My $7000/mo medication has a bunch of "cost relief" programs so they can pretend that they give a shit about affordability, then when you actually try to use them they make you do like 20 phone calls over the span of several months until they finally let you enroll and when you do it only lasts for a short amount of time before they kick you off and you have to start the process all over again. I've had to miss multiple doses of the medication which is dangerous for my physical health because I don't have the money to pay for it and this process takes so fucking long.

Recently, they signed me up for some super shady thing where I pay for the medication upfront and then they pay me back after showing me the receipt. What they didn't tell me is that it has a limit for how much it will pay for, so I pay for the medication, and what a surprise, they rejected my claim and now I lost $5000 to the medication, which could have paid for a car or a semester of community college. Our healthcare system does a great job at making dying sound like a decent alternative to healthcare.

And when the patient turned out to be fine after the scan, the insurance company will try to blame that the doctors are lying so that the insurance company has to pay the hospital more It's like they thought that the doctors must be able to see through the patients' body as if they forgot that the reason for these equipments to exist in the first place is that because the doctors can't really be 100% sure about what's actual situation inside human body

Sure we could save lives by listening to doctors! But who will save our dollars, huh? The REAL value!

Fuckingcapitalists

tl;dr: It doesn't.

So here is a question:

A medical professional examined the person IN PERSON and has a requirement.

In comes the insurance to tell you your doctor is wrong and that you're perfectly fine, your doctor is basically lying to you.

Question: how the fuck did any of this ever become legal?

Prior authorization should 100% be outlawed. It's either insurance adjusters practicing medicine without a license, or insurance doctors making diagnoses without examining a patient, both of which are unethical or illegal.

Though I think the real solution is a system where every time a prior authorization denial is overruled by the DOO or a court, the insurance company has to pay punitive damages of at least $200,000 to the patient.

I work for a neurologist practice, and the amount I have to argue with insurance (and inevitably have to get the neurologist on the phone to directly request something for many) is insane. A good chunk of my job isn't providing care, but arguing with insurance that the care is necessary. These companies are actively delaying patient care, and try to blame the physician whenever possible.

Wildly infuriating, especially when the denials are worded along the lines of "we reviewed this, and don't consider it medically necessary". Motherfucker, a doctor said it was necessary and listed the clinical reasons why this test or procedure would be beneficial. Nothing has radicalized me for universal healthcare more than working in healthcare.

Also, there's this common "feature":

Dr: "You need this procedure."

Me: "How much will it cost me?"

Office Manager: "I won't know until I bill your insurance and find out if it is covered."

Me: "What is the cash price I would pay you if it isn't covered by insurance."

Office Manager: "I have no idea."

Universal health care? I don't want government making my health care decisions! We have for-profit companies for that.

Last time my doctor had to bill my insurance he said he would just run it immediately, because apparently "routine denial" is a thing where they just automatically deny it because if you really need it the doctor will then have his office try again with more justifications. He hated this a lot, because it basically meant he had to just assume first denial for no real reason and then his staff had to take the time to almost always go back and resubmit. He said sometimes he would submit it with the info, it would be denied, and then he would resubmit it two more times and suddenly it would be approved.

Like seriously, what the fuck. But only does that hold up necessary care, it also makes doctors do more bureaucratic work and hire more staff, which, of course, makes medicine more expensive. Brilliant.

American health insurance in a nutshell: https://youtu.be/llx-SaGq4Fs?si=eDIny0fqcGYFkB2a

And before non-Americans ask, yes, that's actually how it is. The humor in this video isn't from exaggeration, the comedy derives from the unexpectedly clear way the absurdity of the system is explained.

i have a friend who's a transplant patient and has been taking the same meds for over 10 years post transplant-- every year it's a furious battle with insurance who, every year, decides the meds are no longer "medically necessary" and drops coverage for it. fucking helloooo these are anti-rejection pills, the textbook definition of "medically necessary."

it's not that insurance companies are stupid, it's that they're saving money on people dying when those people don't get what they needed to live.

insurance is the biggest fucking scam of all time

Frank didn't even look at it. He just fed your claim into their computer and it spat out a rejection.

The cruelty of the US American for-profit health system is what should be uniting all US Americans in protest, riot, and violent overthrow of the current system.

They hire doctors who can't handle being practicing doctors to prop up their delusions. I've only had one on the line in a dispute and he acted quite offended when I asked for his license to prove he was a real doctor. Turns out he was barely a doctor at all. He decided instead of practicing medicine and killing people he would work for a insurance company and kill them that way.