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Come friends, and tell us of what scam the health insurance industry is trying to pull on you this week.  This was made around the time of the ACA and look at that, nothing has changed. Glossary of nonsense in the US Health Insurance Out of pocket maximum - The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits. This resets every year Co-pay - What you pay at time of service Out of network - A provider or other billable that occurs outside of your health plan's network. This could be anyone who interacts with you as a patient, down to individual doctors that turn up as a consult. You do not know who is or is not in network. The provider may not know if they are in your network or not. The health insurer may not know. You are responsible for making this determination whether you're conscious or not. Surprise bill - Surprise! One of the providers you talked to isn't in network, or isn't anymore, or we just want to see if you'll pay. Here's a random bill, have fun sitting on hold. Death panel - A government body deciding who gets care. Insurance company - A corporate body deciding who gets care. Tax - A mean and unfair and UNAMERICAN charge for services in society Health Insurance premium - A FREE MARKET charge for services that may or may not be rendered at the insurers sole discretion. HSA - Health Savings Account. This is where you park money in preparation to be gouged. It's tax-advantaged. You usually get one from your employer. This is what Americans get instead of single payer FSA - Flexible Savings Account. The same as an HSA, except with a baffling stipulation the money you put in is confiscated at the end of the year if it's still around. I'm not making that poo poo up. You usually get one from your employer. This is what Americans get instead of single payer  https://www.researchgate.net/public..._thousand_words skooma512 has issued a correction as of 01:57 on Jun 1, 2023 |
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Sep 10, 2021 19:14
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My sister has a rare genetic condition called Ehlers Danlos that affects how your body produces collagen. This leads to all sorts of whacky things like double jointedness and stretchy skin because collagen keeps your body at just the right amount of elasticity, including your internal organs. Since the condition is so rare she has to see very specific specialists that aren't covered by insurance and has to take some pretty obscure meds to, among other things, keep her bowels moving and pain levels in check. Often times insurance will just decide not to cover her specialist visits, or deny covering her medication while she's waiting for the pharmacy to fill it, because it's not on the "approved" list and ends up being very expensive. My family has pitched in for multiple surgeries to replace her shredded tissue paper ligaments and tendons with donor material so she could walk again. It took her over a year to get approval to see her current physical therapist which has changed her life in a big way, since regular physical therapy will end up dislocating her spaghetti joints. At every turn the screw is tightened just a little more, every treatment has the barrier of cost which you generally won't even know until after you've gone to the doctor. She's in a stable situation now but for years I'd get calls from her trying to talk through tears about how she doesn't know how she's going to cover her meds, and she hasn't gone to the bathroom in two weeks and she can't take the pain anymore, and why are things allowed to be like this? I'd rather just be dead. I never know how to answer those questions for her, when you're powerless in a situation like that, the overwhelming crushing sensation upon your psyche can be too much to bear. It hurt to see her in so much pain and know that all I could do was help pay her still astronomical medical debt, when you care about someone and you see them in a situation like that, you can start to feel powerless yourself. But I know she's not even close to the first person to experience this kind of awful treatment, if your body just decides to randomly go on the fritz for any reason that's not easy to treat, suddenly you're a "burden". This country has never viewed health as something we can collectively treat because we care about each other, but as a cost to be managed by businesses. And the human toll is on people like her as a result. She's worked in health care for 10 years. The same system she works every single day to support is also the same one that's completely letting her down time and time again. It's time to completely dump this system and burn it to the ground, I can't imagine anything worse than health care in America.
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Sep 10, 2021 19:42
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Beached Whale posted:My sister has a rare genetic condition called Ehlers Danlos that affects how your body produces collagen. This leads to all sorts of whacky things like double jointedness and stretchy skin because collagen keeps your body at just the right amount of elasticity, including your internal organs. Since the condition is so rare she has to see very specific specialists that aren't covered by insurance and has to take some pretty obscure meds to, among other things, keep her bowels moving and pain levels in check. Often times insurance will just decide not to cover her specialist visits, or deny covering her medication while she's waiting for the pharmacy to fill it, because it's not on the "approved" list and ends up being very expensive. My family has pitched in for multiple surgeries to replace her shredded tissue paper ligaments and tendons with donor material so she could walk again. It took her over a year to get approval to see her current physical therapist which has changed her life in a big way, since regular physical therapy will end up dislocating her spaghetti joints. At every turn the screw is tightened just a little more, every treatment has the barrier of cost which you generally won't even know until after you've gone to the doctor. This bait and switch is the norm with insurance. Absolutely no certainty about any of it, even after the bill is paid!
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Sep 10, 2021 21:43
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I don't have health insurance so I don't have to worry about this nonsense
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Sep 10, 2021 21:45
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good part of a post here that describes how difficult it is to deal with a mundane problem in America:quote:As I have mentioned, I was benching a couple weeks ago and felt a pop in my left shoulder. It didn’t hurt a great deal but something definitely felt wrong [...]
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Sep 10, 2021 22:41
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Dreylad posted:good part of a post here that describes how difficult it is to deal with a mundane problem in America: Christ almighty. I don't have anything on that level, but last December I dislocated my shoulder (which hurts like a son of a bitch, fuckin' TV and movies get that poo poo so goddamn wrong.) which resulted in an ER visit for it to get popped back in. While my shoulder was out, it rubbed some of the nerves going down my arm which made my dominant hand basically nonfunctional for two weeks. (and took quite a bit longer for all the strength to come back and the tingles to go away.) Because of the numbness in my hand, the ER doc got me into an orthopedist the very next day who checked me out and sent me to physical therapy. After about three months of twice weekly PT and steady progress, my insurance company decided since I used my "allotted" visits for the year, they weren't going to pay for any more visits, even though the orthopedist and the physical therapist both agreed I could use a few more weeks. I even got another referral that was ignored I guess. The final session I had, the therapist gave me a handful of extra exercises to do at home and sent me on my way and told me I could always email them with questions. They were cool about it, and more than sympathetic, saying that dealing with insurance was the worst part of the job and all, but it was still kinda bullshit and I went home feeling kinda pissed. On the drive home, while waiting at a light, I saw two women with handmade signs walking up and down panhandling between the stopped cars. I thought it was just the usual "no job, no food, please help" sort of deal but when they got close I saw that the homemade signs were big posterboard collages of a child, a daughter or niece or something, who had leukemia and they were trying to raise money for treatment. Only in America!
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Sep 11, 2021 01:28
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I went to the doctor a couple years ago because I kept feeling lightheaded. I was assigned a resident who wasn't totally sure about his answer to me, so he pulled in the supervising doc for 3 minutes to talk through a couple things and double check. $100 bill that my insurance wouldn't cover because of the second doctor showing up Lol
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Sep 11, 2021 02:13
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lets throw in the hilarious benefits cliff that comes with medicaid even in 'blue states' or whatever. i am currently disincentivized from earning more money, because the moment my income ticks a penny over the medicaid limit, i'm kicked off, and forced onto the individual market. and of course, the cheapest silver plans don't even come close to the coverage medicaid offers. i am literally staying purposefuly poorer so my health care costs don't go from literally $0 (medicaid is deducitbles/copays/premiums free, at least in my state) to hundreds of dollars a month, and i'd lose vision & dental. i imagine i am one of hundreds of thousands if not millions in this situation. its loving so absurd
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Sep 11, 2021 02:16
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Insurance companies are leeches and should be defeated by repeatedly jamming a lit cigarette onto them until they fall to the ground, dead.
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Sep 11, 2021 02:20
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Judge Dredd Scott posted:lets throw in the hilarious benefits cliff that comes with medicaid even in 'blue states' or whatever. BIL and wife just had a baby they’re in this loophole where they have to carefully not do good at their business so that they can continue to provide post natal care for said baby. they are literally doing accounting tricks and tanking their own potential however they also have to make money to spend on baby because its a loving child it’s absolutely insane and barbaric
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Sep 11, 2021 02:46
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Health insurance companies loving suck 
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Sep 11, 2021 02:53
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SorePotato posted:I don't have health insurance so I don't have to worry about this nonsense
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Sep 11, 2021 03:33
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Not giving any money to health insurance companies puts you in God's favor and negates the need for healthcare anyways. Suited dipshits fighting over my lunch money? Come and get it bozo
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Sep 11, 2021 03:56
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SorePotato posted:I don't have health insurance so I don't have to worry about this nonsense my biggest hospital bill for an ER visit was $12 for parking and $2 dollars for a bottle of juice from the vending machine because i got thirsty
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Sep 11, 2021 04:49
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Moving to the US from Canada as an adult and trying to understand the healthcare system was an experience. A real abrupt transition between a model where you go to the doctor when you're sick/need a checkup to a complex system of insurance plans, provider networks, deductibles and random large bills in the mail for non-covered expenses. Haven't even had to deal with any really serious health issues yet, looking forward to learning all the ways coverage can be denied. It's sort of dangerous coming from a UHC country like Canada to live in the states. You don't have the basic fear of any interaction with the predatory healthcare system that presumably Americans develop at an early age, and it can lead to getting seriously gouged. Wondering if people that moved from other UHC countries like the UK, Japan etc have had similar difficulty with the transition? Understand how and why the US doesn't have UHC but TBH it makes me think less of Americans that they put up with the current system and don't demand change. Totally get it's because plutocrats and insurers bought the govt and are calling the shots, but it's just so outrageous. Guessing it's only tolerated because a lot of people here don't know how bad it really is in comparison to other places, have to believe there'd be non-stop riots otherwise. edit Judge Dredd Scott posted:lets throw in the hilarious benefits cliff that comes with medicaid even in 'blue states' or whatever. Medicaid sounds awesome and similar to the situation in Canada, better even as dental isn't covered by UHC for some dumb historical reason. Little jealous of your insurance situation to be honest. Nocturtle has issued a correction as of 04:55 on Sep 11, 2021 |
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Sep 11, 2021 04:49
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america. it's bad. kill it. i will say that kaiser has been the least of the awfulness that is for-profit private american healthcare: no real surprise bills since it's all in-house and marginally affordable co-pays at max, and their websites/appointments/lab tests/etc all work well, and you usually don't have to travel all the gently caress around to see different specialists and tests. but the downside to kaiser is pretty much all has to go through your GP and you have to be your own advocate; if you're a goony pushover you will absolutely just get told "drink some hot tea and exercise on the beach for a few weeks" and hosed around because they aren't going to be making money by actually offering services up to you unless you're forceful or bleeding out on the ground. their mental health/psych-side is real loving lol but that's also par for america
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Sep 11, 2021 05:01
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Nocturtle posted:Medicaid sounds awesome and similar to the situation in Canada, better even as dental isn't covered by UHC for some dumb historical reason. Little jealous of your insurance situation to be honest. My ex was on Medicaid dental. Had an abscessed tooth. Went to some shady strip-mall dentist that accepted Medicaid (good dentists don't take Medicaid patients). "Yeah that tooth's abscessed and we need to do a root canal". Dentist said they would send in a prior authorization for the root canal from the Medicaid plan, as the insurance middleman company needed to approve expensive procedures before they could be performed. Weeks pass. Ex had to go to the ER twice because the pain was getting so bad and was given a choice at the hospital - "we can pull the tooth now for free, or you can go back to the dentist". Ex left the hospital and scheduled the root canal that week at the dentist, agreeing to pay cash for the procedure on an installment plan since the prior authorization remained in limbo. Tooth was saved. Bill for $700 was received (interest free for the first 6 months!). God bless America. 
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Sep 11, 2021 05:13
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Xaris posted:america. it's bad. kill it. Yeah, I wouldn't say Kaiser is great (you are only a number to them, they really don't care) but at least it is standardized to the extent you can at least attempt to get care without bankrupting yourself. It is about the best you are going to get out of the US system. The issue with Medicaid is while theoretically hospitals need to take medicaid patients in order to get medicare patients, hospitals usually make every effort to try to limit the medicaid patients they see because there is no profit it in for them (hell some hospitals are edging toward dropping medicare patients, which is even more wild.) The US system has aspects do it that seem okay/fine from a distance (ACA/Medicaid/Medicare/SCHIP etc) but the devil is always in the details especially when you get into issues like coverage/out of pocket costs etc. Then there is just not having insurance/having crappy insurance when you just get completely screwed. ------------------ China is an interesting parallel. Before Deng, medical care was very limited (bare foot doctors/only major cities have hospitals etc) but covered by the state. By 1990s, it was a complete free for all and most people simply paid out of pocket. By the 2010s, this was improved with a universal insurance system but still with pretty significant out of pocket costs. More recently, there is a pilot scheme that would edge towards something closer to UHS where the state would directly price control costs and most of them would be covered under state insurance. I just can't see the US ever doing that to be honest.
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Sep 11, 2021 06:14
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Nocturtle posted:
i lived in canada for school, actually. on a student visa, you end up on the provincial MSP, so i was on it for a little while! the big difference is that i have a limited, but still basically every major hospital in my region, list of doctors i can go to, and its not portable to other states unless i'm in the ER. also full prescription coverage. so its definitely still weaker overall but my health care costs are lower in america than they were in canada lmao Syncopation has issued a correction as of 06:37 on Sep 11, 2021 |
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Sep 11, 2021 06:28
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Ardennes posted:Yeah, I wouldn't say Kaiser is great (you are only a number to them, they really don't care) but at least it is standardized to the extent you can at least attempt to get care without bankrupting yourself. It is about the best you are going to get out of the US system. it's also one of the cheaper plans available that aren't complete scams. anyways I don't think hospitals will drop medicare outside the more elite bostonian-dc-nyc-delware poo poo. It's too much of a reliable consistent-money flow to pass up. I think places like Sutter Health and stuff here are virtually all medicare-based.
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Sep 11, 2021 06:29
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Judge Dredd Scott posted:lets throw in the hilarious benefits cliff that comes with medicaid even in 'blue states' or whatever. My friend had an ovarian cyst for 2 years just growing and growing because she’s in the gap where she makes too much money to qualify for Medicare but not enough to actually get insurance. She did a Gofundme. In the time it took to complete the GFE the price went *up* and doctors flaked due to surgery center admins cancelling the procedure. The cyst also grew and she would be constantly menstruating. It grew so much it took a week for pathology to process it and they were worried it had become cancerous due to the long wait, but luckily it wasn’t. They wanted 15,000 cash up front lmao. loving healthcare run by gangsters.
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Sep 11, 2021 06:53
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I don’t know if people in the US realise but in the rest of the world (or at least here in the UK) your healthcare system has sort of a mythic infamy about it; everybody knows it’s bad but most people don’t really know the details. I lived in the US for a few years a decade ago and since coming back there have been several social occasions where people will take the opportunity to ask me questions with a look of horrified wonder. “What happens if you break your arm and you don’t have a job?” “What if you’re hit by a car and the ambulance doesn’t know if you’re insured?” etc. And I do my best to explain that the real horror of the system isn’t just “you have to pay” but the insane labyrinthine admin tesseract of in- and out-of-network hospitals and doctors, pre-existing conditions, insurance copays and yearly maximums, and on and on, knowing full well that I’m doing a piss-poor job at regurgitating second-hand anecdotes I’ve read online. Anyway it seems like we’re drifting inexorably towards selling off the NHS and adopting the US model so probably we’ll have our own horror stories sooner rather than later 
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Sep 11, 2021 09:46
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TACD posted:I do my best to explain that the real horror of the system isn’t just “you have to pay” but the insane labyrinthine admin tesseract of in- and out-of-network hospitals and doctors, pre-existing conditions, insurance copays and yearly maximums, and on and on, knowing full well that I’m doing a piss-poor job at regurgitating second-hand anecdotes I’ve read online.
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Sep 11, 2021 09:59
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TACD posted:Anyway it seems like we’re drifting inexorably towards selling off the NHS and adopting the US model so probably we’ll have our own horror stories sooner rather than later
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Sep 11, 2021 10:22
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lol a thread about how bad health insurance is in america? now cspam really is becoming LF
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Sep 11, 2021 10:23
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last time I got my asthma inhaler refilled I had to pay $60 out of pocket (uninsured price is like $70) then a few weeks later I got a letter from the insurance company saying that should have been covered, here's a check then a few more weeks later I got another letter from the insurance company saying actually that wasn't covered and now you need to pay back the money we sent you.
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Sep 11, 2021 10:38
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Xaris posted:as big of a doomer-brain and anti-uk as I am, I don't think this is going to happen. once the genie is out of the bottle, you can't put it back. that said, absolutely you can fray at it by adding in more co-pays, cutting funding, more co-pays, maybe some small family deductibles, but it's still going to be NHS and "national", just one that gets pricier for the working people. as much as uk loves blowing their dick n balls away with a sawed off at every corner, it'd be a lot of work to take it and transform to anything close to the clusterfuck of US care. The tories have done a great job at nearly starving it to oblivion at this point. It may not ever become as bad as our system but then again check out rail privatization in the UK, they are working off the same plan.
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Sep 11, 2021 10:43
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net work error posted:Health insurance companies gently caress and suck
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Sep 11, 2021 10:43
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Xaris posted:as big of a doomer-brain and anti-uk as I am, I don't think this is going to happen. once the genie is out of the bottle, you can't put it back. that said, absolutely you can fray at it by adding in more co-pays, cutting funding, more co-pays, maybe some small family deductibles, but it's still going to be NHS and "national", just one that gets pricier for the working people. as much as uk loves blowing their dick n balls away with a sawed off at every corner, it'd be a lot of work to take it and transform to anything close to the clusterfuck of US care. But on the other hand actually destroying the NHS is a big propaganda no-no, so yeah, fraying it to worthlessness is the approach they're taking. The up side of that is, the existence of the NHS, even as a completely unusable thing, functions to keep the underlying prices closer to "what does it cost" than "what are people willing to pay", which means paying 100% out of pocket uninsured in the UK is still likely to be cheaper than equivalent treatments in the US even with insurance "covering it" unless you're hitting the max-out-of-pocket threshold on your insurance.
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Sep 11, 2021 14:37
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Judge Dredd Scott posted:lets throw in the hilarious benefits cliff that comes with medicaid even in 'blue states' or whatever. Medicaid health care outcomes are better across the board than commercial insurance because the covered know that they’re not going to be bankrupted by copays / coinsurance. This means they’ll get preventative care.
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Sep 11, 2021 16:58
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Pittsburgh Fentanyl Cloud posted:Medicaid health care outcomes are better across the board than commercial insurance because the covered know that they’re not going to be bankrupted by copays / coinsurance. This means they’ll get preventative care. https://newrepublic.com/article/162658/vaccine-fear-health-care-surprise-billing People didn’t believe free COVID vaccine meant free vaccine because they’re used to being tricked by health insurance.
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Sep 11, 2021 19:59
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my new work from home job is for united healthcare servicing dsnp plans which is basically when a person on medicare is also so poor and unhealthy that they need medicaid as well, and can also be end of life care and poo poo like that so when i finally get on the phones taking calls it's gonna be the absolute most sob poo poo imaginable and I'm trying to make sure I'm sufficiently crack pinged so that when I inevitably get soul crushing awful phone calls of people who are wheezing their nearly last breaths while trying to figure out the intricacies of the american health care system, I can simply jokerlaugh my way through it and be callous enough to not give a single poo poo because if I let myself care about the people who call in it will inevitably destroy my mental health. so I figure, I should make sure that I review the facts of the matter in my own mind before the calls even start, which is that all of this is happening anyway, I need a job and money, and that if I don't hear their sob stories I won't care about them by default so i should simply not care about them when i hear about them either because the alternative would just gently caress me up too bad. I'll do my best to help them navigate the website or whatever though e: to be clear for anyone who might have the wrong idea, im literally just gonna be helping them navigate the website for the most part, so detachment is actually appropriate here
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Sep 11, 2021 20:32
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empty whippet box posted:my new work from home job is for united healthcare servicing dsnp plans A very large part of my job is writing software that provides metrics on LTSS / DSNP patients. The future of healthcare is steadily moving towards singlepayer because we can't afford anything else lol.
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Sep 12, 2021 00:39
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Pittsburgh Fentanyl Cloud posted:A very large part of my job is writing software that provides metrics on LTSS / DSNP patients. The future of healthcare is steadily moving towards requiring insurance but giving no care, number will allow nothing else.
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Sep 12, 2021 01:25
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So I have fairly "good" health insurance - Kaiser - low deductible everything is in house. Its pretty much peak american healthcare and insurance. I was getting my pap smear done and general annual wellness check in and I asked about getting the pneumonia vaccine. I'm only 33 but i've had pneumonia twice and every respiratory infection knocks me flat for months. My doctor checks the computer and says "mmmm no you have to be at least 50 or have diagnosed asthma" - I explain the fact that I can lift weights all day long and am very active but I cant do much cardio because I wheeze for 30+ minutes and feel like im going to die "well we could get you into a pulmonology appointment because it does sound like you could have exercise induced asthma which would qualify you for the pneumonia vaccine" so I get the referral. haven't gone yet because of covid making me paranoid Anyway. The pneumonia vaccine is cheap AF and this whole loving run around I have to do to get it is a poo poo load more expensive than just giving me the god drat loving shot. Before I was on kaiser, Aetna once sent me to collections over .03 because they mailed me 10 different bills in like a week because I had to stop into a clinic every day for 5 days to get b12 shots because my levels had fallen so low they were causing me neurological problems. Both the facility and the doctor billed me separately
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Sep 12, 2021 02:33
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silicone thrills posted:Anyway. The pneumonia vaccine is cheap AF and this whole loving run around I have to do to get it is a poo poo load more expensive than just giving me the god drat loving shot. Prevnar 13 is $300 and Pneumovax 23 is $150 - that's why they gatekeep it so hard You can go to a pharmacy and say you smoke and they'll process it through your insurance - otherwise you can just pay cash
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Sep 12, 2021 02:39
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Pittsburgh Fentanyl Cloud posted:A very large part of my job is writing software that provides metrics on LTSS / DSNP patients. nah, we'll just let people die. McNugget Buddy posted:Prevnar 13 is $300 and Pneumovax 23 is $150 - that's why they gatekeep it so hard if you haven't told your insurance company that you smoke then this could have some pretty serious consequences i think
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Sep 12, 2021 02:39
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empty whippet box posted:nah, we'll just let people die. DSNP / LTSS / Medicaid is funded via grants from the feds but the programs are administered by private insurers. We'll find some way to move people into those programs because that's where the insurers will make their money.
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Sep 12, 2021 02:40
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Pittsburgh Fentanyl Cloud posted:DSNP / LTSS / Medicaid is funded via grants from the feds but the programs are administered by private insurers. yeah i always assumed if the system didnt fully collapse on itself, a medicaid buy-in option would emerge. would be way better than what we have now
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Sep 12, 2021 02:42
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empty whippet box posted:if you haven't told your insurance company that you smoke then this could have some pretty serious consequences i think On the other hand, if they already know, free pneumonia vaccine!
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Sep 12, 2021 02:43
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