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.
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.
Thank you. This is directly relevant to me. And yeah, I’m an American.
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.
Bold assumption that “we” (meaning the government) includes anyone actually reading this, because as far as I can tell the only “we” the government considers is capital owners. Unless you’re proposing some alternate method of behavior alteration.
It’s wild that Americans accept this idiotic healthcare system.
we don’t get a say, it’s up to how much money they can make off us. system is rigged hard unless you have money or a ghost gun apparentlym
We don’t get a say, but half the country will defend this shit and excuse it before they’ll accept any socialized medicine. And they vote accordingly.
Medicare for All is broadly popular. We’re just stuck with a two-party system that has been captured by corporate interests. We can’t vote third party until we get proportional representation like SPAV.
There’s too much to get into but the short version is we literally aren’t given a choice. People here idiotically vote against their own self interests and nothing anyone has tried to fix the problem has worked.
The sad part is that it doesn’t seem to matter who’s voting for who. I was a lead HIPAA security engineer at Blue Cross Blue Shield, and I architected some of the new EMR access auth systems. But I also got to see how ugly the inside of the insurance industry is. It was so depressing that even though they offered me a generous 6 figure salary, I had to quit for my own mental and emotional health. Their lobbyists have way more money than votes matter to begin with, that’s why I had to leave the industry for my own sanity.
The first card fell last week
Hey now, we have some of the best healthcare in the world if you can afford it, and healthcare stats that demonstrate just how few people that actually is.
We don’t accept it. We were born into it, and the powers that be are bought and paid for. Tis bullshit.
Unfortunately there are people here in Canada who think it’s a better system. 😕
What are their complaints about the Canadian system out of curiosity? Just the taxes?
Complaining about the taxes would be the dumbest since the US spends a lot more tax money for a lot less per capita.
From an American: I’m so sorry our idiocy is bleeding into our neighbors up North. Learn from our mistakes!
Tell everyone you know that our healthcare literally bankrupts our working class, and that we still have crazy wait times for appointments due to our staffing shortages! Tell them there is absolutely zero upside to using anything remotely like our system!
Lobbyists in Canada (and northren European countries as well) will always try to dismember any social privelages their citizens have. The payoff is huge and the risks for trying to do so are negligible. Also, they can just blame the immigrants (which is hilarious in the US and Canada since all of us are immigrants or descendents of immigrants).
This is more than mildlyinteresting.
cause of death: not knowing the cheat code to getting treated like a human being that exists for some reason
I don’t think persuasion Checks are a good way to determine who lives and who dies in real life 🥲
Go ahead and roll for persuasion on your motion to abolish persuasion checks in healthcare.
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.
The reason why this would work is because it makes it appear as though you may get lawyers involved. Yeah, they don’t want to pay out claims, but they also don’t want to get sued and lose. This is an intimidation check to make them either back down and pay out or risk potentially going to court with someone who appears to know what’s up. They’d rather just pay the bill at that point, at least as long as this doesn’t become common.
That might be the case if you got to talk to someone with the ability to do anything about it. Customer service is just able to tell you what happened, not really make any change. You can file an appeal, but you can’t really ask for much during that process. It’s mostly automated and the people who process those have very specific criteria for overriding an initial decision and have a very short period of time they’re allowed to spend on each appeal.
So the only way you’d get to someone who might be able to access any of this information is through a lawsuit. Trying to intimidate a worker with no power, no access to information, and a very high quotas is unlikely to have much effect. And these companies all have more lawyers on staff and/or retainer than any of us could afford in a hundred lifetimes. And those people aren’t going to give that information anyway. Nor would they give it to any lawyer you might hire in most cases. Proprietary information has way more legal protections than consumer rights, even in healthcare. You’d need to get a judge to order that release of confidential information about an employee or proprietary algorithm in most states, unless you convince someone to sacrifice their job, their freedom, and possibly their life to become a whistleblower.
So unless your claim is in the hundreds of thousands at least, it’s unlikely you’ll spend less on lawyers just to get your case in front of someone who can answer these questions much less compelled them to give it. Otherwise, they’d have an incentive to pay claims in good faith in the first place. So there’s no intimidation felt on their end by things like this. It just makes them get I to a defensive posture if anything, and likely reduces your likelihood of getting an appeal approved in a timely manner.
Your best bet if your claim is denied and appeal fails and you actually have a case is to hope you live in a somewhat progressive state that funds their insurance commission and has more consumer-friendly laws, and go to them for help. Federal laws aren’t going to help much unless you have evidence of fraud or you understand all the details of the case and can point to specific contract language or laws they violated already. But in that case the appeal should be all that’s needed.
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 ?
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.
Yeah, that sounds about right. After a heart attack scare, a night in the hospital and all the cardiac testing that went with it, I received a letter in the mail from some company I’ve never heard of that determined my tests were necessary and would be covered. Weeks later. Like, motherfucker, what was the other option? We all thought I was dieing… ER had me admitted in less than 2 hours. It was bad … And someone needed to contact a fifth fucking party to make sure I deserve to live?
Fuck me. I wish I could leave this place and get my family someplace sane, where they are safe.
The free market is so much more efficient than the government!
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.
It must be exhausting to be an american
Anyone taking refugees yet?
They deserve it, they worship capitalism
I do not. Many of my friends don’t either. Do we still “deserve it”?
We 100% do.
My christian mother can’t wait for society to burn and Jesus to come back.
Let it. Fucking hell. I’m so tired of protecting these fucking idiots. Good riddance.
I need to immigrate
I need to emigrate.
Gestures Broadly at Everything
Man, you got that right.
it most certainly is.
Tell me you’re American without telling me you’re American.
Ok let me try: bulletproof backpacks.
I remember when Michael Moore’s “Sicko” came out a long time ago and the country was just as riled up as they are now. History repeats. After a while they will arrest the shooter and this will all die back down.
There was a movie in the 2000s that pointed out how fucked up US healthcare is.
Very little changed.
John Q?
Kid gets denied a heart transplant so the dad takes the entire ER hostage until he gets one?
One of the best TV shows of all time is premised on our broken healthcare system.
Wrong answers only…
Fallout
House
Ya, I remember Bowling for Columbine. You’re right - it doesn’t change.
- carve the word “deny”
- carve the word “delay”
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