this post was submitted on 24 Jun 2024
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One such encounter went like this:

Me: “Hi. I’m calling about my daughter’s ambulance and hospital charges. I haven’t been able to reach my grievance coordinator about the appeal.”

Representative: “I can help you.”

**Me: **(Genuinely excited.) “Great!”

Representative: “Oh, I see your daughter turned 18. I can’t discuss her information with you.”

Me: “I sent a release of information form by mail, fax and email. I also faxed our conservatorship papers.”

Representative: “I’m sorry, it’s not on file. What office did you send it to?”

Me: (I give the information.)

Representative: “That’s the wrong fax number. Let me give you the correct one.”

Me: “I’m not inventing numbers out of the ether. This is the third new fax number I’ve been given. Are the address and email inaccurate too?”

Representative: “I’m sorry, but I can’t discuss your daughter’s claims with you without this information. Can you put her on the phone to give verbal consent?”

**Me: **“I can’t put her on the phone. She’s currently in a treatment center and has no access to a phone, which is why I have a conservatorship to help with her medical care.”

Representative: “I’m sorry, ma’am. There’s nothing I can do without the forms or her verbal consent.”

Me: “Who do you think pays the insurance premium and all her providers? I’m just trying to settle her claims, and I don’t know what we owe without access.”

Representative: “I can only answer general questions.”

Me: “OK. From the bills I’ve received, we’re being charged out-of-network fees for the ambulance, ER, ER doctor and hospital.”

Representative: “Was this out of state?”

**Me: **“Yes.”

Representative: “Hang on, I have to transfer you.”

I was on hold for another 15 minutes, and then got cut off. I called back, was transferred twice and then repeated a version of the above conversation before resuming — with a grievance coordinator! 

Grievance coordinator: “The ambulance and ER facility were both out of state and out of network.”

Me: “A treatment center called for an ambulance. I wasn’t given a choice of who responded or where they took her.”

Grievance coordinator: “They used out-of-network providers.”

Me: “They dialed 911. No one stops to ask the closest ambulance what their network status is.”

Grievance coordinator: “They did transfer her to an in-network hospital, but the physicians were not participating providers.”

**Me: **“Under the No Surprises Act, insurance must cover all providers in the case of an emergency, whether they are in network or not — even if out of state.”

(There was a long silence.)

Me: “Are you still there?”

Grievance coordinator: “Yes, ma’am. Once you get the conservatorship papers to us, we can look at those claims. Is there anything else I can help you with?”

Me: “Apparently not.”

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[–] [email protected] 156 points 4 months ago* (last edited 4 months ago) (3 children)

“Death panels!” the conservatives shouted. “The government will have death panels!”

The rubes ate it up, not realizing they had death panels the entire time and paid more for them.

[–] [email protected] 41 points 4 months ago* (last edited 4 months ago)

And the only death panels were all the insurance company death panels that already existed all along the way

rubes

I call them Rubels

[–] [email protected] 20 points 4 months ago

Seriously. The real Obama Death Panel is a lone worker mass-clicking "not covered" all the way down a spreadsheet that has your care as a line items.

I also like doing this juxtaposition:

Repubs under Obama: "death panels are going to kill our grandmas."

Repubs under Donald: "sacrifice all grandmas to the rising line."

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[–] [email protected] 144 points 4 months ago (4 children)

in most 1st world countries literally none of this ever happens.

insurance is the biggest scam of all fucking time. and we get to spend time arguing about gay books in the library

[–] [email protected] 74 points 4 months ago

in most 1st world countries

The US isn't a 1st world country. It just cosplays as one.

[–] [email protected] 15 points 4 months ago

Don’t even think about asking about the extraterrestrials.

Uh, not . . that there are any, it . . that is, if there were any there would certainly be information that . . uh . . about, uh, that. Which there isn’t! Ha ha! Nope. Anyway. Let’s finish getting these taxpayer funded Ten Commandments installations put up, hand me that hammer will ya

[–] [email protected] 11 points 4 months ago

we get to spend time arguing about gay books in the library

Congratulations! You've pointed to the exact reason why we're stuck arguing about gay books! If right wingers didn't have absolute bat shit social issues to bitch about they'd be joining us in bitching about the real issues we face!

Can't have that! Propagandists, sing me a tune!

[–] [email protected] 6 points 4 months ago

In lots of third world ones too. Here in Brazil there's no such thing as "paying for ambulance" if you are in a health plan or using public health systems.

[–] [email protected] 78 points 4 months ago (2 children)

Conservatives love to say free market works, shop for best price, blah blah..... When you are having a heart attack, you don't stop 911 from sending help until you shop around for the best ambulance service..... You take the closest one, go to the closest hospital, and get service from the doctor on call.

Fuck insurance, we should have Medicare for all by now.

[–] [email protected] 23 points 4 months ago

Conservatives are all liars. I mean, you know that. But the academic theory of the free market valuing things correctly requires an assumption that people can go without the goods and services being valued. It's not even a misrepresentation on this one. It's just a straight-up lie.

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[–] [email protected] 67 points 4 months ago

health insurance companies only profit when human beings suffer. full stop.

the only people rooting for these companies is either in on the take, or hasnt suffered their 'service' or are too rich to care. thus proving healthcare is for the rich only

[–] [email protected] 60 points 4 months ago* (last edited 4 months ago) (2 children)

Name and shame - it does absolutely no good to post your experience without the insurance company name.

Health Net pulled constant bullshit with me. The company regularly refused payment on claims, saying they weren't covered after previously paying for the same service under the plan. Health Net even went so far to refuse payment on a claim when they had provided prior approval for the appointment in writing. They would refuse payment on things that were clearly covered and I had to read them the policy to even get them to look at the denial. Health Net literally trashed prior authorization requests my doctor sent in and it took 4 months and personally faxing the request myself to get them to admit they were throwing the faxes away. The list goes on and on.

After major surgery I often spent 10+ hours per week on the phone with them because Health Net would deny so many claims. Getting rid of that crappy insurance company was a major relief.

[–] [email protected] 15 points 4 months ago

Not only that but the ACA rating system for plans is completely useless because the insurance companies invent brand new plans every single year so none of them ever have any kind of rating.

[–] [email protected] 10 points 4 months ago (1 children)

Doesn't matter, it's all of them. My family has had United Healthcare, Cigna, and Anthem in the past 6 years and they're all equally bad. We've had so many issues with coverage for both of my autistic children and mental health care.

The system is designed to screw you unless you have hours of time to question every bill. Luckily my wife doesn't have a job so she can make all of these calls. In most cases we got everything resolved, but after my wife basically made this her daytime job calling about the bills and learning about how billing and coding works.

After our experience, I'm confident that no one knows what they are doing. It's all guesswork. From the doctors, to their office billing people, to the insurance. It's all fucked.

[–] [email protected] 7 points 4 months ago (1 children)

Doesn’t matter, it’s all of them.

It's the majority of them, but there are exceptions. I switched to Blue Shield (not Blue Cross or one of the combined companies in some states) and had almost zero problems. They paid my claims accurately the vast majority of the time and fixed the occasional problem with relatively little fuss. The Blue Shield reps also knew their stuff and I never once had to explain my policy to them.

Health Net is deliberately designed from the bottom up to refuse legitimate claims and to fight tooth and nail when customers demand they follow their own contract. IMO Health Net should be shut down.

...my wife basically made this her daytime job calling about the bills and learning about how billing and coding works.

I had to do the same, despite recovering from surgery. To make matters worse, after I hit the maximum out of pocket amount the medical centers continued to send bills showing I owed a balance. It took nearly a year and repeated escalation to their executive and legal departments to get them to provide refunds. Calls, faxes and certified letters were completely ignored.

Corporate America has become quasi-legal and well-funded organized crime.

[–] [email protected] 6 points 4 months ago (1 children)

I had to do the same, despite recovering from surgery. To make matters worse, after I hit the maximum out of pocket amount the medical centers continued to send bills showing I owed a balance. It took nearly a year and repeated escalation to their executive and legal departments to get them to provide refunds. Calls, faxes and certified letters were completely ignored.

Yup, we always hit our deductible within about 2-3 months due to my kid's therapy, yet we still get full bills from all of our providers even though we should be 90-100% covered at that point. You call the insurance, they say the provider billed it wrong, you call the provider's office and they refuse that they did anything wrong and tell you to call your insurance. It's a never ending cycle.

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[–] [email protected] 53 points 4 months ago* (last edited 4 months ago)

As an American, I’m legit terrified of sustaining some kind of injury or extended illness. The society we have constructed, and that we tolerate, is an absolute abomination. Let me say it again. The United States is an absolute, top to bottom, left to right shit hole. We do not value people, life, or well being in any meaningful or equitable way. This is an economy masquerading as a society.

[–] [email protected] 40 points 4 months ago (4 children)
[–] [email protected] 63 points 4 months ago (1 children)

It actually isn’t, but those in charge know our legal system works so slowly. So the companies already know they just have to delay and they’ll only pay a percentage of a fine for swindling patients. And instead of being accused of robbing, their legal team will get charges lowered and the company will just change its name and start over. Until the punishment fits the crime, the rich scams will continue.

[–] [email protected] 16 points 4 months ago (1 children)

Yup. They violate HIPAA all the time, too. Rules for thee, not for me.

[–] [email protected] 14 points 4 months ago (1 children)

Bingo. Which is why they comfortably hide using the infighting of the two party system. One party has to be willing to accept they’ll be doing most of the work to fix the situation. Up until now, they wanted us believing the task is Sisyphean and impossible, the truth is we can easily catch them with their pants down.

[–] [email protected] 11 points 4 months ago

Oh you sweet summer child. As if that matters.

[–] [email protected] 6 points 4 months ago

It's not but since the Government refuses to enforce it's own laws, it's up to individuals to pursue expensive and extremely long civil cases.

[–] [email protected] 5 points 4 months ago (2 children)
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[–] [email protected] 40 points 4 months ago* (last edited 4 months ago) (1 children)

When I started my first "real" job, where I got health insurance, it was an absolute nightmare trying to find a therapist through their network. I remember having to call them to figure out if they would cover visits to a specialist in trauma. Sat on hold for an hour and 45 minutes, just to get some random woman who would NOT give me any information until I told her "why" I needed to see a therapist.

After trying unsuccessfully to skip past the question, she kept asking, so I said fine, and trauma dumped all over her. I'll save you the details, but I could tell she was shaken once I finished. After all that bullshit, she still couldn't even tell me if the provider was covered or not, and instead sent me a 90 page non-searchable PDF listing a bunch of random therapists in random order located all over the state (which was negative help). I was so upset I just hung up on her.

Medicare for all. Health insurance is a scam that bankrupts Americans, puts barriers between you and care, and actively harms all of us collectively.

[–] [email protected] 5 points 4 months ago

It is so fucking bullshit in every way. I cannot comprehend why someone would have a problem with single-payer, which is so much better by comparison than what we have to do now.

The only thing I can think is "but I might wind up with slightly less coverage than my work currently provides," which is also practically impossible for all but the very upper crust...

[–] [email protected] 32 points 4 months ago (1 children)

As someone who is taking Kaiser Permanente to court over their refusal to release documents, let me confirm that grievance coordinators are the most useless wastes of oxygen ever to steal air on this planet. Even having your lawyer send them the actual text of the law they are currently violating, they will refuse to do anything not explicitly outlined and approved by their policy. Fuck the law. Fuck common sense. If it's not policy, it doesn't matter.

[–] [email protected] 6 points 4 months ago (1 children)

Ignoring the law is a more profitable strategy then following it. Unless this changes, then healthcare companies will continue screwing people over.

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[–] [email protected] 29 points 4 months ago (1 children)

Courts should find insurance companies liable for billing mistakes that you have to spend your time and resources to correct. Compensation should be 100 dollars a minute.

[–] [email protected] 7 points 4 months ago (1 children)

Brilliant. Unfortunately the insurance lobby owns Congress.

Hey - we should get our own lobby and outbribe them

[–] [email protected] 3 points 4 months ago

Kickback congress for 1% of those fees.

[–] [email protected] 29 points 4 months ago

Thank you for the information on the "no surprises act", didn't know that was a thing.

Also, south park actually did a skit like this, but I feel like it's in bad taste given the seriousness of what OP is going through.

[–] [email protected] 27 points 4 months ago
  1. Yes, they are. They don't care about their customers, just the premiums they can rake in without paying out on.

  2. Being the person who pays the bills does not and should not grant that person access to another person's medical records, even if that person is a parent. I get that you submitted the authorization in this case, but I am speaking generally in response to your comment which seemed to imply that third parties should be given medical information if they are the ones paying the bill.

[–] [email protected] 24 points 4 months ago

I worked for a company who went with a cut rate insurance provider one year who basically denied or screwed up every claim. This required calls, faxes and hours wasted any time anyone had a medical procedure. The kicker was that the insurance company hours were the same as our company hours so all of this had to happen during company time. They went with a proper provider the next year.

[–] [email protected] 19 points 4 months ago

Before switching providers I had similar experiences, to the point where I'd start every call with "Please transfer me to a manager. You can help me by transferring me to a manager. No I need to be transferred to a manager. You're not a manager so you can't help me," and so on and it was the only way to get whoever answered the phone to give me straight answers on the first try.

[–] [email protected] 11 points 4 months ago

Should call it death insurance not health insurance.

[–] [email protected] 10 points 4 months ago (3 children)

OP, you may be in lawyer territory. Not to sue the insurance company, though it may come to that.

A lot of these companies will give riff raff (you and me) the run around.

But once an attorney enters the picture, they have to get their attorneys involved and typically corporate attorneys aren't cheaper than one you hire. So the incentive to resolve the situation quickly is higher.

At least for a short time. So a short phone call from your attorney to them will often get the attention of the right people.

[–] [email protected] 13 points 4 months ago

It's an article in the Huffpost bro, the author isn't here.

[–] [email protected] 9 points 4 months ago

There's a reason Allstate is the most frequently sued auto insurance provider. They will give you the run around all day long until you lawyer up and then it's, "Oh! Ha ha! Sowwy! We bunch of dum dums who no can read and no use kumputers good. We no know what happened! Here big check for you go away now."

But for every person who lawyers up, there are probably 20 more who don't. Fuck Allstate.

[–] [email protected] 5 points 4 months ago

Can confirm. I will never work directly with insurance on a difficult issue again. My attorney is worth every penny. He's saved me countless hours of time and the endless frustration/desperation that comes with handling insurance agents. He's also saved me a ton of money in the long run (but not the short run!).

[–] [email protected] 10 points 4 months ago

Causing long term damage (requiring further treatment) is probably their ideal outcome.

Death is so.... "you'll stop paying us"

[–] [email protected] 9 points 4 months ago (1 children)

Any important conversation I like recording it. I know you can do this on Android, idk about iphones.

[–] [email protected] 3 points 4 months ago

Just be sure to check if you're in a one-party or two-party consent state. If it's a two-party consent state you'll need their permission to record the call.

[–] [email protected] 8 points 4 months ago (2 children)

I get providers and insurance companies flagrantly violating ADA all the time with me and my housemate's care. They don't give a shit and nobody is holding them accountable if you don't have money for a lawyer to threaten them officially.

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[–] [email protected] 7 points 4 months ago (1 children)

Insurance is a scam. Get hospitality bill as self pay and tell them to go pound sand. Lo and behold they will quickly work out a reduced amount and a reasonable payment plan

[–] [email protected] 7 points 4 months ago

Unfortunately this isn't an option for many folks, as they have insurance because there's no way to afford the bills that they would be sending if one didn't have insurance, even if a hefty discount was applied.

[–] [email protected] 7 points 4 months ago* (last edited 4 months ago)

Just call them up and make it clear that you are mentally unstable enough that you might go to the person's you are talking to home. If they are afraid of what you might do paperwork gets done fast.

Be creative with it. Last time the insurance denied one of my daughter's claims I accused the adjuster of getting off sexually on the act, in graphic detail until they agreed to process the claim

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