Just so tired of almost every time a doctor submits stuff to insurance, we have to be the ones to make multiple phone calls to both the doctor’s office and insurance to iron everything out, figure out what the issue is (it’s always a different issue), and basically be the go-between for the office and insurance. What am I paying $500+/month for?! It’s like paying for the privilege of having an exhausting part-time job.
And yes, I understand that insurance wants to weasel out of paying anything, but this isn’t even shadiness, just straight up incompetence and lack of communication/following procedures. The amount of emotional energy we have to spend untangling this stuff leaves us drained.
They get paid when the least amount of people they insure use their services. They’re not incentivized to help those they’ve insured. The less they have to pay out to providers, the better the executive bonuses. Thus, they are diligent in collecting premiums, but can just sit on their hands when it comes to paying out.
The more the system denies and delays a claim, the fewer insured people are willing or able to put themselves through the bureaucracy gauntlet, the fewer pay outs.
They’re not in the business of insurance, they’re in the business of making money from the business of insurance. It’s over-complicated on purpose.
And what might be the most important part cannot be elided over: market capitalism is HIGHLY efficient at solving optimization problems, but it only responds to incentives.
So if you can create the right incentives to reward the result you want and punish results you don’t want, a market solution is going to do a marvelous job. It’s great at, say, price discovery. But if the incentives do not align with the desired result, it’s going to grind you under heel.
The incentives the insurance companies are responding to, frankly, are the ones you have outlined and essentially no others. Collect more premiums, make fewer payouts. There’s no “breaking point” here because they have an absolutely vast customer base that has no choice to opt out of the system for a variety of reasons (ranging from the ACA individual mandate to the fact that it is not possible for an individual to make fully-informed financial decisions about their health even WITH advanced knowledge and training that nearly no one has).
Health insurance is pretty much a textbook example of the kind of service that shouldn’t be on private markets.
So over time, market capitalism is going to make them collect endlessly-increasing premiums and pay out less and less. It is going to continue to get worse because the incentives of the system have defined ‘worse’ as being the optimal result. Period. It will eventually get nationalized. Period. All the argument in the meantime is just over how long we want to continue to let people be sick and broke before we apply the only fix.
Also it’s not like you can change insurers when they do this. First it almost certainly didn’t happen during open enrollment but also your insurance provider is probably decided by your employer.
Completely agree. Just had to vent.
They actually use algorithms to deny claims. Also, remember the scene when Mr incredible was an insurance salesman?
You’d think that the doctor’s office would at least be motivated to fix the problem so they get paid, though, 'cause I’m sure as Hell not going to!
But you probably signed that you are liable for all bills regardless of insurance, and before you got any treatment. Read through all the paperwork sometime: it may not be reasonable or fair and you don’t have a choice but somehow it’s legal
My favorite is pre-authorization.
I need a pre-auth before my insurance will cover the Adderall for my ADHD. Every year I must renew this pre-auth or I will not get covered for my prescription.
What is a pre-auth, exactly? It’s a Dr. Promising that yes, this medicine they prescribed is medically necessary. No, prescription alone does not count. Yes, it can come from the same Dr. who prescribed it.
And yes, I have to do it yearly to “ensure it’s still medically necessary” because my ADHD could magically go away one day, apparently
It’s beyond belief, but insurance companies do the same thing to amputees.
Oh I know, I had a family member make the joke about suddenly regrowing a limb
It’s disgusting and absolutely should result in anyone who’s ever approved that being put against the wall for their pure evil
Any hassle they can create to manufacture a reason to deny coverage.
It’s not “beyond belief” it’s disgustingly evil.
Wow. This is similar to what disabled people have to deal with in Russia. Like arm will grow back.
I have to do it quarterly for some reason. Annually would be…better, but still stupid. My doctor even thinks it’s dumb, so he usually just asks me all the rote questions…
…no he doesn’t, he usually goes blahblahblah you’ve been doing this for 10+ years we know the routine. Unfortunately I still have to make an appointment, have an appointment, pay the deductible for said appointment, just to get 3mos of a medication that, thus far, I have a medical need for.
It means they have to compare your request to a list of allowances that change annually at the whim of Corporate
Haha exactly! I mean, I know this is how it works, it just feels like it’s gotten way worse in the last few years.
What you really need on top of that insurance is supplemental insurance! That way you can pay two insurance companies and they can both say no!
I tore an achilles tendon last year. Doc wanted me in physical therapy, but PT wouldn’t take me because they needed an MRI showing the position and size of the tear.
PT was very clear. Tendons don’t show up on xrays.
Doctor was very clear. Tendons don’t show up on xrays.
Podiatrist was very clear. Tendons don’t show up on xrays.
Aetna: “You didn’t do an xray first, MRI denied.”
They try to spend less so aggressively that they end up actually spending more
Fought them for a month, meanwhile I’m in pain, limping with a busted tendon.
Finally we just gave in and did the xray, which - surprise! - showed nothing! Then they approved the MRI.
I hope you don’t have any long term consequences of that
Once I got into PT things seemed to go well, it was just a month of suck getting there.
Corporations are all about stepping over dollars to pick up pennies.
Vote for a single payer system (Medicare for all) if you want out
How? Who do I vote for to make that happen?
Doesn’t USA have referendums?
Yep. The powers that be routinely ignore the ones they don’t like.
No, but there’s a pile of guns.
In some states lol
I mean national
Afaik, no there isn’t a federal referendum as a option in the US, could be wrong but given I’m pretty sure it’s illegal in some states (can’t have those pesky citizens making their own rules)
We have all become unwilling, unpaid employees of every company in their pursuit of higher profits. It’s a feature, not a bug.
Corporations have discovered that there is no real downside (for them) when they don’t function. Customer satisfaction no longer has much of an impact on their profits because the few companies left in each sector are doing the exact same thing.
IMO this is yet another side effect of unchecked corporate power. It’s the same reason prices have risen so rapidly and corporate profits have reached 70 year highs. We are dealing with near monopolies and the billionaire class who created them. Until our government addresses the problem it’s not going to get any better.
In other words it’s not going to get better in our lifetimes.
In one example of this, during one job interview / recruitment process I essentially had to do all of the background check company’s work for them.
That makes literally no sense at all, and I’m not surprised when there’s cases of people just pretending to be doctors or whatever for decades. The “doctors” probably verified their own employment history and credentials.
One of the biggest advantages I see from living under single payer health care is that I don’t have to put in extra clerical work like you describe. Sure, the insurance company should be able to pick up a phone, but In my opinion, the responsibility should rest on the hospital - they are the ones demanding a payout.
Just to offer another perspective, this covers just how difficult the burden of administrative tasks already is for physicians: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8522557/
Not all physicians work for a hospital, so I don’t think they all have much access to large departments that can take up the slack for them. It’s difficult to ask them to chase our insurance for us when the paperwork they already do is driving them insane and taking them away from their patients.
The solution, as you said, is single payer. The overwhelming administrative overhead is a symptom of a very broken system. Nobody directly rendering or receiving care is benefiting from how things currently are in the United States.
I do feel sorry for the admin staff that have to deal with it, and my ire is 90% directed at insurance. However, when they can’t even read the back of the insurance card to follow the instructions to properly file a claim, it just gets tiring.
I completely agree about it being the providers responsibility. The problem is, they don’t want to do anything to resolve the issue either. Other times, it doesn’t even involve the provider, they did everything right but for some byzantine reason it didn’t go through the insurance system correctly and you have to call them and tell them to process it the same way they have processed every other exact same bill from the exact same provider.
Just wanted to vent. I should clarify I live in the US (as if that wasn’t clear from my post LOL!)
they don’t want to do anything to resolve the issue either.
In any other line of work, that’s an excellent way of forfeiting any right to getting paid.
In the jobs I’ve had where I’ve had to bill someone, I’m having a hard time imagining that I could expect to get paid if I just sent a bill to someone who didn’t owe me.
I disagree. The hospital is employed to provide medicine. I pay a medical insurance company to pay for my medicine. If a doctor says I need medicine the insurance company should respond and pay because why else am I paying them.
I don’t know if I should say this but I will.
The last time it was an issue for my kids I conferenced called the insurance and the doctor’s office. I then laid into the insurance adjuster saying things that were truly revolting with as much profanity as I could cram into it.
Haven’t had an issue since. Turns out the system only works if they think you are unstable enough to make it work.
I wish I could Thanos-snap the entire health insurance industry out of existence. It’s a giant, bloated, bureaucratic middle-man that makes the whole process more expensive, time-consuming, and complicated.
I’ve wondered what would happen if people went on a health insurance strike. If everyone (or a large part of the population) cancelled their health insurance, and just negotiated on price directly with providers.
I’d imagine we’d see insurance invest money into making offers to providers. They’d refer the patient to a health insurance company instead of negotiating, and in exchange they’d get a large one time payout for a successful referral. This would please investors in the providers, because they’d see short term gains, and it’d please the insurance company because patients would be forced to have insurance again. Everyone (with money) wins!
It is unique to the way healthcare works in the USA. I don’t know why, the complete system looks broken. I can only tell you we pay less for healthcare here in Europe and we don’t have to call unless it’s really complicated and a rare situation. I’m sorry if that sound a bit off and doesn’t help…
Several decades ago in the USA, healthcare was affordable to working class people. It wasn’t cheap, but it was at least affordable to middle class people. It certainly wasn’t great even back then, because in my view healthcare is a basic human right. And poor people (especially minorities) had limited or no access. But even then, it was still better than the shit show we have today.
Anyway, what happened was some large corporations like IBM and others started offering an executive perk they called “major medical”. This was to help pay for expensive, unexpected medical expenses. It was a nice perk for the country club set. But like anything with money attached to it, some people got together and said, “Gentlemen, how can we weaponize this and take ALL the money?”
So, over time, it became the “standard practice” to tie your health insurance to your employer. This introduced a ton of friction into the system and created an entire ecosystem of rent-seekers who add no value to the patients or providers but charge a fee just because they exist.
Hmmh. I recently learned about that. Seems to be roughly 1980 (Reagan era?) when things started going really sideways and nowadays it’s just bad beyond words…
Source: https://en.wikipedia.org/wiki/Healthcare_in_the_United_States
That graph is depressing and familiar. It’s insane how we think we’re “the greatest country” in the face of cold embarrassing facts.
That was the graph that opened my eyes a bit back in another discussion. I knew that people were dying in the States because they can’t afford insulin/medication/treatment. But I somehow thought they were at least paying less for healthcare and just poor and society didn’t care about people in need. But it’s way worse. They are dying 2 years earlier WHILE paying twice as much for healthcare. And ruined financially if anything happens to them or their loved ones.
And all of that is a scheme to rip off everyone. Sadly a quite successful scheme for decades already. I mean I’m really amazed by the extent. And I wonder if it were possible to adopt another style, give healthcare to everyone plus every citizen an additional $5.000 for free each year. I don’t really see that happening though. Every government in the past decades, no matter their color, has contributed to keep that graph going in this direction.
Edit: And I’d like to see that diagram for a few other countries. Not just against Europe, Japan, Australia, Israel and Korea.
A significant portion of our population is brainwashed into the idea that everything should be privatized for-profit. Even people who are profoundly harmed by this. They have been indoctrinated to despise and be revolted by socialized-anything.
I’ve seen that graph before. One of the ways I interpret it is that as one ages we contribute less (money) to the system, mainly in taxes, SS, Medicare taxes. When we become old and retire we become a burden on the system that we’ve contributed for decades. The “system “ whoever that may be no longer cares about our health and longevity because they already have their money and the lower our life expectancy the less they have to pay out. Collect for decades only to pay out for a few years and we die up to a decade earlier than other countries on average.
I don’t think that’s what the graph shows at all. It shows what the average person spends on healthcare each year versus what they get out of it (life expectancy.)
It does so for several countries and shows how things changed over the last half a century. The steeper a line of a country is, the more the healthcare system and medicine has improved. The flatter a line is, the more money you’re pumping into the system for less benefit. And medicine should improve. We’ve made quite some progress since the 1970s and found cures to ilnesses that were a death sentence back then.
That people need more treatment if they’re old is a true fact. But it’s not really depicted in this graph. Sure it’s somewhere in the numbers but you’d need a different diagram for that. Keep in mind that also in the 1970s people grew older and there were old people around… People had grandmas back then. And also people nowadays are healthier for a longer period of time and also retire later. These things work against what demographics makes worse. But it also doesn’t cancel out each other. You’d need a more comprehensive study and more number to tell, not just speculation which is most certainly wrong.
But the mere fact that the line for the USA is such an outliar shows that there is something severely wrong with that healthcare system. And you can see when it started and that it steadily continues this way. Either you’re a different species and medicine works differently for US citizens than for Europeans, or you have severely unique circumstances in the country, or you’re just getting ripped off and some people get rich with the billions that don’t contribute towards health.
And that you someday retire and become a burden on the system is how it’s supposed to be. That’s why you paid all the money during the decades you worked, despite not being sick (yet.)
And there are some more pecularities in the graph. For example you can see that life expectancy is actually decreasing(!) in the last years. That could depict the drugs (Fentanyl deaths) and the rise of suicide in the last years. I’m not sure but these could be possible explanations. Also im Germany where I live mortality rises. Especially during the Covid years and somehow it affects people from the eastern parts of Germany more than people from the western part of the country. That’s all not in this graph however and the reasons are complex. I’m not sure what the cause is for the decline shortly before 2018. People speculate it’s influenza waves and things like that.
Yeah, I’m in EU and I have never ever contacted my health insurance since the day I chose it. They just send me new insurance cards every couple of years and once they sent a letter that said they have an app that lets me get doctors appointments more easy etc.
Hah, I had an app that lets me get appointments and prescription renewals …. The app would send an effing fax to the doctors office where it would sit in a pile until I called to ask the same thing
I agree with you. I am fortunate enough to have insurance now which covers the things I need without much of a hassle. But at my last job, they had an insurance provider who was very fond of losing paperwork, making up bullshit, and not really delivering on what it was supposed to do.
I recall complaining about this to a co-worker, who was incredulous that I would be so lazy. You see, he had a whole system of who to call and where to file what paper to get the results he wanted… sometimes. But I was amazed at how much effort he put in to work around a system that was totally artificial, inserted between patients and doctors for no other reason than to skim money. And he was proud of it! He was convinced that putting in all this effort showed that the system was working as intended. (I should add that he is the stereotypical “small government” conservative, or at least was until Donald Trump convinced him that the best use of Government was to be a tool to beat up Liberals and Immigrants with.)
It’s like these people are convinced that if something doesn’t require a huge amount of effort, it must be worthless. Meanwhile, their boss’s boss’s boss merits their large salary and stock compensation specifically because they are enough of a psychopath to make monumental decisions on as little data as possible. I am starting to feel bad for most ordinary people who vote for conservatives. Not only are they getting gaslit, but they prefer it that way!
I think Obamacare has gone about as far as we can go in reforming Healthcare while half the country is so masochistic.
It’s sad how effective punching down on patients and workers is. They always use the bullshit Protestant work ethic thing to call folks lazy when we complain about the systemic abuses. And it’s a crime how the corporate bloodsuckers that pay little or no taxes want to frame the working class guy who needs reasonable accommodations and services as a “parasite”.
Unfortunately a big chunk of the voters fall for this song and dance year after year. Like your friend.
It’s all a “culture wars” diversionary tactic to keep us fighting each other instead of demanding systemic changes as a unified class of non-billionaires vs the elites.
Bet that coworker lived doing the artificially confusing and overly complicated taxes too!
Because if they pay out, they make less money, far cheaper to get you to give up trying - which is what a lot of people will do because it’s designed to be an exhausting system.
Healthcare practices vary in how much they are willing to run interference for you on insurance. Most of them will at least try “pretty hard” to help with the claims because it’s good for their income stream to do so. However, sometimes you’ll find yourself using a provider who can’t be bothered with staffing up and/or supervising it to make sure it gets done. In my (limited, anecdotal) experience, this seems to happen more often with specialists or niche providers.
Or sometimes it’s your insurance plan. It might have so many byzantine rules and/or shitty admins that it’s just too much work for even a crackerjack provider staff to deal with it. So they end up kicking it back to you and saying “good luck”. If this happens enough, the practice may stop accepting that plan in the future.
It so you give up.
If you fail to run the gauntlet, or give up in frustration, the insurance company doesn’t have to pay. They could absolutely make this process easier, but the incompetence works in their favor.
I’ve lived in single payer countries as well as in the US, and the incompetence is the same everywhere. In my experience the big difference is in universal healthcare countries the rules are very strictly defined and there’s very little scope for exceptions, so either you qualify or you don’t. The other issue is that even if you qualify there’s often a multi-month waiting list for treatment.
