the fact that your doctor can yell that you need a specific treatment and some guy at an insurance company can just be like "no" should alone be enough make us burn this system to the ground
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Most americans dont interact with our medical care system. They have no idea. Same people think theres an abundance of resources for poor people, that homeless people squander for drugs. Its laughable.
The fact that we all accept our shitty healthcare system and that we are giving the rich more tax relief blows my mind. Doctors go to school to cure people. People go to doctors to get cured. No middle man needed. Insurance companies are no help, they are leaches. Universal healthcare here and now!
The ACA is a healthcare exchange run through the private insurance companies, using subsidies. We are still wasting money on the middleman, and they’re still calling the shots. Real Universal Healthcare is needed.
I have run into it more the last 10 years with medication denial even if I have been on the same medication that is effective for years prior.
If it wasn’t for Good Rx, I don’t know what I would do.
That’s a travesty except no system is actually worse than a healthcare system with inevitable flaws. It can be fixed once the insurance lobbyists and their corruption is stamped out.
If you have united the soon is now. The process is now: submit claim, automatic denial, appeal, get denied by a not doctor, appeal with a doctor, approved. Hopefully you don't die or get worse in the months this spans across.
ACA allowed many uninsured people to obtain coverage. This included part-timers and those ineligible for Medicaid. Was it perfect? No. But it helped them obtain benefits and did away with pre-existing conditions as a reason for denials.
Reading all this... No wonder I won't go to the doctor but mostly because I'm afraid to get a bill I can't pay!! I'd rather risk being healthy on my own accord... Little arthritis: Advil. Little swelling: Icepack.. High blood pressure: 0.
I'm good!!
Medical insurance coverage is determined by the type of plan, and there are so many, it is insane - federal (Medicare coverage can vary by region), federal/state (Medicaid benefits are determined by the state), commercial, employer provided (bizarrely, many employers write their own policies).
+1
It is impossible to discuss all of the variables that impact coverage. Another complicating factor is that physicians, who are incredibly overburdened (patients are often double booked every 10-15 minutes) often do not understand what information is needed to ensure approval for services.
+1
In a nutshell, medical insurance in the US is disjointed and dysfunctional. There are some good plans, but they are often expensive. A single-payor system has benefits but can be problematic, the UK is an example, where patients may have to wait an excessive amount of time for routine procedures.
Do you know how many times people have to wait an excessive amount of time for routine procedures in the US? Because I hate to tell you, but it’s pretty frequent here, too.
You don't have to tell me, and I am not an apologist for our health care delivery system. It is extremely convoluted and generalizing the issues will not identify problems that require remediation. Some countries with single-payor systems provide services in a timely fashion, others do not.
Doctor. Writes a note. For local hospital. Seen by Triage Nurse. Brought to ward. Told to prepare for Surgeon.
Accounts Department. Private Insurance. No.
Medical Card No
Prsi. Yes..
Procedure goes forward. Angioplasty. With Stent.
Cost Zero.
Meds Zero
Two days stay.
€80:00 H.S.E.
🇮🇪🇪🇺
Sadly, often that “guy” at the insurance company is a doctor who receives a yearly bonus for $$$ ‘saved’, assuming the claim is elevated to medical director review. Conflict of interest. Before entering academia, I worked for a large HMO 😞
I can't like this enough. I have multiple autoimmune issues & meds that are subject to prior authorization, I fight this battle every year & have since 2017. We have a bill in the NC legislature that passed the house & is now in the Senate that would rein in the prior authorization process.
For anyone in NC, this bill started in the NC House as HB 434, the "Care First Act." It passed the House almost unanimously and is now in the Senate. PLEASE CALL your NC Senators to urge them to suppose this bill!
I was lucky. My insurance denied my radiation treatment, but my oncologist got on the phone with them and convinced them it was needed. They covered it.
Insurance companies are mostly hoping us doctors are too busy actually taking care of patients to actually pursue the appeals process, figuring we will just give up and change our minds if we are not that concerned or not too stubborn.
At the next protest, I’m bringing the American flag and flying it. I’m taking back our flag. The American Flag that represents freedom, honor, and the pursuit of happiness. Taking it away from people who do not respect what it stands for. Who’s with me? Then let’s roll!
Sounds wonderful. Are there any trade-offs? As in, long wait times, limited specialty appointments? Just curious. I really wish we had that Rx coverage here.
No Trade off really, wait times in the public system for non-urgent surgery can be a month or two, but that seems normal even with top end insurance the wait time for a top surgeon booking can be similar.
What is the days supply amount for the listed medications on the chart? Some of those listed prices appear exorbitant for some of the more common meds. For instance, here are some for Lisinopril for a 30 day supply from GoodRx for the city of New York, NY: https://www.goodrx.com/lisinopril?
Every day it makes me want to burn it to the ground.
And, often, even when they know they'll say yes, they delay that yes so long that the pt or the hospital or the doc will cancel a surgery because the yes came too late.
Deny and delay is the way to billions in profits.
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I mean yeah it’s shitty but don’t you know lord Obama did it? Ya know. With the Heritage Foundation?
If it wasn’t for Good Rx, I don’t know what I would do.
Insurance companies literally almost killed me.
I agree with you 1000000%.
This can’t be. I mean, Obama publicly admitted it was a Republican plan, but I thought he was joking.
This is basic about insurance. It is a scam.
It’s a shakedown.
And since Obama signed Romney care into law… prices have gone up and outcomes have plummeted.
I'm good!!
+1
+1
Accounts Department. Private Insurance. No.
Medical Card No
Prsi. Yes..
Procedure goes forward. Angioplasty. With Stent.
Cost Zero.
Meds Zero
Two days stay.
€80:00 H.S.E.
🇮🇪🇪🇺
We also have Free Universal Healthcare and subsidised drugs $5 to $25 (max)
Quite a range.
And, often, even when they know they'll say yes, they delay that yes so long that the pt or the hospital or the doc will cancel a surgery because the yes came too late.
Deny and delay is the way to billions in profits.