It’s also pretty shocking to find out what y’all have to deal with. German healthcare can be mildly annoying at times (the bureaucracy of finding the right form to fill out to get something like psychotherapy approved can be tedious), but I’ve never heard of anyone here getting their request dismissed without a good, legally predefined, reason. Apparently American Healthcare companies can just say no just because they feel like it?? whack.
my ukrainian coworker recently was dealing with something with our healthcare company and she was like “wait. y’all weren’t exaggerating? you actually have to fight for your right to get medical care here?” and we were like “we been saying. america’s online presence is a cry for help”
Initially, yes. Then you appeal the claim. Then your appeal gets denied. Then you call with the claim number and challenge the result of your appeal. Then the insurance company contacts the doctor to verify necessity. If your doctor successfully convinces your provider that they know more about medicine than a corporate insurance company, then you’ll be the lucky recipient of an approval.
Source: 20+ specialist appointments and scans per year for the last five years
I’ll never forget when I was prescribed a medication for a heart condition, literally crucial for me to continue living, and the insurance company denied the claim. Without insurance it was $600/mo at a time when I was making $5.25/hr.
Coworker that was a double breast cancer survivor was denied coverage for the drug that kept the cancer from coming back again. Like, they want you to die so you don’t cost them money.
Maybe this is the time Americans actually think about the value of an institution who’s only purpose is to extract wealth from normal people.
I really don’t get how your insurance company can be like “you need this treatment to live” (Or anaesthesia is vital for an operation, and an insurance company just be like “nah…”.
I remember the phone call with the insurance clearly. I asked the lady on the phone, “I don’t understand - my doctor says this is crucial but you’re saying I can’t have it?” And she said, verbatim, “I’m not saying you don’t need it or can’t have it. I’m saying we’re not going to pay for it.” And when I told her “Then you’re giving me a death sentence.” she went silent. I ended up stretching my one month doses over 3 months so it was “only” $200/mo.
Then I feel for her…end of the day we all only go to work cause we have to.
My GF used to work for a company that provided in home care and facilities for the elderly, there were people whose job it was to phone up families and basically say “I know <relative> died last week but you owe us this money/equipment…”. That mustn’t have been fun.
She probably had no authority to do anything about it. Delay, deny, defend…she’s part of deny/defend. She’s there to tell you that you were rejected, not to explain why or appeal. If a doctor calls, they’ll go into “you didn’t submit X step of paperwork declaring the patient has Y, and so even though you noted it elsewhere we’re denying”
Going off script risks her job, and for what? By design, she can do nothing to actually help
It’s actually an easy translation. “Nah” means “we don’t anticipate you being capable of paying us more than what we’d have to spend to give this to you, so if you can’t find cheaper the more lucrative option is letting you die.”
It’s been real popular to knock Americans around these parts for a while, I’ve noticed, and we certainly earn our share of it. But I get the sense Europeans don’t quite understand how bad things have gotten here and how truly cornered and out of options many of us feel. Folks are being squeezed past their breaking point.
Impossible to guess exactly when that’ll be true for enough people to cause something dramatic, but any populace has its limit and we seem to be approaching it. I really hope we start heading the other direction soon, but this incoming administration does not make that look likely.
Well, I don’t really mean this as a positive per se, but it’s entirely possible the incoming administration tosses a few crumbs to keep things just simmering (while of course further dismantling everything of any real value). That’s been the playbook for the power brokers for some time. I didn’t mean there was some possibility there’d be any actual good. The incoming folks are essentially the most predatory version of that class of people, I’m under no illusions.
Edit to add: I tentatively reject the idea that your country is not far behind, respectfully. That’s my point. I am fairly sure the differences are bigger than you realize.
Ha, you’re right, and our countries are of course more closely linked than maybe I realize. Hope it didn’t sound like I was diminishing your struggles. Cheers and best wishes!
i think in a lot of ways our legacy as a british colony has never really eroded. our countries have been consistently aligned for a long time for better and for mostly worse for both countries
It’s been real popular to knock Americans around these parts for a while, I’ve noticed, and we certainly earn our share of it. But I get the sense Europeans don’t quite understand how bad things have gotten here and how truly cornered and out of options many of us feel. Folks are being squeezed past their breaking point.
Comon, it’s not as bad as Russia. Except to have to pay to visit dentist. And optometrist. And surgeon, therapist and any other doctor. And separately pay for cast if you break bone. And pay for ambulance. And for anything else. Ok, maybe not better then Russia, but at least budget for healthcare was not stolen to build Putin’s palace. Even if only because you don’t have any budget for healthcare. Fine, America is worse than my shithole, but at least you don’t have to deal with Putin and his “small victorious war”.
My friend, you actually got me hahaha. I started out feeling like “ah fuck, here I am complaining about how things have gone for us, who am I to complain compared to this guy?” Well done lol
TBH it was hard for me to wrap my head around Europe’s healthcare, I’ve was always told that it was similar to where I’m from (Scotland) but I would read about insurance and employer healthcare and be really confused, since up here everything (prescriptions, glasses, teeth) is free and there’s no insurance.
There’s been stories of tourists asking where to pay / show their insurance card and the receptionist at the hospital would shrug and say that they don’t know what to do.
I’m from (Scotland) but I would read about insurance and employer healthcare and be really confused, since up here everything (prescriptions, glasses, teeth) is free and there’s no insurance.
I’m in England, and I know there is a difference, but I highly doubt private insurers haven’t made it up your way, and are slowly carving the NHS hollow from within just like they are down here (a very superficial look confirms that hundreds of millions are already being spent on private firms carrying out NHS Scotland work).
People get denied NHS treatment all the time, if not directly (and yes, some directly, like trans people, but also disabled people with long term and complex cases, which I know from personal experience), then via cuts and waiting times.
Sure, we have it better than the yanks, and you up north have it better than us down south, but please lets not pretend our NHS is in good shape (or hands, Starmer has made it clear that he is for more privatisation), providing prompt and accessible healthcare, or not going the exact same way the US healthcare system is (often being bought up by the very same companies).
The last thing we need is to be getting complacent.
That sounds nice and simple! I don’t 100% understand the German system either, I just know that it costs about 15% of my income each month (half is paid by my employer), and if my doctor writes a prescription on a pink sheet of paper, the meds don’t cost me more than like 5-10€ (apparently it’s some sort of co-pay thing).
We also have a system for private health insurance, because people employed by the government aren’t allowed to benefit from the government-subsidized health insurances. But I’m not earning enough to know specifics about it haha
It’s all gone electronic very recently, but the “pink” medicine is considered optional in a way. It’s mostly QOL-improving stuff like aspirin or ibuprofen. It used to be free, but the decision has been made to further disadvantage the poorest part of society for which 5 € can make quite a difference.
Interesting! Is there a color for medicine that is absolutely necessary? I know that when I was seriously messed up and needed Antibiotics those were put on a pink slip, idk how optional those were :o
I’ve also seen the green papers, which are for completely self-paid stuff (so like, weird unproven teas and supplements)
It was even worse before the ACA. Before then, insurance could kick you off your plan for no reason and refuse to cover new users for pre-existing conditions.
In practice, the way this worked was quite simple: You got cancer, your insurance canceled your plan, and then they would refuse to give you a new plan because you had a pre-existing condition - cancer.
I had a knee surgery last year and while dealing with my insurance company was a pain about equal to the surgery itself, they ultimately had to pay for rehab because they couldn’t disagree that rehab after a surgery like this is absolutely necessary
When I went in about my hernia, because it was hurting really bad, they ended up finding another hernia that wasn’t causing any pain. But because the other one wasn’t causing any pain, UHC denied my surgery to fix the one that wasn’t causing pain because it wasn’t deemed medically necessary.
So basically when I went in to fix the one hernia, the doctor couldn’t fix the other hernia because UHC wouldn’t cover that half of the surgery.
So I’m sitting here years later with a hernia that I’m just waiting on the day that it starts hurting so that I can go spend another few thousand dollars fixing all because UHC didn’t want to pay for preventative maintenance.
Edit: And I almost forget the best part, after the surgery they took 5 months to pay because they wanted to ensure that the other hernia wasn’t fixed. And because they took so long to pay when I had to pay it was a nightmare for me using my FSA account for it.
Do you know what kind of things might get turned down and what would count as a good reason? And if your claim gets turned down, do you have any options other than “go bankrupt or suffer” like us in the U.S.?
I’d take hunting for the right form any day over being told to hork down ibuprofen for what I know is a serious problem, and hope the insurance company might eventually deign to approve an MRI. There’s a reason a lot of Americans are out of shape, and it’s not just because of desk jobs and junk food.
The one time I’ve personally heard about a claim being denied (at first) was when a person who is in group therapy wanted to do their insurances online solo therapy offer as well. Technically, the law says that doing solo therapy in addition to group therapy is fine, but that specific online program was intended as a catch-all offer for people who can’t find a therapy spot at all. But I think the insurance gave in and let them take it anyway after a call or two.
I know insurances are allowed to not cover it if you want wacky treatments like chiropractors and acupuncture. Some treatments, like tooth cleaning, are limited to I think twice a year, after that you have to pay the dentist out of pocket. There are also certain meds that count as “lifestyle drugs”, which are not covered by default. I know that Mounjarno (the weight loss version of Ozempic) was one of them. So if your doctor decides to prescribe it, they write it down on a green sheet of paper to signal that it’s self-pay only. There was some sort of system to ask the insurance for an exception, but I’ve never heard of anyone needing to do that.
What I’ve never heard either is insurances denying MRIs or anything like that. I don’t think they’re allowed to do that here?? I’ve only ever had one MRI and a few X-Rays taken, but when I did I wasn’t even thinking about the insurance because whenever something isn’t covered by insurance doctors will usually wait a second and ask whether you’re sure that you want to pay yourself. If they don’t ask, it’s fine.
It’s also pretty shocking to find out what y’all have to deal with. German healthcare can be mildly annoying at times (the bureaucracy of finding the right form to fill out to get something like psychotherapy approved can be tedious), but I’ve never heard of anyone here getting their request dismissed without a good, legally predefined, reason. Apparently American Healthcare companies can just say no just because they feel like it?? whack.
my ukrainian coworker recently was dealing with something with our healthcare company and she was like “wait. y’all weren’t exaggerating? you actually have to fight for your right to get medical care here?” and we were like “we been saying. america’s online presence is a cry for help”
Thankfully, your coworker was from ex-republic. And not any, but from U in RUB.
Initially, yes. Then you appeal the claim. Then your appeal gets denied. Then you call with the claim number and challenge the result of your appeal. Then the insurance company contacts the doctor to verify necessity. If your doctor successfully convinces your provider that they know more about medicine than a corporate insurance company, then you’ll be the lucky recipient of an approval.
Source: 20+ specialist appointments and scans per year for the last five years
I’ll never forget when I was prescribed a medication for a heart condition, literally crucial for me to continue living, and the insurance company denied the claim. Without insurance it was $600/mo at a time when I was making $5.25/hr.
And this applies to all treatment.
Coworker that was a double breast cancer survivor was denied coverage for the drug that kept the cancer from coming back again. Like, they want you to die so you don’t cost them money.
Maybe this is the time Americans actually think about the value of an institution who’s only purpose is to extract wealth from normal people.
My dad survived colon cancer but then any further colonoscopy was denied for five years because it was no longer “preventative”.
I really don’t get how your insurance company can be like “you need this treatment to live” (Or anaesthesia is vital for an operation, and an insurance company just be like “nah…”.
I remember the phone call with the insurance clearly. I asked the lady on the phone, “I don’t understand - my doctor says this is crucial but you’re saying I can’t have it?” And she said, verbatim, “I’m not saying you don’t need it or can’t have it. I’m saying we’re not going to pay for it.” And when I told her “Then you’re giving me a death sentence.” she went silent. I ended up stretching my one month doses over 3 months so it was “only” $200/mo.
That’s inhumane. I wonder if the person on the other end of the phone just didn’t give a shit or what…
I think she did. I could hear pain in her voice.
Then I feel for her…end of the day we all only go to work cause we have to.
My GF used to work for a company that provided in home care and facilities for the elderly, there were people whose job it was to phone up families and basically say “I know <relative> died last week but you owe us this money/equipment…”. That mustn’t have been fun.
She probably had no authority to do anything about it. Delay, deny, defend…she’s part of deny/defend. She’s there to tell you that you were rejected, not to explain why or appeal. If a doctor calls, they’ll go into “you didn’t submit X step of paperwork declaring the patient has Y, and so even though you noted it elsewhere we’re denying”
Going off script risks her job, and for what? By design, she can do nothing to actually help
It’s actually an easy translation. “Nah” means “we don’t anticipate you being capable of paying us more than what we’d have to spend to give this to you, so if you can’t find cheaper the more lucrative option is letting you die.”
Yeah, they’re in it to make money, not to provide a health service. I forgot that bit.
It’s been real popular to knock Americans around these parts for a while, I’ve noticed, and we certainly earn our share of it. But I get the sense Europeans don’t quite understand how bad things have gotten here and how truly cornered and out of options many of us feel. Folks are being squeezed past their breaking point.
Impossible to guess exactly when that’ll be true for enough people to cause something dramatic, but any populace has its limit and we seem to be approaching it. I really hope we start heading the other direction soon, but this incoming administration does not make that look likely.
Your incoming administration won’t do a thing for your average person. If it’s any consolation we Brits aren’t far behind.
Well, I don’t really mean this as a positive per se, but it’s entirely possible the incoming administration tosses a few crumbs to keep things just simmering (while of course further dismantling everything of any real value). That’s been the playbook for the power brokers for some time. I didn’t mean there was some possibility there’d be any actual good. The incoming folks are essentially the most predatory version of that class of people, I’m under no illusions.
Edit to add: I tentatively reject the idea that your country is not far behind, respectfully. That’s my point. I am fairly sure the differences are bigger than you realize.
Appreciated. Whatever you do the U.K. likes to copy though. I suppose it’s like karma for introducing Thatcher and Reagan.
Ha, you’re right, and our countries are of course more closely linked than maybe I realize. Hope it didn’t sound like I was diminishing your struggles. Cheers and best wishes!
You had a point because although incredibly similar, there are differences. I should have said I was speaking relatively.
What a pleasant exchange _
i think in a lot of ways our legacy as a british colony has never really eroded. our countries have been consistently aligned for a long time for better and for mostly worse for both countries
Slight correction the incoming administration is likely to do quite a bit for the average person.
All of it’s going to be bad, but they’re gonna do quite a bit.
Edit: Or one way to look at it is that they’re going to do a lot to the average person not for the average person.
True that.
Comon, it’s not as bad as Russia. Except to have to pay to visit dentist. And optometrist. And surgeon, therapist and any other doctor. And separately pay for cast if you break bone. And pay for ambulance. And for anything else. Ok, maybe not better then Russia, but at least budget for healthcare was not stolen to build Putin’s palace. Even if only because you don’t have any budget for healthcare. Fine, America is worse than my shithole, but at least you don’t have to deal with Putin and his “small victorious war”.
My friend, you actually got me hahaha. I started out feeling like “ah fuck, here I am complaining about how things have gone for us, who am I to complain compared to this guy?” Well done lol
TBH it was hard for me to wrap my head around Europe’s healthcare, I’ve was always told that it was similar to where I’m from (Scotland) but I would read about insurance and employer healthcare and be really confused, since up here everything (prescriptions, glasses, teeth) is free and there’s no insurance.
There’s been stories of tourists asking where to pay / show their insurance card and the receptionist at the hospital would shrug and say that they don’t know what to do.
I’m in England, and I know there is a difference, but I highly doubt private insurers haven’t made it up your way, and are slowly carving the NHS hollow from within just like they are down here (a very superficial look confirms that hundreds of millions are already being spent on private firms carrying out NHS Scotland work).
People get denied NHS treatment all the time, if not directly (and yes, some directly, like trans people, but also disabled people with long term and complex cases, which I know from personal experience), then via cuts and waiting times.
Sure, we have it better than the yanks, and you up north have it better than us down south, but please lets not pretend our NHS is in good shape (or hands, Starmer has made it clear that he is for more privatisation), providing prompt and accessible healthcare, or not going the exact same way the US healthcare system is (often being bought up by the very same companies).
The last thing we need is to be getting complacent.
I’m northern English, and work for the NHS. I’m honestly quite scared.
I wish it were any consolation at all to say you weren’t alone in those feelings…
That sounds nice and simple! I don’t 100% understand the German system either, I just know that it costs about 15% of my income each month (half is paid by my employer), and if my doctor writes a prescription on a pink sheet of paper, the meds don’t cost me more than like 5-10€ (apparently it’s some sort of co-pay thing).
We also have a system for private health insurance, because people employed by the government aren’t allowed to benefit from the government-subsidized health insurances. But I’m not earning enough to know specifics about it haha
It’s all gone electronic very recently, but the “pink” medicine is considered optional in a way. It’s mostly QOL-improving stuff like aspirin or ibuprofen. It used to be free, but the decision has been made to further disadvantage the poorest part of society for which 5 € can make quite a difference.
Interesting! Is there a color for medicine that is absolutely necessary? I know that when I was seriously messed up and needed Antibiotics those were put on a pink slip, idk how optional those were :o
I’ve also seen the green papers, which are for completely self-paid stuff (so like, weird unproven teas and supplements)
I’m English, I’m jealous of the eyes and teeth thing.
Scotland seems almost utopian.
It was even worse before the ACA. Before then, insurance could kick you off your plan for no reason and refuse to cover new users for pre-existing conditions.
In practice, the way this worked was quite simple: You got cancer, your insurance canceled your plan, and then they would refuse to give you a new plan because you had a pre-existing condition - cancer.
I had a knee surgery last year and while dealing with my insurance company was a pain about equal to the surgery itself, they ultimately had to pay for rehab because they couldn’t disagree that rehab after a surgery like this is absolutely necessary
I’ve got UHC and I recently had a hernia surgery.
When I went in about my hernia, because it was hurting really bad, they ended up finding another hernia that wasn’t causing any pain. But because the other one wasn’t causing any pain, UHC denied my surgery to fix the one that wasn’t causing pain because it wasn’t deemed medically necessary.
So basically when I went in to fix the one hernia, the doctor couldn’t fix the other hernia because UHC wouldn’t cover that half of the surgery.
So I’m sitting here years later with a hernia that I’m just waiting on the day that it starts hurting so that I can go spend another few thousand dollars fixing all because UHC didn’t want to pay for preventative maintenance.
Edit: And I almost forget the best part, after the surgery they took 5 months to pay because they wanted to ensure that the other hernia wasn’t fixed. And because they took so long to pay when I had to pay it was a nightmare for me using my FSA account for it.
Fuck UHC.
Numerous times since the 50s USA health insurance companies have decided some policies are costing too much money, so they have cancelled the policy.
Do you know what kind of things might get turned down and what would count as a good reason? And if your claim gets turned down, do you have any options other than “go bankrupt or suffer” like us in the U.S.?
I’d take hunting for the right form any day over being told to hork down ibuprofen for what I know is a serious problem, and hope the insurance company might eventually deign to approve an MRI. There’s a reason a lot of Americans are out of shape, and it’s not just because of desk jobs and junk food.
The one time I’ve personally heard about a claim being denied (at first) was when a person who is in group therapy wanted to do their insurances online solo therapy offer as well. Technically, the law says that doing solo therapy in addition to group therapy is fine, but that specific online program was intended as a catch-all offer for people who can’t find a therapy spot at all. But I think the insurance gave in and let them take it anyway after a call or two.
I know insurances are allowed to not cover it if you want wacky treatments like chiropractors and acupuncture. Some treatments, like tooth cleaning, are limited to I think twice a year, after that you have to pay the dentist out of pocket. There are also certain meds that count as “lifestyle drugs”, which are not covered by default. I know that Mounjarno (the weight loss version of Ozempic) was one of them. So if your doctor decides to prescribe it, they write it down on a green sheet of paper to signal that it’s self-pay only. There was some sort of system to ask the insurance for an exception, but I’ve never heard of anyone needing to do that.
What I’ve never heard either is insurances denying MRIs or anything like that. I don’t think they’re allowed to do that here?? I’ve only ever had one MRI and a few X-Rays taken, but when I did I wasn’t even thinking about the insurance because whenever something isn’t covered by insurance doctors will usually wait a second and ask whether you’re sure that you want to pay yourself. If they don’t ask, it’s fine.
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