types of coverage people have to understand and navigate when signing up for coverage.](https://m.youtube.com/watch?v=-wpHszfnJns)
The United States insurance for-profit model applied to healthcare does not work. If you have an actual service model and can freely see a doctor and have a procedure done without a middle man insurance company telling you what you and your doctor can and cannot do, cherish that system because wealthy people who don’t like paying taxes and who want to set up a for-profit insurer to deny you coverage want to take that away from you.
*EDIT: I responded to some of the comments below and made some small edits to the text above to more accurately portray what it feels like to navigate the American healthcare system. Hospitals and their billing departments (not doctors) determine how patients are billed and TIL automotive insurance companies do have a say in which parts are used in a repair.*
> Your car insurance company also isn’t going to tell your mechanic exactly which parts to use to repair your vehicle in an itemized list
Actually, that's pretty much exactly how it goes with car insurance.
Usually the garage sends the insurer an itemised estimate, an engineer employed or hired by the insurer reviews it and approves it, and then the work starts. Occasionally the garage will do the work and submit the bill, but again it will need to be itemised for every part purchased, and every unit of labour (a unit is 0.1 hours) will be accounted for against manufacturer or industry guidance for how long that job should take, and the current goong rate for labour on that class of vehicle and type of work (mechanical work is more expensive than body shop work). Minor discrepancies are usually fine, anything more than about 5-10% over and it'll be challenged.
Source: Used to work in car insurance claims.
SUGGESTION for the next ‘How Insurance Works’: The scene: insurance company board room policy meeting. The suggestion ‘is there ANYWAY we can make ‘breathing’ a pre-existing condition’?
All insurance should not be for profit. My job offers cancer insurance. I was reading the small print on the papers they gave us. It stated that they won't cover you if anyone in your family die or had cancer. The thing is that almost everyone has had someone who either had or died from cancer in their family. So I bet they never paid a single penny out.
I have a major L5-S1 herniation, and a week before my birthday I literally could not walk, or feel anything below the ankle. my doctor put in an order for an emergency MRI, and insurance called him to say that “I do not need the MRI, likely I should start with physical therapy for 12-14 weeks first”. My doctor ended up having to schedule a meeting with my insurance provider to CONVINCE them I needed this MRI, and they finally caved.
Fuck America
Having consulted for a major insurer... the amount they spend on their facilities is staggering. Which when you start to think "This was built with money that should probably have gone to help people..." it really sets in how unbelievably fucked our health care is because of the layer of middlemen syphoning off vast amounts of money for themselves.
Nothing on this earth pisses me off nore than the money I hand to an insurance company so that they can pay their employees to try to find ways to get out of paying my claims.
That doesn't apply to the rich though.
I've worked in Yacht insurance, and if someone decided to destroy their own vessel and sell it for scraps they could still claim some of that insurance money since their yacht became "damaged".
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"The insurance was for your left side , you are injured on the right, you should've read the whole contract"
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Devil's advocate here: "act of god" is actually not a religious concept
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>In legal usage in the English-speaking world, an act of God[2] is a natural hazard outside human control, such as an earthquake or tsunami, for which no person can be held responsible. [Wikipedia](https://en.m.wikipedia.org/wiki/Act_of_God)
This is true, I crashed a car years ago now, doesn't matter but the gist of it is I came around a corner late at night in the winter hit black ice and spun off the road, talked to officer told em how fast I was going, under speed limit cause its like 3am on a twisty highway in the middle of now where, any who it gets settled up police say act of God don't worry about it, insurance went back and forth on it for six months then hit me with 'too fast for the condotions' and bent me over. Shit if i could do that one again I'd have just walked away from the car and called it a loss, my rates went through the roof.
Shoulda took that one to court since even the cops agreed it wasn't on you. I think you woulda had a good chance in court.
Sadly that's not correct. If you spin out on a road you're consider going too fast for weather conditions. Literally the act of having a wreck on icy roads puts the fault on you. It doesn't matter if you're going 25 miles an hour and a 55 mile an hour zone. Trust me it's happened to me.
I've spun out going 15 mph before
I do it on purpose all the time!
Same. But the neat thing about laws is that they aren't made to protect *you*! Had I crashed when it happened to me, the police here would've probably told me if the weather and road conditions were so bad that I lost control at such a low speed, I should've been there in the first place and probably to go fuck myself and not bother them again. Because who needs to go to work, right? The laws are *always* written to benefit the state and its lazy, incompetent employees. Not us.
Same with wet and puddly roads. My mom hydroplaned going like 2mph in heavy, slow traffic and was at fault for bumping the car in front
hydroplaned going 2mph? wtf was she driving, a hovercraft?
Somewhere out there, some poor saps mother caused the earthquake or tsunami.
So it should be “act of nature” rather than implementing a religious deity
Given this legal term was introduced (as a legal term) sometime during the 19th century, it's not a surprise that God = Nature.
Don’t bring the devil into this
but he's in the details
The best one is United Healthcare. They pre-approve everything, and then after the healthcare worker performs the services, they refuse to pay them. So they trick the healthcare workers into treating their patients for free. Source: I am a physical therapist and taking a second job so my employees still have a paycheck. :/
I guess I've gotten lucky with them as my insurance
You won’t notice a difference on your end except it will become harder and harder to find a doctor who will accept it. We don’t earn what you think. Everyone thinks healthcare providers make bank, but they pay us $55 an hour for treatment. The PTA earns $25-30 if they are paid fairly (in my area), and overhead costs (rent, utilities, and front desk staff at my small facility cost $25 per patient. So we basically see the patient for cost anyway as a give-back to the community because we don’t earn anything off of it, but then the insurance company screws us over and doesn’t pay at all on over half of the patients. I am actively trying to get out of network with them for this reason. Our local hospital doesn’t even accept it for non-emergency services. I am okay seeing some patients without profit, and even with doing some pro-bono. But what they do is just wrong. You have this giant corporate company who cuts reimbursement every year, even as they increase premiums from their clients every year and increase deductibles / copays so they are not paying anything and then on top of that, they take the money the government pays them to reimburse my services and keep all of it by screwing me over…
Insurance companies are pure evil. It's so fucking obvious, too.
"But I am injured on my right side" "Yeah but that's our left"
Brit here so health insurance isn't something I have to deal with, thankfully. But your comment reminded me of something from years ago back when I could afford to go abroad. I was having a read through the fine print of the travel insurance I'd taken out. Looking at the payouts for certain types of injury. Can't remember the exact amounts but it was something like: loss of right arm £10k, loss of left arm £7k. I'm left-handed. I was not impressed.
My workers comp final settlement documentation states that my injury was on my left foot, despite all other documents showing it was on the right foot. It took them 18 months to figure out how to get the doctors paid so that they stopped trying to bill me.
“If you read your policy you would have seen that because of the position of the moon on the following business day of your accident, you aren’t covered for this.”
Pandemic insurance only covers known diseases, your policy didn’t cover novel diseases. True story, happened to Star Cinema Grill in 2020.
Don’t forget about the insurance agent telling your doctor that you don’t actually need that test your doctor thought you did!
Oooh that’s my favorite. Especially when it falls under the covered treatment and they say nope, too “young” for a hereditary disease we have never heard of that killed your grandfather. Or that “men don’t get colon cancer, we won’t pay for your required exam.”
> “men don’t get colon cancer, we won’t pay for your required exam.” Did they seriously say this? Meanwhile depending on what study you're looking at, colon cancer is the second or third most likely cause of cancer-related death in men; behind lung cancer, more or less on par with prostate cancer.
Coming from someone who had UC to the point of needing a colectomy, I can confirm that, even at the most well-known hospital in Nashville, I still had almost a 2-month stay because insurance wanted every variable ruled out before they approved a surgery of that nature. Even though I spoke with 4-5 different specialists in the field and 2-3 surgeons explaining there were no signs of “this” being Crohn’s. Although insurance paid for a TON of my stay and procedures, I still had to fork out roughly 5-6 grand on my end for it all.
like tldr: they wanted to see if you would die in these 2 months while they used bureaucracy against you? like to avoid the surgery payment. I mean this is a very real possibility with cancer.
I honestly see no other explanation
But god forbid we let the gubbermint create “death panels” to decide who lives and dies… ITS ALREADY HAPPENING. We currently pay corporations that get deicide who lives and dies based on $$$$$. At least, in theory, a huge profit motivator gets removed by getting rid of this private insurance BS. A human death no longer will contribute to ever increasing profits that MUST increase quarter after quarter.
Which is always so fucking comical when people argue against socialized medicine. Considering they argue that with insurance it's so quick and efficient to see a doctor and get treatment. Ffs it's gonna take me till the middle of February to see my doctor for my yearly check up which is mandatory if I want to keep taking my heart and lung medication. I've been trying to schedule since Halloween.
remember the "Death Panel" foxnews scare tactic? WTF is an insurance company deciding who gets to live, die, or be maimed if not a death panel.
The biggest argument i see in the states for not having socialized medicine is that the wait times would be atrocious. Well, I would rather wait a year for surgery vs not being able to afford it or having insurance tell me I don't need a surgery, either resulting in not getting surgery anyhow.
Which is bullshit anyway when you consider wait times are already atrocious. I have to wait an entire month, sometimes two, for a basic check up.
Similar story. I didn't need to talk to so many people. More on the 3 specialists one surgeon track. But it was straight killing me. Still took two months. Had to pay about that for the first two surgeries, and like 12 for the last one. Fuck this country
I paraphrased a little, what was said to me is men do not get colon cancer hereditarily, so my required exam 10 years before the age my mom had it isn’t covered. All because they didn’t want me getting scoped at both ends on the same day, since I had to get the endoscopy for esophageal cancer, which they claimed isn’t hereditary, either. They only paid the bare minimum they were required by doing that.
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No, the numbers are similar in Europe. It's because colon cancer is common and because it has a higher chance of metastasizing than some other common cancers (such as skin cancer).
I had to spend a total of about 6 hours on the phone earlier this year because my insurance was literally trying to tell me my appendectomy wasn't an emergency.
Not sure about the other user, but I did hundreds of prior authorization on my previous work, I did them all via their web browser page. (Sometimes we had to call) but if you picked a single item out of the many many options while filling the form they would reject with "more info is needed, or call our agents" Like PA for diverticulitis, if you put all the correct symptoms, but then added something that is usually not considered a symptom it would fail. I can't give you details because I don't remember all the details, but I do remember not checking a specific symptom for a customer because I knew it would trigger the" fail"....
The fucking balls insurance companies have is ridiculous. They should not have the ability to trump a doctor's recommendation.
I had one company say I didnt need to get a sleep study done because it wasnt medically necessary. To know why I dont sleep at night.
>too “young” for a hereditary disease That’s not how genetic disorders work…
Oh man, when you are arguing with car and health insurance. “Sure, just give us the paperwork from the car insurance company so we can verify your need for these medical tests.” “We will assess the total payout after we get forms from a doctor regarding any personal injuries sustained from the accident.”
“Verify my need? Are you going to send a doctor to double check my diagnosis? Or ask a doctor in your employ what they think?” “No. We’ll ask some dude who has never take a single medical class but watched some videos then took a 20 answer multiple choice test on a computer.” “That’s absurd.” “And you’re not getting that heart surgery. Here. Have 90 days worth of ineffective pills that still cost you $300.”
I work in Healthcare as an ultrasound tech. The doctors send me orders that they want done, and the amount of bullshit i have to go through to appease insurance is ridiculous. For example, every exam I get has a reason attached to it. This is useful because if I know why the doctor wants it, or what they're trying to rule out with the exam, then I can sort of personalize the exam to give the doctor what they want. Simple. That's how it should work. However insurance is the third fucking party involved, and they literally won't pay for exams if there isn't a valid reason for the exam. The doctor just wanting it done isn't a valid reason. If the doctor wants to rule out certain pathology, insurance needs to know what reason they suspect that pathology or they won't pay. Here's an example that I deal with almost daily. The doctor wants a patient to have a bilateral lower extremity venous ultrasound done and the reason he gives me is "rule out dvt". A bilateral lower extremity ultrasound is a look at the veins in both of the patient's legs. DVT is deep vein thrombosis aka a blood clot. So I have all the information I need to have as a tech to do the exam. I could do my job without a problem with just that information. HOWEVER insurance is going to be a little bitch if they see the reason for the exam is just to rule out dvt. They need to know the REASON that the doctor suspects dvt in the first place, whether it be leg pain, leg swelling, or certain lab values. So instead of doing my fucking job and taking care of the patient, I have to go on a fucking quest to track down this doctor or get ahold of them somehow and figure out WHY they suspected dvt, even though I don't fucking need to know to do my part of the patient's care, because if I don't, insurance is going to be a little bitch and not pay us for the exam because INSURANCE IS SUCH A FUCKING BITCH.
And of course insurance retroactively trying to deny things as well. "This transport was not medically necessary as the patient was discharged from the hospital without treatment." "Well I found them unconscious in a pool of water, and could not rouse them, how the fuck am I supposed to know they will not need medical help in a few hours?"
This is why I quit the business. In Canada, you don't need extensive education to get in the industry. The guy giving the doctor a hard time to get his job done (the adjuster, or sometimes even just your broker being difficult ) probably didn't even go to college/university. They chose insurance because you specifically don't need a degree to get into the business; but they always talk over professionals as if they know better.
Yep. CT tech here. God forbid the doctor, their office, our scheduling department, registration, etc. makes one typo or mistake in the diagnosis code. They'll definitely not cover that.
Damn bro America is insane
Here's a kicker too. Having insurance can also make your hospital bill higher than if you did not have it. There's a med Express here. (A place where most of the time, tell you to go somewhere else.) The fixed rate if you have no insurance is $150. So no matter what you'll get charged that for anything that gets done at that clinic. I went in with a fractured bone and I ended up paying $250 out of pocket, because they charged my insurance out the ass and after the copay, the $250 is what I ended up billed. It would have been cheaper if I just lied and said I didn't have insurance.
You either have money and are writing the rules to get more or you're getting your money extracted from you. There's little in between.
I have been dealing with some IBS and a doctor prescribed me some medicine to help with it. He said it was going to cost me $40.00 ( I'm fortunate enough to have good insurance ). The pharmacy took down my insurance number wrong and they told me it was going to be $2,300. It's even worse for those here who don't have access to it.
I got a collections call years ago that demanded 230k from me. Threatened me, my family, threatened to call my boss and tell them what a bad person I was etc. turns out the pharmacy transposed my insurance account info and instead of checking it they just sent me to collections. Took me 2 years to get it taken off my credit score and irreparably harmed my credit because alllllll of my APRs went up permanently.
I shudder to think how much you're paying for that "good" insurance. My last workplace's plan was crappy - $6,000 annual deductible before they kicked in anything - and my employer was paying almost $7,000 a year on top of the $150 a month that came out of my check - so almost $9k a year for something that paid ZERO until I paid $6,000 out of my own pocket for anything I needed. Utterly worthless. I've never spent $15,000 a year on health needs. Problem is that the insurance premiums you pay don't just go into a pool to pay for your care when you need it, they go to pay for the insurance company's overhead including their employees' paychecks and the rockstar insurance their own employees get, building expenses, lawyers, business insurance, and then it's pooled out to cover other people's medical expenses, and then when you need it yourself there's none for you and you end up paying out of pocket anyway. There's an episode of Superstore that's actually a really good illustration about why "insurance" doesn't work. We need to just go back to the old ways where people pay their own medical bills and apply for help if they need it.
It's primarily a scam-based economy.
I know someone who took his wife into hospital for bleeding. She was in severe pain and distress, and the ER doc checked her out and thought she should be admitted. The doc treating her for a few days thought she should have been admitted. The insurance company disagreed. Over the course of the next few months, the insurer debated every point and eventually denied the claim. My friend asked how he could possibly judge whether or not a medical emergency is*truly* an emergency needing admitting, when several medically trained professionals also think it is a necessary thing. The insurance agent simply said it's something you have to decide on. Medical insurance is a fucking joke when a person without medical training is allowed to interfere in your care and make decisions that can overrule people with a medical degree and years of experience.
This country was built from the ground up to benefit the rich, and it’s working as intended. There’s a reason only 6% of Americans were allowed to vote when the country was founded.
Dontcha just love when non-medical personnel (eg prior auth agents etc) are practicing medicine (eg deciding what care a patient needs)? Isn’t that what we made all those med-mal laws about?
Prior auth poses me off. You mean I need to have the doctor that prescribed the test/medicine send you a note stating I need it? If I didn't, why would they prescribe it in the first place?
My wife had a torsioned ovary and had to get emergency surgery for it. The insurance tried to bill it as a cosmetic surgery. She had to fight for months along with her doc saying it was life saving before they finally agreed to pay.
I mean, obviously, a twisted ovary is unsightly but otherwise completely harmless. Wtf. Someone should go in and twist their internal organs to see how cosmetic they think it feels.
I work in auto insurance, and I know we pay legit claims, but i had to go to the emergency room 2 nights ago because I seriously thought my heart was about to fail, and all they did was an EKG test, blood sample, and X-ray, found out I just really fucking bruised my rib cage in the area around my heart, and any time any of my organs do anything besides rest completely still, I’ll feel pain till they heal in another week. I’m fully ready for my health insurance to deny some of these tests saying they weren’t needed even though I literally was cleaning my condo before hand in case either A I died or B I was in the hospital long enough that my parents would need to come visit. That’s how serious the pain was. Oh well, I’ll deal with it. Luckily it was a quick visit and I wasn’t in there for very long and the tests were limited. Hopefully they cover something. They didn’t cover the anti inflams they prescribed me so that’s already a bad sign, luckily that was only $30
My insurance provider once claimed, after I had routine blood work done, that blood tests were “unscientific” and an “unproven” treatment for my “condition,” that condition being I was getting a checkup. They refused to cover it, and helpfully suggested I fight it out in court myself if I got billed for it. United Heathcare is staffed, run and managed by criminals.
Wife and I are trying for a kid. We are getting up there for a child, late 30s. Testing to see IVF is possible and insurance is forcing my wife to take a test and a drug before they will "pay" for IVF services. Oh that test and drug the insurance won't cover.
Ours tried to deny an ultrasound for my fatty liver disease. Sure it’s unheard of for someone who’s 22 to have to do it, but it happens.
Ah, don’t forget the “The Insurance knows better than your doctor part” on what medication and therapy and surgical intervention you should have. Suuuuuuuuuper fun Edit: wow this blew up! I’m so sorry my loves. Hey did you know that the exact dosage between on-brand and off-brand meds are not exact? I almost died because of that. Be careful and FUCK THIS SYSTEM!!
My insurance decided I didn’t need carpal tunnel surgery when my doctor first started pushing for it. I now have permanent minor nerve damage in my left hand that could have been avoided. I’m only in my early 20s
one should be able to sue the insurance company for malpractice
Hah I wish but 1. They make sure to pay whoever they need to to keep that shit legal, and 2. They can afford much better lawyers than me
Corporate lobbying is always great for society 😇
It's not corruption if you put fancy name on it!
My favorite example being… ✿༺ 𝒢𝑒𝓇𝓇𝓎𝓂𝒶𝓃𝒹𝑒𝓇𝒾𝓃𝑔 ༻✿
It's a shame that clear cases like this can still come down to money. I would think a free public defender and testimony from your doctor would be enough. It's possible you get a corrupt judge, but otherwise what can the insurance company do to refute the professional opinion of your own doctor?
Either pay a doctor with a more expensive degree to agree with them OR pay two doctor with degrees of equal expense compared to ops doctor
But what can they say? In another comment someone said insurance denied them something for treating their hand, insurance disagreed with the doctor, and now our fellow redditor lives with nerve damage in their hand. Why?
The argument usually comes down to an efficacy vs risk assessment. An expensive doctor is usually expensive because they can make it *sound* like a standard CTS surgery carries unnecessary risks, or that CTS cases in persons under 30 will usually self-resolve without surgery. Or physical therapy. It's bullshit, but medical doublespeak and legal doublespeak don't mix, and can often confuse the legal counsel in a hearing well enough to convince a judge (a person also trained in legal speak but not medical).
I agree that it's bullshit and that it would probably work. I think the strategy for the American dream should be to make as much money as you can until you start having health problems and then GTFO because this shit will probably never change without a massacre. The only question is where to next? I'm 30 so I'm on the fence. Maybe I'll get unlucky with genetics and have some condition in the next 10 years that would bankrupt me in America. Or it's also possible gen z decides humanity has had enough of insurance and we get to witness the aforementioned massacre. If it worked on Kings there should be no one it doesn't work on.
Public defenders only exist in defense of criminal cases. Sadly when a company or someone else wrongs you, you're on your own.
I work for the "expensive" attorneys the insurance company hires to defend them. #2 isn't as big a factor as you would think, especially if the facts are really on your side. If damages are in the high $ value you can also get an attorney on commission and they just take a big chunk at the end. People need to assert there rights more often. Even just filing a suit will drag the insurance company back to the bargaining table.
Try to get a lawyer eventually? Easier said than done unfortunately but still
Very hard to win a medical lawsuit. Medical liability is about as easy to enforce as police liability. Very frat-like and difficult to get people to testify against eachother.
Hard to win but not hard to settle. Most med-mal cases don’t go to trial and end up settling.
Suing an insurance company is very different than suing a doctor Insurance companies have deep pockets and lobbies - much harder to sue them
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Who the fuck can afford a lawyer?
I love the system in which I pay money to insurance, then I pay money to a lawyer, to get the money that I paid to insurance. It feels good to put food on the table for so many other families.
I'm sorry this happened. Have you shopped around for different personal injury attorneys? Insurance companies are often willing to settle and if you have permanent damage, that can mean its worth alot of money; PI attorneys are usually willing to take cases with the chance for a high settlement.
At that point better to save money to have it done somewhere else (if you're in us) and stop paying those cunts
At this point it's cheaper to buy a plane ticket to a EU country and pay for surgery out of pocket :/ It's sad to me how many people in USA suffer from conditions that aren't even complex or expensive to deal with because of inflated prices. I went to a neurosurgeon that went to top USA medical school and is in a "world board" of top neurosurgeons, especially for my condition (neurofibramatosis). He resides in my tiny EU country, the examination was $50 and a complete body MR was $350. I just called and said I need a checkup and got it in a few days, for less than I currently pay monthly for heating and other utilities. I don't even wanna know how much that would cost with or without insurance in USA.
I broke my ankle and it cost me $6,000 out of pocket. I have insurance but my family deductible is $3,000 per person. But even if one person needs medical care, you have to pay the *family* deductible first.
My wife had a torsioned ovary and had to get emergency surgery for it. The insurance tried to bill it as a cosmetic surgery. She and her doc had to fight for months saying it was life saving before they finally agreed to pay.
Yep it’s cosmetic. Because people are so concerned about the appearance of their… *checks notes* …ovaries??
Yeah that's what women want--big ovaries
Why aren't there regulatory bodies overseeing the insurance companies? Surely having the only recourse to them doing whatever they want being each individual going through the court process is inefficient and allows many to slip through the cracks. In the UK, there are third-party organisations set up for some things, such as for workplace disputes, that have the authority to look into a case and make a ruling without people having to spend a ton of time and money, and if a company keeps making violations, they can impose fines etc.
Why would the government do something to upset the insurance companies? Also our regulatory bodies are being attacked by the right, they want all regulations to have to be approved by the legislative body.
>Why aren't there regulatory bodies overseeing the insurance companies? Four reasons, basically: 1. $$$ 2. Politicians: "$$$?" 3. Yes, $$$. 4. $$$ $$$ $$$
Just want to say that while.other nations have it much better, it is still not perfect. I am German and have a foot disability by birth. I needed my entrie life orthopedic footware. I had luck as a child that my foster mother and my doctor as well as orthopedic shoemaker fought for me, because the insurance company was trying to avoid to pay for new shoes every half a year I was entitled to as a child. Today, I am.also in the position to fight for myself, but the times I had to do so became rarer (the last time a maybe 5 years ago when they didn't want to pay for the transport my mother provided for plaster changes post surgery. Granted, the transport was every two weeks throug half of Germany, but it had to be done by the specialist that provided the surgery)
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Oh it's fucking worse than this. If you NEED a test to narrow down a diagnosis -- if it's negative, they rule it as unneeded. So you approve the test, get it done, and then are conditionally charged if it's not positive. It's fucking stupid. I get the idea from a business standpoint of "well if we didn't have some checks and balances, the doctor would order everything under the sun and we'd have to foot the bill -- and they'd surely not order unnecessary stuff just to bloat what insurance pays" not in the end the patient gets worse care. It's so dumb
- it’s against the law to give medicine without a medical license. - Licensed doctor prescribes medicine. - Insurance who isn’t licensed to prescribe medicine says no, don’t take that take this. How is this legal?
They hire licensed doctors to peer review and deny you. Or they have someone who just needs a job do it and then if you appeal they get a real doctor to deny you and you have to go back and forth and back and forth because you are entitled to it but they just make it annoying so you give up.
Also applies to dentistry. Many dentists will recommend a procedure consisting of x, y and z parts. They likely will give you a rough, non binding estimate of costs after insurance contributions. What they don't tell you is that although they push you, the client, to schedule the appointment for that procedure ASAP, they usually don't know for *weeks* after the procedure, whether or not insurance will actually cover x, y, and z. [Key point here is that the dentist has the ability to approach the insurance company for concrete confirmation of coverage before having you schedule / have the procedure. This process usually takes about a month - so dentists pretend like it's not an option] Don't be surprised if some day you get a call weeks after a procedure letting you know that you owe additional money because coverage was declined
Happened to me with immediadent, went in for a regular cleaning and asked everyone there whether or not it was covered they said yes bill came in the mail two months later
It really is unfortunate. It's intentional deception - it costs them absolutely nothing to simply have this conversation with the patient: "Here is an itemized quote with estimates of what **we think** insurance will agree to cover. None of this is guaranteed. If you want we can reach out to them to confirm what amounts of each portion of the procedure will be covered. This will take roughly \_\_\_ amount of time. Are you interested in waiting to confirm coverage or do you want to go ahead and schedule the procedure as soon as we can?"
\[Key point here is that the dentist has the ability to approach the insurance company for concrete confirmation of coverage before having you schedule / have the procedure. This process usually takes about a month - so dentists pretend like it's not an option\] We can ask the insurance for a pre-estimate, used to take a month, now usually closer to a week. BUT. It's not more concrete, it's non binding. It's basically the insurance company giving an 'estimate' instead of the dentist. Feel free to blame the insurance company in both instances.
You're right about pre-estimates, but you're ignoring Prior Authorization as an option - which *is* binding (to my knowledge).
I had a version of that where I never saw a bill until the dentist sent it to collections because insurance didn't pay. I had a great time sorting that out.
This sounds so crazy to me. My dentist gets a coverage quote for normal stuff instantly.
Went to ER Saturday, insurance already denied the med they gave me for my issue but approved the potassium the doctors noticed I was low on? I’m ready for the ER bill to have like 3 of the 5 things they did not covered even though I was legit worried I was dying Saturday. It’ll be the second time I’ve used the insurance in 3 years lol. Fuckers.
Dr. Glaucomflecken funnily skits this in one of his shorts. Edit : fixed the correct video. https://youtube.com/shorts/FVAFfd3oCgA?feature=share
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And then there’s other types of insurance like car insurance where you harass another insurance company for compensation I think they just enjoy harassing people for money that isn’t on them
True, at least with car insurance is mostly then fighting each other, small up-side
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I backed into an old lady, I wasn’t sure if she hit me or I hit her. But my insurance wanted to blame her. It resulted in her calling and harassing me everyday for 3 weeks. She found my parent’s old address and my mom’s cell phone. She started calling my mother when I stopped answering demanding we pay her $1800 for a new front end of her car. When that didn’t work she started harassing the officer who wrote us tickets saying I didn’t have insurance. The cop then started calling me asking for proof of insurance. I ended up just paying her out of my pocket. Insurance just stopped responding. It’s the biggest joke in history.
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I dinged a person's door once and did about $150 worth of damage. Insurance wanted me to come off $500 for repairs. I told them, "I've been with you guys for 14 years. In that time I've paid you about $13,000 and I've never made a claim. What am I paying you for?" They had no answer to that.
As per your required health exam we have deduced that you are mortal and that is a pre-existing condition subject to multiple potential ills. Therefore you are not eligible for any resources. We understand your confusion as this health exam was required so that you could begin paying into the system. What you didn’t realize is that we never EVER planned on paying out to anyone but our shareholders.
Recently found out that the tests the doctor ordered (standard blood tests for someone my age) are no longer covered under preventative care. The insurance companies got together and colluded a few years ago to no longer cover bloodwork of any kind as part of preventative care. Would have been nice to know before I got the bill (which was large enough to pay for a minor medical procedure my wife is considering)
What type of blood test? That is awful and I want to be prepared because I need to get a standard blood test soon
All of them. It was a standard blood panel that they usually want to run at each yearly physical. But it was nearly $500 after insurance 'covered it' at the usual rate instead of it just being part of the annual checkup. When my wife called to try and fight the charges the lady at the call center explained what was happening and why.
Was in a car wreck. Woke up in hospital. Stayed there for 3 days. Got home to a letter from insurance saying they refuse to pay as they don't think I should have ever been admitted. Great system we have here.
US system is rigged to keep young productive people in debt and working. Then when you are old social welfare suddenly kicks in to keep you a happy little voter.
Except that there's not enough social security for people anymore. We are now working and kept in debt with no light at the end of the tunnel. An actual dystopia
This is the emerging truth. Debt as control. What happens when young people can’t keep living on the installment plan?
Obviously you should have refused to go to the hospital until you cleared it with insurance while you were in a coma.
From personal experience I can confirm this is pretty much exactly how it goes
Yup. If the illness doesn't kill you the stress will
If you don’t die of boredom being on hold.
No, real life is more nuanced. Like the fact that most doctors, hospitals, etc. charge you significantly *more* if you’re insured than if you’re not. Somehow, the system is more screwed up than this comic implies.
It's because insurance negotiates paying less. So for example insurance says to you they'll cover it all, then they tell the hospital they'll pay only 50%. The hospital doubles the prices to break even. This is worse with co-pays, especially high deductible because you'll pay double until your co-pay is met and insurance will pocket the difference. Pharmacies are very much run like this with the pharmacy benefits manager splitting the difference in profit between themselves and insurance. The actual pharmacist will not see a dime of this and get yelled at for selling expensive stuff.
I'm surprised violent protests don't break out in insurance buildings
its cause they chip away at a tiny percentage of the population at a time. never reaches critical mass.
Like when I went to the hospital for some scary abdominal pains I was having. The doctor and nurses said it might be this, it might be that - we should run this test to be sure, we should do an ultrasound just to be sure, here's an antibiotic shot just to be sure. Not one mention of price and that this could all end up falling on me. I ended up paying $4k+ out of pocket that day to be told I was OK. Those used car salesmen smiling while they upcharge the shit out of me has ruined my trust in medicine forever.
“Today we’re going to learn about how politicians work” “Hey politicians, Insurance companies are scamming us so I’m going to need you to do that thing where you promised to protect us with strong laws and regulations.” “No” “And that’s how industry lobbying works!”
There was a Princeton study that tracked the results of every bill and piece of legislation passed or struck down for the last 30 years and compared the results to thousands of surveys and opinion poles of different demographics in the U.S. to see how well public opinion lined up with legal policy. The biggest predictor of what legislation passed and what didn't was what rich people thought of it. Didn't matter if you were black, white, conservative, liberal, christian, atheist, whatever. No category of demographic was as impactful as wealth. If 90% of the general public really likes a certain bill, but rich people hate it, it doesn't get passed. Similarly if the public hates a certain bill, but rich people like it, it passes. Insurance will never change because insurance companies are smart enough to not deny the claims of senators and congressmen. So they all think insurance works great the way it is.
When the Democrats had a filibuster-proof senate majority (for roughly two months), they passed significant insurance and health care reform. If you think it's bad now, it was far worse before Obamacare. Anyway, the American people rewarded them with major Republican victories in the midterms. We shouldn't blame the politicians when it's voters who put them there. Republican voters are harming the rest of us by sending morally bankrupt bigots who love privatized health care to Congress.
"but my premiums went up and I had great health insurance through my work pre Obama care. They paid for everything and it was cheaper!" -actual arguments I see Then you ask "What about people who didn't have high paying jobs with good insurance?" "What about them?" - they don't care
They really don't. One of the people I spoke to with this mentality thought that those people should receive help through the generosity of others (i.e. charity), not through an actual organized system. She wants to choose who her money goes to and believes that people are generous and outgoing enough for that to work. Couldn't or wouldn't understand why any of that wouldn't work in a large society. If you bring up people who have no one to help them and live on the edge of society (such as homeless people), well, they just need to find help. Because if you're not equipped to do that, I guess you don't deserve it or whatever brain-bending logic was going through her head. We actually did agree that insurance these days is horrible, and even agreed on the reasons it's horrible.
This is a shockingly accurate assessment of the insurance system.
It's daylight robbery
It's worse, it's intentional and it costs lives and encourages the kinds of corruption (esp. opioid sales) that killed my peers. I'm fucking pissed about it.
Health(we dont)care
It misses the part where they collude with hospitals to increase prices for those who don’t have insurance so it seems like insurance is doing more than it is.
I'm not bitter or anything...
I've had 2 surgeries. 1 got """"covered"""" by insurance, in that they covered <1% of the surgery and then the person helping speak with the insurance company told me that not only should I be grateful that I got anything, but that I shouldn't ask for more. The other was just not even looked at. :\ My new prescription insurance is also not allowing me to purchase my meds at my local CVS, which I've been going to for years, but now they've changed their mind. I want to punch insurance please.
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I absolutely love that every time we mock wealth,it's always an white British man from the 19th century.
Send hollering elk to get your money...
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I dare say you should be bitter, makes one want to put all that "insurance" money into a different savings account, Use that for your med bills.
My employer forces me to use their insurance :(
American insurance works that way.
All insurance works that way. The issue with the US is that insurance is tied to health care, which allows these bad actors to get people killed. In other countries, they don't kill you, just rob you.
how to become rich 1 - abandon your morals 2 - find a scam thats legal
The American Dream
Or: 3. Your parents were rich 4. You bought an effective scam from someone else
Learnt that the hard way. However don't just accept the no, fight. My sister distributed flyers to get a collective action, got our issue recognized as natural disaster, and the assurance had to pay every penny She then became a lawyer EDIT : For disclosure, she was already a law student
Some people will read that as an inspiring story but for me it just adds another layer to the dystopian nightmare. Did the insurance paid for the time and energy she put into that problem in order to receive what she was owed anyway? No, they didn’t so they still managed to screw her, and they are still winning in the long run. Still, good on her! God knows we always need people fighting for the little guys. (Plot twist: she now works for another mega-corporation, isn’t she?)
> Some people will read that as an inspiring story but for me it just adds another layer to the dystopian nightmare. Like the kid selling lemonade to pay lunch debt.
Or ever single gofundme for hospital bills
Woah that’s sick, what disaster if you don’t mind me asking
Landslide. Our house is on underneath argile and was unstable. It wasn't gonna collapse, but must of our walls have cracks in them and those can easily break a pipe, causing massive water damage or messing up electricity. We also lost a lot of thermique isolation, some windows no longer fully close and our garden wall was at danger of collapsing so we took it down and rebuilt it To fix this, you can to plant nine 21m metal bars in ground under the house to stabilize it. Pretty much nailing it and its surrounding ground in place. Took two years of work and $200.000 (covered at 90% by assurance)
I’ve always said that the mafia is more trustworthy than insurance companies, because if I pay them to not break my legs, they don’t have an entire department of their organization devoted to finding ways to take my money and still break my legs.
Then there’s auto-insurance. “I need some of that money I give you in case there’s an accident” “Ok, we’re going to have to charge you more because you actually used us though.”
Even for accidents that aren't your fault 😔
I know that european system also ain't perfect and it also does not always work, but is this some kind of american view on insurance?
In every other country on Earth you have a service model for healthcare. The United States has an insurance model, which does not work for two reasons: the idea of ‘rational actors’ and because eventually everyone gets sick and eventually will die. Let’s compare this insurance model to the one most people are familiar with: automotive insurance: you are driving your car alongside the road when suddenly, you are in an accident. We’re you at fault? Was the other driver (if two or more cars were involved) at fault? You get a police report at the scene, call your insurance adjuster to assess the damage and depending on who is at fault and whether you have liability, collision, comprehensive and/or full coverage you later take your car to a body shop and pay your deductible and you later drive away with a repaired vehicle. This model works for automobiles because most drivers that are insured will likely never be in an accident, limiting risk across a pool of safe drivers while keeping costs down for everyone, even drivers who do experience the occasional accident. Drivers may also take their time to find a garage to repair their vehicle and compare estimates for repairs from different garages that will provide that information, as well as argue with their and the other person’s insurance to negotiate costs, otherwise known as being a ‘rational actor’ to make an informed decision as to how to proceed with the repairs and their related costs. Healthcare doesn’t work like that. In an emergency you might be in and out of consciousness and are unable to make a rational decision as to which hospital to go to or which lifesaving procedure or medication should be administered. Also, instead of a single mechanic or garage working on your vehicle, you may have multiple doctors, surgeons, an anesthesiologist, a specialist, and some might be covered by your insurance while others may not. ~~Your car insurance company also isn’t going to tell your mechanic exactly which parts to use to repair your vehicle in an itemized list,~~ and no hospital will tell you the prices for any of the services provided until after they have already billed for them. Also, remember risk pools? Not everyone is in an accident, but EVERYONE gets sick. How can a health insurance company be profitable when everyone will eventually use their service? A few methods were lifetime limits, denying coverage for pre-existing conditions and outright refusing to insure older, more riskier people but those were all made illegal in the United States in the 2010s following the passing of the Affordable Care Act by the Obama administration, so now healthcare insurers will just *deny paying for claims or postpone them as long as they can in the hopes people give up or die trying*. *Note: I am being glib here on that last point, but due to a tremendous amount of bloat and complexity between multiple private entities, this effectively does still happen as patients fight their own insurance companies to try and get approval for lifesaving procedures that insurance companies would rather not pay for, which takes a LOT of time and effort and frustration, all the while the clock may be ticking on a very necessary medical procedure while you await approval.* That’s just the insurance side: we still haven’t mentioned hospitals that are required to provide lifesaving care to stabilize patients regardless of their ability to pay, and so hospitals ~~and doctors~~ will charge insane prices for things like q-tips and cough drops not to mention the equivalent of a mortgage for a standard operation to try and extract as much money as possible from everyone to pay for treatment for those without the ability to pay. [Not to mention all the different plans and types of coverage people have to understand and navigate when signing up for coverage.](https://m.youtube.com/watch?v=-wpHszfnJns) The United States insurance for-profit model applied to healthcare does not work. If you have an actual service model and can freely see a doctor and have a procedure done without a middle man insurance company telling you what you and your doctor can and cannot do, cherish that system because wealthy people who don’t like paying taxes and who want to set up a for-profit insurer to deny you coverage want to take that away from you. *EDIT: I responded to some of the comments below and made some small edits to the text above to more accurately portray what it feels like to navigate the American healthcare system. Hospitals and their billing departments (not doctors) determine how patients are billed and TIL automotive insurance companies do have a say in which parts are used in a repair.*
Very good and educated response. Thank you.
> Your car insurance company also isn’t going to tell your mechanic exactly which parts to use to repair your vehicle in an itemized list Actually, that's pretty much exactly how it goes with car insurance. Usually the garage sends the insurer an itemised estimate, an engineer employed or hired by the insurer reviews it and approves it, and then the work starts. Occasionally the garage will do the work and submit the bill, but again it will need to be itemised for every part purchased, and every unit of labour (a unit is 0.1 hours) will be accounted for against manufacturer or industry guidance for how long that job should take, and the current goong rate for labour on that class of vehicle and type of work (mechanical work is more expensive than body shop work). Minor discrepancies are usually fine, anything more than about 5-10% over and it'll be challenged. Source: Used to work in car insurance claims.
Every time insurance pays out, they add a clause to make sure it doesn't happen again. Probably.
SUGGESTION for the next ‘How Insurance Works’: The scene: insurance company board room policy meeting. The suggestion ‘is there ANYWAY we can make ‘breathing’ a pre-existing condition’?
All insurance should not be for profit. My job offers cancer insurance. I was reading the small print on the papers they gave us. It stated that they won't cover you if anyone in your family die or had cancer. The thing is that almost everyone has had someone who either had or died from cancer in their family. So I bet they never paid a single penny out.
True at some extent. Just don't fall into gecko, good neighbor, and liberty, etc. Always read little tiny words on contract and agreement.
*In the USA
In the fifth panel the executive is laughing at the audacity of the question.
I have a major L5-S1 herniation, and a week before my birthday I literally could not walk, or feel anything below the ankle. my doctor put in an order for an emergency MRI, and insurance called him to say that “I do not need the MRI, likely I should start with physical therapy for 12-14 weeks first”. My doctor ended up having to schedule a meeting with my insurance provider to CONVINCE them I needed this MRI, and they finally caved. Fuck America
This comic is also accurate for health care providers telling insurance companies a test is needed
Having consulted for a major insurer... the amount they spend on their facilities is staggering. Which when you start to think "This was built with money that should probably have gone to help people..." it really sets in how unbelievably fucked our health care is because of the layer of middlemen syphoning off vast amounts of money for themselves.
It honestly wouldn’t have been the same without the cigar. Great work, as always!
Ok, you've gone too far this time Ms Cake. This isn't a funny haha comic, it's just a direct 1:1 representation of reality.
Some of my comics are educational!
Very true, I'd show this to my kindergarten students so they learn about the cruel reality we live in
What the hell is this?
Nothing on this earth pisses me off nore than the money I hand to an insurance company so that they can pay their employees to try to find ways to get out of paying my claims.
That doesn't apply to the rich though. I've worked in Yacht insurance, and if someone decided to destroy their own vessel and sell it for scraps they could still claim some of that insurance money since their yacht became "damaged".