this post was submitted on 08 Apr 2024
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Mildly Infuriating

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Just so tired of almost every time a doctor submits stuff to insurance, we have to be the ones to make multiple phone calls to both the doctor's office and insurance to iron everything out, figure out what the issue is (it's always a different issue), and basically be the go-between for the office and insurance. What am I paying $500+/month for?! It's like paying for the privilege of having an exhausting part-time job.

And yes, I understand that insurance wants to weasel out of paying anything, but this isn't even shadiness, just straight up incompetence and lack of communication/following procedures. The amount of emotional energy we have to spend untangling this stuff leaves us drained.

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[–] [email protected] 104 points 8 months ago (5 children)

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.

[–] [email protected] 46 points 8 months ago* (last edited 8 months ago) (1 children)

And what might be the most important part cannot be elided over: market capitalism is HIGHLY efficient at solving optimization problems, but it only responds to incentives.

So if you can create the right incentives to reward the result you want and punish results you don't want, a market solution is going to do a marvelous job. It's great at, say, price discovery. But if the incentives do not align with the desired result, it's going to grind you under heel.

The incentives the insurance companies are responding to, frankly, are the ones you have outlined and essentially no others. Collect more premiums, make fewer payouts. There's no "breaking point" here because they have an absolutely vast customer base that has no choice to opt out of the system for a variety of reasons (ranging from the ACA individual mandate to the fact that it is not possible for an individual to make fully-informed financial decisions about their health even WITH advanced knowledge and training that nearly no one has).

Health insurance is pretty much a textbook example of the kind of service that shouldn't be on private markets.

So over time, market capitalism is going to make them collect endlessly-increasing premiums and pay out less and less. It is going to continue to get worse because the incentives of the system have defined 'worse' as being the optimal result. Period. It will eventually get nationalized. Period. All the argument in the meantime is just over how long we want to continue to let people be sick and broke before we apply the only fix.

[–] [email protected] 8 points 8 months ago

Also it’s not like you can change insurers when they do this. First it almost certainly didn’t happen during open enrollment but also your insurance provider is probably decided by your employer.

[–] [email protected] 13 points 8 months ago

Completely agree. Just had to vent.

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[–] [email protected] 74 points 8 months ago* (last edited 8 months ago) (1 children)

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.

[–] [email protected] 13 points 8 months ago* (last edited 8 months ago)

In one example of this, during one job interview / recruitment process I essentially had to do all of the background check company's work for them.

That makes literally no sense at all, and I'm not surprised when there's cases of people just pretending to be doctors or whatever for decades. The "doctors" probably verified their own employment history and credentials.

[–] [email protected] 51 points 8 months ago (5 children)

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

[–] [email protected] 24 points 8 months ago (2 children)

It's beyond belief, but insurance companies do the same thing to amputees.

[–] [email protected] 21 points 8 months ago

Oh I know, I had a family member make the joke about suddenly regrowing a limb

It's disgusting and absolutely should result in anyone who's ever approved that being put against the wall for their pure evil

[–] [email protected] 8 points 8 months ago* (last edited 8 months ago)

Any hassle they can create to manufacture a reason to deny coverage.

It's not "beyond belief" it's disgustingly evil.

[–] [email protected] 12 points 8 months ago (1 children)

Wow. This is similar to what disabled people have to deal with in Russia. Like arm will grow back.

[–] [email protected] 5 points 8 months ago* (last edited 8 months ago)

Oh don’t worry, disabled vets deal with it all the time in America too. Oh, that leg you lost during your deployment? Gotta prove it’s still missing, and that you’re still disabled every year. And if you fail to get personal copies of everything in triplicate, the VA will magically “lose” your paperwork and you’ll be stuck without benefits until you start the entire process all over again.

[–] [email protected] 8 points 8 months ago

I have to do it quarterly for some reason. Annually would be...better, but still stupid. My doctor even thinks it's dumb, so he usually just asks me all the rote questions...

...no he doesn't, he usually goes blahblahblah you've been doing this for 10+ years we know the routine. Unfortunately I still have to make an appointment, have an appointment, pay the deductible for said appointment, just to get 3mos of a medication that, thus far, I have a medical need for.

[–] [email protected] 6 points 8 months ago* (last edited 8 months ago)

Same with my MS. It's frustrating to know that if they fuck around and drag their feet one year, i could be getting further brain damage without my meds.

[–] [email protected] 5 points 8 months ago

It means they have to compare your request to a list of allowances that change annually at the whim of Corporate

[–] [email protected] 48 points 8 months ago (2 children)
[–] [email protected] 11 points 8 months ago

What you really need on top of that insurance is supplemental insurance! That way you can pay two insurance companies and they can both say no!

[–] [email protected] 10 points 8 months ago

Haha exactly! I mean, I know this is how it works, it just feels like it’s gotten way worse in the last few years.

[–] [email protected] 47 points 8 months ago (1 children)

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."

[–] [email protected] 29 points 8 months ago (2 children)

They try to spend less so aggressively that they end up actually spending more

[–] [email protected] 19 points 8 months ago (2 children)

Fought them for a month, meanwhile I'm in pain, limping with a busted tendon.

Finally we just gave in and did the xray, which - surprise! - showed nothing! Then they approved the MRI.

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[–] [email protected] 14 points 8 months ago

Corporations are all about stepping over dollars to pick up pennies.

[–] [email protected] 44 points 8 months ago (1 children)

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

[–] [email protected] 7 points 8 months ago (8 children)

How? Who do I vote for to make that happen?

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[–] [email protected] 29 points 8 months ago (4 children)

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.

[–] [email protected] 17 points 8 months ago

I worked in healthcare tech for a long time and I would say that healthcare facilities should focus on delivering healthcare. We had so much administrative overhead from dealing with this insurance bullshit that it drove up costs to staff a ton of people to deal with insurance bullshit and thus increased costs. If we had single payer it would be a single process that couldn’t possibly be more convoluted than what we have now. Sending shit to insurance clearing houses with exact ordering of diagnosis matching procedures so that they don’t get kicked back. The hospital doesn’t want you dealing with this shit either they just want the money that the insurance provider said it would pay for your treatment. It’s 90% insurance bullshit all the way down.

[–] [email protected] 13 points 8 months ago (1 children)

Just to offer another perspective, this covers just how difficult the burden of administrative tasks already is for physicians: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8522557/

Not all physicians work for a hospital, so I don't think they all have much access to large departments that can take up the slack for them. It's difficult to ask them to chase our insurance for us when the paperwork they already do is driving them insane and taking them away from their patients.

The solution, as you said, is single payer. The overwhelming administrative overhead is a symptom of a very broken system. Nobody directly rendering or receiving care is benefiting from how things currently are in the United States.

[–] [email protected] 7 points 8 months ago* (last edited 8 months ago)

I do feel sorry for the admin staff that have to deal with it, and my ire is 90% directed at insurance. However, when they can’t even read the back of the insurance card to follow the instructions to properly file a claim, it just gets tiring.

[–] [email protected] 10 points 8 months ago (1 children)

I completely agree about it being the providers responsibility. The problem is, they don't want to do anything to resolve the issue either. Other times, it doesn't even involve the provider, they did everything right but for some byzantine reason it didn't go through the insurance system correctly and you have to call them and tell them to process it the same way they have processed every other exact same bill from the exact same provider.

Just wanted to vent. I should clarify I live in the US (as if that wasn't clear from my post LOL!)

[–] [email protected] 6 points 8 months ago* (last edited 8 months ago) (1 children)

they don't want to do anything to resolve the issue either.

In any other line of work, that's an excellent way of forfeiting any right to getting paid.

In the jobs I've had where I've had to bill someone, I'm having a hard time imagining that I could expect to get paid if I just sent a bill to someone who didn't owe me.

[–] [email protected] 5 points 8 months ago

The patient is ultimately liable to make the payment. You sign that when you get the service. So if the insurance company isn't forking out, the provider may send the bill to collections.

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[–] [email protected] 24 points 8 months ago* (last edited 8 months ago) (1 children)

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.

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[–] [email protected] 23 points 8 months ago

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.

[–] [email protected] 16 points 8 months ago* (last edited 8 months ago) (3 children)

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...

[–] [email protected] 9 points 8 months ago (6 children)

Several decades ago in the USA, healthcare was affordable to working class people. It wasn't cheap, but it was at least affordable to middle class people. It certainly wasn't great even back then, because in my view healthcare is a basic human right. And poor people (especially minorities) had limited or no access. But even then, it was still better than the shit show we have today.

Anyway, what happened was some large corporations like IBM and others started offering an executive perk they called "major medical". This was to help pay for expensive, unexpected medical expenses. It was a nice perk for the country club set. But like anything with money attached to it, some people got together and said, "Gentlemen, how can we weaponize this and take ALL the money?"

So, over time, it became the "standard practice" to tie your health insurance to your employer. This introduced a ton of friction into the system and created an entire ecosystem of rent-seekers who add no value to the patients or providers but charge a fee just because they exist.

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[–] [email protected] 15 points 8 months ago* (last edited 8 months ago) (2 children)

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.

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[–] [email protected] 13 points 8 months ago

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.

[–] [email protected] 11 points 8 months ago

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.

[–] [email protected] 11 points 8 months ago

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.

[–] [email protected] 9 points 8 months ago (1 children)
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[–] [email protected] 7 points 8 months ago (2 children)

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

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[–] [email protected] 7 points 8 months ago

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...

[–] [email protected] 7 points 8 months ago

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.

[–] [email protected] 6 points 8 months ago

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

[–] [email protected] 6 points 8 months ago

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!

[–] [email protected] 6 points 8 months ago (3 children)

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.

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