keithabandit
33582
639
13
Dec 15, 2024 9:13 PM
keithabandit
33582
639
13
onelostcat
No link?
Meowmix138
28 Severely disabled daughter unable to get a hysterectomy because she is physically healthy although she has PCOS and her monthly cycle including PMS causes severe pain, discomfort, terrible mood swings and gastrointestinal issues and lasts 2 weeks out of every month. Why should she suffer? Why put her on behavioral medication that causes damage to her organs over time when a surgery can fix everything?
rubypilgrim
well it's pretty clear why they're being denied. It's video games. /s
FlaminkoFactor
I was recently getting labwork to identify cause of a skin issue. Primary care Dr. tells me shes “99% sure” a type of screen/labwork is covered by insurance. I say I’ll speak to billing assistance just in case. Billing assistance: this is NOT covered and would cost me 1k. Doctor (after I report back): lol jk jk glad u checked!
Result: I won’t get to know if I have a shitty underlying illness. US healthcare lessons learned: (1) Never take their word for it (2) Fuck Preventative care, apparently
[deleted]
[deleted]
PineappleLoopsBroether
LOO EE JEEEEE
ChewyTheWookie
Report to who? No one who cares that remains has influence anymore. We neglected doing what it takes to keep what little hard won gains in protections and rights our predecessors achieved. Now we find out.
keithabandit
https://www.propublica.org/getinvolved/insurance-denial-health-care-investigation
HelpfulCorn
Submitted my story
LeCoq1963
Had a wisdom tooth removed that caused a cavity to form on one my molars. Since it was an out-of-pocket expense I went to a dentist instead of an oral surgeon because it was the cheaper alternative. The dentist missed removing a bone fragment that necrotized and went septic. An oral surgeon had to scrape out (debride) a portion of my lower jaw that went to rot because of it.
LeCoq1963
The irony is that my health insurance doesn't cover a dental issue that almost killed me.
kahlas
What ProPublica wants is stories that will sell copies of what they are publishing. They don't care about our struggles. Can't do anything to fix the issue. They just see a quick way to boost sales for themselves. I'm not inviting the public into my life so that ProPublica can profit off the misery, pain, suffering, and hardship health insurance companies have created in their drive to make a profit. I'm not making myself a victim twice. It's congress that should be investigating this.
ThatOtherMacAvoyWoman
Where’s the link???
carrotsonfire
If a licensed physician is deciding you need a certain treatment, it should take no less than a licensed physician to be able to deny it, but ONLY with the same information. They can't deny without knowing the medical history.
Photeus
That's the thing with insurance companies. They are a scam, so they believe that doctors are always trying to scam them. They also hire doctors on their end that'll deny more expensive treatments in favor of any possible cheaper alternative, even if it's less likely to be effective. The medical records requests are actually a type of denial reason and they do request records. Reviewing that information slows down the process immensely and they'll still seek alternatives.
Nalianna
According to the IRA,. "We only have to be lucky once. You have to be lucky every time."
melandevile2000
Dental insurance straight up won’t cover anything. They don’t have to deny much.
nomind
And the yearly maximums on dental. Need a root canal, hope you don't need a filling too. Just getting wisdom teeth removed hit my maximum one year.
thomn8r
My dentist flat out told me it would be cheaper to just pay out of pocket than use my UHC dental insurance
bripi
They will not lack for input!
Fn0rd
Regardless of who’s asking, this sounds like the start of a “potential future CEO assassination suspect” database. Some may call that paranoid of me but Just because you’re not paranoid doesn’t mean they’re not following you.
WhenInDoubtC4
I wonder how many people's stories will not be told because the denial of the claim resulted in their untimely death
ruint
read a book called 'bad pharma'
lacarpitrondookmarriot
Can someone provide a link to this?
idrinkcheapbeer
The first one that comes to mind is the root canal bait and switch. The root canal is covered, of course it is. Your coverage handles 80% of your bill! But the crown. That is cosmetic and Im afraid that isn't covered. Both procedures are well over a thousand dollars.
Remmon1
And of course, from a dentist's perspective, the crown is not cosmetic. It's there to reinforce the remaining part of the tooth and prevent it fracturing at some point in the future. Which would then require removal and replacement with an implant.
idrinkcheapbeer
they were happy to direct me to applications for some kind of health care credit card. They just happened to have them right there!
azgrak
There are a few news agencies I trust implicitly and ProPublica is one of them. The Associated Press and Reuters rounding out the top three.
VaultGirl69
They need only write about Care Credit. Their interest rates are insane and it's the only option if you don't have cash in hand or out of pocket insurance. I had a tooth replaced in college and it took me years and years to pay it off.
chunkym0nkeyyy
I advise patients to avoid Care Credit at all costs, and take out any other kind of loan to pay for medical care if needed, friends/family, second mortgage, anything with a reasonable fixed interest rate (it's a total nightmare that this is a necessary discussion, but that's besides the point). CareCredit almost as bad as payday loans. It's shameful that any physician office pushes/suggests it.
VaultGirl69
Don't forget veterinarians.
thebeerbabe
My vet suggested this to me today. For a $1500 loan, the interest was 725% (literally) and I would have had to pay back $6500.
VaultGirl69
We live in a debt driven society. Most places don't have credit scores. Your financial and human worthiness comes down to carrying and taking on debt and making large partial payments, which is so stupid.
Maevoline
My wife's doctor had to tell the insurance that METFORMIN was, in fact, the generic form of Glucophage - insurance was certain that it was the brand and, therefore wouldn't cover it. After giving them PROOF (via THEIR denial letter) BCBS said they never would have said that - promptly covered the (once again GENERIC) form of the drug
HelpfulCorn
Who would have a PA for Metformin? It's like the cheapest diabetes drug you can prescribe
Maevoline
You don't have to tell me that twice - got to the point where doc had to order the drug by NDC rather than by name just to make sure it was covered
mdshohagm772
Nice
mdshohagm772
mdshohagm772
/gallery/LrerPSx/comment/2433364379
Whatwhatsomethingbutt
ProPublica is incredible. Reading it is also the surest way to make yourself sad.
forelle
Hey look, actual journalists doing actual journalism
Cats2cats
Check your state rules. They vary state to state. If the company denies 3x’s in some states it bumps to a 3d party(state) review.
whatsisname
As an aside: Dental and Vision being their own separate insurances is one of the stupidest fucking things ever.
agentmcgee
It's even like this in the UK with the NHS. Unless you're diabetic, under 18, or pregnant (and probably some other conditions I've forgotten) dentists and opticians cost money. Good luck getting an NHS dentist though. My closest one is 300 miles away!
Maevoline
Don't forget prescription coverage. It is separate and your EMPLOYER gets to make decisions about what's on the formulary (covered drugs benefit list)
KarlPhylos
Ah, yes. Insurance for the main body, luxury bones, and unnecessary bits. Right.
chunkym0nkeyyy
Eating and seeing are optional. You would cost insurance companies less in the long run if you didn't do either of them.
dreammer243
Don't you know teeth are luxury bones. And eyes are uh... luxury orbs
Ribaldrie
I’ll ponder them
MoonMoon89
We verified wife's hearing aids were covered, and they paid for the hearing exam, but they "couldn't find her" for the claim on the devices.
ugopb4me
Send an email my dude(g.n.)
LegendaryGrumpyCat
Hearing aids are not covered for me either. I am a teacher. Hearing damage is primarily from my job, it should be covered.
Dxoh
Even if it wasn't from your job, it should be covered. We wouldn't say, "oh, you got injured by a falling brick, but you aren't a construction worker, so better luck next time"?
davaloha
Have you tried bone conduction headphones? I have the skokz open run (not the pro) and they work amazingly well for my tinnitus with great sound quality for music/games etc and you can use the app petralex (with one free profile) to turn your phone into a microphone during conversations if you're struggling with that too
chiefrunswithscissors
Cos the kids are that loud?
Never heard of hearing loss as an occupational hazard of teaching.
Should still be covered but I don't get why teaching would cause that unless you're a music teacher
RevengeIsIceCream
preschool teacher maybe? they are loooooud
davaloha
They really are, it doesn't take too long listening to a cacophony of screaming on a daily basis to develop tinnitus unfortunately
ThingsThatDontJustifyGenocide
My brother's wife was denied her meds because "not the subscriber's name".
MoonMoon89
That was what they said! It was the SAME NAME from when they put in the exam claim, but they kept sending it back!
Solkanarmy
she should use that when it's time to pay bills
AlxEverett
In the hopes that it might help someone who is new to skeazy health insurance companies. I was told numerous times by my doctors that various treatments I was getting were “covered” only to find out later that means they cover 50-60% of the cost and I got bills for the rest.
GWJYonder
Yeah, this hit my in-laws' budget hard after some knee surgery. She was in quite a bit of pain, but needed to wait to go through all the pre-authorization stuff, including at least one appeal. All that finally goes through and even with the pre-auth she still needed to pay almost half of it out of bucket for bullshit technicalities.
AlxEverett
I found out as I was getting fired that after 3 years I had finally reached the $5,000 mark to where they would cover them 90% but it was too late
drinkthederpentine
You guys seriously need to actually read your benefits information
Dxoh
Mine wouldn't cover hearing aids, because they considered them elective, I guess.
derekjohn
So is wearing glasses.
BeardicPerformance
Eyes are a luxury organ
Assbandit
How is hearing considered "elective"...? That's one of the stupidest shit I've ever heard. Fuck these companies.
Dxoh
I don't know their specific reasoning for it, just that the insurance my company picked would cover an ENT and hearing tests, but not actual hearing aids. Probably with the same weird reasoning that makes dental and vision insurance separate from health.
thechickenlittle
Insurance usually doesn't cover hearing aids for adults. Evil dickheads, they are.