…what? Insurance companies are not a “barrier” between doctors and patients. What, do you think some sort of insurance gremlin will manifest out of the ground and kick you in the nuts if you try to visit a doctor while uninsured? Doctors don’t care whether you’re insured or not, as long as they get paid. Insurance companies exist to soften the blow of expensive treatment. The product is not getting completely fucked over if you get very unlucky, just like with any other insurance (life insurance, car insurance, whatever). It’s kind of like bitcoin mining pools, but the other way around. Now, is mandatory health insurance justified? That’s a different discussion.
Insurance must be the only industry that actively tries not to deliver the service that its customers pay them for.
well there’s the whole telecom industry too
And car insurance. And wall street. And Google with Pixel Pass. Actually I think capitalism just fails to deliver in general.
No no, you’re confusing the product and the customer. The customer is the stockholder and investor who owns equity in the insurance company, or in its bank. The product is quite literally denying care.
I think every industry strives to be able to not deliver something after being paid, they usually just can’t get away with it.
Want to hear something crazier? They don’t even have doctors. Non doctors are telling your doctor what is medically necessary.
I had an issue with my foot and the doctor requested an MRI as an ultrasound wouldn’t show them anything they needed to see. The fucking insurance company says no, do the ultrasound… So I paid for a fucking useless ultrasound and then they refused to move forward with anything else… The issue kinda went away thankfully but there’s still something odd with my foot that I guess I just won’t fix until I can pay completely out of pocket.
I’m so fucking happy that at least $1,200 monthly is taken out of my potential pay to cover a fucking useless insurance scam, because remember even if your employer “pays” it’s factored into your total compensation so you’re still the one paying.
it’s factored into your total compensation so you’re still the one paying.
I never understand why so many people assume insurance is “free” from the employer or that they pay 0-1000 per week/month. What we see is the tip of the iceberg. Insurance companies are perfectly lucrative and they pay tons and TONS of money to workers that make sure they make as much as possible.
80% of premium revenues must be spent on treatment, the other 20% is what they have to profit off of. If they don’t spend 80% of the premiums on treatment they MUST refund excess earnings. See: https://www.healthcare.gov/health-care-law-protections/rate-review/
This means if they took in 100 billion in premiums in a year, they MUST spend 80 billion dollars on treatments. The 20 billion left over is where they can make money. So they will make sure 4/5ths of everything they make goes into treatment so they never give refunds and they maximize potential profits. If they can convince companies to raise premiums 10% next year, costs will rise 10%, profits will rise 10%. It’s so obviously designed to raise the cost of premiums and treatments at the expense of all else it’s insane.
They also don’t spend a dime over 80% of what they make if they can help it. There’s where claim rejections come in. They have mathematicians figuring out the ideal numbers and those guys make stupid amounts of money.
I’ll do you one worse. Sometimes, they do have doctors. In cases where people are trying to get coverage, especially for a severe workplace injury with lifetime effects, the insurance company will send you to a doctor who barely passed med school. They’ll have you do a “physical” that’s basically turn your head and cough. Then they write up a report that says you don’t need coverage.
Since they are technically a licensed doctor, this is still considered “expert” opinion in court (if it comes to that). The doctors involved can make way more money at this then they can working their mediocre asses in any real capacity.
My ex suffers seizures. After years of bad doctors, he managed to see a neurological specialist who helped him manage his issues. His doctor informed his insurance that treatment was working and his symptoms had regressed - he even managed to earn his driver license back. His insurance took that as “he’s better now” and kicked him off. They sent him a bill for thousands of dollars that he had to pay before he could try to get back on his plan. He wasn’t able to afford his medication, nor his therapy, and his symptoms came back swinging. I still have a photo of his rejection letter somewhere that I keep as a reminder of how backwards and awful the insurance system is.
Good god when I hear stories like this one I think if I were in their place I’d try my best to get hired abroad so I can have proper coverage. I know it’s not possible for everybody but it is what comes to mind
I’ve been fighting with my insurance company since May. My wife had a medical emergency and I had to take her to the ER at 3AM on a Sunday. The team of doctors treating her all agreed she needed to be hospitalized and have emergency surgery. She was admitted and underwent surgery and was out in three days.
A week after she was discharged we received a letter from the insurance company letting us know they had decided not to cover the $67k hospitalization bill because they had decided it wasn’t medically necessary.
So yeah, that’s great. Not to mention we had finally hit our $6,000 deductible (after I had cardiac issues and ended up in the ER the previous month) so insurance would finally have had to actually pay something.
So glad we pay them $1500 a month for them to make decisions on what is medically necessary and what constitutes an emergency after the fact.
First. I hope your family is OK.
Second its total bullshit the medical insurance companies can just declare something isn’t needed (usually by a doctor on thier payroll). Then use that as a justification to decline coverage.
This is supposedly a standard tactic for them too. Decline all big claims and see who fights it.
That’s insanely immoral especially because anyone with a huge medical bill clearly has some shit going on and the last thing they need is the massive stress of a massive medical bill.
We have movies and TV shows that poke at how bad our medical coverage is and we Americans just accept that the plot is acceptable.
The ones that come to mind are:
The Rainmaker kid dies of lung cancer because insurance declined treatment due to it being “experimental”.
Breaking Bad yeah. Cooking meth to pay for cancer treatmentThey should be held legally to prove why the procedure is not necessary only then they can refuse the claim. Otherwise they have to provide the claim. This should be the law.
Is this a US thing that I’m to Europe to understand?
Yeah in the United States of Billionaires healthcare is a product to extract profit from in every way possible.
Pharma companies get public funding for research and then turn around and charge insane prices for the final product infuriatingly referring to research costs to justify their pricing.
Hospitals are bought and run by investment companies.
“Insurance”
scammerscorporations have their own fiefdoms that they control so there’s very little competition and their sole reason for existing is to take your money and deny coverage for absolutely anything they can possibly deny you for so they keep the most money possible.We have The Best System In The World™ (for the ultra wealthy)
Apparently, yeah.
You probably haven’t even shot up a school or anything have you.
Get that person a hamburger and a mountain dew stat!
When I had top surgery (getting the fat sucked out of my tits so I could put an “M” on my drivers license, funny how many jobs fell through right I9 verification…), I did a lot of research into what I needed to do to get it covered. I got letters from doctors and therapists, I’d been in hormone therapy for a while, and my policy said it covered it. I checked with a rep, they said yeah, you just pay for it up front and submit for reimbursement.
So I took out a $5500 loan, had surgery, and then attempted to file for reimbursement. Turns out that my specific policy, from my step-dad’s employer had a rider that exempted it. Somewhere buried in the fine print, didn’t come up until after I had taken out the loan.
It’s pretty common for trans people to end up turning to sex work to finance their medical care (and tbh, survival in general). That’s how I joined that statistic.
For a second I was like why does any drivers licenses have Ms on them for people that have had masectomy? Durrr.
The funny thing is, I probably wouldn’t have had gender surgery if it wasn’t a legal requirement. I barely had anything and could pass topless anyway. I just needed to be able to get a job, which was proving difficult with the non matching ID. It is 100% legal where I live to fire someone for being trans, and it had happened at multiple times by that point.
Fuck, I hope that’s not on mine. I had bottom surgery and they have paid upfront for everything except the OR day. $120k just sitting for a year as I ping the insurance and hospital every month.
My current plan has an exclusion, which fucking sucks. I want to get bottom surgery and move across the country so that I don’t have to deal with this shit anymore.
Disclaimer: I think the current U.S healthcare system is hilariously bad and should be heavily reformed.
Insurance is not a bad thing, and there is a clear product involved in it. To demonstrate, you can go to a doctor in the U.S and pay in cash for the treatment. As I’ve understood it, you can even negotiate lower prices than the list prices if you are paying in cash. Still, it’s probably going to be expensive to the point of potential financial ruin.
This is the product that insurance offers in any domain it operates - buying your way out of risks you cannot accept. Fundamentally, the concept is sound, albeit very poorly implemented in the case of U.S healthcare.
It’s basically just a bunch of people pooling their money together and having that pool of money pay in the case of an adverse event.
One of the primary alternatives to the mess that is U.S healthcare today is in fact another form of insurance - it’s just that enrollment would be mandatory and as such the risk spreading would be as uniform as possible, along with subsidies for people carrying higher amounts of risk. That’s fundamentally what universal healthcare is in other countries.
Health insurance companies sure seem like socialized healthcare but with some rich guys that steal money out of the pot
Insurance transition from protection against highly unlikely emergencies to our default payment system is the biggest scam in world history.
This is a serious part of the problem. Home insurance, car insurance, can be bad, but at least you don’t usually have to deal with them. You can go years without needing anything from your home insurance.
You WILL need healthcare, minimum once a year. Most people need it every month or every few months. Your car insurance doesn’t pay for your oil changes or new tires because those are guaranteed maintenance costs, not unexpected emergencies.
Yeah, it’s a big misunderstanding to think that insurance is not a product. It is product. The problem is that these companies all have the most shit versions of this product. It’s like living somewhere where every sandwich shop had a slice of bolongne on white bread, and they just changed which brand of mayonnaise they used.
My favorite is when they send me and letter in the US mail for the sole purpose of telling me they decided to cover our medication the doctor prescribed. The language they use is infuriating.
As if we should call them back and praise them, be grateful for their service, and just ignore that I’m paying them.
Denial is a product
That’s dark, man.
insurancemedical mafiaI hate our healthcare system and especially the parasites that run health insurance companies, but they do provide a product.
- They pool our money together so that the ones that need healthcare can afford it. Barely anyone can afford out-of-pocket cancer treatment or a stay in the ICU after a serious accident. It could be a serious pain in ass to get insurance to pay sometimes if they even do, but overall, they do pay. If they never paid, we’d have a revolution by now. The last time they started with not paying, people started demanding change, which almost lead to the public option.
- They offer a check on healthcare providers that want to over -treat and -prescribe to charge more money, or doctors that go rogue with whacky ideas. Since the general population doesn’t know much about medicine, doctors would be able to prescribe all sorts of illegitimate treatments if we didn’t have a body making sure that their recommendations were legit.
I agree that they do fucked up things, like withhold on pay outs, deny interventions that may save lives, charge way too much, and lobby to maintain or even improve their wealth and power, but they do still offer a product. I’m someone that is lucky enough to have access to 100% free government healthcare in the US. Even with that, I’m often jealous of people that have private insurance because I find many benefits to their healthcare over mine.
If we want to improve our healthcare, I think it would be best to acknowledge the reality of the situation rather than exaggerate it.
The issue is that they are run as for-profit businesses but the product that they provide is a public good. They make money by providing as little product as possible. This type of structure is fine if your company makes luxury goods, but in the case of health insurance it results in unnecessary pain and death.
They offer a check on healthcare providers that want to over -treat and -prescribe to charge more money, or doctors that go rogue with whacky ideas. Since the general population doesn’t know much about medicine, doctors would be able to prescribe all sorts of illegitimate treatments if we didn’t have a body making sure that their recommendations were legit.
My dad can’t get a medication that actually resolves one of his health problems because it’s not on whatever list of medications his insurance company has for that issue. Even though his doctor prescribed it and it worked up until he got a new insurance. Now he has to use some other medication that barely helps. Insurance companies are bullshit. Doctors should be reviewing what other doctors are doing. Not some office peon who probably gets a bonus for rejecting claims.
Yeah, the system is jacked up. We need a better one like our lives depend on it.
What is this thread? Since I got chronically ill my insurance has paid my salary for a year and is now paying into unemployment and pension for my wife, who’s caring for me. And besides that they’re still paying for all our medical expenses despite me not paying into them anymore.
Yeah, I had to fight for them to pay for a transport. But overall they definitely are offering a service I am greatly benefitting from.
I’m truly glad that it’s helping someone; however, for every one of you there are a hundred people denied important procedures because insurance has decided its opinion is more important than the doctor’s.
An easily available example off the top of my head is Styropyro’s most recent video where he might have cancer but Insurance has denied his brain scan.
Germany: If your physician thinks, you need your brain scanned, they will give you a referral, you make an appointment for your brain scan, your brain gets scanned, and your physician now knows if your brain has a problem. Your insurance pays for this.
Source: got my brain scanned, brain is fine and at the proper location.
Not sure if you are in the USA or Germany based on your URL but The general idea is that a private company should not have to hold the cards for our fate, and our health treatment. That’s what you are clearly missing. If you get chronically ill in some of the better parts of Europe, you won’t have any medical or financial consequences of that. Ambulance is don’t cost much of anything directly, hospital stays don’t cost you much. In the USA you cannot say the same. Going to the hospital for some major illness like cancer or emergency surgery could cost you anywhere from $15,000 to $200,000. Look up the cost of having a baby at a hospital especially when there are complications. It’s unbelievable.
The idea is that you should pay into a system that works for everyone, namely the government and taxes, and they help you out in return once you have a hardship at a low or no cost because you have been paying into it. This is not how insurance works. In most cases, you pay stupid amounts of money into insurance, and once the new year rolls around, you have lost your entire deductible and you’re out of pocket is completely reset. You have severe limitations on your FSA or health savings accounts so you can’t save enough money. Literally not allowed for you to save and stockpile lots of money for covering healthcare. You have to pay into this stupid for-profit company that doesn’t give a damn about you and will never lift a finger to help you. Sometimes people are lucky and benefit from the insurance. Those situations are extremely rare, and situations in which people are financially ruined by insurance and healthcare are far more common.
I’m glad that the system in place has worked for you currently. But that does not mean it works for everyone, and that’s something you need to understand. Just because something works for you doesn’t mean it’s a great system.
Yeah, I’m in Germany. It is widely known that the US medical system absolutely sucks ass. Doesn’t mean that the concept of health insurance sucks. In most of the developed world it works well. It’s only the US implementation that is majorly flawed.
The problem is greatly unequal access to healthcare. I’m glad your insurance is doing well for you, but there are many out there who are struggling to pay for expensive family insurance with high deductibles that still leave them in medical debt.
I’m also currently in a situation where I’d like to find a new job, but I have some expensive medication ($750 a month for one of them) and I am worried about losing my insurance/not being able to afford the premium while I wait for benefits to kick in at a new job. I also have absolutely no way of knowing if another employer’s plan will cover my medication or if my current group of providers will be in network. All this added stress, and yet I’m lucky to work in a field where almost every employer offers health insurance.
Ideally, there would be universal safety nets to provide the services you’re benefiting from to all Americans. It’s not even like we’re saving money by relying on private insurance, as the US spends way more per capita on Healthcare for average results, at best.
So I’m glad that your insurance is taking care of you, truly I am. But spare a thought for the thousands of Americans out there who are struggling to survive under the same system.
I think the issue is that you look like you are talking about health insurance in the US. There is basically a zero percent change the person you are responding to is talking about insurance from any plan in the US.
Yeah, I should have realised that everyone is talking about the US. Everything about their medical system sucks. It’s powered by greed and not much else. I bet most third world countries have better health care than them.
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Well said!
