re: How many of you have truly been screwed over by an insurance company?

quote:

---

And on that note, one of the biggest problems your garden variety consumer has with insurance is that they don't fully understand what's covered in their own policy. So when it's time to make a claim, they're pissed off because they don't have the coverage they thought they had.

---

So if you don't specifically get coverage for, say, gallbladder cancer, it's perfectly fine for you to be rejected for any types of screening, treatment, or surgery?

Are we supposed to piecemeal coverage for every single thing we could possibly die from?

If people really think that's acceptable, we're going to see more murdered health insurance execs, and they are going to have deserved it.

Travelers is a dishonest company.

We're screwed over by any insurance company every month when we pay our bill

I needed jaw surgery. How my jaw lined up I was grinding my teeth away. Tried everything possible outside of surgery.

Orthodontist wrote a letter
Dentist wrote a letter
Oral surgeon wrote a letter
They all stated it was a medical necessity, and if it wasn’t performed my teeth would be grinded away by the time I was 40.


Insurance denied me multiple times saying that the surgery was cosmetic

quote:

---

And this doesn't even get into the fact that's it's a failed internal medicine guy arguing about orthopedic procedures. It's often not even their specialty, but they're supposed to know better than the doc who actually does it for a living

---

I hope my attempts to deliver my side of the story to be both believable and easy to follow. It is extremely frustrating, and in the right company, my side of the story contains a lot more details and a lot more expletives.



An example:
CT chest to rule out lung cancer is a recommended screening procedure
Incidental finding of a lung nodule on a CT chest in the right patient essentially follows the same protocol.
In any which way, the patient needs a CT scan every 6 months for 2 years, if the mass doesn’t grow, they don’t need any more scans. If it grows, there’s a high enough chance of cancer or weird infection that they need a significant escalation of care. But it’s not debatable that they need a scan every 6 months.
I had a guy who had 3 scans, 6 months apart.
Insurance denied the 4th scan (at 2 years)
They quoted the guidelines that I was very much following as their reason for denial.
They forced me to spend 25 minutes (this is roughly two patient encounters worth of time. It isn’t insignificant. Again- not worried about the income I could have generated on two patients. Worried about telling two patients, “nah. You can’t bring Grandma in for her cough today. I have a meeting with someone who can’t read to do.”) on the phone across two separate days to read their guidelines back to them and get immediate approval.


I went ahead, after the quick approval, and asked my “peer” what her specialty was.
Urology.
I then asked if she had a valid Louisiana medical license. She responded that she isn’t obligated to answer that question or whether she was practicing at all.

Now, I get that the general approach to most primary care from the general public is that it’s fairly “easy” and the “anyone can do it” field of medicine. And I get that it doesn’t garner very much “respect” or “clout” but that never really bothered me- I was born with a fairly small penis, and it still isn’t anything to brag about. But I’m yet to meet a urologist who keeps up with any of the general cancer screening guidelines that don’t pertain to their surgical organs of interest, and I find it incredibly frustrating the amount of time my office spent (probably another hour all told) submitting the order, getting denied, resubmitting documentation, getting a time set up for us to meet for me to read someone lol exactly why they denied it and literally just explain that they read their own rules wrong. Objectively.
So my office loses about 90 minutes of man hours for me to honestly just apply simple logic/understanding to a dick doc about the lungs.



This, for the record, is an extremely simple case with an objective right answer. The problem with medicine is that if an algorithm and linear logic worker, doctors would be entirely useless outside of procedures. But it doesn’t. And there are plenty of grey areas with good points on both sides. More recently I spent 45 minutes arguing with one who I’ll actually accept/respect as a peer in terms of qualifications regarding the particular care. The short of it is “quadriplegic, bed sores, just got out of the hospital, skilled nursing says she’s too sick for them (at least four have said so) and I wanted to put her in a rehab hospital (and was talking to a rehab doctor). Eventually she decides the patient isn’t sick enough to need a rehab doctor to see her. And she’s too sick for a nursing home. She tells me, “look. We can agree the patient doesn’t need to go home.” To which I responded “the patient is currently at home. And if she isn’t admitted into the rehab, she’ll end up in the ER 3 times in the next 2 months.”
In the end, she eventually still denied me.
Patient has been admitted twice again so far and sent back home by a hospital I have no affiliation with, they’ve denied her an LTAC stay as well. So my office sent four more referrals to four more nursing homes today to try to find someone to care for this patient who the insurance thinks is too sick to go to a rehab or LTAC.

You may think, “well, those hospital stays are going to cost the insurance way more than a short stay at a hospital that helps a patient improve their functional status and act as a springboard to return them home in a safe environment to take care of their activities of daily living,” but don’t worry. The insurance company won’t give the hospital a dime because the hospital has discharged her less than 30 days ago since she was too sick for the nursing home and not sick enough for the two steps between the hospital and the nursing home.
And then they’ll also use that data to justify paying my office less, because we are doing too poor a job of managing her care at home and should have gotten her to go to a nursing home.

Two summers ago I was stopped at a light early on a Saturday with someone stopped behind me, and then third truck guy “fell asleep” and hit the second truck full speed and pushed it into my truck.

Middle truck was older, smaller, and completely destroyed. They took the lady driving it to the hospital. Just wrecked my bumper and tailgate

I called the “sleeping” driver’s insurance the following Monday. Told them who I was, got transferred to a claims person, and the first thing they said was “are you lawyering up too?” Middle truck lady already had a lawyer.

I said no, just fix my truck. They paid to fix whatever the repair guys said was needed, no questions asked. The repair guy was laughing about it, he said “we’re gonna go ahead and redo the entire bed liner, get a new bed extender, and I can probably tack on a new hog logo if you want. They’re going to pay for anything for you to just go away.”

And then I found five dollars.

Not screwed per-se, but just had to go thru these random "assist" programs rather than thru my health insurance that I pay $300/month for because they were trying to screw me.

$300 insurance thru work with BCBS, said the colonoscopy would be about $3k before the anesthetist fees. They couldn't even give me an estimate, said it'd be anywhere from $4k-6k. Went thru an "assist" program and got it done for $1700 out the door with all fees and any biopsy removal/assessment included.

$300 insurance a month and they wanted $1500 for two MRIs, same assist program could do it for $800 out the door AT THE SAME FACILITY with a radiologist consult for the results if I don't go thru my insurance.

Health Insurance, and our whole healthcare system, is 100% a scam.

Health insurance is the worst. Consistently will not pay for routine stuff. Example: Mrs. FCP needed a nerve burn. Insurance would only pay if preceded by three nerve blocks. Once that was done (at their expense), they would pay for the nerve burn. This was despite the doctor telling them it would not work. So, we went through their hoops, and a few years later, when it was time to do it again, they still required another round of nerve blocks x3 before they would pay. We ended up just paying cash instead. Which, if I'm being honest, probably played right into their plan.

Actually have decent insurance, and I still regularly use a discount card b/c some medication's prior authorization wasn't renewed.

Me