I find it HIGHLY ironic that conservatives are anti-single payer because they “don’t want the government to say if they can have a procedure.” Instead they apparently prefer our current system of a for-profit company saying what medical procedures they can have. Health insurance overrides doctor decisions ALL THE TIME because approving procedures costs them money. Good doctors know the best ways to fudge the order to get things approved because that’s the only way to actually help their patients.
this post was submitted on 26 Jul 2023
22 points (100.0% liked)
A Boring Dystopia
9514 readers
815 users here now
Pictures, Videos, Articles showing just how boring it is to live in a dystopic society, or with signs of a dystopic society.
Rules (Subject to Change)
--Be a Decent Human Being
--Posting news articles: include the source name and exact title from article in your post title
--Posts must have something to do with the topic
--Zero tolerance for Racism/Sexism/Ableism/etc.
--No NSFW content
--Abide by the rules of lemmy.world
founded 1 year ago
MODERATORS
Like gender affirming healthcare, women’s healthcare, etc… yea, government having a say is horrible unless they do what you want, then it’s ok.
Conservatives can’t even support their own ideals. What are they arguing about when they support the same shit they say they don’t…
pfft. insurance companies won't cover anything that it isn't mandated to.
It's so fucked because there's basically no way to tell if something is approved before you try to get reimbursed. Policies change daily and you basically have to rely on algorithms to chew up your claim and spit out an answer that will hopefully be accurate for the next hour.
It's so funny to me when articles are like "shop around to find which hospital will do the procedure for less" when nobody has a clue how much something will cost before they try to submit a claim. Anybody who has ever tried that advice has certainly become frustrated halfway through the second call.
But didn't you know?
Person elected or hired by someone elected to take decisions on behalf of people taking decisions on behalf of people is satanic commie librul villainy!
Person not accountable to anyone but greedy shareholders doing so? The natural order of things!
/s
Fuck Cigna.
After I suddenly became seriously disabled, they fought tooth and nail for like a year to keep me from even getting short-term disability. I had to hire an attorney (worth it!) to get my benefits.
If I didn't have a safety net, I would have become homeless just waiting on getting my short-term disability.
Edit: On a related note, fuck the US. They'd prefer disabled people just die quietly under a bridge than give us anything at all.
I wish I could say this was in any way surprising to me
Get rid of middlemen. Medicare for all
Is the algorithm profit for shareholders?
Can someone describe a “proper” rejection for patient care?
Typically, your claim will be reviewed by someone with no medical history, they are just an insurance claims agent. They don't have to have any experience or any particular education beyond high school. This person will require copious amounts of medical documentation from you. Both documentation from all of your doctors' offices as well as long forms for you to fill out. Obviously, this is never a massive burden for the disabled (/s). If it's Cigna, they will likely lie and say they didn't get it and you'll have to send it all over again. This will go on for multiple requests. Great delaying tactic!
After they "review" and deny you, which they will, it goes to a physician paid by the insurance company for approval of the insurance agent's opinion. If the agent denied your claim, the doctor is not going to disagree. They will deny your claim "medically". On the extremely off chance that you were approved on the first round, which, let's be honest, you weren't, the doctor will try to find a way to disqualify you. They are paid specifically to find reasons that someone doesn't qualify. And that applies to both the agents and the doctors. Sometimes nurses are in there as well. Sometimes insurance companies will try to have nurses make the decision instead of doctors and you have to insist on a doctor.
Once you know a doctor is looking at your claim (or has auto-denied it, as their managers expect), and especially after it has been denied (which of course it has been), you need to get what's called a peer-to-peer call between that insurance doctor and your real doctor who isn't just some corporate shill. Your doctor will schedule and handle this, but you will have to ask them to do so.
Then your doctor explains why they are wrong and you get approved. Or you go through a back and forth for a while and hope for the best.
Signed,
Extremely familiar with the process and not at all bitter
Edit: This is how Cigna's disability process works. It will be similar but with fewer steps and people involved for regular insurance claims like getting a test paid for.
In both cases, the process is deliberately designed to confuse and exhaust the patient so that the insurer doesn't have to pay out. It works a lot of the time.
"No, Mr Trump, you're not getting the heart. Given your habits and overall health, it would be a waste of a perfectly good organ. You're basically a tiny yeti mushroom dick on a barrel of toxic sludge"
Ok, maybe the last part wasn't very "proper", but it's just as true as the rest 🤷