Or are those just a minority of cases?

49 comments

  2. Definitely a minority of cases overall. I have never had an issue. I have even had a health insurance company go to bat for me when a provider tried to bill me direct for something that wasn’t technically covered, but I was not aware of prior to receiving the service.

    As with most things, people are more likely to be vocal about the bad than the good.

  3. If you have company sponsored insurance, you may fair a little better. However it widely varies and it’s not consistent.

    In my case, family of 5 all young, no health issues, if I took a private plan through the state, it’s $750/mo. We still have to meet a $5500 deductible and pay copays and small stuff. It’s horrible.

    My company plan, I pay $500/mo $7500 deductible, and 20% co pays, it’s still horrible. I typically accumulate $10k annual debt in medical spite paying insurance.

  4. I’m sure they can be, but as a generally healthy person I’ve never had an issue with them.

  5. Yes. If anything, it’s worse than reported because the really horrific stuff straight up kills the patient, who dies alone with no one to report what happened. The entire industry is a blender for people’s savings, and the people who are buying up all the health care systems have zero problem committing atrocities to improve their margin a fraction of a percentage. The fact that the country is as successful as it is with this economic weight belt holding it back is amazing, just imagine how much the country could get done if everyone profiteering off the system was taken out back and shot for committing crimes against humanity.

  6. With some carriers, especially given the AI lottery news of late, it is completely random.

    Your claim might go through fine, especially if a hospital or medication isn’t involved, but the next person gets denied because they changed the procedure (HCPCS/CPT) or diagnosis (ICD) code by one digit. E.g. a visit taking 10 minutes longer, but not a new or complex patient.

    Insurers have reached the point where they put everything through a AI bot that would deny both things different in some miniscule way as well as nearly identical basic procedures.

    The flip side to this is that the privatized parts of Medicare and Medicaid, Advantage and MHCP respectively, get busted all the time for billing the government for more codes than people actually need.

    Its essentially reached the point of pure cost optimization. Get more premiums and reimbursement in while paying less out.

    That doesn’t work for public health, but the US is now almost 100 years into anything else being Communist. Even though the Public side of us spending, which is mostly on the elderly, is more than total (public and private) in many countries.

  8. I’ve had the exact same service completely covered and another where I get hit with a sizable copay, both times I haven’t hit my deductible.

  9. To put it shortly, yes. Insurance companies make things incredibly difficult. There are a lot of hoops that people have to jump through which only help to discourage the coverage of services. This can mean mean chasing additional documentation for a specific cause, or navigating unfriendly and incredibly time consuming online/phone systems. My experience has mainly been with helping patients acquire durable medical equipment and it’s really hard sometimes.

  10. Yes, don’t get sick. If you do be prepared to spend your illness doing paperwork and jumping thru hoops.

  11. I pay 450 a month for my wife and I, the state gives us $350 to make a $800 plan affordable. That’s with a 14,000 Out of pocket max for both of us and a 12,000 deductible.

    Wife got routine health stuff done and they purposely misclassified the bill and we’ve contacted our provider and insurance for over 6 months and they refuse to figure it out.

    That service would have been free but instead cost $300.

    Why the fuck would I bother paying for health insurance if they purposely charge us for something different with no recourse.

  13. Not in my experience. Last month I was sick, was able to see an actual doctor not just a PA or nurse. Received a diagnosis and medication. Also the doctor heard a heart murmur that had previously been undetected. I was had an appointment with a cardiologist in a week, have had two tests and received a tentative diagnosis the same day as the tests, with a further test scheduled next week. The further test is being done at one of the top hospitals in Atlanta. I’ve received comprehensive and prompt care without any red tape.

  14. Not always, and not for everyone, but yes they absolutely can be.

    One under-remarked thing that I think sucks is getting random bills months after the fact. My wife lost a pregnancy a few years ago and had to have a surgical procedure to remove the dead tissue due to how far along she was. That was an extremely traumatic and upsetting experience all by itself, but getting bills in the mail from various providers months after the fact was like tearing the wound open again. Bad!

  15. I work in healthcare and I can tell you that insurance companies are the part of the job that makes me hate working in healthcare the most.

    The drugs we give are dictated by the insurance company, the tests we can do are dictated by the insurance company, the cost of the patients care is dictated by the insurance company, and for some patients even the doctor(s) the patient can see is dictated by the insurance company.

    There are even cases where the only “covered” drugs a patient can get are hundreds of dollars or more, including cases where those drugs are $0 or relatively cheap for some patients and just completely inaccessible to others. This often ends with us telling the patient that we simply don’t have any options because treatment is cost prohibitive.

    Honestly, our healthcare system is so broken. It’s demoralizing.

  16. Yes they are, at least in my experience. But it does vary. I just hate my current health insurance company

  18. I’ve had good and bad experiences. The secret is to not pay and continue to negotiate/fill out paperwork. Eventually you should get the services you want/need. The hope is you don’t die or become crippled during the process.

  19. Yes, but people are also illiterate when it comes to insurance as well. It’s certainly convoluted but the extreme cases are a result of 1 offs of people getting fucked over or don’t understand what they’re doing or purely rage baiting. Like there was a post on r/mildly infuriating where OP was complaining at prices of his drug where it clearly showed a certain store where his doctor wrote the prescription to had to pay $5 (yes 5 dollars) but he posted as if his options were 5 other stores that would’ve been out of picked at $2000. Or another post where the guy had to pay $100 out of $16000 for an ambulance ride and emergency room visit for a fever

  20. It’s both. Those cases are legitimate and are a reflection of a system that’s broken and definitely effects those who receive good care at expected costs. From physician availability to your monthly premiums to what employers can afford to pay for their employee plans, it’s all related.

    How we got here is a tragedy, we can’t tear down one of the largest industries without making huge waves that would have unexpected consequences.

  21. In my experience yes. And it’s been getting worse.

    I make what most people would consider a good amount of money. I have insurance fully covered by my company. It is theoretically “good” insurance.

    My insurance barely covers anything. In the last few years they haven’t covered: an MRI, a CT scan, hearing aids, endoscopy, etc. one time they denied me the 2 weeks of antibiotics THEY REQUIRE before allowing me to have a CT scan that they also won’t cover (some like… 10% of the $800 for the scan went to my deductible).

    I used to hit my deductible yearly. I still have lal the same health problems, but I haven’t hit it years.

    And the worst part is they lie, obfuscate, anything to get out of telling me in advance what will be covered and what will count towards my deductible.

    I am currently putting off a surgery and an MRI due to money. And if I, who makes a good salary am struggling… I don’t know how people less well off are dealing.

    Also:

    https://www.ajc.com/pulse/georgia-among-the-worst-states-for-health-care-analysis-finds/2IYHCHEJB5FYZGAEJLO367OY3Q/

  22. my insurance doesn’t cover fuck all but that’s probably the only issue i’ve faced. i can’t go to any nearby eye doctors or dentists because they don’t take it.

    the worst thing was having to go and get blood taken for a hormone test at the only hospital near me. they told me that the lab they use does not take my insurance and i literally had to LEAVE THE HOSPITAL to find someone who would take my goddamn blood.

    so yeah everyone here probably has great insurance. those of us on gov insurance aren’t so lucky.

  23. I’ve never had any issues with paperwork or denied claims at all. Never had an issue seeing a doctor or getting a specialist.

  27. They’re fine until they’re not. I haven’t had an issue with insurance, but my husband has. We’re on the same insurance, the only difference is he has a few of diagnoses that require regular treatment. Man oh man.

    The worst is his back. He works with an orthopedic surgeon and will eventually need surgery due to a degenerative condition. He is getting by with shots that he’s supposed to get 4 times a year. Except that it takes a month of fighting each time to get the shot because insurance keeps denying it. Even though there’s plenty of documentation showing that they help, insurance denies every time because THEY said the shots don’t help. Never mind the doctor’s or the patient’s experiences. The doctor’s office usually has to submit at least 3 times to get approval, this last time the surgeon himself had to call. Meanwhile, hubs is in pain because the shot wore off a month earlier.

    Thankfully, they only denied his CPAP once and are ok with him not dying at night. 🙄

    So, yes- most of the time you won’t have a problem, but when insurance sucks it sucks.

  30. Yes, my wife needs an expensive procedure that she could get at the hospital where she works. My insurance will not pay for it. If she got insurance from the hospital, her insurance would also deny it. The procedure exists, it is effective, but is relatively new. We cannot afford it cash.

  31. Yes. I worked in a dental office and the amount of claims incorrectly denied and paperwork we had to do was honestly ridiculous.

  32. Yes. It’s (or should be) a national shame, but trying to enforce any consequences for a corporate entity that measurably makes people’s lives worse in the US is impossible. Legislative capture is complete, and the insurance firms operate with utter impunity.

  33. It depends on what insurance you have with your employer.

    Some employers have great insurance, while others have shit. For example, I had insurance with a company that refused a procedure. I made several appeals. All denied.

    A year later, I switched jobs, and that carrier approved the procedure immediately.

    I have great medical insurance with a private company and also with the VA. Both have been great.

  34. Minority of cases. The only major incident I’ve dealt with was a 4 night stay in the hospital with a major surgery and minor surgery, the whole thing only cost $900. Other than that I pay $15 to see a family doctor and $2-$5/prescription and I’ve never had something denied, I’ve actually received checks in the mail from my insurance company for overpayment.

  36. When everything goes fine, you barely even notice it.

    But if everything doesn’t go fine, you’re in for a never-ending nightmare. There is never a “small” incident with health insurance, it feels like. If everything doesn’t go off 100% flawlessly, everything is going to be suffering for several months, at minimum.

  37. It’s a minority of cases, often people who misunderstand their policies. Insurance companies aren’t “good” by any stretch of the imagination, but it’s been my experience that when I stick to what’s in the policy, they will too and cover what they promised.

    Homeowners and car insurance are _way_ nastier than health insurance.

  39. Yes, if you have anything outside the norm. My insurance company denied claims from when I was outside the country and had some extreme pain I needed checked at an ER even though I supposedly have some coverage outside the country, demanding US billing codes and that I translate all the medical information myself.

    My brother has also needed intensive care to survive, including tracheal reconstruction surgery, and my parents always had to fight to get them to not put them on the hook for hundreds of thousands of dollars. That stress on top of my brother being months in the hospital was not great to put it mildly.

  41. Yes and no. There are definitely lots of frustrating things that health insurers cause, but a lot of the stories you see can be misleading.

    **The Misleading Part**

    Simply put, someone who has everything go smoothly is not going to complain. Someone who has a problem is way more likely to write a long rant about why healthcare sucks. So if 100 people are content and 1 is upset, the upset person could very well be the only one to share their story.

    Another source of confusion is that the American system for billing basically forces the patient to receive an inflated list of charges before receiving their real bill with the actual amount of money owed. This leads to tons of posts where pictures of medical bills get posted that make it look like the patient owes $1 million… but the final calculation is that they owe more like $1 thousand.

    **The Accurate Part**

    For one thing, there’s no doubt that Americans pay far and away the most for healthcare without ending up with particularly good health outcomes. The whole healthcare system is incredibly confusing and you really do get [instances of patients getting screwed over,](https://kffhealthnews.org/news/tag/bill-of-the-month/) even though these issues only pop up in a small percent of cases.

    There’s also the cost of insurance altogether. It really does cost thousands of dollars to have insurance in the first place, even for someone who has no medical expenses during the year. And for insured people, they’re rarely covered at 100%. They’re still going to pay a copay or coinsurance for medications or procedures on top of all that money they’ve already paid in premiums.

    **TL;DR:** The system has lots of legitimate problems but it’s not as bad as you might think.

  42. Yes, it’s a huge scam.

    I had premium private health insurance for decades. I was drowning in medical debt and frequently couldn’t afford to get the treatment I needed.

    Eventually I ended up on government healthcare and it’s a far superior experience. Healthcare decisions are driven entirely by medical need and it’s affordable.

    I frequently talk to people who have transitioned to government healthcare and we all the same story…you get sicker and sicker and sicker on private insurance and then government healthcare does the work of saving your life and stabilizing your health with testing and treatment that was always available but you just couldn’t afford it. Then you have to restructure your life to stay on the only healthcare that can provide you the healthcare that will keep you alive.

    The lost productivity and economic damage caused by the private healthcare system is staggering. You are not a fiscal conservative or a free market economist if you are supporting private healthcare.

    Private healthcare means paying for something you will never receive. Every horrible thing you hear about this system is true.

  43. I have had constant issues. At this point I have cited federal laws and reports to my insurance on some claims and still been denied.

    Hell, I just got a letter (which I called to confirm) stating that my psychiatrist is being removed from my insurance on June 29th *2022*. That’s more than a year, retroactively for someone I see every three months! And no explanation for it.

  45. Yes, they really are.

    I don’t know why we put up with them.

    It does work most of the time, but when it goes wrong it goes really wrong.

    And almost everyone has heard about a time when an ER visit forced to pay your deductible in one night.

  46. It is a combination of 1) a small minority of cases that people are very vocal about (because they got legitimately screwed) and 2) people just not understanding how health insurance works.

    It is rare for people to het screwed over by their health insurance but it does happen. Sometimes people are also just dramatic and make mountains out of molehills. I got a bill for thousands of dollars because my dr billed my old health insurance instead of my new one. I called the number on the bill, said hey I think there is a mistake here because I have insurance, and within 5 minutes they updated my information, resubumitted the claim, and told me to disregard the bill. A different person would go on reddit and farm that story for karma about how I got a 10k bill due to a billing error. In the end I paid nothing.

    The most common thing that happens is people say something wasn’t cover by their insurance when really they just haven’t hit their deductible. They complain, “why should I pay my premium when the insurance doesn’t actually cover anything?” That’s how you know they are a healthy person who doesn’t actually use their insurance very often. I have a lot of chronic medical conditions. Most years I hit my deductible by February and my out of pocket max by June. I have never gotten a surprise bill (that I have actually had to pay) because I understand how the system works. People mostake their ignorance for some type of corruption.

    Lastly, sometimes people get an experimental treatment that isn’t covered by insurance, but this treatment wouldn’t be covered by socialized healthcare either.

  47. The only paperwork I’ve done was I had to notify them if I had health insurance with another insurance company. Other than that I’ve never had to do any paperwork or had any claims denied.

  48. Yup. If you’re allergic to a medication for a specific condition, good luck getting another one covered if it’s not on their preferred list. If you have a long term undiagnosed condition, insurance may refuse to pay for a specialist. Want a medical test done? Insurance may refuse even if your PCP orders it.

    Even with ‘good’ insurance, it’s difficult for women to find doctors who don’t dismiss them as ‘depressed’ or dishonest when describing symptoms.

    In my immediate family, the same company that took great care of my chronically ill husband outright neglected my daughter & me. It’s maddening when I talk to people who live where their medical needs aren’t dismissed.

    Likewise, they are aghast to discover no job=no insurance in the US.
    Sure, if they deem you poor enough you might qualify for cheaper insurance, but it’s often still too expensive if you’re low income.

    So many of our politicians make money from insurance & pharmaceutical investments I’ve lost hope we’ll ever have a better system.

Leave a Reply
You May Also Like