They get paid when the least amount of people they insure use their services. They're not incentivized to help those they've insured. The less they have to pay out to providers, the better the executive bonuses. Thus, they are diligent in collecting premiums, but can just sit on their hands when it comes to paying out.

The more the system denies and delays a claim, the fewer insured people are willing or able to put themselves through the bureaucracy gauntlet, the fewer pay outs.

They're not in the business of insurance, they're in the business of making money from the business of insurance. It's over-complicated on purpose.

We have all become unwilling, unpaid employees of every company in their pursuit of higher profits. It's a feature, not a bug.

Corporations have discovered that there is no real downside (for them) when they don't function. Customer satisfaction no longer has much of an impact on their profits because the few companies left in each sector are doing the exact same thing.

IMO this is yet another side effect of unchecked corporate power. It's the same reason prices have risen so rapidly and corporate profits have reached 70 year highs. We are dealing with near monopolies and the billionaire class who created them. Until our government addresses the problem it's not going to get any better.

In other words it's not going to get better in our lifetimes.

My favorite is pre-authorization.

I need a pre-auth before my insurance will cover the Adderall for my ADHD. Every year I must renew this pre-auth or I will not get covered for my prescription.

What is a pre-auth, exactly? It's a Dr. Promising that yes, this medicine they prescribed is medically necessary. No, prescription alone does not count. Yes, it can come from the same Dr. who prescribed it.

And yes, I have to do it yearly to "ensure it's still medically necessary" because my ADHD could magically go away one day, apparently

I tore an achilles tendon last year. Doc wanted me in physical therapy, but PT wouldn't take me because they needed an MRI showing the position and size of the tear.

PT was very clear. Tendons don't show up on xrays.

Doctor was very clear. Tendons don't show up on xrays.

Podiatrist was very clear. Tendons don't show up on xrays.

Aetna: "You didn't do an xray first, MRI denied."

Vote for a single payer system (Medicare for all) if you want out

One of the biggest advantages I see from living under single payer health care is that I don't have to put in extra clerical work like you describe. Sure, the insurance company should be able to pick up a phone, but In my opinion, the responsibility should rest on the hospital - they are the ones demanding a payout.

I wish I could Thanos-snap the entire health insurance industry out of existence. It's a giant, bloated, bureaucratic middle-man that makes the whole process more expensive, time-consuming, and complicated.

I've wondered what would happen if people went on a health insurance strike. If everyone (or a large part of the population) cancelled their health insurance, and just negotiated on price directly with providers.

I don't know if I should say this but I will.

The last time it was an issue for my kids I conferenced called the insurance and the doctor's office. I then laid into the insurance adjuster saying things that were truly revolting with as much profanity as I could cram into it.

Haven't had an issue since. Turns out the system only works if they think you are unstable enough to make it work.

It is unique to the way healthcare works in the USA. I don't know why, the complete system looks broken. I can only tell you we pay less for healthcare here in Europe and we don't have to call unless it's really complicated and a rare situation. I'm sorry if that sound a bit off and doesn't help...

I agree with you. I am fortunate enough to have insurance now which covers the things I need without much of a hassle. But at my last job, they had an insurance provider who was very fond of losing paperwork, making up bullshit, and not really delivering on what it was supposed to do.

I recall complaining about this to a co-worker, who was incredulous that I would be so lazy. You see, he had a whole system of who to call and where to file what paper to get the results he wanted.... sometimes. But I was amazed at how much effort he put in to work around a system that was totally artificial, inserted between patients and doctors for no other reason than to skim money. And he was proud of it! He was convinced that putting in all this effort showed that the system was working as intended. (I should add that he is the stereotypical "small government" conservative, or at least was until Donald Trump convinced him that the best use of Government was to be a tool to beat up Liberals and Immigrants with.)

It's like these people are convinced that if something doesn't require a huge amount of effort, it must be worthless. Meanwhile, their boss's boss's boss merits their large salary and stock compensation specifically because they are enough of a psychopath to make monumental decisions on as little data as possible. I am starting to feel bad for most ordinary people who vote for conservatives. Not only are they getting gaslit, but they prefer it that way!

I think Obamacare has gone about as far as we can go in reforming Healthcare while half the country is so masochistic.

The amount of inefficiencies in the healthcare system is staggering. Like, you almost wouldn't believe it kind of staggering. I can't go into much detail without doxing myself, but it's bad.

Healthcare practices vary in how much they are willing to run interference for you on insurance. Most of them will at least try "pretty hard" to help with the claims because it's good for their income stream to do so. However, sometimes you'll find yourself using a provider who can't be bothered with staffing up and/or supervising it to make sure it gets done. In my (limited, anecdotal) experience, this seems to happen more often with specialists or niche providers.

Or sometimes it's your insurance plan. It might have so many byzantine rules and/or shitty admins that it's just too much work for even a crackerjack provider staff to deal with it. So they end up kicking it back to you and saying "good luck". If this happens enough, the practice may stop accepting that plan in the future.

Because if they pay out, they make less money, far cheaper to get you to give up trying - which is what a lot of people will do because it's designed to be an exhausting system.

It so you give up.

The amount of emotional energy we have to spend untangling this stuff leaves us drained.

That's the point. Take a look at the Fortune 500 and Global 500, and notice how many of them are US healthcare companies. No company gets that big doing all the work themselves...

If you fail to run the gauntlet, or give up in frustration, the insurance company doesn't have to pay. They could absolutely make this process easier, but the incompetence works in their favor.

I've lived in single payer countries as well as in the US, and the incompetence is the same everywhere. In my experience the big difference is in universal healthcare countries the rules are very strictly defined and there's very little scope for exceptions, so either you qualify or you don't. The other issue is that even if you qualify there's often a multi-month waiting list for treatment.

Same with HSA cards. I quit paying into mine because they wanted proof I got work done after using at a dentist.

Yeah, because dentists usually sell fun things. Fuckin morons

It is shadiness, because the odds are that you wil make a mistake and they will hold it against you. The whole private insurance setup exists to find ways to delay and poasibly deny coverage.

That is also why you pick what you will be covered for before the year starts, as if you can predict which major medical issues you will have in the upcoming year. Better pick a bunch of stuff that isn't likely, and they can deny when you didn't pick the obscure one!

Poor souls are weighed down by the egregious amounts of money they have to take in and hand out. Leaves little time to do much else

Living in Europe with single payer health care, this sounds crazy. I just go to the doctor, leave, pick up my drugs, etc. It's all handled by the insurance except maybe a few bucks on some drugs. Worst case I have to show my insurance card but that rarely even happens.