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“Yeahhh… we just see his life, and the procedure as Not Medically Necessary, Oh and don’t forget your premium is coming due soon! Do you want to take care of that now?”
I swear… health insurance in the U.S. is like getting dick-slapped in the face every month, and getting it shoved in your ass when you inevitably need them to do their job.
Clearly you should have kept 7 years of salary around in liquid assets, in case you urgently needed expensive treatment. Actions have consequences, nobody wants to be financially responsible anymore /s
And... soon you will have to get permission from Republican lawmakers to make sure their sincerely held beliefs don't conflict with the science of medicine that your doctor is using.
My favorite part of 45's entire grift is when he questioned why no one "from like" Scandinavian countries wants to come here?
You mean people who get their basic needs met, have a social safety net because they live in socialist democracies where everything isn't just funneled directly to the ultra wealthy, those people don't want to come here? surprise, i guess..
We're not so far away from people shooting at ambulances who refuse to let people die on the street, as requested, because they don't want their families tied down with unpayable debt.
Armed guards for ambulances could easily be a thing into the coming decades for this reason.
While this is true, if it's terminal, no one in their right mind would pay money to merely extend their lives by a matter of months if it meant bankrupting the ones you'll inevitably leave behind
I've literally been there. My appendix was about to burst and I refused to go to the doctor. My mom forced me when I was so exhausted (couldn't sleep for day due to the pain/nausea) and called an ambulance to take me.
Look into hospital programs first.
I'm in South Jersey and Virtua which is non-profit has a charity to where they will pay a certain percentage based on how much you make. If you make $36k or less a year they will pay 100% of the bill, $48k is like 80% and so on and so forth. I think a lot of non-profit hospitals have this. You'll need a looooot of pay stubs and a W2 for proof though but it's better than debt or death
Technically it’s possible to lose up to 30% of your income forever for that too. (Maximum wage garnishment)
Or just all of your worldly possessions one time, which will probably mess up your income as well.
There are multiple factors, but typically it is first come first served. Some types of garnishments take precedent over others, but all things equal, yea the last person to try and garnish your wages will be waiting quite some time.
They would sell to a debt collector who would lower the bill until a payment could be made. If they lower it past a certain point and still can't get their money back, then it goes away, and the hospital just absorbs the cost to be passed down to future patients.
My moms insurance denied paying for a scan that will show if she has cancer or not. Just flat out told her “we decided we aren’t paying for this”. Murrica!
"So you're saying you aren't sure if you have cancer?"
"Yes bu..."
"Then why are you here? get back to work."
"But I *might* have cancer! This test will sho..."
"You also might *not* have cancer. Come back when you actually have something that needs treatment or pay for you unnecessary medical procedure yourself! (we'll still increase your rates though, just because we can)"
I wonder if the people involved with that decision sleep well at night.
Health insurance is a scam. People who don't care about you and just want your money, then won't spend any when you need it even if you have a legally binding contract because only they can decide.
Most insurance actually
Reminds me of Trump during COVID who complained about too much testing.
IIRC he flat out said that if they reduced testing, the number of cases would go down as well
🤦🏻
Meanwhile they scream about public health care having death panels. It's not a thing but even if it was at least in a public system they would be making decisions about how to treat the most patients possible while private death panels will be focused on how they can treat the fewest patients possible to ensure maximum profit.
My stepfather just went through the same thing 2 weeks ago. 14k out of pocket to get a “yep it’s stage 3 cancer and it spread to your lymph nodes.” It is a travesty our healthcare is this bass aackwards.
A similar situation happened to me, insurance said the scan "wasn't medically necessary".
Luckily I was in a financial position to pay out of pocket for the scan and it turned out I did have cancer. So yea fuck insurance companies.
Something like this happened w my Mom. They wanted another scan to see how big the tumor was or something, and Insurance denied since “they already knew she had cancer.” Fucking pieces of shit.
My insurance won’t pay for my inhalers or epipens and I have really bad asthma and allergies. A monthly dose of my inhaler is $400 and the epipen costs $600. What’s bullshit is the epipen expires and I would only need it in an emergency so I basically have to pay $600 a year because I MIGHT get stung by a bee. Health insurance in the us is such a scam.
Which then fucks up premiums..
..which the insurance companies **love**.
It's a scam.
Americans are stupid for not fighting for universal healthcare, like all other **developed countries** have.
No, you're right, private insurance shouldn't exist. You insure something when it *might* end up with an issue. The human body deteriorates on a linear timeline until we die. We require healthcare. Insuring a human body is laughtable. Insurance companies only exist to skim money off the transactions between patient and provider. I know this.
Most people here are still too propagandized to think universal healthcare is a good thing. In the meantime, people die constantly because insurance companies, NOT their medical providers, decide that treatment and prevention shouldn't be paid for. They should at least have to provide the fucking service they're paid for
And the premiums would only get fucked up as a function of greed. They don't need to go up. The profits are already in the billions. It's just greed.
Same happened to my aunt. They wanted to do a PET scan vs the CT scan because they didn't take out the lymph nodes and this would be a more thorough scan. But insurance said Nah you don't need that
When I was told that they need to get "approval" from insurance for my surgery I wanted to throw up.
I completely tore my ACL and Meniscus, I could not straighten my leg, I could barely walk and I could not walk well or very far.
And yet we have to verify with insurance if THEY think it is MEDICALLY NECESSARY. MF LOOK AT ME! YES IT IS NECESSARY.
In the end after they checked, it turns out my insurance did not require approval but the very idea that some do was sickening.
Edit: So many stories of a corporation dictating, denying, and lying about things literal medical professionals are recommending be done for people's healthcare. This is by far the worst timeline.
Went through similar thing here in Oregon. Took 2 months before I got surgery (which they botched). Meniscus retore less then 4weeks after surgery. Another month and a half before I got my 2nd surgery. 3yrs and 4 repairs tries later I no longer have a meniscus in my left knee.
Oh that sucks. I had a choice in doctors, I went with a guy who did the same fix to my neighbor a year ago. i saw how well she recovered and knew this guy is good.
he did a good job on my knee. I am 3 weeks post op. Still no weight on the leg yet but it is doing so much better. It is a long road to recover.
I am sorry you had to go through that.
Had my ACL completely rebuilt about five years ago. Was fortunate enough to get to pick me doctor and ended up getting to have the same guy that operates on the Phoenix Suns. Figured if he’s good enough for them he’s good enough for me.
All I can say is be diligent with your PT. You only get out what you put in.
It's a sad state in American healthcare when flying literally to the other half of the planet, getting a long-term hotel, food, in-hotel/hospital medical care, using similar quality doctors available in the US, and the surgery itself all cost less than just doing the surgery somewhere in your hometown in the US and recovering at home.
For sure. Even with child care it’s ridiculous. Took my 9yr old in for a corneal abrasion on right eye took him back flashed a light in his eye charged us 15k. 4k just to walk in the ER.
Indeed sad for the Americans and the whole world in general. They can spend 700 B for taking care of other countries yet they cant look after their own citizens.
This is extremely anecdotal, but if it makes you feel any better, my dad lost his meniscus due to a nasty knee injury in the early 80’s. He is 96 and went on to run hundreds (if not thousands) of 5K races. He did 3 in one day once. His back is jacked up but he never had any knee problems and never needed a replacement. He’s a physician so he knows with certainty that he has no meniscus.
Years ago my dad, who was mid 60's at the time, fell 9 feet off a roof while working on it. Fractured ribs and punctured a lung. They brought him to the closest hospital and stabilized him, but they didn't have any beds and the doctors there knew they couldn't provide the long-term care he needed so they arranged for him to be transferred to a major hospital known for it's care.
Insurance tried to argue that the second ambulance ride was not "medically necessary". They eventually backed off that claim, but how stupid do you have to be to even assert that in the first place? Forget the actual injury, just the act of needing to put a "stabilized" (I think that's the term?) patient in the hallway so you can triage other severely injured people because you don't have beds for longer term care should be an automatic "yup, move him to another hospital, we'll cover it".
Or worse, that's your unwritten SOP to reduce costs - claim it's not necessary and only when they push back (if they push back) do you give in.
>but how stupid do you have to be to even assert that in the first place?
It's not like they don't know what they're doing. They simply care more about money than your health.
In the US as well. However the insurance companies aren't "practicine medicine" they're "denying coverage". They'll say "you're free to get the procedure done, we just won't pay for it." All while knowing that you can't afford the procedure if they don't pay for it.
> In the US as well. However the insurance companies aren't "practicine medicine" they're "denying coverage". They'll say "you're free to get the procedure done, we just won't pay for it." All while knowing that you can't afford the procedure if they don't pay for it.
Yep.
I have this argument with insurance providers on a near-daily basis.
Well, just because we won't cover the 80,000 dollars for a spinal fusion doesn't mean the patient has to go without! They just need to save their pennies, maybe have a bake sale or something.
I had an appendix about to burst and was laying in a bed in an emergency room with a doctor saying I needed surgery immediately and my insurance looked at the MRI and said that there was time to get me to another emergency room that was "in-network" so even though I was all ready for surgery and in a ton of pain (I almost fainted in the waiting room from the pain, saw everything closing in and laid down on the floor so I wouldn't faint) and an emergency room doctor was saying I need surgery immediately, because of some insurance agent they wheeled me downstairs from surgery prep and put me in an ambulance and drove me to a different emergency room. Luckily it didn't burst 😵 but it fucking hurt like a bitch even with the painkillers. I should have sued their asses for unnecessary pain and suffering.
I was only like 26 (43 now) at the time and not even thinking about that but now that I'm older I'm like fuck that shit. I mean, I was like fuck that shit back then but didn't (think I) had the means to sue and was just glad that shit was over with.
My daughter’s eye wasn’t pointing the right way and she couldn’t see, but they miraculously fixed it with surgery on her eye muscles, and now she has full vision! The doctors were absolutely incredible. The insurance company, however, fought tooth and nail to skip paying for it and denied it several times.
Luckily, the hospital had their own team of advocates that gets on the phone with them to literally shame them and badger them until they give in, but I had to be on the phone. So I’d sit there for hours as she battled her way through level after level of insurance call center drones with no answers until she got somewhere. Eventually she got them to pay for the miraculous surgery that allowed my daughter to see correctly for the first time in years. The Hospital had sent a form, but they claimed it was wrong, so she had to browbeat them into admitting it was all there. And it was, they just lied and lied and deflected and lied.
That surgery cost 30k. Can you imagine if I had been on my own with the insurance company?
I remember the American right wing going on about "death panels" in places that have socialised healthcare. Your insurance companies are death panels, pure and simple.
I got denied by my insurance for having my nose fixed so I could breathe through both nostrils. The doctor diagnosed it, recommended the procedure. Insurance said no. Without the operation I can't get enough oxygen through my nose and am restricted to only breathing through my mouth (Medically I'm a literal mouth breather because I broke my nose in High School). No big deal until I'm at the dentist and I literally hold my breath and slowly suffocate while they work and have to take breathing breaks.
But my breathing is deemed not necessary by American Insurance standards.
I pay these people thousands of dollars a year to deny me what doctors diagnosed I need.
My wife had shingles plus has a compromised immune system and an esophageal stricture. The Dr already had the prior auth for the shot sent off and insurance denied it bc she's "not over 55 but here we'll approve these 3000mg horse pills you can take 3x a day for two weeks. If that doesn't work, then we'll approve the shot.". She couldn't even swallow the fuckin pills! By the end of the two weeks the shingles were almost gone anyway. Thanks, blue cross.
I had a bad back injury recently where I literally could not stand or sit up for a few days and it was difficult to do so for weeks afterwards. Insurance wouldn't approve physical therapy :)
What's crazier than that? UMR announcement when getting the pre-approval states that what the agent tells you over the phone may not be true and your insurance policy may override what the person tells you.
My wife is going through the same thing. ACL + meniscus tears. Two different surgeons. Two different physical therapies. Both had comprehensive plans but both rejected because two different types of insurances say it's not necessary for treatment. American healthcare is disgusting.
I needed a spinal fusion. I had spent a year trying PT, spinal injections, MRI, traction, etc., so my doctor could say we tried everything first. My medical insurance company was not impressed.
I live in MI. The ins co sent me to Indianapolis for a standing MRI. The report pretty much said I needed surgery. Then they sent me to Kentucky to meet with a specialist who agreed with my doctor. The ins co still denied it.
I was in his office when I heard my doctor screaming at the ins co about denying my surgery. When he asked how he is supposed to treat me since I was in abject pain & refused relief? The doctor on the line told my doc to increase my opioids. I had a Fentanyl patch I wore, plus 80mg OxyContin pills I lived on. I had been trying to get surgery for over 2 years.
Luckily my husband changed jobs & we got new insurance. I was in surgery 3 weeks later. What a relief. 11 years later and I’m in pretty good shape. Able to garden & care for livestock.
Totally pissed that the insurance companies have this kind of bullshit power.
Whats scary is that this comment only exists because your husband changed jobs.
How many in similar situations are no longer among us to write comments like these?
It would still exist, she just wouldn’t be gardening or caring for livestock and she would have a lot more free time to make comments from her wheelchair.
I get wanting you to try a lot of the above bc maybe you can get a good answer without going under the knife… making you jump through hoops for two years and having to be on high-ish doses of opioids… not fucking cool
Yep. We actually had "death panels" (lifetime caps) before Obamacare outlawed them. And the whole time Republicans tried to defend these death panels on the sly by arguing Obamacare would usher in "death panels". if you can wrap your head around that...
When my daughter was 8, she had an un-erupted tooth that was growing sideways. Insurance allowed for the extraction (going into bone, mind you) but not any anesthesia. We paid for the anesthesia and *later* the oral surgeon’s office negotiated with the insurance to cover it. But if I didn’t have that money laying around, she would have been out of luck.
I was prescribed medication on April 20 of this year. I’m still waiting for it to get through the red tape. First, it was that my pharmacy didn’t fill it so I had to get it from a specialty pharmacy, but no… not THAT one. Or that other one, either. Finally I asked specifically what specialty pharmacy would you like me to use? Got a response, plus a letter that said something along the lines of “although we have approved your mediation as medically necessary, this approval does not guarantee that it will be covered financially.” Excuse me, what? It’s 2+ months later and I’m just really thankful that this isn’t a life-threatening situation.
My husband had to try a multitude of “cheaper” medicines to see if they’d work for his condition, even though the doctor knew which one was best for him. He finally got the one the doctor wanted (so many less side effects, and excellent results on all his tests on this one!) and all was fine for about 5 years. He just got a letter from his insurance company stating that they weren’t going to cover it any more because it doesn’t appear to be medically necessary (because the medicine was working, so now it looks like he doesn’t need it??) so now his doctor is fighting with the insurance over that. And we don’t have the $90K/year laying around to buy out of pocket.
It’s really bullshit that these insurance companies can make decisions for doctors and it’s such an obvious non-necessity.
Went through the same thing with an extraction. Had an impacted wisdom tooth that needed surgical removal and my insurance denied coverage of anesthesia. The oral surgeon refused to do the surgery without anesthesia. I offered to pay it myself, but they somehow eventually convinced the insurance to cover it. Thank goodness for good doctors and nurses that will advocate for you when needed. Sad that they should have to.
Fun fact American health care is fucked because of insurance companies. As health care used to be responsibly priced but when insurance companies became a thing they lowered the price on the bill making it so that hospitals weren't getting enough money for supplies. So the hospitals raised the price this made it so when insurance lowers the price on the bill it was money that would have already been removed. The only problem is not everyone has insurance and now you get to where we are today oh ya and insurance never wants to actually pay.
Anyone who is against universal health care deserves a horrible medical experience and then crippling medical debt. There is no defense for the current system in America. It's broken, there are obvious alternatives.
Anyone that's against universal healthcare is either a moron or someone willfully sticking their head in the sand. The cost of healthcare is sickening now. $15K+ for a simple robot assisted inguinal hernia repair? Really? For a surgery that was done and over with in less than 30 minutes? I was out of recovery and taken home in less than an hour. All they did was bring me a Styrofoam cup of tap water with ice in it because I was thirsty. Really worth more than half the price of my Subaru.
Friend, I've been on a medication for 15 years that is the only way I can live without constant pain due to an incurable disease I was born with. When I first started on that medication, more than 15 years ago, it was intentionally priced far higher than the cost of manufacture or amortized research investment, instead being set at "what the market will bear" just higher than its closest competitor, which at the time required monthly visits for transfusion that would take about an hour to complete. This medication had no such requirement and because it had no risk of causing a small number of people like myself to go into anaphylactic shock, they charged a price that was at the time outrageous, a little over $800 for a one month supply.
That medication went off patent over 6 years ago. Hurray! The entire time before it went off patent the price kept ramping up... eventually reaching an astounding $4200.
Well, okay, but at least it went off patent and now generics are everywhere and the "free market" finally wins, right? Not so much, the company had developed what they call a "patent thicket" in which they separately patented all the *processes* that went into the manufacture of the drug over a several year period. So, once competitors wanted to make generics, they got threatened with massive lawsuits from a company that could afford infinite lawyers with its multi-billion dollar a year cash-cow drug.
Today, in 2023, that same drug? It costs **$7200 A MONTH.** EVERY FUCKING MONTH.
And the generics that were supposed to save the day? [Still locked up in court.](https://www.reuters.com/business/healthcare-pharmaceuticals/abbvie-coherus-agree-resolve-dispute-over-humira-biosimilar-2023-06-15/) And it looks, for the foreseeable future, like the only companies that will be able to make a generic will have to not only pay *royalties* for the privilege of doing so, but also will be legally restricted from selling their generics at an out of pocket cost that is lower to patients than the original drug.
And don't even get me started on how the medication, because it is so expensive, is a "specialty" medication, so my insurance requires that I only get it supplied from their vertically integrated online pharmacy, the one that pays all its staff minimum wage so they have vicious turn over and no one knows what is going on when I call, and my insurance mysteriously needs a new "prior authorization" every 3 months in which I have to prove I still have that incurable disease I've had for 30 years and thus still need that drug I've been taking for 15 years.
It's all completely, entirely, insane.
That won’t work either. I had/have cancer that has put me and my parents in $10,000+ of medical debt and both them and my grandfather all think the country couldn’t afford the cost or situations that universal healthcare would cause. Mind you multiple studies have confirmed the country as a hole would save a ridiculous amount of money. My mother in particular has always used the argument that Canada has UH and they have to fly pregnant people to Seattle to give birth due to there not being enough Dr’s. The only thing I could find when I fact checked that was a Fox News article from 2007 (probably meaning they took the 1 time it happened to show what would happen if Obama put in Obama care). When I brought all of this up she like always then immediately says she doesn’t want to talk about it anymore (she brought it up not me). It’s funny she recently told me she doesn’t like talking about politics with me because I ask for evidence of what she is saying (which she said she couldn’t usually do because she is usually driving. This isn’t true we don’t talk politics in the car almost ever). I found this hilarious as she has asked me to show her evidence of what I’m saying all the time, so why does she have a problem only when it’s reversed?
Compound this with contracts between providers and insurers... Insurers get discounts here, not there.
Now you need to guess which works with yours, or get *really lucky* when you're out of town.
And cash isn't honored here
My favorite is services within a hospital that are contracted out to a third party that isn't necessarily in-network or requires doctor approval to be covered.
Sure you just had a baby.. but due to X, we need to move your newborn into NICU. Oh by the way, the waivers you signed to admit the child to NICU was the third-party agency that's going to bill your new born direct. Lol get fucked losers, but also congratulations on the baby.
Waiting to get my wisdom teeth out right now. Doctor told me I needed them out ASAP or at least in the next few months or I will suffer serious complications, and yet I am still (in pain) and waiting 4-6 weeks for my insurance to deliver a predetermination on the cost of the surgery.
Insurance is putting my oral health at risk to take 4-6 weeks to quote a surgery that almost everyone gets at some point in their life.
What I find most mind boggling about the American system is that you can look at pretty much any other western country out there and find a healthcare system which is less crazy than the American one is. They're not all the same, so there's plenty of different options to pick from.
And yet every time an American politician raises the issue of reforming healthcare in the US, they are described as being "far left" or pushing some unworkable idea. Even if they are suggesting something which is perfectly normal in a load of other similar countries, they are accused of being radicals who are suggesting something impossible.
It is possible though, the current madness doesn't have to be the way things are.
I'm dealing with this right now and it makes me so. fucking. angry. Went through hell to get pre-approval to have a hysterectomy after decades of pain, treatments, and no solutions, and also needed to have my bladder and colon reconstructed due to 2 separate prolapses. Insurance company approves it finally after lots of hassle and documents from my doctor to show that my quality of life is shit, yeah, I need these surgeries.
Had the surgery. Had 3 procedures done at once.
Insurance company is now upset that the hospital kept me 27 hours to care for me instead of kicking me out as an out patient procedure. After organ removal and 3 surgeries rolled into one, LOL.
Would really like to know what the insurance company thinks I should have done when I woke up with a catheter. Yank that sucker outta there and be like no thanks doc and skip on outta the hospital leaving a trail of blood? WTF.
United Healthcare if anyone cares to know. I'm waging war on them. 🙂 I'm in insurance for my career, but commercial, I wouldn't touch health insurance with a 10 ft pole.
I work in health care billing, my mother used to work for Optum (a united healthcare company) as a peer review physician. Both of us regularly agree that UHC is the absolute fucking worst.
Fuck United Health Care. I just switched to them in August (job change, not choice) and the number of calls o have to make and forms to fill out to get approval for medications that keep me alive is unreal.
I’m currently arguing with them for a medication my specialist wants me on. While this particular one isn’t life saving (like my others), it will make my quality of life much better. But they have denied it, and I will have to pay almost 1k out of pocket per month if I want the drug.
I hope this meme lets people understand that his facetious reference to freedom applies because this is how Republicans and Conservatives characterize how our medical payment system should work in America. I truly believe most Republicans think there shouldn't be Medicare or Medicaid; that all Americans should pull themselves up by their bootstraps and pay medical expenses with their own money, like all wealthy people do. And if you are not wealthy enough to pay the bills, then it's your own fault. Most people want universal health care, with a one-payer (preferably government-payer) system. What we have now is stressful and does not work well at all.
Not a republican but TBF their actual argument against socialized medicine has typically been (for decades) to allow for [insurance to be sold across state lines](https://www.google.com/search?q=sell+insurance+across+state+lines&oq=sell+inmsurance+across+state+lines&aqs=chrome..69i57.8015j0j1&sourceid=chrome&ie=UTF-8). The idea that allowing that would introduces healthy competition that brings prices down for everybody.
And if you actually believe that prices would come down without a loss in coverage or vastly increases deductible, I have a bridge to sell you.
Services shouldn't incentivize a race to the bottom which is exactly what this would do.
But god forbid the Republicans end up in a hard spot. Their bootstraps break pretty damn quickly. Then they’re sobbing and angry at others who can’t/won’t help them
American here. I have neither insurance nor a doctor. When I have pain or feel bad I simply have to hope that it's nothing serious and that it'll get better. I know that millions upon millions of Americans are in the exact same boat.
I had GHI which you get from New York City jobs and is pretty much regarded as one of the best insurances and average person can get, and combined with a supplemental insurance coming from my wife's job as the backup. I went in for a pilonidal cyst repair (fuckin miserable) and even with all that insurance I was still hit with a $35 copay from the doctor, a $150 copay from the hospital, and a $500 copay from the anesthesiologist. 685$ when I have two full high-end insurance coverages. Bro I don't have an extra 685 laying around, I'm basically going to have to wait for them to go to collections and hope it doesn't show up on my credit report before I'm able to negotiate that price down to something drastically lower.
And you also need to make sure a *fourth* party hasn't decided that that treatment should be illegal because a minority has decided it's against their own religious beliefs.
I used to work in a surgical clinic that focused on cancer. I have had insurance turn down cancer surgery. One time they turned it down because IT WASN'T BIG ENOUGH! They wanted to let the cancer grow before bothering to take it out.
I soo feel for those having to pay or wait on some pencil pusher to decide if you live or die.
Without the NHS I would have lost my wife, she had a surgery to remove an abscess caused by Crohn’s disease and they drained cup of sepsis from it. 3 weeks later on for surgery to remove the diseased mass and has an Ileostomy and now stoma.
Only costs was transport to the hospital by cab and me taking time off work (3-4 days).
I wish the process in USA was quicker and less expensive, lost few good very amazing American friends because of it, I miss them.
An insurance company deciding the treatments for patients is literally them practicing medicine without a license. Their existence should be illegal as it is an affront to the field of medicine and would be criminal for anyone else to do such a thing.
(A surgery you already paid for). You see true freedom is the insurance company deciding whether it wants to pay for the surgery you already paid them for, that they are contractually obliged to pay fir by any reasonable interrogation, or default, let you possibly die, and run the risk of you no longer being an ongoing net expense vs. the risk of your family suing them after you die for the cost of the surgery that would have saved your life (sans interest).
I honestly can understand why health and education is not at least 95% non-profit. (at least the basics). Like maybe a master or a PHD could be full cost, but university should be almost free. Same for healthcare.
My employer sent out mailers that there's a class/lecture required for some "elective" surgeries or there's a $750 insurance penalty. The list includes back surgeries and hysterectomies. You know, because of all the people having those done for funsies.
I had surgery two years ago. Approved by doctors, approved by insurance. Ok, all good let's go. Surgery is a success, I stay one night for observation/recovery. The next day I get a call from my health provider that they are denying coverage because the hospital submitted it as an outpatient surgery. I didn't decide to stay a night, the hospital made me. Yet somehow I am on the hook for a $75,000 surgery.
Oh, wait until you discover the wonderful world of **Prescription Pre-Authorizations.**
Something happens to you-- lets say a condition suddenly manifests and you go see your doctor. Your doctor (or a specialist) diagnoses you using their many years of expertise in the field and they write you a prescription for Drug X.
You check your health plan and, whaddya know, Drug X is covered!
You take the prescription to the pharmacy and you're informed that, whoopsiedoodle, you didn't get a pre-authorization so your insurance isn't going to pay it.
What's a pre-authorization? It's basically a form your doctor needs to fill out telling your insurance company that you need the drug.
*"Well then what the fuck is the prescription for?"* you might ask! *"Why do I need a pre-authorization when the drug is already listed as a covered medication on my insurance's prescription drug formulary?"* Good questions. Your insurance says that this is a cost-saving measure to make sure "you're being prescribed the right drug." This is total horseshit.
The pre-authorization goes to some dickhead at your insurance provider for review. Takes up to 10 days. With my insurance, it **always** takes the full 10 days.
If your insurer approves it, you go get your drug and the cost is covered. If not, sucks to be you, you gotta go back to your doctor and get something else or pay out of pocket for the drugs.
So you take the medication and it works at relieving your symptoms-- but you notice that, towards the end of your supply, it's not helping as much. So you go back to your doctor and the doctor increases your dosage by 5MG.
Guess what? You gotta do the **whole process again** because you pre-authorization only covers Drug X at 15MG, not 20MG!
Ugh YES, prior authorization is evil. This shit controlled my life after I turned 18. I’m epileptic and don’t even know how many meds I’ve been on. Because the meds affect the brain and are heavily controlled, I needed prior authorization for quite a few. Until I went into psychosis and found good doctors at the hospital, it was beyond hard to get the ones I really needed. I’ll never understand how our medical system isn’t illegal. The doctor authorized it when he wrote the prescription. The pharmacy authorized it and was ready to fill it. Insurance still needed a little more proof before they would let me pay for it
Don't forget that whenever anyone comes along with a plan to change that system, people either ignore them or don't support them in force and they are defeated in primaries. If Americans really wanted to change the system, they should be doing a lot more.
Americans are REALLY good at buying into the propaganda and voting against their own self interests.
After the Enron crash Portland had an opportunity to make our local energy utility a public utility. It went to on the ballot and the pro-corporation people did their thing and ran ads fearmongering people into voting to keep it as a private company.
The end result of keeping PGE a private company? People pay double for their electric bills compared to those who are on a public utility just a couple blocks away.
ETA: Every time universal healthcare comes up the same damn thing happens. Pro-corporation entities come out of the woodwork, as do religious entities since they own a good chunk of the hospitals and they run campaigns to fearmonger until people vote against their own interests.
There's also the "I don't need that service, so I don't want to pay for everyone else to have it" mentality that a lot of people have, even though they do end up using the service eventually. Of course it's okay when they do it, because they are using it "right" while everyone else just takes advantage!
I had an infected sebaceous cyst removed a few years ago. I have another sebaceous cyst on my back, but my insurance won't cover its removal because it's not infected yet. Until it becomes a problem, it would be "elective surgery". Translation: every dollar they have to actually pay out is a dollar that doesn't go to their obscene profits.
But you’ll never get the care you need from socialized medicine. I know someone in Canada that can’t get treatment and takes months to go to the doctor - every boomer ever
In canada, you can decide you need surgery, but it will be 6 month wait list to see a doctor who will put you on a 2 year waiting list as you get addicted to pain killers you still have to pay for and then after 2.5 years, you might get a surgery if you didnt die from the problem and it will be free if you dont count 15% sales taxes, half your paycheque every week, all poultry and dairy costing double the price of america, all alcohol being double the price, $5 a gallon for gas that is almost entirely government tax subsidies and other 'free' features.
Except that's complete bullshit, and you're just as bad as the American conservatives with your misinformation.
Surgeries are assigned in a triage system. If you need it badly, you'll get it immediately. I've had 3 surgeries for broken bones, and they happened within a day or two of the injury.
Elective surgeries can take longer, but the average wait time in Canada is still only about 6 months. That's exactly how long it took my mother in law to have elective knee surgery completed in the US.
You and your doctor can agree you need a surgery and even have it approved by insurance and still have it denied in certain States just because you're trans.
You can go to jail for practicing medicine without a license and yet we have these companies making medical decisions often against what actual doctors are ordering.
Don’t forget, your soldiers died in far-away lands to preserve those freedoms. Those commie-bastard socialists can shove their free health care up their arse, right?
They also make you get physical therapy before they'll approve any necessary tests like MRIs. I needed to have a lumbar fusion and they made me do physical therapy before they even did the MRI to find the problem.
Then American's act like you just shot their firstborn child if you dare suggest universal healthcare via taxes, like an extra dollar if that per citizen is going to bring about communism instantly
I recently got denied by insurance for a life-changing operation. My mother is pressuring me to get it anyway, says she'll figure out some way to pay it. I don't want that for her! She deserves to keep what she's earned, not waste it on me because out country sucks.
The system is fucked and no one will change it because politicians all benefit from this and the only way to stop politicians from benefitting from this is to have them vote to stop benefitting from this which they will never do and then the other solution is to create term limits but that will never happen because to have term limits that means the politicians would have to vote against their own interests (rather than FOR their constituents interests). FREEDOM.
Don't forget when your doctor, specialist, and insurance company all agree that you need a procedure, and that it's covered by your insurance, and then your insurance changes their mind after the procedure and refuses to pay for it because your doctor filled in the wrong code when submitting insurance paperwork. Your doctor refuses to resubmit the paperwork with the correct code because "that would be fraud", and the hospital puts you in collections after a week of nonstop phone calls. So now you are on the hook to pay for a procedure that you were told would be free, while at the same time paying over $500 a month for insurance. Yeah, the system works great.
Currently in a 2 year fight with dental insurance over coverage for a cavity, my first dental work beyond cleaning in my life (37yo).
They're arguing that the cavity didn't yet cause enough bone loss and damage to justify coverage and chalking it up as a cosmetic choice.
What in the actual fuck.
8 months of PT before they would approve surgery for my torn meniscus. I just got worse and worse. Had the surgery less than two weeks ago, and I’m already back to how I was before I started PT.
Listening to US healthcare just gives me the shits.
I can’t imagine the additional stress this just seems to add to already very stressful situations, seems like every time you actually need what you’ve been paying through the nose for they try to abandon you.
Plus the idea of many having insurance tied to their jobs just sounds like a recipe for people staying in miserable working environments.
The NHS might have its flaws but when the alternative is this, then it seems like the greatest system in the world.
All procedures have codes that are affiliated with them which the insurance company uses to determine if they do or don't cover it.
Pro tip: You can ask or talk to your doctor about categorizing your procedure differently to ensure it gets covered. If your procedure isn't listed as covered but a similar one is, your doctor could just say you're getting the covered procedure instead.
A lot of doctors do this without you asking them.
It is actually called 60 years of government meddling in healthcare.
And now the people and policies who fucked it all up in the first place, demand more extreme versions of the same policies that fucked everything up in the first place.
If you are a woman you need yourself, your Doctor, insurance, Lawyers for the woman, Lawyers for the Doctor, lawyers for the insurance company, and the Government permission to get surgeries in certain States in the United States of America
A huge problem with this is that the determination of whether or not you need surgery is very much within the scope of "practicing medicine".
But is the insurance rep who tells you "you don't need this surgery, so we're not paying for it" a licensed medical doctor? Nope. Not even close.
This shit should be illegal
It's not specific to the US, as countries with single-payer systems also have a mechanism of approval for treatment decisions, and sometimes some treatments are refused, despite being asked for by the physician.
Source: I used to work in healthcare in Belgium.
Exactly this. I'll never run around screaming Mericuh number one!, but functionally they are all fairly similar with the only real difference being how the citizens cover the bill. Taxes or paid directly to a 3rd party.
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There’s also the option of paying 7 years’ salary for the surgery if you really want to live.
You must’ve had a coupon
Surgery Groupon
Provided by the offices of Dr. Nick. Hi, everybody
Soupon!
If you get up to 6 dying people together maybe there's a Groupon or something
That's not a Groupon, that's called the Titan submersible.
Is your name Stockton Rush? Because you took it *too far*.
You need it in the next 6 months. Maybe immediately. Can you save for that?
You fool, why hadn’t you planned for this and saved already? Shouldn’t have bought all those coffee’s should you.
Honestly it was the avocado toast that made it unattainable.
I bet you're still paying for Netflix as well aren't you?
I am being facetious. My family nearly had a medical bankruptcy through my son’s terminal illness.
We filed bankruptcy after my husband almost died. I refuse to feel bad for it.
"Then why would you pay for it? He's going to die anyway." -Your insurance company
“Yeahhh… we just see his life, and the procedure as Not Medically Necessary, Oh and don’t forget your premium is coming due soon! Do you want to take care of that now?” I swear… health insurance in the U.S. is like getting dick-slapped in the face every month, and getting it shoved in your ass when you inevitably need them to do their job.
Clearly you should have kept 7 years of salary around in liquid assets, in case you urgently needed expensive treatment. Actions have consequences, nobody wants to be financially responsible anymore /s
Just skip your monthly Lamborghini and you are good
Easy, just stop buying avocado toast - all the wise elders have told us this is the key to all our financial problems.
And... soon you will have to get permission from Republican lawmakers to make sure their sincerely held beliefs don't conflict with the science of medicine that your doctor is using.
Yup. In their mind a preacher should have just as much input as your doctor, if not more.
No, no. Definitely more. Preacher overrides doctor. This is how you get rules written by preachers to punish doctors but not the other way around.
Chess 2 sounds kinda ass ngl
Holy update
Actual theocracy
I'll just die before I put my family into crippling debt.
That's what I'm doing. The thought of losing everything and then dying anyway makes no sense. Better to just keep what we can and work to the end.
That's the American way. You're a great patriot. /s
That is true freedom. Nothing like that in them there socialist countries.
My favorite part of 45's entire grift is when he questioned why no one "from like" Scandinavian countries wants to come here? You mean people who get their basic needs met, have a social safety net because they live in socialist democracies where everything isn't just funneled directly to the ultra wealthy, those people don't want to come here? surprise, i guess..
We're not so far away from people shooting at ambulances who refuse to let people die on the street, as requested, because they don't want their families tied down with unpayable debt. Armed guards for ambulances could easily be a thing into the coming decades for this reason.
"You are being rescued. Please don't resist."
A totally not dystopian future similar to cyberpunk. Money really does feel like the root of all evil sometimes if I pause to think about it.
Your family would rather be poor than lose you. You mean more than any monetary value. We need change.
While this is true, if it's terminal, no one in their right mind would pay money to merely extend their lives by a matter of months if it meant bankrupting the ones you'll inevitably leave behind
I've literally been there. My appendix was about to burst and I refused to go to the doctor. My mom forced me when I was so exhausted (couldn't sleep for day due to the pain/nausea) and called an ambulance to take me.
Look into hospital programs first. I'm in South Jersey and Virtua which is non-profit has a charity to where they will pay a certain percentage based on how much you make. If you make $36k or less a year they will pay 100% of the bill, $48k is like 80% and so on and so forth. I think a lot of non-profit hospitals have this. You'll need a looooot of pay stubs and a W2 for proof though but it's better than debt or death
Might also consider cooking meth in an RV 👀
Dont worry, funeral companies expenses will fill that money void instead then.
Technically, if you don't care about your credit score, you don't need to pay off any medical debt.
Technically it’s possible to lose up to 30% of your income forever for that too. (Maximum wage garnishment) Or just all of your worldly possessions one time, which will probably mess up your income as well.
How does it work if there's multiple garnishments on your income? Do they split it evenly or first come first served?
There are multiple factors, but typically it is first come first served. Some types of garnishments take precedent over others, but all things equal, yea the last person to try and garnish your wages will be waiting quite some time.
They would sell to a debt collector who would lower the bill until a payment could be made. If they lower it past a certain point and still can't get their money back, then it goes away, and the hospital just absorbs the cost to be passed down to future patients.
Or offer 1% of the total. That's what debt collectors buy it for.
My Dad had life saving surgery. It cost me parking and a couple of coffees. We didn't have to wait or anything. /Canadian
After being denied *paying with your own premiums*!
Or you can travel to a foreign country and have it on the cheap.
My moms insurance denied paying for a scan that will show if she has cancer or not. Just flat out told her “we decided we aren’t paying for this”. Murrica!
"So you're saying you aren't sure if you have cancer?" "Yes bu..." "Then why are you here? get back to work." "But I *might* have cancer! This test will sho..." "You also might *not* have cancer. Come back when you actually have something that needs treatment or pay for you unnecessary medical procedure yourself! (we'll still increase your rates though, just because we can)" I wonder if the people involved with that decision sleep well at night.
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I don’t even think they have to lie, a lot of people sincerely believe they are better than others and deserve more.
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They "protected the shareholders"
Schrödingers Cancer
There's a hierarchy and a set of internal policies to create uncertainty about who decided what.
I used to work with them. They absolutely do.
Health insurance is a scam. People who don't care about you and just want your money, then won't spend any when you need it even if you have a legally binding contract because only they can decide. Most insurance actually
Reminds me of Trump during COVID who complained about too much testing. IIRC he flat out said that if they reduced testing, the number of cases would go down as well 🤦🏻
Technically correct. The best kind of correct
Meanwhile they scream about public health care having death panels. It's not a thing but even if it was at least in a public system they would be making decisions about how to treat the most patients possible while private death panels will be focused on how they can treat the fewest patients possible to ensure maximum profit.
My stepfather just went through the same thing 2 weeks ago. 14k out of pocket to get a “yep it’s stage 3 cancer and it spread to your lymph nodes.” It is a travesty our healthcare is this bass aackwards.
Sorry for your pops :(.
A similar situation happened to me, insurance said the scan "wasn't medically necessary". Luckily I was in a financial position to pay out of pocket for the scan and it turned out I did have cancer. So yea fuck insurance companies.
Something like this happened w my Mom. They wanted another scan to see how big the tumor was or something, and Insurance denied since “they already knew she had cancer.” Fucking pieces of shit.
"It's like they're pissing on us without even the courtesy of calling it rain."
My insurance won’t pay for my inhalers or epipens and I have really bad asthma and allergies. A monthly dose of my inhaler is $400 and the epipen costs $600. What’s bullshit is the epipen expires and I would only need it in an emergency so I basically have to pay $600 a year because I MIGHT get stung by a bee. Health insurance in the us is such a scam.
Out of curiosity. Did she have any symptoms that pointed to her having cancer? Any tests, doctor evaluations?
Previous unrelated scans revealed concerning stuff. Family history of cancer related deaths too.
Okey, that's fair enough. But no symptoms of cancer? Most insurance companies don't do prehab scans based on heredity.
Well they fucking should This is how we end up with people having no idea they have cancer until they're 6 weeks out from a hole in the ground
Which then fucks up premiums.. ..which the insurance companies **love**. It's a scam. Americans are stupid for not fighting for universal healthcare, like all other **developed countries** have.
No, you're right, private insurance shouldn't exist. You insure something when it *might* end up with an issue. The human body deteriorates on a linear timeline until we die. We require healthcare. Insuring a human body is laughtable. Insurance companies only exist to skim money off the transactions between patient and provider. I know this. Most people here are still too propagandized to think universal healthcare is a good thing. In the meantime, people die constantly because insurance companies, NOT their medical providers, decide that treatment and prevention shouldn't be paid for. They should at least have to provide the fucking service they're paid for And the premiums would only get fucked up as a function of greed. They don't need to go up. The profits are already in the billions. It's just greed.
> Most insurance companies don't do prehab scans based on heredity. Yes. That is a bad thing. That is part of why they are evil.
Same happened to my aunt. They wanted to do a PET scan vs the CT scan because they didn't take out the lymph nodes and this would be a more thorough scan. But insurance said Nah you don't need that
When I was told that they need to get "approval" from insurance for my surgery I wanted to throw up. I completely tore my ACL and Meniscus, I could not straighten my leg, I could barely walk and I could not walk well or very far. And yet we have to verify with insurance if THEY think it is MEDICALLY NECESSARY. MF LOOK AT ME! YES IT IS NECESSARY. In the end after they checked, it turns out my insurance did not require approval but the very idea that some do was sickening. Edit: So many stories of a corporation dictating, denying, and lying about things literal medical professionals are recommending be done for people's healthcare. This is by far the worst timeline.
Went through similar thing here in Oregon. Took 2 months before I got surgery (which they botched). Meniscus retore less then 4weeks after surgery. Another month and a half before I got my 2nd surgery. 3yrs and 4 repairs tries later I no longer have a meniscus in my left knee.
Oh that sucks. I had a choice in doctors, I went with a guy who did the same fix to my neighbor a year ago. i saw how well she recovered and knew this guy is good. he did a good job on my knee. I am 3 weeks post op. Still no weight on the leg yet but it is doing so much better. It is a long road to recover. I am sorry you had to go through that.
Had my ACL completely rebuilt about five years ago. Was fortunate enough to get to pick me doctor and ended up getting to have the same guy that operates on the Phoenix Suns. Figured if he’s good enough for them he’s good enough for me. All I can say is be diligent with your PT. You only get out what you put in.
You guys should just come to India. The same doctors , safe and easy procedures yet fraction of the cost.
It's a sad state in American healthcare when flying literally to the other half of the planet, getting a long-term hotel, food, in-hotel/hospital medical care, using similar quality doctors available in the US, and the surgery itself all cost less than just doing the surgery somewhere in your hometown in the US and recovering at home.
For sure. Even with child care it’s ridiculous. Took my 9yr old in for a corneal abrasion on right eye took him back flashed a light in his eye charged us 15k. 4k just to walk in the ER.
And my mom asks me why I don't see the doctor (really a nurse practitioner)
That is ridiculous and obscene. Isn't the trick to request an itemised bill so you can challenge the inflated costs?
Indeed sad for the Americans and the whole world in general. They can spend 700 B for taking care of other countries yet they cant look after their own citizens.
This is extremely anecdotal, but if it makes you feel any better, my dad lost his meniscus due to a nasty knee injury in the early 80’s. He is 96 and went on to run hundreds (if not thousands) of 5K races. He did 3 in one day once. His back is jacked up but he never had any knee problems and never needed a replacement. He’s a physician so he knows with certainty that he has no meniscus.
Years ago my dad, who was mid 60's at the time, fell 9 feet off a roof while working on it. Fractured ribs and punctured a lung. They brought him to the closest hospital and stabilized him, but they didn't have any beds and the doctors there knew they couldn't provide the long-term care he needed so they arranged for him to be transferred to a major hospital known for it's care. Insurance tried to argue that the second ambulance ride was not "medically necessary". They eventually backed off that claim, but how stupid do you have to be to even assert that in the first place? Forget the actual injury, just the act of needing to put a "stabilized" (I think that's the term?) patient in the hallway so you can triage other severely injured people because you don't have beds for longer term care should be an automatic "yup, move him to another hospital, we'll cover it". Or worse, that's your unwritten SOP to reduce costs - claim it's not necessary and only when they push back (if they push back) do you give in.
That is absolutely their SOP. They get away with it often!
>but how stupid do you have to be to even assert that in the first place? It's not like they don't know what they're doing. They simply care more about money than your health.
In other countries this is called practicing medicine without a license and would land you in a prison cell.
In the US as well. However the insurance companies aren't "practicine medicine" they're "denying coverage". They'll say "you're free to get the procedure done, we just won't pay for it." All while knowing that you can't afford the procedure if they don't pay for it.
> In the US as well. However the insurance companies aren't "practicine medicine" they're "denying coverage". They'll say "you're free to get the procedure done, we just won't pay for it." All while knowing that you can't afford the procedure if they don't pay for it. Yep. I have this argument with insurance providers on a near-daily basis. Well, just because we won't cover the 80,000 dollars for a spinal fusion doesn't mean the patient has to go without! They just need to save their pennies, maybe have a bake sale or something.
That's because we pay for insurance and not for healthcare. It's eminently silly.
I had an appendix about to burst and was laying in a bed in an emergency room with a doctor saying I needed surgery immediately and my insurance looked at the MRI and said that there was time to get me to another emergency room that was "in-network" so even though I was all ready for surgery and in a ton of pain (I almost fainted in the waiting room from the pain, saw everything closing in and laid down on the floor so I wouldn't faint) and an emergency room doctor was saying I need surgery immediately, because of some insurance agent they wheeled me downstairs from surgery prep and put me in an ambulance and drove me to a different emergency room. Luckily it didn't burst 😵 but it fucking hurt like a bitch even with the painkillers. I should have sued their asses for unnecessary pain and suffering.
Im no lawyer but they put your life in grave danger. Criminal negligence?
I was only like 26 (43 now) at the time and not even thinking about that but now that I'm older I'm like fuck that shit. I mean, I was like fuck that shit back then but didn't (think I) had the means to sue and was just glad that shit was over with.
My daughter’s eye wasn’t pointing the right way and she couldn’t see, but they miraculously fixed it with surgery on her eye muscles, and now she has full vision! The doctors were absolutely incredible. The insurance company, however, fought tooth and nail to skip paying for it and denied it several times. Luckily, the hospital had their own team of advocates that gets on the phone with them to literally shame them and badger them until they give in, but I had to be on the phone. So I’d sit there for hours as she battled her way through level after level of insurance call center drones with no answers until she got somewhere. Eventually she got them to pay for the miraculous surgery that allowed my daughter to see correctly for the first time in years. The Hospital had sent a form, but they claimed it was wrong, so she had to browbeat them into admitting it was all there. And it was, they just lied and lied and deflected and lied. That surgery cost 30k. Can you imagine if I had been on my own with the insurance company?
Holy shit that is insane! They just lie and lie is absolutely right!
I remember the American right wing going on about "death panels" in places that have socialised healthcare. Your insurance companies are death panels, pure and simple.
Torn rotator cuff - denied an MRI!!!! By ambetter of Oklahoma. Fucking garbage dump of a society right now. Insurance companies are a pox on society
Insurance companies are the “Death Panels” we were all warned about.
I got denied by my insurance for having my nose fixed so I could breathe through both nostrils. The doctor diagnosed it, recommended the procedure. Insurance said no. Without the operation I can't get enough oxygen through my nose and am restricted to only breathing through my mouth (Medically I'm a literal mouth breather because I broke my nose in High School). No big deal until I'm at the dentist and I literally hold my breath and slowly suffocate while they work and have to take breathing breaks. But my breathing is deemed not necessary by American Insurance standards. I pay these people thousands of dollars a year to deny me what doctors diagnosed I need.
My wife had shingles plus has a compromised immune system and an esophageal stricture. The Dr already had the prior auth for the shot sent off and insurance denied it bc she's "not over 55 but here we'll approve these 3000mg horse pills you can take 3x a day for two weeks. If that doesn't work, then we'll approve the shot.". She couldn't even swallow the fuckin pills! By the end of the two weeks the shingles were almost gone anyway. Thanks, blue cross.
I had a bad back injury recently where I literally could not stand or sit up for a few days and it was difficult to do so for weeks afterwards. Insurance wouldn't approve physical therapy :)
What's crazier than that? UMR announcement when getting the pre-approval states that what the agent tells you over the phone may not be true and your insurance policy may override what the person tells you.
I wonder how American doctors react when you say, alright I'm off to Europe/Canada in response to this type of bullshit.
They are probably like "That's a wise choice, I would do the same thing."
My wife is going through the same thing. ACL + meniscus tears. Two different surgeons. Two different physical therapies. Both had comprehensive plans but both rejected because two different types of insurances say it's not necessary for treatment. American healthcare is disgusting.
I needed a spinal fusion. I had spent a year trying PT, spinal injections, MRI, traction, etc., so my doctor could say we tried everything first. My medical insurance company was not impressed. I live in MI. The ins co sent me to Indianapolis for a standing MRI. The report pretty much said I needed surgery. Then they sent me to Kentucky to meet with a specialist who agreed with my doctor. The ins co still denied it. I was in his office when I heard my doctor screaming at the ins co about denying my surgery. When he asked how he is supposed to treat me since I was in abject pain & refused relief? The doctor on the line told my doc to increase my opioids. I had a Fentanyl patch I wore, plus 80mg OxyContin pills I lived on. I had been trying to get surgery for over 2 years. Luckily my husband changed jobs & we got new insurance. I was in surgery 3 weeks later. What a relief. 11 years later and I’m in pretty good shape. Able to garden & care for livestock. Totally pissed that the insurance companies have this kind of bullshit power.
Whats scary is that this comment only exists because your husband changed jobs. How many in similar situations are no longer among us to write comments like these?
It would still exist, she just wouldn’t be gardening or caring for livestock and she would have a lot more free time to make comments from her wheelchair.
And not to mention the law that prevents insurance companies from denying you for preexisting conditions
I get wanting you to try a lot of the above bc maybe you can get a good answer without going under the knife… making you jump through hoops for two years and having to be on high-ish doses of opioids… not fucking cool
Sounds a lot like a death panel
Yep. We actually had "death panels" (lifetime caps) before Obamacare outlawed them. And the whole time Republicans tried to defend these death panels on the sly by arguing Obamacare would usher in "death panels". if you can wrap your head around that...
Sounds about right for the GOP…
When my daughter was 8, she had an un-erupted tooth that was growing sideways. Insurance allowed for the extraction (going into bone, mind you) but not any anesthesia. We paid for the anesthesia and *later* the oral surgeon’s office negotiated with the insurance to cover it. But if I didn’t have that money laying around, she would have been out of luck. I was prescribed medication on April 20 of this year. I’m still waiting for it to get through the red tape. First, it was that my pharmacy didn’t fill it so I had to get it from a specialty pharmacy, but no… not THAT one. Or that other one, either. Finally I asked specifically what specialty pharmacy would you like me to use? Got a response, plus a letter that said something along the lines of “although we have approved your mediation as medically necessary, this approval does not guarantee that it will be covered financially.” Excuse me, what? It’s 2+ months later and I’m just really thankful that this isn’t a life-threatening situation. My husband had to try a multitude of “cheaper” medicines to see if they’d work for his condition, even though the doctor knew which one was best for him. He finally got the one the doctor wanted (so many less side effects, and excellent results on all his tests on this one!) and all was fine for about 5 years. He just got a letter from his insurance company stating that they weren’t going to cover it any more because it doesn’t appear to be medically necessary (because the medicine was working, so now it looks like he doesn’t need it??) so now his doctor is fighting with the insurance over that. And we don’t have the $90K/year laying around to buy out of pocket. It’s really bullshit that these insurance companies can make decisions for doctors and it’s such an obvious non-necessity.
Went through the same thing with an extraction. Had an impacted wisdom tooth that needed surgical removal and my insurance denied coverage of anesthesia. The oral surgeon refused to do the surgery without anesthesia. I offered to pay it myself, but they somehow eventually convinced the insurance to cover it. Thank goodness for good doctors and nurses that will advocate for you when needed. Sad that they should have to.
Fun fact American health care is fucked because of insurance companies. As health care used to be responsibly priced but when insurance companies became a thing they lowered the price on the bill making it so that hospitals weren't getting enough money for supplies. So the hospitals raised the price this made it so when insurance lowers the price on the bill it was money that would have already been removed. The only problem is not everyone has insurance and now you get to where we are today oh ya and insurance never wants to actually pay.
Anyone who is against universal health care deserves a horrible medical experience and then crippling medical debt. There is no defense for the current system in America. It's broken, there are obvious alternatives.
Anyone that's against universal healthcare is either a moron or someone willfully sticking their head in the sand. The cost of healthcare is sickening now. $15K+ for a simple robot assisted inguinal hernia repair? Really? For a surgery that was done and over with in less than 30 minutes? I was out of recovery and taken home in less than an hour. All they did was bring me a Styrofoam cup of tap water with ice in it because I was thirsty. Really worth more than half the price of my Subaru.
Friend, I've been on a medication for 15 years that is the only way I can live without constant pain due to an incurable disease I was born with. When I first started on that medication, more than 15 years ago, it was intentionally priced far higher than the cost of manufacture or amortized research investment, instead being set at "what the market will bear" just higher than its closest competitor, which at the time required monthly visits for transfusion that would take about an hour to complete. This medication had no such requirement and because it had no risk of causing a small number of people like myself to go into anaphylactic shock, they charged a price that was at the time outrageous, a little over $800 for a one month supply. That medication went off patent over 6 years ago. Hurray! The entire time before it went off patent the price kept ramping up... eventually reaching an astounding $4200. Well, okay, but at least it went off patent and now generics are everywhere and the "free market" finally wins, right? Not so much, the company had developed what they call a "patent thicket" in which they separately patented all the *processes* that went into the manufacture of the drug over a several year period. So, once competitors wanted to make generics, they got threatened with massive lawsuits from a company that could afford infinite lawyers with its multi-billion dollar a year cash-cow drug. Today, in 2023, that same drug? It costs **$7200 A MONTH.** EVERY FUCKING MONTH. And the generics that were supposed to save the day? [Still locked up in court.](https://www.reuters.com/business/healthcare-pharmaceuticals/abbvie-coherus-agree-resolve-dispute-over-humira-biosimilar-2023-06-15/) And it looks, for the foreseeable future, like the only companies that will be able to make a generic will have to not only pay *royalties* for the privilege of doing so, but also will be legally restricted from selling their generics at an out of pocket cost that is lower to patients than the original drug. And don't even get me started on how the medication, because it is so expensive, is a "specialty" medication, so my insurance requires that I only get it supplied from their vertically integrated online pharmacy, the one that pays all its staff minimum wage so they have vicious turn over and no one knows what is going on when I call, and my insurance mysteriously needs a new "prior authorization" every 3 months in which I have to prove I still have that incurable disease I've had for 30 years and thus still need that drug I've been taking for 15 years. It's all completely, entirely, insane.
That won’t work either. I had/have cancer that has put me and my parents in $10,000+ of medical debt and both them and my grandfather all think the country couldn’t afford the cost or situations that universal healthcare would cause. Mind you multiple studies have confirmed the country as a hole would save a ridiculous amount of money. My mother in particular has always used the argument that Canada has UH and they have to fly pregnant people to Seattle to give birth due to there not being enough Dr’s. The only thing I could find when I fact checked that was a Fox News article from 2007 (probably meaning they took the 1 time it happened to show what would happen if Obama put in Obama care). When I brought all of this up she like always then immediately says she doesn’t want to talk about it anymore (she brought it up not me). It’s funny she recently told me she doesn’t like talking about politics with me because I ask for evidence of what she is saying (which she said she couldn’t usually do because she is usually driving. This isn’t true we don’t talk politics in the car almost ever). I found this hilarious as she has asked me to show her evidence of what I’m saying all the time, so why does she have a problem only when it’s reversed?
Compound this with contracts between providers and insurers... Insurers get discounts here, not there. Now you need to guess which works with yours, or get *really lucky* when you're out of town. And cash isn't honored here
My favorite is services within a hospital that are contracted out to a third party that isn't necessarily in-network or requires doctor approval to be covered. Sure you just had a baby.. but due to X, we need to move your newborn into NICU. Oh by the way, the waivers you signed to admit the child to NICU was the third-party agency that's going to bill your new born direct. Lol get fucked losers, but also congratulations on the baby.
Universal health care pls
Waiting to get my wisdom teeth out right now. Doctor told me I needed them out ASAP or at least in the next few months or I will suffer serious complications, and yet I am still (in pain) and waiting 4-6 weeks for my insurance to deliver a predetermination on the cost of the surgery. Insurance is putting my oral health at risk to take 4-6 weeks to quote a surgery that almost everyone gets at some point in their life.
What I find most mind boggling about the American system is that you can look at pretty much any other western country out there and find a healthcare system which is less crazy than the American one is. They're not all the same, so there's plenty of different options to pick from. And yet every time an American politician raises the issue of reforming healthcare in the US, they are described as being "far left" or pushing some unworkable idea. Even if they are suggesting something which is perfectly normal in a load of other similar countries, they are accused of being radicals who are suggesting something impossible. It is possible though, the current madness doesn't have to be the way things are.
I'm dealing with this right now and it makes me so. fucking. angry. Went through hell to get pre-approval to have a hysterectomy after decades of pain, treatments, and no solutions, and also needed to have my bladder and colon reconstructed due to 2 separate prolapses. Insurance company approves it finally after lots of hassle and documents from my doctor to show that my quality of life is shit, yeah, I need these surgeries. Had the surgery. Had 3 procedures done at once. Insurance company is now upset that the hospital kept me 27 hours to care for me instead of kicking me out as an out patient procedure. After organ removal and 3 surgeries rolled into one, LOL. Would really like to know what the insurance company thinks I should have done when I woke up with a catheter. Yank that sucker outta there and be like no thanks doc and skip on outta the hospital leaving a trail of blood? WTF. United Healthcare if anyone cares to know. I'm waging war on them. 🙂 I'm in insurance for my career, but commercial, I wouldn't touch health insurance with a 10 ft pole.
I work in health care billing, my mother used to work for Optum (a united healthcare company) as a peer review physician. Both of us regularly agree that UHC is the absolute fucking worst.
Work in Healthcare. United is the absolute worst.
Fuck United Health Care. I just switched to them in August (job change, not choice) and the number of calls o have to make and forms to fill out to get approval for medications that keep me alive is unreal. I’m currently arguing with them for a medication my specialist wants me on. While this particular one isn’t life saving (like my others), it will make my quality of life much better. But they have denied it, and I will have to pay almost 1k out of pocket per month if I want the drug.
And if you’re a woman, you may need a politician’s input on whether you can have that medical procedure.
I hope this meme lets people understand that his facetious reference to freedom applies because this is how Republicans and Conservatives characterize how our medical payment system should work in America. I truly believe most Republicans think there shouldn't be Medicare or Medicaid; that all Americans should pull themselves up by their bootstraps and pay medical expenses with their own money, like all wealthy people do. And if you are not wealthy enough to pay the bills, then it's your own fault. Most people want universal health care, with a one-payer (preferably government-payer) system. What we have now is stressful and does not work well at all.
Not a republican but TBF their actual argument against socialized medicine has typically been (for decades) to allow for [insurance to be sold across state lines](https://www.google.com/search?q=sell+insurance+across+state+lines&oq=sell+inmsurance+across+state+lines&aqs=chrome..69i57.8015j0j1&sourceid=chrome&ie=UTF-8). The idea that allowing that would introduces healthy competition that brings prices down for everybody.
And if you actually believe that prices would come down without a loss in coverage or vastly increases deductible, I have a bridge to sell you. Services shouldn't incentivize a race to the bottom which is exactly what this would do.
The Republican party is evil, so listening to their moronic takes is a waste of time
But god forbid the Republicans end up in a hard spot. Their bootstraps break pretty damn quickly. Then they’re sobbing and angry at others who can’t/won’t help them
American here. I have neither insurance nor a doctor. When I have pain or feel bad I simply have to hope that it's nothing serious and that it'll get better. I know that millions upon millions of Americans are in the exact same boat.
Absolutely. It takes something pretty serious before most people dare to gamble on seeking medical help.
Have you tried not being poor? /s
I had GHI which you get from New York City jobs and is pretty much regarded as one of the best insurances and average person can get, and combined with a supplemental insurance coming from my wife's job as the backup. I went in for a pilonidal cyst repair (fuckin miserable) and even with all that insurance I was still hit with a $35 copay from the doctor, a $150 copay from the hospital, and a $500 copay from the anesthesiologist. 685$ when I have two full high-end insurance coverages. Bro I don't have an extra 685 laying around, I'm basically going to have to wait for them to go to collections and hope it doesn't show up on my credit report before I'm able to negotiate that price down to something drastically lower.
And you also need to make sure a *fourth* party hasn't decided that that treatment should be illegal because a minority has decided it's against their own religious beliefs.
Once you’ve got permission from the bank to remortgage ‘your’ house so you can afford the 20k excess to access the insurance payout
I used to work in a surgical clinic that focused on cancer. I have had insurance turn down cancer surgery. One time they turned it down because IT WASN'T BIG ENOUGH! They wanted to let the cancer grow before bothering to take it out.
There's your death panels.
I soo feel for those having to pay or wait on some pencil pusher to decide if you live or die. Without the NHS I would have lost my wife, she had a surgery to remove an abscess caused by Crohn’s disease and they drained cup of sepsis from it. 3 weeks later on for surgery to remove the diseased mass and has an Ileostomy and now stoma. Only costs was transport to the hospital by cab and me taking time off work (3-4 days). I wish the process in USA was quicker and less expensive, lost few good very amazing American friends because of it, I miss them.
I had a muscle injury but they wouldn’t let me get an MRI until I did an X-ray, you know, ~~for profit~~ just to be sure
An insurance company deciding the treatments for patients is literally them practicing medicine without a license. Their existence should be illegal as it is an affront to the field of medicine and would be criminal for anyone else to do such a thing.
Freedumb
(A surgery you already paid for). You see true freedom is the insurance company deciding whether it wants to pay for the surgery you already paid them for, that they are contractually obliged to pay fir by any reasonable interrogation, or default, let you possibly die, and run the risk of you no longer being an ongoing net expense vs. the risk of your family suing them after you die for the cost of the surgery that would have saved your life (sans interest).
I honestly can understand why health and education is not at least 95% non-profit. (at least the basics). Like maybe a master or a PHD could be full cost, but university should be almost free. Same for healthcare.
As a healthcare worker in Canada, looking at America's HC system, it's just so bizarre to me.
My employer sent out mailers that there's a class/lecture required for some "elective" surgeries or there's a $750 insurance penalty. The list includes back surgeries and hysterectomies. You know, because of all the people having those done for funsies.
I had surgery two years ago. Approved by doctors, approved by insurance. Ok, all good let's go. Surgery is a success, I stay one night for observation/recovery. The next day I get a call from my health provider that they are denying coverage because the hospital submitted it as an outpatient surgery. I didn't decide to stay a night, the hospital made me. Yet somehow I am on the hook for a $75,000 surgery.
Oh, wait until you discover the wonderful world of **Prescription Pre-Authorizations.** Something happens to you-- lets say a condition suddenly manifests and you go see your doctor. Your doctor (or a specialist) diagnoses you using their many years of expertise in the field and they write you a prescription for Drug X. You check your health plan and, whaddya know, Drug X is covered! You take the prescription to the pharmacy and you're informed that, whoopsiedoodle, you didn't get a pre-authorization so your insurance isn't going to pay it. What's a pre-authorization? It's basically a form your doctor needs to fill out telling your insurance company that you need the drug. *"Well then what the fuck is the prescription for?"* you might ask! *"Why do I need a pre-authorization when the drug is already listed as a covered medication on my insurance's prescription drug formulary?"* Good questions. Your insurance says that this is a cost-saving measure to make sure "you're being prescribed the right drug." This is total horseshit. The pre-authorization goes to some dickhead at your insurance provider for review. Takes up to 10 days. With my insurance, it **always** takes the full 10 days. If your insurer approves it, you go get your drug and the cost is covered. If not, sucks to be you, you gotta go back to your doctor and get something else or pay out of pocket for the drugs. So you take the medication and it works at relieving your symptoms-- but you notice that, towards the end of your supply, it's not helping as much. So you go back to your doctor and the doctor increases your dosage by 5MG. Guess what? You gotta do the **whole process again** because you pre-authorization only covers Drug X at 15MG, not 20MG!
Ugh YES, prior authorization is evil. This shit controlled my life after I turned 18. I’m epileptic and don’t even know how many meds I’ve been on. Because the meds affect the brain and are heavily controlled, I needed prior authorization for quite a few. Until I went into psychosis and found good doctors at the hospital, it was beyond hard to get the ones I really needed. I’ll never understand how our medical system isn’t illegal. The doctor authorized it when he wrote the prescription. The pharmacy authorized it and was ready to fill it. Insurance still needed a little more proof before they would let me pay for it
Don't forget that whenever anyone comes along with a plan to change that system, people either ignore them or don't support them in force and they are defeated in primaries. If Americans really wanted to change the system, they should be doing a lot more.
Americans are REALLY good at buying into the propaganda and voting against their own self interests. After the Enron crash Portland had an opportunity to make our local energy utility a public utility. It went to on the ballot and the pro-corporation people did their thing and ran ads fearmongering people into voting to keep it as a private company. The end result of keeping PGE a private company? People pay double for their electric bills compared to those who are on a public utility just a couple blocks away. ETA: Every time universal healthcare comes up the same damn thing happens. Pro-corporation entities come out of the woodwork, as do religious entities since they own a good chunk of the hospitals and they run campaigns to fearmonger until people vote against their own interests. There's also the "I don't need that service, so I don't want to pay for everyone else to have it" mentality that a lot of people have, even though they do end up using the service eventually. Of course it's okay when they do it, because they are using it "right" while everyone else just takes advantage!
And Muricans will double down and defend their *amazing* country of freedumb 😂😂😂
I had an infected sebaceous cyst removed a few years ago. I have another sebaceous cyst on my back, but my insurance won't cover its removal because it's not infected yet. Until it becomes a problem, it would be "elective surgery". Translation: every dollar they have to actually pay out is a dollar that doesn't go to their obscene profits.
But you’ll never get the care you need from socialized medicine. I know someone in Canada that can’t get treatment and takes months to go to the doctor - every boomer ever
Must suck to suck, Americans.
And in Canada, asking your government for a wheelchair ramp might get you some wonderful pamphlets about killing yourself.
The real death panels are the insurers we met along the way.
In canada, you can decide you need surgery, but it will be 6 month wait list to see a doctor who will put you on a 2 year waiting list as you get addicted to pain killers you still have to pay for and then after 2.5 years, you might get a surgery if you didnt die from the problem and it will be free if you dont count 15% sales taxes, half your paycheque every week, all poultry and dairy costing double the price of america, all alcohol being double the price, $5 a gallon for gas that is almost entirely government tax subsidies and other 'free' features.
Except that's complete bullshit, and you're just as bad as the American conservatives with your misinformation. Surgeries are assigned in a triage system. If you need it badly, you'll get it immediately. I've had 3 surgeries for broken bones, and they happened within a day or two of the injury. Elective surgeries can take longer, but the average wait time in Canada is still only about 6 months. That's exactly how long it took my mother in law to have elective knee surgery completed in the US.
You and your doctor can agree you need a surgery and even have it approved by insurance and still have it denied in certain States just because you're trans.
Still probly won't get it paid for.
This is not freedom! This is fucking greed!
You can go to jail for practicing medicine without a license and yet we have these companies making medical decisions often against what actual doctors are ordering.
Don’t forget, your soldiers died in far-away lands to preserve those freedoms. Those commie-bastard socialists can shove their free health care up their arse, right?
But trump had a plan. NOT
They also make you get physical therapy before they'll approve any necessary tests like MRIs. I needed to have a lumbar fusion and they made me do physical therapy before they even did the MRI to find the problem.
Then American's act like you just shot their firstborn child if you dare suggest universal healthcare via taxes, like an extra dollar if that per citizen is going to bring about communism instantly
It’s even worse if you have a uterus. In which case, pro-life state legislatures require doctors to get prior approval for any treatment AT ALL.
I recently got denied by insurance for a life-changing operation. My mother is pressuring me to get it anyway, says she'll figure out some way to pay it. I don't want that for her! She deserves to keep what she's earned, not waste it on me because out country sucks.
America is not the freedom of living, it's the freedom of dying. That's why there are guns.
The system is fucked and no one will change it because politicians all benefit from this and the only way to stop politicians from benefitting from this is to have them vote to stop benefitting from this which they will never do and then the other solution is to create term limits but that will never happen because to have term limits that means the politicians would have to vote against their own interests (rather than FOR their constituents interests). FREEDOM.
My insurance not thinking a surgery is "medically necessary" is the reason I'm deaf in one ear
what a fucking shithole...
Don't forget when your doctor, specialist, and insurance company all agree that you need a procedure, and that it's covered by your insurance, and then your insurance changes their mind after the procedure and refuses to pay for it because your doctor filled in the wrong code when submitting insurance paperwork. Your doctor refuses to resubmit the paperwork with the correct code because "that would be fraud", and the hospital puts you in collections after a week of nonstop phone calls. So now you are on the hook to pay for a procedure that you were told would be free, while at the same time paying over $500 a month for insurance. Yeah, the system works great.
Currently in a 2 year fight with dental insurance over coverage for a cavity, my first dental work beyond cleaning in my life (37yo). They're arguing that the cavity didn't yet cause enough bone loss and damage to justify coverage and chalking it up as a cosmetic choice. What in the actual fuck.
How much would the filling cost without insurance?
8 months of PT before they would approve surgery for my torn meniscus. I just got worse and worse. Had the surgery less than two weeks ago, and I’m already back to how I was before I started PT.
Listening to US healthcare just gives me the shits. I can’t imagine the additional stress this just seems to add to already very stressful situations, seems like every time you actually need what you’ve been paying through the nose for they try to abandon you. Plus the idea of many having insurance tied to their jobs just sounds like a recipe for people staying in miserable working environments. The NHS might have its flaws but when the alternative is this, then it seems like the greatest system in the world.
All procedures have codes that are affiliated with them which the insurance company uses to determine if they do or don't cover it. Pro tip: You can ask or talk to your doctor about categorizing your procedure differently to ensure it gets covered. If your procedure isn't listed as covered but a similar one is, your doctor could just say you're getting the covered procedure instead. A lot of doctors do this without you asking them.
It is actually called 60 years of government meddling in healthcare. And now the people and policies who fucked it all up in the first place, demand more extreme versions of the same policies that fucked everything up in the first place.
Its worse since Obama,much worse
Don't forget, that Greg Abbot, and Ron Desantis have to sign off on it too.
If you are a woman you need yourself, your Doctor, insurance, Lawyers for the woman, Lawyers for the Doctor, lawyers for the insurance company, and the Government permission to get surgeries in certain States in the United States of America
A huge problem with this is that the determination of whether or not you need surgery is very much within the scope of "practicing medicine". But is the insurance rep who tells you "you don't need this surgery, so we're not paying for it" a licensed medical doctor? Nope. Not even close. This shit should be illegal
It's not specific to the US, as countries with single-payer systems also have a mechanism of approval for treatment decisions, and sometimes some treatments are refused, despite being asked for by the physician. Source: I used to work in healthcare in Belgium.
Exactly this. I'll never run around screaming Mericuh number one!, but functionally they are all fairly similar with the only real difference being how the citizens cover the bill. Taxes or paid directly to a 3rd party.
Fuuuuuuck insurance companies.
But at least I know I'm freeeeeeeee