'My Health Insurance Company Is Trying to Kill Me': Huff Post

[appalachiablue]

- My Health Insurance Company Is Trying To Kill Me, Huff Post, June 22, 2024. Ed. "They are genius (and stealthy) in their tactics to exhaust me financially, emotionally and physically."
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I suspect that my daughter and I are growing too costly and inconvenient for my health plan’s customer profile.

They are genius (and stealthy) in their tactics to exhaust me financially, emotionally and physically. The company manuals must contain strategies for this, cleverly disguised as “working together.” I have tried to be patient and cooperative. I pay the premiums for my top-tier PPO plan on time. I have accepted the fact I must cover a sizable deductible, copays, and coinsurance. It’s harder to swallow the exorbitant “out of pocket maximums” we are required to pay before a health plan will cover at 100%. Not many people hit that mark, and are likely bankrupt by then.

Looking at this logically, it was silly of me to believe the health plan when it said it wanted to help me or my family. After all, this is strictly business for the company, and businesses must make money. It’s nothing personal — unless we die. I learned the hard way how to survive in this wild world. It entails reading the fine print, contending with confusing website portals, and enduring long wait times while being serenaded by repetitive jazz when attempting to reach a live person. Based on my decades-long journey, it appears that a health plan’s modus operandi is: When in doubt, deny.

Unfortunately, at times I discover that a claim has been denied only after being contacted by a collections agency. Why?

Because insurance approval or denial decisions can be delayed while providers are grilled for “more information” to justify their treatment plans, and bills deemed delinquent are routinely sent to collections. Claims are typically rejected for one or more of these reasons: Preauthorization forms or superbills are not submitted properly. The facility or doctor is not in network. The treatment is not medically necessary. (fav) Paperwork and shifting protocols during a crisis doesn’t help anyone’s well-being. This, coupled with the medical field’s reluctance to share digital files (citing privacy issues despite encryption solutions), means we are sent on a scavenger hunt for hard copies of our medical records...
https://www.huffpost.com/entry/health-insurance-no-surprises-medical-debt_n_665cdbb5e4b01ea28f32c18f

[MayReasonRule]

1. Meat Grinder Health Care For A Soylent Green Economy

... is not the way to achieve life, liberty and the pursuit of happiness.

[appalachiablue]

3. Amen, it's horrible, inhmane. What will it take to reform this nightmare..

Thanks for replying.

[area51]

2. The US needs to change over to universal heathcare,

but likely never will.

[appalachiablue]

4. It should have changed decades ago, the stress & pain of this

nightmare has gone on way too long and has harmed thousands, more.

[marble falls]

5. Which is a shame, because a significant number of the population is covered by a unversal healthcare system ...

... we vets only being a large part of it. Congress is another, Active duty military and dependents are.

Around 40% of the US is https://www.statista.com/statistics/200954/americans-with-government-health-insurance/


The largest group not covered: the young. The ones who would benefit most, if an ounce of prevention is worth a pound of cure.

[Ohioboy]

10. The for-profit insurance companies benefit from Medicare too

Private insurance companies get to drop you off to Medicare at an age when you are more likely to start needing care.
Republicans forget this when they talk about raising the age for Medicare and Social Security. They don't consider the affect it may have on the whole system. If they ever do succeed in raising the age, it will most likely raise the price for private insurance.

[marble falls]

12. An example of how a managed healthcare of the public benefits everyone. But it would be good to eliminate ...

... insurance companies from at the public policy aspects.

[Beck23]

19. But Medicare can't drop you

Medicare is government. Private Medicare Advantage companies are not government, and they are out to make money off you, or they drop you.

[jaxexpat]

8. Correct. The closest I know of is Medicare and Republicans want to eliminate it.

Social Security and Medicare are as close as right-wing thinking has let America get to Universal or Single Payer healthcare. Republicans spend king's ransoms on propaganda to undermine the public trust in them. They are popular with retirees who would vote "conservatives" into extinction if they bothered to learn the simple fact that instead of stripping them, via "privatization", they must expand them into birth-to-death healthcare.

But we are a nation born of slave power and way too many can't imagine any other way to drive an economy. They can't understand the utter simplicity of how only empowerment of the workforce can ensure security and prosperity. The system promotes coupling insurance to employment (though not by law, as that would infringe on the rights of employers). If unencumbered by healthcare insecurities, people would be free to find employment in their fields of competence, talents and interests instead of saddled to some thankless grindstone because their families must be insured against phantoms of catastrophe. Republi-can'ts can only imagine a prosperity wherein the wealthy thrive off the labors of a work force driven by personal financial insecurity and desperation.

So, we live our little lives in quiet desperation for insurance for healthcare from hell. Our insurance-based healthcare system is purposely designed, (mostly by short-term greed, long-term neglect and perpetual indifference), to create and maintain friction and mistrust between consumers and their providers, employers and their employees, humans and their sanity. It will not change until voters learn to NEVER trust corporate interests, the fairy tale "science" they call economics, or a political system based on most-money-wins.

[Beck23]

24. Why is there Medigap?

Yes, and when Medicare was created, Southern lawmakers were concerned about providing free insurance for black people. They agreed to vote for Medicare as long as there was a gap that required additional paid-for insurance, called Medigap. They thought blacks wouldn't be able to afford Medigap, so they couldn't get Medicare.

Medigap is highly regulated so they can't rip you off like a private Medicare 'Advantage' company. If you have Medicare and Medigap, your only payment will be the Medicare deductible for the year which was $240 this year, and of course, your Medigap premium. Everything else is totally paid for including MRIs, surgery, etc.

[Orrex]

6. Nowhere near the same level of frustration or bullshit, but...

Two minor things that stand out in my own insurance experience:

1. Every time they send me an EOB, it's like 16 pages, with multiple charges listed in an obscure format, culminating in "Amount your provider may bill you: X" These EOBs are often for treatment received months prior, so the details are sketchy, and you have to contact your provider to see if you were or weren't billed. And they might have billed a lesser amount based on their own calculations and policies, so you can't simply look at your payment history to see if you've already taken care of it.

2. I had to get a doctor-prescribed MRI a few years back, scheduled for 6:15 am. The insurance company refused to reveal whether or not they'd cover it, saying instead that they would determine eligibility based on the results of the MRI. They also said that I should call the morning of the MRI before going in for the test.
"Will you have people in the office at that time?"
"We open at 8:00," they said.
Ultimately they paid it, but I had no way to know in advance if this doctor-prescribed scan would cost me $75 or $1600.

There's no way that a 13-figure industry could be this unworkable by accident. Every delay, obstacle, and ambiguity in the insurance process is 100% by design, absolutely intended to screw the individual for the sake of the shareholders.

[appalachiablue]

30. Thanks for sharing your healthcare insanity story. Nothing

should be this difficult, the hell people are put through, all in the name of greed.

[Orrex]

31. Thank you, but let me stress that they did pay, and medically everything turned out ok

As big a pain in the ass as it was, I can't even imagine what it's like for people who have to navigate that bureaucratic labyrinth while also recovering from major surgery or while providing round the clock care for an ailing loved one.

I mentioned this thread to my wife, and she added that the EOB may not even give sufficiently clear detail for the victim to figure out what procedure they're talking about. If you had three doctors' appointments in August and two courses of bloodwork, the billing party might be any of 50 different agencies along the way, but all the EOB says is "Blood work 8/13/2023." And even that might not correspond with your appointments or with any payment date.

I repeat that every nonsensical paperwork obstacle is a conscious choice by the insurance industry. Even if a particular obstacle wasn't deliberately designed that way, then it is deliberately kept that way.

Thank your posting the OP. The HuffPo story has been haunting me all day long!

[appalachiablue]

33. Glad they paid, but the kind of maze & uncertainty you had to deal with

is daunting to me. I'm apprehensive about encountering this kind of bureaucracy, complication and what all that people experience. I'll see how it goes.

20+ years ago I helped my mom thru some fairly serious medical treatments and one major surgery. She had Medicare but things weren't nearly as complicated as now. Since then the GOP has been working hard to limit, cut, and kill it off, of course!

[2naSalit]

7. I call it...

The hoopdance from hell or hoopdance from hell while performing the dance of the seven fucking veils.

[appalachiablue]

14. Perfect, hell dance it is! I haven't yet had an insurance co.

try to stress, exhaust and kill me but I know the time will come, grr.

[2naSalit]

15. Had a spell of it in my 30s...

I avoid them as much as I can since. I hope to be healthy when I die.

[Beck23]

9. Don't go with Medicare Advantage

This sounds like a Medicare Advantage scam. These are private companies, not Medicare. I got back on Medicare because of this. You have to have a Medigap plan which can be a little pricey, but all your big bills will be paid.

The American public will be screwed by the healthcare system until we get national healthcare, and hospitals are turned back into nonprofits.

[DownriverDem]

11. Do you understand

that folks go with Medicare Advantage plans because they can't afford the pricey Medigap plan and a drug plan? Almost half of seniors go with Medicare Advantage plans. I'm tired of folks not understanding this.

[Beck23]

25. That's too bad

Last edited Sun Jun 23, 2024, 11:21 AM - Edit history (1)

It's taking advantage of old people. I was on one of those plans for a while. I was lucky to be able to go back to Medicare since I was relatively healthy at the time.

[Skittles]

32. I understand how MA pimps manage to get so many people on board

what I DON"T get is why those people cannot understand how this is trashing Medicare itself - we GET that's all people can afford but they shouldn't be acting like they're getting a great deal because we're ALL getting fucked

[Wonder Why]

13. If it's not the insurance company, the provider's billing department will finish the job.

Them: "You haven't paid. We'll turn you over to a collection agency who will torture you for the money"

Me: "But the insurance company is required to pay by Medicare rules. They have paid every other similar charge without question for the last 12 years including every other charge of the same type to you this year. It's only $72 out of thousands they paid out. Their web site clearly shows when and how much they paid. They even provided me with the check number of the check they sent you. I sent you all the evidence. Just talk to them to see what happened."

Them: "You haven't paid. We'll turn you over to a collection agency who will torture you for the money"

[Midnight Writer]

17. Been there. They told me on the phone the claim was valid and they would pay it.

Next thing I knew I'm getting calls and nasty letters from a collections agency.

[Hermit-The-Prog]

16. The Wealth Care Industry wants all your resources before you die.

There are multiple layers between you and the doctors, nurses, orderlies, pharmacists, technicians, etc. who actually provide health care.

[appalachiablue]

18. Thread winner!! The WEALTH CARE INDUSTRY

[Hermit-The-Prog]

22. Somebody has to pay for skyscrapers, private jets, and vacation mansions.

[appalachiablue]

23. You know it!

[Beck23]

27. In addition

In addition, a lot of medical practices are being bought by private equity so they jack the prices up and reduce care.

[TNNurse]

20. My first experience with this was just a shock.

After my mastectomy for metastatic breast cancer (which I will say was accomplished speedily), I received a call from my insurance company. The young woman on the phone introduced herself as "the person who approved your surgery". Had I been a little stronger and not so medicated, I might have responded with fire. I do not know what I said. But now I would say, "who the hell are you to decide whether my metastatic cancer needs to be removed?" But that did and will not happen.

Recently, I have been working to get a piece of medical equipment replaced. Because of the surgery, radiation and such I have a condition called lymphedema in my arm. If not kept under control (can really not be fixed), there is potential for infection, really massive swelling and even possibility of losing the arm. I work at it, I am cautious, I am diligent. I got a "compression machine" which I use three times a week for an hour to help move fluid out of the arm. I also wear a compression sleeve every day. The machine was 11 years old. It was apparently first generation. Besides the pump there was a "garment" that wrapped around my chest, abdomen and arm which fastened with Velcro. The seams and Velcro began to fail. I contacted the company for a new "garment" and they informed me it was essentially obsolete and would need to be replaced. Since I am now on Medicare....yes, I received my new machine yesterday after more than 6 months of working at it. The last person I spoke with was very nice and helpful and I got it 2 days after that call. My machine still worked, my arm is stable, this was not a medical emergency. However, if there had been problems, my medical care would have cost the insurance company a hell of a lot more that the $1700.

All I can think of are the medical situations that require immediate care, 6 months of waiting could be lethal.

[RainCaster]

21. Then there is the idea that dental care must be isolated

Somehow, caring for our teeth falls into a different category, which requires a different insurance plan, along with a whole different deductable.

[Beck23]

26. Dental is a challenge

Even the dental savings plans cost at least $40 a month because the co pays are really high. That's without having any major work done. In that case, it's higher.

[RainCaster]

28. Only in America

[Jilly_in_VA]

29. Sounds like United Healthcare

or as I prefer to call them Untied. They are the worst, but only slightly worse than Blue CrossAnthem or whatever they choose to call themselves. I've stuck with plain old Medicare since I got on it. Due to a mixup, by the time I got on it I was "too old" to get Medigap at a reasonable price, so I'm stuck there. I really haven't done too badly, all things considered.

Dental, however, is a SCAM. I have my own, which basically sucks, but luckily my husband put me on his, which is pretty good, since I've had to have some nasty work done. Hopefully this next bit will be the last.