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How medical insurance works
(lemmy.world)
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this post was submitted on 07 Oct 2024
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My insurance that I pay a ridiculous sum of money for has started doing this neat new thing. When the doctor orders imaging, they mark it as “requested more information but never received any”, and reject the claim. They don’t actually request any additional information, and they ignore me when I contest their decision. So glad that I pay like $400 per month for this coverage.
Yes, I think that's exactly what my doctor was trying to describe. He said if they're at that point, they basically have to guess what information they're looking for other than "I'm a qualified physician that has run diagnostic tests and determined this is the best course of treatment. Here are those tests and why it indicates X and therefore requires Y."
I've had to do unnecessary labs to prove an ailment wasn't something else that some person hundreds or thousands of miles away thought it might be.
If you think you hate insurance companies, find an honest doctor and ask them what they think of the US Healthcare system and health insurance. I've never seen a doctor so worked up and angry than when discussing the current medical system.
Edit: this guy is fun to watch on this topic: https://youtu.be/s33AVskz3T8?si=Qqx2nAJjguMOxnNL
It's like calling your ISP and you can see the fucking wire dangling down from the pole but they won't continue unless you turn the modem off and on first.
I worked in Pharmacy claims remediation for a while. Fun times. Never again. Why the fuck is my barely-above-minimum-wage-ass the one that has to tell medicaid that little Timmy is gonna die if he doesn't get his chemo?
Because it's more profitable if Timmy dies. Why would they want effective, highly paid workers doing the job of trying to cut into their bottom line?
It's a modern war for a modern economy.
Instead of pitting the poor and destitute soldiers of opposing countries against each other in bloody combat, we have opposing corporations (in my case, the pharmacy and the insurance company) pitting their minimum-wage phone-jockeys against each other in a battle of wits when death is on the line.
Fortunately for our patients, I'm part Sicilian.
Thank you for your service o7
No, unironically though, helpful folks in the healthcare industry despite the system's labyrinthine and hellish construction have kept me from several major breakdowns. You going to bat for the patients has likely saved at least one person from a psych ward visit.
I file a complaint with the department of insurance instantly when they deny anything. I don't negotiate with them for 3 months first, I jump straight to sicking the Feds on them and my doctors have always provided me every bit of data I need and cheered me on.
And I've won every time. It annoys me that I have to do it, but I enjoy that it costs the insurance extra every time.
I didn’t even know that was an option. Thank you! I will do that from now on.