This is more than mildlyinteresting.
Thank you. This is directly relevant to me. And yeah, I’m an American.
Can’t I just get care? I got a whole grown ass person’s life to live, and i can’t be an expert in everything.
Oh ya, you can get care. And then you fight with insurance about whether or not that was the right doctor to use or if it was really necessary in the first place. But insurance won’t talk to the hospital and the hospital won’t talk to insurance so you have to talk to each of them in turn while waiting on hold every time. It’s a wonderful system.
In most countries you can, yes.
You could but half the country voted for the guy who hates poor people
75+ million fascists voted for a fascist.
To be fair, neither party was going to pull the trigger on Medicare For All. We’re not getting universal healthcare until the working class stops letting wedge issues divide it.
The Democrats have fought nationalized healthcare tooth and as well
You say that, but when the Dems had a filibuster proof super majority in Congress for a handful of weeks over a decade ago, we got the ACA.
They literally brought the health insurance executives in to write that bill. It was a step forward. But it was also a captive market that was supposed to be subsidized by state and federal governments. So the health insurance companies would just make a profit no matter what.
You say that, but when the Dems had a filibuster proof super majority in Congress for a handful of weeks over a decade ago, we got the ACA.
The ACA barely passed in its original form (219-212) with a bunch of democrats voting against it too. A few aligned themselves with big business however many other democrats voted against the ACA because they believe it didn’t go far enough.
The ACA was still the biggest win for the American people on healthcare in decades.
Yeah, there were some pretty conservative Congress people back then. There no way we were gonna get enshrined abortion rights, since many Dems were staunchly pro-life, hence ACA as an alternative.
Hey why did we get the shitty ACA instead of actual universal healthcare if the Dems had power and were committed to getting universal healthcare?
Because there were other people in Congress who talked about death panels and tried to kill it at every turn. Reps hate the populace, and try their best to neuter everything good for the people. Also, some pretty right-leaning Dems were there. Have you paid ANY attention to politics?
Maybe don’t tout a half-measure that comprimised with literal ghouls as a defining unequivocal win for the party then?
You some champion of missing the point? That’s what we got despite all odds.
It’s like you people don’t understand politics or history. No wonder we elected a fucking fascist into office. JFC
You can get whatever you want, but you have a $37,849.45 bill because you used the wrong door.
See, that door you used was operated by Attenya Healathus, not the Hospital, which is operated by Wellmeat (formerly Agape Plalauthis) so your care was not covered. If you had entered through the door (as outlined in your EOB) to the right, it would’ve only been an $800 copay for your splinter removal.
Are you rich? Then yes. If you’re not rich, then you need to suffer and struggle for needing to use valuable resources that could be used on people more deserving; like the wealthy.
It’s not that they’re hoarding scarce healthcare resources so they’re available for the wealthy. They could provide care for everyone, but then the system wouldn’t run at the desired profit level.
There is also a giant undercurrent of wealth ministry in the American upper classes. Since about the 1960’s they’ve been pushing the idea that God blesses good people with money and punishes bad people by making them poor. It’s mixed with the Protestant Work Ethic so they also see poor people as lazy and undeserving.
It’s a completely self serving and self fulfilling ideology but it makes them feel good so we all have to suffer because we lost the lottery at birth.
The mentality goes back much farther than the 1960s. In a traditional Christian family the father is the giver of rules and justice. “Wait til your father gets home!” Kids learn that doing what daddy says leads to rewards and disobedience leads to punishment. Follow the rules and you prosper, break them and you suffer. This translates very directly into thinking poor people must be bad people. They must have broken the rules somewhere along the line because look how they’re being punished. Wealthy people must have done all the right things in all the right ways, because they’re getting rewarded with prosperity and that’s what’s supposed to happen. f you’re conditioned into that mindset, class differences make perfect sense.
More that people wouldn’t be reliant on shitty jobs for healthcare. The current state of affairs ensures obedient workers.
i didn’t say healthcare resources. money is a resource and you must give it to your betters if you want access to affordable healthcare. they are hoarding one resource by denying access to another.
So the Hippocratic oath is essentially meaningless in America?
It was always meaningless. It never had any legal repercussions if it was broken, just like ethics agreements politicians get to waiver.
I tells ya it’s a situation awful enough to drive a man to stay in a hostel.
And your doctor will have to fight with the insurance company over the phone for an hour to do a pre-auth. When my doctor wants to perform something or give a certain treatment not covered, he assures me he will make this long and stressful call. I really wonder what they are discussing and what goes on in these conversations…
What doctor has time to do that? I’m in Canada and I can never trust my doctor to have any conversation with anyone, at any time longer than five minutes at a time for anything.
The best tactic I’ve found if you want to get anything done for yourself or someone close to you is for you to do the legwork and make calls, contacts and literally hound people to do their job. If no one is there to push things along, no one is going to magically appear to help you … that is a fantasy that seldom and rarely happens, even in our publicly funded system.
You or someone who is capable should advocate for you every step of the way, otherwise you will just get lost and forgotten in the system … whether you are in the US or Canada.
I have a doctor that actually cares. If I had one that didn’t, I would not stop until I found one that did. It’s mostly getting the insurance to cover medications that they don’t. The doctor usually spends the last hour of his day doing this, for me and other patients. You have to find a local doctor outside of a major city with less client base so they DO have the time. I am in the US. My deductible is very high but the medication I take is life sustaining and I can never pay for it. I have to do this every 6mo to a year: make an appointment and hope the doctor gets their way. Once they didn’t and that is why I am at my current doctor. There is not much negotiating a patient can do calling the insurance themselves. They will just look and see you don’t know what you are talking about. No matter how you complain about the symptoms, your financial burden, your family, or the fact of it being life-sustaining. Best to have a medical professional advocate. I have even tried with doctor letters and emails forwarded before calling. That is why I wonder what the doctor actually says that gets through.
What you are saying is generally true. The only real oversight in ensuring things are moving forward is us ourselves as patients. It’s our responsibility as patients to take charge of our health.
That being said, P2P is sadly a standard aspect of American medical practice. Essentially anyone in a direct patient contact position position has done them. In the clinic or hospital, it may be your primary clinician handling it but it doesn’t necessarily have to be. It can be handled by other clinical staff or a group of nonclinical doctors also.
You dont have to worry about P2P since it will get taken care of (whether the service will be covered by insurance is another story). Instead I’d focus on keeping disconnected parts of the system abreast of your medical conditions and current list of medications. Because health information is protected there really isn’t a great solution for centralizing this data yet so if you go to a clinic that’s on a different EMR, they’re not going to have all of the necessary information available to them.
Do you think your health record got that black mark before you took control of your health journey, or after?
(Mine is “surgery seeking”, apparently, as my old region has the mitigation history and the new region doesn’t; and one surgery every 15 years seems to be too many for them!)
I’m in Canada and I can never trust my doctor to have any conversation with anyone, at any time longer than five minutes at a time for anything
The best tactic I’ve found if you want to get anything done for yourself or someone close to you is for you to do the legwork and make calls, contacts and literally hound people to do their job.
This is my experience in the US as well. Also nobody knows anything about anything.
Doctor A puts you on a medication, doctor B doesn’t know until you tell them and then he says “he put you on that!? You shouldn’t be on that, I’m taking you off it.”
You go to have a surgery and say “hey guys, did you know that I’m difficult to intubate? Because I could die if you don’t take that into account”, they didn’t know.
“Hey guys, I have reason to believe that the insurance card I was issued in the mail isn’t completely correct, can anyone help me with this?”, 4 different people at the company that issued the card have no idea what’s going on, don’t even know about the policy tied to the card in question and think you must have accidentally called the wrong company (you didn’t).
“Hey guys how much is this going to cost?” it is literally impossible to say.
When I was a clinic assistant in a cancer-focused plastic surgery clinic, it was my job to fight with the insurance companies. I did prior authorizations for every surgery and they would do shit like approve the removal of a melanoma without requiring prior authorization, but performing the skin graft to repair the 10cm diameter hole required a prior authorization because the procedure code falls under the “Plastic Surgery” heading and they wanted to make sure you’re not getting skin grafts for cosmetic reasons.
Agree I feel fortunate to have found a doctor(and their PA, and their staff) who feels like my own personal swat team to get my treatments. I am not wealthy and don’t have gold plated coverage, I just found a winner.
It’s so much paperwork and phone tag.
I was the feisty little gremlin that fought with the insurance at a cancer-focused plastic surgery clinic. I got really good at stacking up all of the info in the first submission so that they couldn’t drag their heels on shit that was time-sensitive.
Preesh.
As an EMT I rode with too many people who were sobbing in the bus because they knew the financial hit that was coming when we got to the ER.
I’m in medical school now and looking at either emergency med or family med, and either way, I am going to be exceedingly careful about how I construct my notes, diagnoses, evaluations, and treatment plans to leave as few cracks as possible for the insurance companies to try to weasel their way into.
I would encourage you to CAREFULLY and WITH DETAIL listen to your senior tutors (senior grisled paramedics, charge nurses, etc). They have a very particular line to walk and you can blow the show if you don’t learn the language.
It’s performative…everyone in the equation wants the patient to get the best, but if you haul off and make it obvious, they may be screwed.
Not saying you’d do that, but it’s a new world of…bullshit nuance.
Edit and if they ever give you a knowing look, and ask you to check the blinker fluid, or if the vending machine is stocked with saline, nod, and go “check”. They want to talk to the patient with no witnesses, so they can coach them on how to fit a proper insurance code.
I am quite familiar with this nonsense from the patient side as well. As a physician, I think I will be well-placed to ensure that my patients are getting appropriate care while not giving the insurance company bullshit reasons to deny claims.
Good on you. I mean no assumption, only shared advice from some years in the trenches.
I’ve had doctors lead me to make certain statements so they can more readily justify a given treatment that they know I need.
It’s a bit of a wink-and-a-nod situation.
It’s even worse if you’re part of an HMO, because the doctors are beholden to the business side, unlike independent doctors who don’t have a management overhead telling them how many times a year they can prescribe a treatment, becuase they’re doing it more frequently than other doctors in the system.
This demonstrates the major issue with socialized care, because it’s also managed this way. I’ve been in both HMO and PPO systems - overall they both cost about the same despite HMOs acting like they cover more day-to-day stuff. It’s just with PPO (independent doctors), I get care that’s more tailored to me and my wishes, I don’t get pushback from corporate, because there’s no corporate involved. I may have to discuss with my doctor how to present things so my insurance won’t push back, but at least the insurance company doesn’t directly control my doctor’s salary, bonus, etc.
All this crap started in the 80’s as business management orgs started taking over healthcare organizations and consolidating them, and turning them into profit centers.
It must be exhausting to be an american
I need to immigrate
I need to emigrate.
it most certainly is.
Man, you got that right.
Gestures Broadly at Everything
Anyone taking refugees yet?
They (Americans) deserve it honestly.
- They worship capitalism
- Gleefuly joke about killing communists (via helicopters)
- Do not bat an eye when US govt invades 3rd world countries
- Rig international organizations in their favor
- Impose their will & turn other countries into a puppet states
- Fund Coups & Terrorists & bomb & sanctions on other emerging (As in developing) countries to destabilize them
- Stage Regime-change operations
- Greedy & Resource-Hoarding Nation with a mostly Selfish & Solipsistic Population
- & you rescued Nazis
- Not to mention how willing people are in joining the Military-industrial complex
I could go on & on
We 100% do.
My christian mother can’t wait for society to burn and Jesus to come back.
Let it. Fucking hell. I’m so tired of protecting these fucking idiots. Good riddance.
I do not. Many of my friends don’t either. Do we still “deserve it”?
I do not. Many of my friends don’t either. Do we still “deserve it”?
- carve the word “deny”
- carve the word “delay”
.
.
.
Semi related, recently I was referred to what I thought was a “specialist” from my doctor for a thing but I couldn’t myself determine if they were in-network with my insurance. Turns out what was implied to be a specialist was actually just a company that determines where to send people for this specific service, so we’re at the point that a primary care provider is working with a 4th party to deal with the 1st party and the 5th party is running services at the 2nd party and I am 1) the person responsible to figure out this insanity and 2) will likely be billed an obscene amount of money for something that should’ve been a 1:1 convo with a doctor and a hospital because one or five of the likely 30 people across 8 companies missed an email. (And you know all those people are they themselves dealing with the same nightmare and probably being paid a paltry $15/hr.
Yeah, that sounds about right. After a heart attack scare, a night in the hospital and all the cardiac testing that went with it, I received a letter in the mail from some company I’ve never heard of that determined my tests were necessary and would be covered. Weeks later. Like, motherfucker, what was the other option? We all thought I was dieing… ER had me admitted in less than 2 hours. It was bad … And someone needed to contact a fifth fucking party to make sure I deserve to live?
Fuck me. I wish I could leave this place and get my family someplace sane, where they are safe.
The free market is so much more efficient than the government!
cause of death: not knowing the cheat code to getting treated like a human being that exists for some reason
I don’t think persuasion Checks are a good way to determine who lives and who dies in real life 🥲
Go ahead and roll for persuasion on your motion to abolish persuasion checks in healthcare.
Its only illegal once you are prosecuted for it. That is how businesses operate. Its not just regulation we need but a justice system that has some teeth
No idea how effective this would be, I think the doctor would have to request this themselves. When I worked for an insurance company, member services didn’t even have access to authorization details.
Usually this is a tactic some doctors do for a peer to peer, but generally you ain’t getting a peer to peer as a patient. Peer to peers use unqualified doctors to question treatment at a time convenient to the insurance company in the hope that your doctor decides “this isn’t worth my time, the patient needs to figure their own shit out.” Importantly, you can’t bill for the time spent on this shit. If they made it legally required to allow billing, it would disappear.
This is advice for doctors, not patients.
Usually doctors do the peer to peer and then the patient can appeal once services are denied (which is almost always the case if you’ve reached the peer to peer stage).
I’ve used this before with mild succees. It’s far from reliably effective. You’re more likely to get the decision over turned at the appeal stage, the problem being that precious time is lost while going through that process.
I do like to schedule an appointment so that patients are part of the peer to peer call. That way they can tell the doctor, nurse, PA, NP or whichever other service reimbursement bouncer the insurance company has hired that they’re putting a curse on them and their family.
I hate how useful this is.
