And your doctor will have to fight with the insurance company over the phone for an hour to do a pre-auth. When my doctor wants to perform something or give a certain treatment not covered, he assures me he will make this long and stressful call. I really wonder what they are discussing and what goes on in these conversations...
cause of death: not knowing the cheat code to getting treated like a human being that exists for some reason
It's hard as one having free (state paid) healthcare in EU, to imagine anything but just going to the doctor, and the doctor seeing to it, that you get the correct treatment.
No paperwork, no hassle, no bill.
I can't imagine why USA hasn't introduced something similar yet, but prefer all that bureaucracy that only makes the whole process way more expensive. Just to make sure some unemployed poor guy doesn't get free treatment!!
USA is a psychopathic society.- carve the word "deny"
- carve the word "delay"
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Good luck getting them to give you an answer at all to any of those questions. You're going to need to get a lawyer and spend a lot of money and time getting any response at all from anyone who actually works for the company, since the customer service doesn't have access to any of that information and they wouldn't be allowed to reveal it even of they did. It's an insurance system, not a social service system where you have some kind of rights.
Insurance companies are designed to find any reason possible not to pay a claim, whether it's homeowner's insurance, liability insurance, or any other type of insurance. And they have plenty of lawyers on staff so they're happy to make the lawsuit take long enough to cost you more than the claim is worth to you and it barely costs them anything.
I guess I get hung up on the whole:
Everyone knows this is true; it's not a secret in any way. But it's a violation of a number of regulations
bit.
So it seems like we could very easily stop these corporations from literally killing people with already existing regulations we are just choosing not to. COOL.
Semi related, recently I was referred to what I thought was a “specialist” from my doctor for a thing but I couldn’t myself determine if they were in-network with my insurance. Turns out what was implied to be a specialist was actually just a company that determines where to send people for this specific service, so we’re at the point that a primary care provider is working with a 4th party to deal with the 1st party and the 5th party is running services at the 2nd party and I am 1) the person responsible to figure out this insanity and 2) will likely be billed an obscene amount of money for something that should’ve been a 1:1 convo with a doctor and a hospital because one or five of the likely 30 people across 8 companies missed an email. (And you know all those people are they themselves dealing with the same nightmare and probably being paid a paltry $15/hr.
I jump straight to filing a complaint with the Department of Insurance. The insurance company immediately gives me the authorization every time.
Can they respond to the DOI that I haven't followed proper escalation procedures? Sure. But they just fold because they know they're in the wrong and I am clearly willing to escalate matters.
This is more than mildlyinteresting.
I tells ya it’s a situation awful enough to drive a man to stay in a hostel.
There are also advocates who can help you navigate the insurance nightmare. We had to do it when I needed surgery a few years ago.
Its only illegal once you are prosecuted for it. That is how businesses operate. Its not just regulation we need but a justice system that has some teeth
The tragedy, in my opinion, is that Americans have to do this stuff at all. You need a tactic to get the service you're literally paying for out of your own pocket.
I hate how useful this is.
This is what I want to see.
Beat them back at their own game.
It is like when police say they wish that policing was like in The Andy Griffith Show. Tell them that everyone knew where sheriff Andy Taylor lived. Why don't you tell everyone where you live, sheriff ?
Saved this advice for future reference - thank you!
My wife's neurologist has done this with her insurance more than once. Especially the practicing out of scope or without a license. Usually she got her way. Probably the best doctor my wife has ever had.
