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djamp42 t1_je86b33 wrote

It would be one thing if the current system actually worked well. But it's fucking horrible. I'm disputing a charge right now.

Insurance is saying the doctor needed prior authorization. My wife is actively having a heart attack in the ER on vacation at Disney world with my 2 kids. The insurance company couldn't even pronounce the name of the procedure that needed authorization. Like I'm not going to know that, I don't know if the Dr knows that, and it's against the law to deny me coverage for prior authorization in an emergency.. but they still did it.


HarryHacker42 t1_je86tqp wrote

The whole USA system is designed to make it hard and charge you more, that's why we need to discard it and start over with another country's model as the goal.

They've found numerous insurance companies that had the policy of "reject every [nth] claim" such as "toss every 5th claim" so you get a rejection and either pay it or go complain, and if you complain, they'll usually pay it, but it is just to hassle you. And hospitals *LOVE* to have an out-of-network doctor visit and charge everybody huge rates the insurance doesn't cover. Its so bad they're making it illegal. There is nothing to fix, it needs to be replaced.

And worse, Christian hospital chains are buying up as many hospitals as they can get so they can deny abortions and contraception and anything they feel like.


djamp42 t1_je877fn wrote

You might have something on that nth claim thing, because I had a bunch of other bills from that same event and they were all covered, even ones from the same doctor, but for whatever reason this one was denied.


Superspudmonkey t1_je93wd4 wrote

Was that not what Obamacare was before it had to compromise to pass?


roseumbra t1_je8xoan wrote

Sorry you have to deal with this. Honestly do what you can to tell the doctors office you Cannot pay them a dime before the claim is approved by insurance. They have staff designed to deal with this in ways you don’t have the years of training to. If you force them to tackle insurance with hard stops before they see a dime they will find a way…

It’s all about how the fucked up the coding when sending it. And this is why I hate the healthcare system.


djamp42 t1_je97acq wrote

Yeah that coding shit is a disaster. The entire thing is a disaster.