this post was submitted on 10 Sep 2024
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[–] [email protected] -1 points 1 day ago

...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.

[–] [email protected] 63 points 6 days ago* (last edited 6 days ago) (3 children)

Insurance must be the only industry that actively tries not to deliver the service that its customers pay them for.

[–] [email protected] 23 points 6 days ago (1 children)

well there's the whole telecom industry too

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

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.

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[–] [email protected] 58 points 6 days ago (2 children)

Want to hear something crazier? They don’t even have doctors. Non doctors are telling your doctor what is medically necessary.

[–] [email protected] 18 points 6 days ago (1 children)

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.

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

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.

[–] [email protected] 15 points 6 days ago* (last edited 6 days ago)

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.

[–] [email protected] 15 points 5 days ago (1 children)

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.

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

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

[–] [email protected] 25 points 6 days ago (1 children)

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.

[–] [email protected] 11 points 5 days ago (1 children)

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 treatment

[–] [email protected] 5 points 5 days ago

They 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.

[–] [email protected] 30 points 6 days ago (2 children)

Is this a US thing that I’m to Europe to understand?

[–] [email protected] 20 points 6 days ago* (last edited 6 days ago)

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" ~~scammers~~ corporations 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)

[–] [email protected] 16 points 6 days ago (1 children)

Apparently, yeah.

You probably haven't even shot up a school or anything have you.

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[–] [email protected] 27 points 6 days ago (4 children)

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.

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[–] [email protected] 24 points 6 days ago (1 children)

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.

[–] [email protected] 14 points 6 days ago

Health insurance companies sure seem like socialized healthcare but with some rich guys that steal money out of the pot

[–] [email protected] 17 points 6 days ago (2 children)

Insurance transition from protection against highly unlikely emergencies to our default payment system is the biggest scam in world history.

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[–] [email protected] 21 points 6 days ago

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.

[–] [email protected] 29 points 6 days ago* (last edited 6 days ago) (26 children)

Pooling everybody's money so that the ones who are unfortunate get money to help with their situation definitely is a product. Just because you don't understand something doesn't mean it doesn't exist.

[–] [email protected] 33 points 6 days ago (3 children)

Where do you find Insurance like this? Because all of American Health insurance is just about pooling everybody's money into the pockets of shareholders will denying as much coverage as possible

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[–] [email protected] 29 points 6 days ago (7 children)

That's what the concept of insurance is, but health insurance very much does not match the concept.

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[–] [email protected] 20 points 6 days ago (5 children)

Pooling everybody's money

It's called taxes

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[–] [email protected] 13 points 6 days ago (1 children)

Healthcare isn't something that only the unfortunate need. Healthcare is something every person needs. If you live long enough, it will be costly. This is why insurance as a concept is fundamentally unable to handle healthcare. It is antithetical to the concept of insurance.

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[–] [email protected] 23 points 6 days ago (2 children)

If you squint your eyes just enough, insurance is like gambling... You are betting that something is going to happen to you, the insurance company is betting against that. The insurance company can improve their chances by adding conditions to that something.

[–] [email protected] 16 points 6 days ago

That's the part that makes the US system insane.

In countries with a public health care system, the goal of the patients and the doctors is the same. Everybody's goal is to prevent diseases and sickness, and to treat it when it isn't prevented. The administrators just estimate how much funding is needed to achieve that goal.

In the US system, the patients are trying to prevent and treat their sicknesses and diseases. The administrators are trying to find ways to avoid paying for any treatments, and the doctors make more money if they can find a way to bill more things.

And, what's especially insane is that healthcare really isn't a normal market like other things. If you're buying a truck, you can shop around, haggle with salespeople, etc. If you're hit by a truck, you're not going to be comparison-shopping emergency rooms.

[–] [email protected] 10 points 6 days ago

It's way worse than gambling. When you win a jackpot there are laws that require you to get paid out.

Insurance companies can just say no and fight you in court until you die because it's cheaper for them to pay some lawyers than for your treatment.

[–] [email protected] 25 points 6 days ago

What's this "we" bullshit? You and I never had a say in it. It's not like we get to vote on this stuff.

[–] [email protected] 30 points 6 days ago (5 children)

TBH Hospital Boards aren't all that innocent, either.

[–] [email protected] 26 points 6 days ago (1 children)

The largest hospital in my region owns the largest health insurer in the region.

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[–] [email protected] 23 points 6 days ago

Same as student loan "servicers" collecting billions in interest to just keep track of peoples' debts.

[–] [email protected] 10 points 6 days ago (1 children)
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[–] [email protected] 19 points 1 week ago (2 children)

This! Health insurance is the reason why medical costs in the US are so ridiculous. Health insurance, and IMO all insurance, is a scam. And since the "customers" (people who NEED care) can't see the price of service beforehand, there is no way for them to choose the most cost efficient option, which allows providers to charge whatever they want. Then the insurance company can come up with reasons not to pay and put the client on the line for the cost.

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[–] [email protected] 15 points 6 days ago

No no no! Their product is keeping the system operating properly. You know, checks and balances. And by that I mean check you bank balance because your medical care just cost more than anywhere else in the world.

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

~~insurance~~ medical mafia

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