If a second civil war ever occurs in the U.S., the first people to be targeted for elimination from existence will be, in no particular order: Politicians (former and current), police who either abused their authority or simply stood by and watched an atrocity happen instead of doing their jobs, anyone who has ever worked for an insurance company and been involved in denying any claim, and CEOs. The unrest in the U.S. is pretty real. The solution is simple though: Delist any company on the stock market that is involved in any way with the medical industry and also set hard percentage limits on profits (e.g. 10%). The stock market is inherently evil.
@@privacyvalued4134 well you see the funny thing about that is they will come up with imaginary costs to keep profits bellow 10% While still making more
@Bamidélé Because, when you make 10x the amount of all your employees combined (this is a rough, a likely low estimate) then they are making all the problems such as a disintigrating middle class, increasing rate of inflation, destroyed housing market, increased unemployment, etc etc etc... Srsly, when 1% of the ppl of the world hold 80-90% of the money, it's no wonder whole countries are collapsing rn.
You... You aren't still conforming to CSV's work ethic. Are you? I'm not even a pharmacist and I'm still concerned for your welling being. I hope you find better places soon. 🙏
CPhT here, retail setting too at the big W, the pain is real, just wanted to lead us all in a prayer: Dear Big Labcoat in the sky, send a comet into BCBS/UHC's corporate offices. In refills, we trust.
My son was born deaf and had cochlear implant surgery at 9 mos. The ins company gave prior authorization and then TOOK IT BACK after the ($400000) surgery was done. I had to appeal and get on the phone with the medical director… luckily I am an MD myself and the company had approved my daughter’s surgery for the same condition a few years prior so I had that to argue. These companies should all get a RICO investigation. The emotional pain and worry they inflict on ill people is criminal
It's a problem that patients have to have a medical degree or another advanced degree (in a life science AND law) to joust effectively with the Insurance dragon. Whenever I read a story of someone fighting the monster, I want to jump in and help, but THERE ARE SO MANY PATIENTS needing this kind of help. We need an aggressive patient advocacy industry.
I'm a lawyer who agrees with you that a RICO charge is EXACTLY what's needed, along with a Department of Justice and a U.S. Attorney willing to bring it. We have the method for legal redress. Unfortunately, I'm not sure any administration, regardless of politics would sign off on it. My response here is underscored by the fact my son has experienced sudden total hearing loss in one ear, and I can imagine the forthcoming battles if the cause remains a mystery. Best of luck to you and your family. Wishing you all good things.
It's always fun when your doctor tells you that, for an FDA-approved therapy, they have received no successful authorizations from any of the nationwide insurance companies.
A lot of times, it's because the commercial insurances are waiting on Medicare to approve it first. Most insurance companies follow the lead of Medicare in a lot of things. This of course is stupid, because commercial insurances can and have approved 'experimental/investigational' procedures on a case by case basis if the patient complains loud enough via their lawyer... 🙃
Imagine Glauc does a series of these satirical bits, one a week for say six months, then drops the dime and reveals that they are all transcripts from real conversations that actually happened.
@@Naxhus2 that would require health insurance providers to actually talk to their customers. More realistic is denial paperwork, appeals, and appeal denials.
It's true. Take a look at your health insurance company's "benefits booklet". You will see exactly this. Same "terminology". "Medically Unnecessary" as a proper noun is a catch all for "We just don't want to cover it- for no specific reason. We don't honor the contract we have with you and do what we said we would when you hired us. And what you've been paying for. And fuck you ha ha ha ha. "
you just need to call the other hotline and jump through 1 million hoops to get the form to submit the appeal. it will then be denied for unknown reasons, unless you make another 2h phone call. easy.
After the appeal is denied, the primary doctor has to do a peer to peer review, which means calling in, waiting 40 minutes on hold, giving all the information, being triaged to a nurse, waiting another 20 minutes on hold, giving her all the information and finally being advised that you are approved for a peer to peer review and the doctor should call you within the next 72 hours at his convenience, most likely when you are in the middle of a PAP smear. Not that I’m bitter or anything today.
And after 2 failed peer to peer reviews, with specialists that aren’t even in that specialty, they will FINALLY forward it to an external state reviewer, a reviewer employed by the state, with the same specialty, the insurance company hates these, and it usually goes through after this, and has taken at least a year and a half, and your child’s specialist is so irritated by then that they will get anything approved bc they have spent so much time making those appointments with random specialists who deny everything
I'm an insurance authorization specialist, and I once got so angry at all the BS that UHC put us through to get scans for two cancer patients that I asked to speak to the manager. I then proceeded to make that manager cry. I should probably feel bad about it, but I don't.
Glorious, isn't it? And we're not making any progress. I worked at Blue Cross/Blue Shield in the early 90's when their "managed benefits" department was first started. We denied a poor soul who brought his child, with cancer, who couldn't breathe, to the ED. He didn't "notify the insurance company" before taking the poor baby for treatment. That was the end of it for me.
True story. My grandfather worked for Blue Cross and Blue Shield back in the 50s in Indiana. He had a well paying position and about 5 kids at the time but he was miserable and felt like Jimothy there. He quit and started his own business which unfortunately failed. He moved out to Rhode Island where my grandmother was from and they lived with her family for a while until they could get back on their feet. He never went back to the insurance industry and though my dad said they experienced some hard times, grandpa never regretted his decision. I'm proud of that.
This is absolutely a hundred percent true, except for one detail: The rep would absolutely say "Oh, yeah, it looks like the claim might have been denied in error. Let me send that back for reprocess." THEN the rep would say "No, our medical directors looked it over and determined this claim was correctly denied. You'll have to submit an appeal." It makes a difference of about 90 days, plus another year for the appeal.
right. they lose nothing by lying about all the nice things they're going to do for you and then not doing it. because the member services agent is not accountable to you and has no authority to fix your problem anyway. they do it all the time, lie about what they'll cover, lie about reprocessing denied claims, lie about anything to get you off the phone, because their job is not remotely at risk for lying to a customer. that disdain for the customer is not only not a problem for their advancement, it's the very reason for their job - they are there to run interference against you. giving them an insulting name like "Advocate" is just what makes UHC special.
@@jedinxf7 Oh don't worry, it isn't UHC exclusive. It's also at Aetna and it's even worse there. Worked there for a bit and it was insane. Everyone in the company knew advocates had no power but you were told to tell the customers otherwise. It grinds you down from wanting to help to just treating people like objects.
As someone who has cancer and now sees the corrupt reality of healthcare in the US this is all too real. My insurance said chemotherapy wasn’t a covered procedure. Been trying to hit me with 400,000 bills…and it’s just not the insurance companies awaiting justice it’s the hospital system. They both work together to artificially inflate prices…sad world we live in
Afraid the stalling is hoping you die before you need more treatment. Another thing that ought to be governed by law. Speed is of the essence in cancer treatment & insurance companies kill a lot of people by slow walking treatment, even someone on medicare.
Then let me give you something to fight back with. Most hospitals are also charities. If you can't afford to pay your bills, you tell them that. Tell them there's no way you will ever be able to pay it back. Because they are charities, they have to cover it if you can't.
@@etherraichu If they are a non-profit hospital, this is true. If they are not, the billing department will still usually be willing to lower the bill immensely. if you hit someone with a $400,000 bill, you're unlikely to ever see a cent of it. If you hit them with a more reasonable bill, you'll probably actually recover some costs. I sincerely hope you don't have to go for that option, but if all else fails, talking to billing is at least an option.
I used to do medical billing for patients in a Dr office. Some things to help you and see if you can get someone to help you: 1. If any of the hospitals are non profit you can look at what they are supposed to do 2. Always get an itemized bill (you have to ask which is ridiculous) 3. Question everything they send you in regards to bills 4. Check dates! Hospitals only get so long to submit it to insurance. If they miss their date I believe you can successfully fight them on paying since they were negligent Most of the time they’ll fix it when you ask for an itemized bill but if not, you can call and get quotes for prices and look at your explanation of benefits. You shouldn’t have to be dealing with this while getting treatment. I hope you are in better health soon
I called an insurance company once because they had refused to pay a claim for emergency surgery I had done on a minor. Neither parent would fill out the form requested by the insurance company to determine if the injury occurred as the result of an accident. Since the child had a broken leg from playing basketball, I pointed out that it was all documented in the paperwork my office had sent to the insurance company. I also pointed out that nearly all fractures occur by accident since most humans are too smart to intentionally break a bone. I was eventually told that the claim was being processed in a different department. When I requested to speak to someone in the other department, I was told that there were no phones in that department. When I offered to mail them a phone, they hung up on me. When the parents got the bill from my office, the insurance forms were completed and the claim was paid by the company … after nearly a year. My suggestion for patients who feel they are improperly denied… call your state insurance commissioner. Insurance companies hate that. If all else fails, call the local TV stations, newspapers, etc. Bad press and regulatory inquiries are not popular with insurance companies in my experience.
Last year, I had to make several calls because my insurance had my policy wrong and denied five claims 😭. It took months, and they kept giving me different windows of time and then changing them when I'd call in again. The only reason it ended up getting fixed in the end was because I ended up getting the same random employee my last two calls, and he remembered me 💀 He got my last batch of appeals approved during the three minute call, and had me confirm they were paid out on the website before I hung up. My own personal Jimothy 🙏🏾
@joko 28 Everything in the video is pretty much what happens. Always ended with 'You can appeal.' Some of it was not understanding how basic insurances worked (patient had a copay/deductible, not understanding the difference between routine/annual/preventative vs diagnostic/problem services) miscommunication between doctors and patients (not knowing they were under observation instead of inpatient, one patient wasn't told they had breast cancer because she was billed for a dx mammogram instead of a routine preventative mammogram). Stuff like that. One specific example was when I worked at Aetna back in the day, and virtual/CT colonoscopies was just developed but not covered and deemed experimental. Patient was billed thousands of dollars because a regular colonoscopy was 'too short' (length). Any new technologies, procedures, etc are deemed experimental/investigational by most insurances. Usually, they follow the lead of medicare... Oh, and when Viagra first came out... you would not believe the calls we got about that. "Why isn't it covered!? I can't believe I have to talk to a girl about this! We want to have sex more than six times a month! (Elderly couple)"
I've never blamed a rep for any of the nonsense policies. They didn't make them. They're just trying to make ends meet. But I'll also never forget the BCBS rep (before ACA) that told me I'd need to have a "separate pregnancy plan" to cover anything OBGYN related (prenatal care), anything related to complications, or labor and delivery. And I'd need to buy into that plan for 8 months BEFORE any of the coverage kicked in. .................. 😒 So I guess FU if you have a complicated pregnancy or premie. (Which I did have a complicated pregnancy, but fortunately was able to hop over to my husband's plan which covered things well enough that we "only" ended up paying $20,000 out of pocket......)
@@WxBuggin noice I have paid 30k out of pocket from my hard earned life savings and thought it was over and then they told me chemotherapy wasn’t a covered treatment for cancer and I owed 400,000 so I’m pretty much done…
@ErSomethingSomething Unfortunately, we had many, MANY people (even when I worked as customer service in non-health related industries) that get... personal... when screaming at the messenger. I had one woman say, 'Well, when I die, I'll be up in heaven looking down at you smiling while YOU BURN IN HELL!' *click* And this was because I wasn't able to Google up random grants that she can apply for to help out with her medical bills and she didn't have internet access. Prenatal and birth related claims were ALWAYS messy. Never liked getting those calls. The claims were a lot of times billed incorrectly, mixed up with eachother (baby and mom are billed separately) or a completely random baby or mother was attached together. One woman gotten bills for non-covered services because she switched her OBGYN doctor. Apparently, we both learned at that time that once you're with an OBGYN would 'diagnose' you officially as pregnant, you are to stick with that doctor until birth. I ESPECIALLY hated the calls where mothers got a final bill for medical/hospital charges for stillborn or babies that passed afterward. The health insurance and billing industries need a much needed overhaul.
and there's always some republican mob yelling... "why should I pay for people who dOnT WOrK hArd EnOugh to pay for their own disease?". Holy hell, public healthcare system is essential infrastructure like sewer system, it's never meant to be capitalist and by choosing to have it doesn't mean US is turning communist either, it's not even socialism, just what a country needs to stay modern. Imagine a city without any water and sewer system. I don't know why people don't get that.
And even with all this blatant scams health insurance companies does, a lot of Americans still think their healthcare system is better than other countries. This includes my mom. Who can't quit her job because of her health insurance.
Most Americans know. They just don't trust anyone in our country to make it better. These big conglomerates will assure any changes will make it worse for us, better for them like they have before. They'll pay off any lawmakers or politicians like they have before. They'll jack up costs, like they have before. Bureaucracies ensure they don't lose, and this one is entrenched.
Man... this hits HARD. I recently started having a weird set of symptoms, including muscle spasms that get worse with exercise. I've been to about 5 different doctors trying to figure out what it might be, and all of them think that this is most likely adult onset leigh's disease or leigh-like disease, a genetic mitochondrial disorder. The only way to check for it is with genetic testing. I have one of the best insurances I know of. They cover pretty much anything, even a lot of out of network stuff. But they refuse to cover adult genetic testing becauase it "is never medically necessary". Leigh's disease is a fatal, life-limiting condition, that usually k*lls people in 10 years at most, and I can't even get tested for it without shelling out thousands of dollars, because it "isn't medically necesarry" to know if the thing that has currently left me bedridden is the genetic condition that runs in my family or not.
I feel the same friend. they can't find what's wrong me. close to 10K spent (& 2022 bills still coming) & no real answers. & that 10K isn't what I pay for the insurance. but there some private companies that do DNA screening (not 23 & me btw). but that's not free. it's just not free. it might be something to look into. I really might be cheaper than going through insurance. I held on doing myself as I found a Dr that knows how to work the system.
I'm so sorry. That must be extraordinarily stressful and scary. I hope you get the testing you need, and deserve. Our healthcare system seems irretrievably broken. Thankful to Dr. G to using comedy to address this horrendous gap in the U.S. standard of living. But reading cases like yours makes me feel hell is not good enough for these companies. Best wishes to you, and sending compassion.
I was dying from B12, folate and iron deficiency, my symptoms were much like what you're describing. The deficiencies had been present for decades. Once my deficiencies were corrected, I could finally leave the bed, the walker and the wheelchair behind and start working again. I have a confirmed mitochondrial dysfunction (COX IV), but no mitochondrial disease found amongst the 1500 most common genes. Perhaps B12 injections is a possible, and reasonably cheap, path for you to try. Even if entirely out of pocket it's not horribly expensive. Very few side effects, no toxic levels recorded in history (since 1948). Suggest it to your doctor and see what they say.
My dad just did a genetic testing for pankreatic cancer to search for best treatment. We have one of the best health insurances in Europe, but they don't cover that. My dad is at the end of the line, this could be our only hope. We had to pay the full thing
At this point I think there should be a law where if the doctor who actually examined the patient says something is necessary, then insurance MUST cover it. Regardless of whether they think it's necessary or not.
Me when I finally found a prescription that worked for my chronic medical issue after years of trying other drugs to treat the condition, had been on it for 6 months, and THEN the insurance decided I would need to get off of it and try a bunch of other things AGAIN before they would pay for it. You know. The issue I had been hospitalized before with multiple times.
Been there too. Wrote back with there list of meds and costs,compared to what worked. Asked for peer reviewed paper that supports that treatment.Reminded them of hospital costs for crisis, LTC if catastrophic fall but if they insist send letter of financial responsibility for change signed by MD and will do it. Next day approved.
Yep, I have said for years that if they looked at the total cost of treating a patient, vs each silo monitoring it’s cost (hospital cost vs dr office vs pharmacy, etc) it would reveal way more is being paid through our fragmented system than if they paid for what works. I remember when a patient was hospitalized while all testing was done and a diagnoses and treatment plan determined. Within a few days the months of various outpatient visits (in the 1980s). I refuse to believe that wasn’t more cost efficient and better for the patient. Sorry about the rant! 😂
That always made me livid. When that generic form of remicade came out, my hospital was flooded with ibd patients in flares. All because insurance forced a ton of people to try it.
@@cherylcarlson3315 smart. The problem is, most people don't know you can do that or have the knowledge to pull it off. And you're right, a single hospitalization is expensive enough to wipe the cost savings of most medications.
My mom has spent so many hours on the phone fighting insurance companies on behalf of patients. And recently only had time to fight with them for herself because she’s retired.
When my spouse started working from home a lot he was amazed when he realized how much time I spend dealing with insurance appeals. Like, hours a day for weeks at a time.
"I said I'm going to Hell... Michigan! Hell, MI - sadly you're already in the same region and country as Hell. If you want reform, you're gonna have to escape Hell."
Memory trip here. In 2021 my then 55 year-old husband with treated uveal melanoma left eye was following up with medical Oncology every year or so (from 2017 onward) when all of the sudden the CT scan of chest, abdomen, and pelvis were "not medically necessary." Fought it, tried appeals (HAHAHA). Fast forward to this January 2023 and he has mets to liver (not surprising) since that is where 90% of the time uveal melanoma metastasizes. But according to insurance, it was "not medically necessary." I hate insurance companies for that very answer.
@@zelousfoxtrot3390 It's not negligence. They know people die when they do this. They bank on it and profit off it. Then they spend those profits lobbying politicians, mostly Republicans, to rig the system further in their favor.
I had a severe, multi-day migraine and the neurologist wanted to do three days of outpatient IVs. The insurance took 7 business days (12 days total with weekends) to make a decision on the IVs, then ultimately denied it because “how do we know she still has a migraine after all this time?” The neurologist’s office explained they could know I still had one because they had been sending Urgent requests every single day because of how sick I was. The insurance then went with “We have no way of knowing if it is the same migraine or a new one.” Still denied. The neurologist sent me to the Emergency Room, which the insurance had to cover and was ultimately more expensive. It still didn’t break the migraine after all that time, but I at least got a couple hours of sleep finally.
I read the propublica report on this last night, and one wonders how these people can live with themselves, and what they think will happen when it's their turn as the meat in the grinder---which, statistically, and given COVID, will happen.
@@cleementine That's the same reason why I often return the credit card solicitations with outrageous interest rates in the reply envelope with the rate circled and a note pointing out that Christianity, Islam, and Judaism all condemn usury and no one claiming to follow them should participate in it.
You know that ethics question of “if you press a button you’ll receive $10,000 but one random person will die?” That’s health insurance execs in a nutshell.
This is my biggest fear living in the US right now. I have a great health insurance... but it is worthless if I mistakenly or unknowingly go to an out of network doctor. What happens if I am unconcious and the ambulance just drives me to the nearest hospital, which happens to be out of network? Suddenly, instead of having a great health insurance, I am bankrupt.
Aetna was by far the worst for me. I’d call them to make sure a doctor or a procedure would be covered. Aetna would tell me that they were covered. Then I’d see the doctor or have the procedure, after which I’d get a letter telling me that the doctor or procedure wasn’t covered. I’d call them up and they’d lie, saying that no one would have ever told me something of that nature was approved.
When I switched to my employer's health insurance, they refused to cover a medication that I had been on for nearly two years, claiming it "wasn't medically necessary". I spent over a month fighting them on this. I filed THREE appeals, all of which were rejected, my endo went to a peer-to-peer review where the insurance doc just told her to shut up (I wish that was a joke), and after enough calling and bitching, an external investigation was launched and my medication was quietly approved a week later. I am a hospital housekeeper. This was *hospital insurance* that forced me to pay out of pocket for the meds that keep me alive.
The issue is "wrongful" is so vague, just like the idea of "medical necessity". A doctor/qualified medical professional doesn't practice medicine without medical necessity, so to deny a claim based on it is absurd. I hate it so much and I work in appealing medical denials
@@emilymoxie what I was trying to say, is that if they denied a 1000$ test or treatment that is medically reasonable, they should be fined a 1000,000$ or something. Something to encourage them to be more reasonable and responsible.
yes, the purpose of laws is to deter socially harmful behavior, and the only deterrent for an easy to commit, immediately profitable fraud is to make it cost significantly more than the upside of getting away with it. they should also make at least a portion of the fine over the actual denied claim (which must be refunded in any case) payable to the patient and payable to the provider, to incentivize billing offices actually going to bat for clients to get claims correctly submitted and processed and to join them in suing the insurer for these illegitimate denials. hospitals have a lot more resources to advocate for patients (and themselves) after all.
I’ve been fighting insurance companies for over a quarter of a century, since my oldest child was born. I’m so tired. But I keep fighting because insurance companies suck and my kids need medical care. We have Anthem, and they blame their subgroups for our denials. I hate all of them. I cannot understand how anyone can work for an insurance company knowing how corrupt they are and how sadistic they are toward people in dire need.
@@radumeirosu6251 lol. You don’t know much. Someone like me would never be allowed to immigrate to another country. 1) you need money to get yourself there, 2) If you are disabled or you kid is disabled they won’t let you. Seriously, such a lame, uneducated, and unhelpful comment.
I spend the majority of my day fighting these denials with the Worker's Compensation Insurance companies. They'll deny visits saying "the doctor or treatment was not authorized by the adjuster" when the adjuster is the one who scheduled the appointment. Though my personal favorites are when they change a code to "better reflect services rendered" then deny it for being the wrong code, or the "in order to review this charge please send a copy of the invoice" right above "this charge was reviewed per the attached invoice"
I just had a PET scan denied today. I didn’t order it ( the pulmonologist did) but the appeal process has been given to me as the primary MD. Because the specialists are too busy making money to deal with this time wasting crap so they leave it to the primary MD, along with refills for the medications they prescribe. Not that I’m bitter or anything today.
Not to mention the insurance company’s doctor that is agreeing with the denial makes the patient’s doctor schedule an appointment with THEM, and denies the approval anyway even though the insurance’s doctor is from some other random specialty than the requesting (patient’s) doctor.
Careful-actual medical insurance providers may implement this revolutionary response device into their absolutely logical and sympathetic patient-care system 😂
I have endometriosis. It was really bad in my early 20's. The insurance denied this hormone shot that was the treatment. So after exploratory surgeries and maybe 4 surgeries to keep cleaning out the endometriosis. Then the pain was so different. But my Dr just prescribed me pain killer . He never touched my stomach, did an ultrasound or a pap smear. This went on for a few months. My stomach looked like I was 5 months pregnant and I walked hunched over because of the pain. At work I made friends with a Dr. He came in and said this was too much. He told me I had to go see the specialist put of town. So I did. He felt my stomach and said he could feel something. Then an ultrasound showed a mass. I met him I'm his actual office. Took down noted on how my general practitioner was saying. He was livid. I had to have an emergency hysterectomy the next day. Before they were calling the insurance to get it approved. They said nope but now they pay for the hormone treatment now. The Dr was pissed sternly saying it was too late. They removed a tumor the size of a grapefruit. And took all my intestines out and cleaned me up. My bladder and colon were fused together. My liver and rib are connected. That they couldn't fix. Worst recovery ever. I was 23.
When you are on medical leave from work and going through surgeries and trying to get better. You still have to work 40+ hours a week just fighting the insurance companies.
As a Psych nurse, I once had an insurance person question my desire to admit a patient because they ‘didn’t have enough sutures’ when they cut themselves in a stated suicide attempt.
I’ve gone through this so many times with Anthem Blue Cross. I caught them denying a claim saying they had reviewed “the entire medical record” when it hadn’t been completely sent to them yet.
I’m a doctor, and hold myself to the highest standards of professionalism. With that being said, I dream of the day I spend a night in jail for punching a CEO of an insurance company in the face.
I had a insurance claim denied at an urgent care because there was "professional charge" to see the doctor and a "facility charge" to be in the building and that it wasn't REALLY an urgent care but a hospital adjacent building. Like I'm supposed to fucking know that before I go in. And this all came up a year and a half AFTER the visit due to an insurance company audit.
This is exactly how it goes down. Except Dr G saved us the 45 mins on hold and being transferred from one bureaucrat to another, plus or minus the calls being dropped and having to call back. Oh and the waiting room full of people whose appointments are being backed up because of this.
It’s not a shame. It’s an abject policy failure and an abject moral failure by politicians bought and paid for by corporate profit interests over the interests of the citizens and communities they are supposed to be serving.
I worked in medical billing, and this is all true. Also yes, United is the absolute worst and would deny everything. After telling dying patients that their treatment was denied for all the reasons listed above, I went back to get my master's in public health in Sweden because I didn't want to be told that single payer wasn't possible. Anyways, long story short, I work in global health now, implementing health systems improvements in Africa. Do you know how much money the US government spends on improving free access to healthcare in every other country besides the US????
At least outright denying the claim is a step up from what one of my patients went through recently. The pharmacy I work at isn't contracted to bill for compounded medications, so patients have to submit forms to their insurance for reimbursement on compounds. One patient's insurance company called us every other day more than 2 weeks, asking for the exact same clarifying information every time. They kept saying whoever we'd spoken to the last time didn't record the info properly when we gave it to them. Toward the end of this ordeal, they started mentioning how the deadline to get these claims processed was coming up soon. Putting two and two together, I suspect the insurance company was just trying to run out the clock so they could say, "Sorry, we weren't able to get the information needed to process this claim before the deadline, and now that the deadline is passed your claim is no longer eligible for reimbursement."
Unfortunately you aren’t spared issues in other countries with wait times so long that people die waiting to be seen and yet budgets for said health care remains the same or gets cut because the world is just that cruel
As an American, I'm glad that international relations can be fostered by such things. What kind of things does your country do? Maybe I can feel a bit less depressed.
I admit to working for a health insurance company for about a year. Less than 10 years later I became fully disabled with multiple disease that have almost no covered treatments. I honestly believe it is karma. I did my best to screw the system from within, I really did.... but now I fight for coverage of off label meds, non covered procedures, and the yearly battle to get exceptions and quantity limitations through.
I worked for an insurance company for 5 years, back when pre-existing conditions could legally be used by insurance companies to deny claims. That was my job. Of the 4 people within my cubicle square, 2 of us ended up with severe depression and 1 started having panic attacks. The fourth left went on medical leave.
You are akin to veterans they send to kill innocent people abroad and come back fucked up beyond repair. Not a hero nor a villain, but like everyone else except for an inconceivably small minority, a victim.
The shit thing is, most insurance companies have an in-house doctor who's never actually seen or treated a patient in their lives, and they have the audacity to sit there in their office and tell me on the phone that I should not give oxygen therapy to a COPD patient with 80% oxygen saturation because the patient is still conscious, or that I should not schedule an urgent PCI for a heart attack patient because they need to examine the ECG themselves first to decide whether it is actually necessary. I am an atheist, but whether it be God, or Karma, or whatever it is, I hope it gives them just 10% of the pain that they caused. Not even the whole thing, just 10%, and they will be crying and screaming in agony, I swear to you.
Ahahahahahaha! This is my favorite one so far! I once was told insurance companies were going to com after me for a video I did about winning insurance appeals.... Have you had their team show up?
Just got my spine fused (T6-L2) and my insurance denied the study-backed, commonly used for post-op fusion patients, bone growth stimulator because, wait for it, it’s not “medically necessary” in my case. Oh, I almost forgot: they also refused to approve a refill of pain meds for me post-op so I got to stand there at the pharmacy counter with my walker like an idiot trying to figure out how I’ll manage my pain without the prescription from my doctor. Thanks American Health Insurance, for adding more pain to the healing process than the actual healing process.
I am barely ambulatory. I mostly use a wheelchair but, I am able to walk very short distances with assistance or a walker. But, it's always a bit scary because of balance issues and sudden spasms. I don't get much warning and if I can't immediately sit, I fall. My cardiologist ordered a (chemical) stress test because of my issues with standing let alone walking. Denied. So, they tried again. Denied.They would only cover a treadmill test. The cardiologist personally called and explained the patient, me, wasn't physically able to do a treadmill test. Their response was, that I wasn't paraplegic, I was able to stand and take a few steps so they would only cover the treadmill test. So....I show up for the treadmill test, the Dr monitoring the test takes a look at me and saysto the tech, "this guy can't do this". I say, " according to the insurance company I can". So, short story, they put a gait belt on me. The doctor has a running monologue about the evils of insurance company that included multiple F bombs. I do the treadmill test with the tech standing ready to try and grab the gaitbelt if I fall. He grabs me and basically throws me up on the table. Dude is sweating almost as much as me. When its over Dr. Is still steaming mad and says he's thankful I didn't fall and break my hip or worse but now unfortunately the mother effing insurance company can say "look we were right, he could do it".
I used to work with UHC and Aetna as a customer service rep...and I always feel bad about these denials... esp Ive seen cancer patients unable to get reimbursed bec of these bs.
I LITERALLY had United Health Care deny part of my claim because of that EXACT wording. Their “cardiologist, a ‘board certified’ thoracic surgeon” said that my overnight stay for my outpatient procedure was “medically unnecessary”, even though the doctors wanted to monitor me overnight due to my chronic heart disease and congenital heart defect. He apparently “looked over my records” and determined that the stay wasn’t necessary and could monitor myself at home. 🤦🏼♂️🙄
I swear jimothy is Actually the devil testing the insurance people for true evilness. If they know exactly what they are doing there is no way getting out of hell later
I used to work back office for a company that worked for an insurance company (I know it's a mouthful), but one tiny thing that slightly speeds up the process is to fill out the forms nurses give you as completely as you can. Insurance companies would make every excuse to delay payments, including incomplete forms.
as someone who worked for a 3rd party that handled cases. this is ACCURATE. although they do have written out standards and guidelines you can look up why they came up with it is by hiring some Dr's and making up their own rules. and yes medical necessity and out of network were COMMON denials
I had a patient who was progressively paraparetic (paralysis of the legs). Over 3-4 months, their insurance refused an MRI request three times including after a peer-to-peer. They didn’t show up for follow ups because they could no longer walk or get into the car. After the last denial I asked them to call an ambulance and show up at an ER instead.
Meanwhile in my country i had to go for a surgical procedure, (healthcare isnt free but insurance covers it all) Hospital submits, pre-authorisation, insurance calls me a day later to confirm the procedure and the nature of my condition, tells me not to worry and they will get it approved asap, gets it approved 1 day later and at the end of the week i got my procedure done and paid $0. I thought this was the standard of insurance claim experience until i see the horrors of American health insurance.
I literally go through this with united almost annually. They will deny my chemotherapy because we are using more than one drug, and they're costly. They wanted my doctor to lower my dose to which she said it wasn't effective at a lower dosage and without the addition of another drug that works differently. It's difficult to treat chronic lymphocytic leukemia and sometimes takes multiple drugs. United always tells me that treatment decisions are between my provider and me but try to play doctor and dictate my treatment plan without ever having examined me so no. If I had another option I would go with it pretty quickly.
One of my top two reasons for leaving the US. I was getting sick from the stress of dealing with the medical/insurance system. It's so much less stressful back home in Canada. Thankful that was an option for me.
My Mother was in desperate need of lifesaving heart surgery. She was denied 5 times by United healthcare. They said it wasn't medically necessary. She died of a massive heart attack new years day of this new year. I hope they burn in hell.
As a person whose family (me included) has made an incredibly extensive (and necessary) use of my country's medical system, you can't believe how thankful I am I don't live in US, coz I am not at all sure that I and my relatives would be alive nowadays
I know this is supposed to be a parody, but it's honestly so accurate that it makes me so frustrated and upset. I've spent hours appealing on behalf of patients because of ridiculous denials.
Actual conversation between me and my health insurance when they denied me a nerve block for debilitating migraines. “It was determined to be Not medically necessary, it’s an experimental procedure, you can file an appeal”
It would be really funny (and uplifting) to see a video where Jimothy goes rogue and actually helps someone ... like Mr. Incredible. And, speaking of super heroes, it'd also be awesome to see a Jimothy + Jonathan crossover video!
OK so I've been thinking about this and I think in the GCU (the glaucomfleken cinematic universe) Jimothy needs a redemption arc. He becomes a healthcare vigilante superhero who's sole purpose in life is to spite United Healthcare.
This is one of the main reasons that, despite all the horror stories surrounding VA, I just get my care through them and don't even bother with health insurance (yes, I qualify as 100% covered). A hell of a lot less red tape dealing with the government.
Shit like this makes me realise that £300 a month for National Insurance isn't that bad of a trade off for me and others not having to worry about this.
This is exactly how it is. And UHC is especially despicable. We need a system where district attorneys prosecute these insurance company scams and levy huge fines and restitution. Patients are simply too ill to pursue the civil suits that are their only real recourse in some states. Of course, patients can’t even sue their insurance companies in most jurisdictions. And state boards of insurance are rarely helpful.
I remember the American boyfriend of my cousin. He came here for a year, they weren't engaged or anything, to study German. Dislocated his shoulder (for the 5th time or so), went to the hospital to get it sorted. They gave him a surgery appointment. He was a student, said he couldn't afford it. They laughed and told him that of course he doesn't have to pay a cent since his insurance, that he didn't even know he had as an American in Germany, would pay it all.
Sounds like my week. I'm a physical therapist who has a patient who was denied her neck MRI 3 times. She needs to fail PT in order to get her MRI, but I can't treat her neck because she has a bunch of red flags that require her to get an MRI. So I got her an x-ray to rule out instability but it came back positive. So she needs an MRI right? Not according to the insurance company! So an orthopedic surgeon, NP, and PT all ask for an MRI but the dude at the computer says no. Why aren't they liable?
My insurance has been denying a lumbar mri for neuro involvement for over a year because I haven’t seen a CHIROPRACTOR. I’ve had four rounds of pt and they say I haven’t done enought because they instantly deny the claim and take so long to process the appeal until they deny because it’s been so long we’re out of the “completed round within the past six weeks” window.
👏👏👏 I was shocked when I came to the US and saw this. How come no one does anything about it?? It seems like we are trapped creatures dominated by insurances. 😓 Can someone kindly please enlighten what chain of events led us to this point?
I had to take a leave of absence, ironically from medical school, because Aetna refused to cover a drug that I'd taken daily for years - despite appeals by my doctor, who was literally a professor of neurology at UT Southwestern. It's wildly unethical, and it should be illegal.
I am 65. When I was born, in a hospital, my mother stayed in that hospital for a week. I asked once and my father said the entire bill was around $50. Things were pretty much that way until "healthcare insurance" raised it's ugly head and asked, "How can I help you today?"
I once has an ortho surgeon fight to get a cortisol injection covered for me for about two months and by the time it was finally approved, I'd finished college and moved away 😢 I do appreciate how much he went to bat for me though
Premed here, applying this cycle. I'm watching this right after my shift as MA at a small medical center - and the last task I got was that a PET scan was denied was a patient with prostate cancer and to submit an appeal. This video hit me right in the feels...
im interested in seeing real life convos and stories about how this works. just like some healthcare workers have dark humor to help them get through a difficult day, I wonder how it goes from the insurance perspective.
@C. J. well originally, I had hoped to work in a museum. I have a masters degree in art history. However with covid and the economy being poor after graduation, I didn't have any job opportunities. My mom is a medical coder, so I went to her bosses and said can I help out? They assigned me to do accounts receivable on two large practices. Basically I see why the insurance has denied a claim, and tell the insurance "you're a crock of dung, and here's why." Often times it's fixing "mistakes" that the insurance companies deem happened. Such as they thing the medical record support a lower level of service, which just means they believe the doctor/medical professional spent less time than they billed for. I submit appeals as well to say "pay me because you're dumb and here's why." Sometimes it works and they pay me what is owed, sometimes it doesn't. 🤷 it kinda depends on the procedures being done. Ultimately, I don't work at the insurance company. I work with them, begrudgingly, to make sure my patients don't pay more than they absolutely have to. I rarely drop a full charge bill to a patient.
Tonight at 10, a strange story of a brutal murder. The suspect was covered in blood screaming "How experimental is it now!"
Unfortunetly the guy that was murder wasn't treated in time because it out of thier network and it's not medically necessary
If a second civil war ever occurs in the U.S., the first people to be targeted for elimination from existence will be, in no particular order: Politicians (former and current), police who either abused their authority or simply stood by and watched an atrocity happen instead of doing their jobs, anyone who has ever worked for an insurance company and been involved in denying any claim, and CEOs. The unrest in the U.S. is pretty real. The solution is simple though: Delist any company on the stock market that is involved in any way with the medical industry and also set hard percentage limits on profits (e.g. 10%). The stock market is inherently evil.
@@privacyvalued4134 well you see the funny thing about that is they will come up with imaginary costs to keep profits bellow 10%
While still making more
@@privacyvalued4134 I like this strategy. It would solve a lot of problems
@Bamidélé Because, when you make 10x the amount of all your employees combined (this is a rough, a likely low estimate) then they are making all the problems such as a disintigrating middle class, increasing rate of inflation, destroyed housing market, increased unemployment, etc etc etc... Srsly, when 1% of the ppl of the world hold 80-90% of the money, it's no wonder whole countries are collapsing rn.
I am a pharmacist working in retail settings, and I say the same thing too at work, “there is a special place in hell for these people”
Yep. It is called the money mountain.
You... You aren't still conforming to CSV's work ethic. Are you? I'm not even a pharmacist and I'm still concerned for your welling being. I hope you find better places soon. 🙏
What percentage of claims are denied?
“The…special hell.”
CPhT here, retail setting too at the big W, the pain is real, just wanted to lead us all in a prayer: Dear Big Labcoat in the sky, send a comet into BCBS/UHC's corporate offices. In refills, we trust.
My son was born deaf and had cochlear implant surgery at 9 mos. The ins company gave prior authorization and then TOOK IT BACK after the ($400000) surgery was done. I had to appeal and get on the phone with the medical director… luckily I am an MD myself and the company had approved my daughter’s surgery for the same condition a few years prior so I had that to argue. These companies should all get a RICO investigation. The emotional pain and worry they inflict on ill people is criminal
It's a problem that patients have to have a medical degree or another advanced degree (in a life science AND law) to joust effectively with the Insurance dragon. Whenever I read a story of someone fighting the monster, I want to jump in and help, but THERE ARE SO MANY PATIENTS needing this kind of help. We need an aggressive patient advocacy industry.
I'm a lawyer who agrees with you that a RICO charge is EXACTLY what's needed, along with a Department of Justice and a U.S. Attorney willing to bring it. We have the method for legal redress. Unfortunately, I'm not sure any administration, regardless of politics would sign off on it. My response here is underscored by the fact my son has experienced sudden total hearing loss in one ear, and I can imagine the forthcoming battles if the cause remains a mystery. Best of luck to you and your family. Wishing you all good things.
Lol people still think accountability exists.
@@Dfree2502i know. Right?😄
@@Dfree2502 Become a standard-bearer
It's always fun when your doctor tells you that, for an FDA-approved therapy, they have received no successful authorizations from any of the nationwide insurance companies.
That ought to be illegal. Insurance companies practicing medicine!
A lot of times, it's because the commercial insurances are waiting on Medicare to approve it first. Most insurance companies follow the lead of Medicare in a lot of things. This of course is stupid, because commercial insurances can and have approved 'experimental/investigational' procedures on a case by case basis if the patient complains loud enough via their lawyer... 🙃
@@CanyonALynn Then we need to make medicare approve way more things then. Whatever the solution, it needs to come quickly.
@@5amiann It's almost like profit driven motives might not be the best fit everything.
The only way to deal with it is lawyer up. They’ll cave.
Is this finally it? Is this where Jimothy quits healthcare to go work for the devil in a less morally taxing job?
becoming more and more clear that perhaps there isn't any reforming the system from the inside!
Well said.
Well, he works in health insurance, not healthcare. He could quit health insurance and go work in healthcare :)
I think Satan's current PA, Joanne, could do with a PA of her own. I think she'd be fun to work for.
@@drhandle4498 😆😆😆
Poor Jimothy... Tried to sneak in an actual decent response in the mystery bag but that didn't work xD
Now I'm picturing him slowly replacing the BS reasons with truth telling ones like "We value Wealth over Health" and "We just hate you"
@@pokedude720 "Because f*ck you, that's why"
This isn't parody or exaggeration, this is straight facts.
Imagine Glauc does a series of these satirical bits, one a week for say six months, then drops the dime and reveals that they are all transcripts from real conversations that actually happened.
@@Naxhus2 that would require health insurance providers to actually talk to their customers. More realistic is denial paperwork, appeals, and appeal denials.
It's true. Take a look at your health insurance company's "benefits booklet". You will see exactly this. Same "terminology". "Medically Unnecessary" as a proper noun is a catch all for "We just don't want to cover it- for no specific reason. We don't honor the contract we have with you and do what we said we would when you hired us. And what you've been paying for. And fuck you ha ha ha ha. "
the cherry on top is that he didn’t explain how to file an appeal
you just need to call the other hotline and jump through 1 million hoops to get the form to submit the appeal. it will then be denied for unknown reasons, unless you make another 2h phone call. easy.
Do it in writing,be ditzy (or passive aggressive) and send a copy to CEO
After the appeal is denied, the primary doctor has to do a peer to peer review, which means calling in, waiting 40 minutes on hold, giving all the information, being triaged to a nurse, waiting another 20 minutes on hold, giving her all the information and finally being advised that you are approved for a peer to peer review and the doctor should call you within the next 72 hours at his convenience, most likely when you are in the middle of a PAP smear. Not that I’m bitter or anything today.
And after 2 failed peer to peer reviews, with specialists that aren’t even in that specialty, they will FINALLY forward it to an external state reviewer, a reviewer employed by the state, with the same specialty, the insurance company hates these, and it usually goes through after this, and has taken at least a year and a half, and your child’s specialist is so irritated by then that they will get anything approved bc they have spent so much time making those appointments with random specialists who deny everything
@@3Beez08 "Please stay on the line. Your call is very important to us. Current wait time is ......."
I'm an insurance authorization specialist, and I once got so angry at all the BS that UHC put us through to get scans for two cancer patients that I asked to speak to the manager. I then proceeded to make that manager cry.
I should probably feel bad about it, but I don't.
My insurance said chemotherapy wasn’t a covered procedure for cancer and that a $400,000 bill was my responsibility…
We are warmed by your success. It's not a large fire, but the hearth remains lit.
You channelled your inner Karen for a good cause
I... I think I jsut fell in love with you.
@@GitSumGaming please tell me you took them to court.
What makes this sketch even funnier is the fact that an Insurance Ad played before the video started.
Pure Comedic Timing.
This isn't a skit, it's a documentary.
It's the inclusion of the apology in the excuses bag that makes it fiction.
Glorious, isn't it? And we're not making any progress. I worked at Blue Cross/Blue Shield in the early 90's when their "managed benefits" department was first started. We denied a poor soul who brought his child, with cancer, who couldn't breathe, to the ED. He didn't "notify the insurance company" before taking the poor baby for treatment. That was the end of it for me.
True story. My grandfather worked for Blue Cross and Blue Shield back in the 50s in Indiana. He had a well paying position and about 5 kids at the time but he was miserable and felt like Jimothy there. He quit and started his own business which unfortunately failed. He moved out to Rhode Island where my grandmother was from and they lived with her family for a while until they could get back on their feet. He never went back to the insurance industry and though my dad said they experienced some hard times, grandpa never regretted his decision. I'm proud of that.
The appeal was denied by the way. I mean it never was filed, but it was still denied.
This is absolutely a hundred percent true, except for one detail: The rep would absolutely say "Oh, yeah, it looks like the claim might have been denied in error. Let me send that back for reprocess." THEN the rep would say "No, our medical directors looked it over and determined this claim was correctly denied. You'll have to submit an appeal."
It makes a difference of about 90 days, plus another year for the appeal.
right. they lose nothing by lying about all the nice things they're going to do for you and then not doing it. because the member services agent is not accountable to you and has no authority to fix your problem anyway. they do it all the time, lie about what they'll cover, lie about reprocessing denied claims, lie about anything to get you off the phone, because their job is not remotely at risk for lying to a customer. that disdain for the customer is not only not a problem for their advancement, it's the very reason for their job - they are there to run interference against you. giving them an insulting name like "Advocate" is just what makes UHC special.
@@jedinxf7 Oh don't worry, it isn't UHC exclusive. It's also at Aetna and it's even worse there. Worked there for a bit and it was insane. Everyone in the company knew advocates had no power but you were told to tell the customers otherwise. It grinds you down from wanting to help to just treating people like objects.
Yeah they hope they can delay until you die before they have to pay out.
As someone who has cancer and now sees the corrupt reality of healthcare in the US this is all too real. My insurance said chemotherapy wasn’t a covered procedure. Been trying to hit me with 400,000 bills…and it’s just not the insurance companies awaiting justice it’s the hospital system. They both work together to artificially inflate prices…sad world we live in
So sorry for the double whammy. Hope you find comfort, strength and caring
Afraid the stalling is hoping you die before you need more treatment. Another thing that ought to be governed by law. Speed is of the essence in cancer treatment & insurance companies kill a lot of people by slow walking treatment, even someone on medicare.
Then let me give you something to fight back with. Most hospitals are also charities. If you can't afford to pay your bills, you tell them that. Tell them there's no way you will ever be able to pay it back. Because they are charities, they have to cover it if you can't.
@@etherraichu If they are a non-profit hospital, this is true. If they are not, the billing department will still usually be willing to lower the bill immensely. if you hit someone with a $400,000 bill, you're unlikely to ever see a cent of it. If you hit them with a more reasonable bill, you'll probably actually recover some costs.
I sincerely hope you don't have to go for that option, but if all else fails, talking to billing is at least an option.
I used to do medical billing for patients in a Dr office.
Some things to help you and see if you can get someone to help you:
1. If any of the hospitals are non profit you can look at what they are supposed to do
2. Always get an itemized bill (you have to ask which is ridiculous)
3. Question everything they send you in regards to bills
4. Check dates! Hospitals only get so long to submit it to insurance. If they miss their date I believe you can successfully fight them on paying since they were negligent
Most of the time they’ll fix it when you ask for an itemized bill but if not, you can call and get quotes for prices and look at your explanation of benefits.
You shouldn’t have to be dealing with this while getting treatment. I hope you are in better health soon
I called an insurance company once because they had refused to pay a claim for emergency surgery I had done on a minor. Neither parent would fill out the form requested by the insurance company to determine if the injury occurred as the result of an accident. Since the child had a broken leg from playing basketball, I pointed out that it was all documented in the paperwork my office had sent to the insurance company. I also pointed out that nearly all fractures occur by accident since most humans are too smart to intentionally break a bone.
I was eventually told that the claim was being processed in a different department. When I requested to speak to someone in the other department, I was told that there were no phones in that department. When I offered to mail them a phone, they hung up on me.
When the parents got the bill from my office, the insurance forms were completed and the claim was paid by the company … after nearly a year.
My suggestion for patients who feel they are improperly denied… call your state insurance commissioner. Insurance companies hate that. If all else fails, call the local TV stations, newspapers, etc. Bad press and regulatory inquiries are not popular with insurance companies in my experience.
Last year, I had to make several calls because my insurance had my policy wrong and denied five claims 😭. It took months, and they kept giving me different windows of time and then changing them when I'd call in again. The only reason it ended up getting fixed in the end was because I ended up getting the same random employee my last two calls, and he remembered me 💀 He got my last batch of appeals approved during the three minute call, and had me confirm they were paid out on the website before I hung up. My own personal Jimothy 🙏🏾
I pray that hero enjoys a happy and healthy life with his family
Bro, some years ago, I used to work at two health insurance companies as a member services rep... I STILL have borderline PTSD. Don't miss it at all.
Could you tell some stories about working there?
@joko 28 Everything in the video is pretty much what happens. Always ended with 'You can appeal.' Some of it was not understanding how basic insurances worked (patient had a copay/deductible, not understanding the difference between routine/annual/preventative vs diagnostic/problem services) miscommunication between doctors and patients (not knowing they were under observation instead of inpatient, one patient wasn't told they had breast cancer because she was billed for a dx mammogram instead of a routine preventative mammogram). Stuff like that. One specific example was when I worked at Aetna back in the day, and virtual/CT colonoscopies was just developed but not covered and deemed experimental. Patient was billed thousands of dollars because a regular colonoscopy was 'too short' (length). Any new technologies, procedures, etc are deemed experimental/investigational by most insurances. Usually, they follow the lead of medicare...
Oh, and when Viagra first came out... you would not believe the calls we got about that. "Why isn't it covered!? I can't believe I have to talk to a girl about this! We want to have sex more than six times a month! (Elderly couple)"
I've never blamed a rep for any of the nonsense policies. They didn't make them. They're just trying to make ends meet.
But I'll also never forget the BCBS rep (before ACA) that told me I'd need to have a "separate pregnancy plan" to cover anything OBGYN related (prenatal care), anything related to complications, or labor and delivery. And I'd need to buy into that plan for 8 months BEFORE any of the coverage kicked in.
.................. 😒
So I guess FU if you have a complicated pregnancy or premie. (Which I did have a complicated pregnancy, but fortunately was able to hop over to my husband's plan which covered things well enough that we "only" ended up paying $20,000 out of pocket......)
@@WxBuggin noice I have paid 30k out of pocket from my hard earned life savings and thought it was over and then they told me chemotherapy wasn’t a covered treatment for cancer and I owed 400,000 so I’m pretty much done…
@ErSomethingSomething Unfortunately, we had many, MANY people (even when I worked as customer service in non-health related industries) that get... personal... when screaming at the messenger. I had one woman say, 'Well, when I die, I'll be up in heaven looking down at you smiling while YOU BURN IN HELL!' *click* And this was because I wasn't able to Google up random grants that she can apply for to help out with her medical bills and she didn't have internet access.
Prenatal and birth related claims were ALWAYS messy. Never liked getting those calls. The claims were a lot of times billed incorrectly, mixed up with eachother (baby and mom are billed separately) or a completely random baby or mother was attached together. One woman gotten bills for non-covered services because she switched her OBGYN doctor. Apparently, we both learned at that time that once you're with an OBGYN would 'diagnose' you officially as pregnant, you are to stick with that doctor until birth. I ESPECIALLY hated the calls where mothers got a final bill for medical/hospital charges for stillborn or babies that passed afterward.
The health insurance and billing industries need a much needed overhaul.
For profit health insurance is one of the greatest travesties we have ever inflicted upon ourselves.
and there's always some republican mob yelling... "why should I pay for people who dOnT WOrK hArd EnOugh to pay for their own disease?". Holy hell, public healthcare system is essential infrastructure like sewer system, it's never meant to be capitalist and by choosing to have it doesn't mean US is turning communist either, it's not even socialism, just what a country needs to stay modern. Imagine a city without any water and sewer system. I don't know why people don't get that.
And even with all this blatant scams health insurance companies does, a lot of Americans still think their healthcare system is better than other countries. This includes my mom. Who can't quit her job because of her health insurance.
Yup…and it’s mostly those who have never had serious enough issues to open their eyes to the reality
I was like that too…then I got cancer
Most Americans know. They just don't trust anyone in our country to make it better.
These big conglomerates will assure any changes will make it worse for us, better for them like they have before. They'll pay off any lawmakers or politicians like they have before. They'll jack up costs, like they have before.
Bureaucracies ensure they don't lose, and this one is entrenched.
Man... this hits HARD. I recently started having a weird set of symptoms, including muscle spasms that get worse with exercise. I've been to about 5 different doctors trying to figure out what it might be, and all of them think that this is most likely adult onset leigh's disease or leigh-like disease, a genetic mitochondrial disorder. The only way to check for it is with genetic testing. I have one of the best insurances I know of. They cover pretty much anything, even a lot of out of network stuff. But they refuse to cover adult genetic testing becauase it "is never medically necessary". Leigh's disease is a fatal, life-limiting condition, that usually k*lls people in 10 years at most, and I can't even get tested for it without shelling out thousands of dollars, because it "isn't medically necesarry" to know if the thing that has currently left me bedridden is the genetic condition that runs in my family or not.
I feel the same friend. they can't find what's wrong me. close to 10K spent (& 2022 bills still coming) & no real answers. & that 10K isn't what I pay for the insurance. but there some private companies that do DNA screening (not 23 & me btw). but that's not free. it's just not free. it might be something to look into. I really might be cheaper than going through insurance. I held on doing myself as I found a Dr that knows how to work the system.
I'm so sorry. That must be extraordinarily stressful and scary. I hope you get the testing you need, and deserve. Our healthcare system seems irretrievably broken. Thankful to Dr. G to using comedy to address this horrendous gap in the U.S. standard of living. But reading cases like yours makes me feel hell is not good enough for these companies. Best wishes to you, and sending compassion.
I was dying from B12, folate and iron deficiency, my symptoms were much like what you're describing. The deficiencies had been present for decades. Once my deficiencies were corrected, I could finally leave the bed, the walker and the wheelchair behind and start working again. I have a confirmed mitochondrial dysfunction (COX IV), but no mitochondrial disease found amongst the 1500 most common genes.
Perhaps B12 injections is a possible, and reasonably cheap, path for you to try. Even if entirely out of pocket it's not horribly expensive. Very few side effects, no toxic levels recorded in history (since 1948). Suggest it to your doctor and see what they say.
My dad just did a genetic testing for pankreatic cancer to search for best treatment. We have one of the best health insurances in Europe, but they don't cover that.
My dad is at the end of the line, this could be our only hope.
We had to pay the full thing
take some magnesium you be back to normal
The more I deal with health care insurance as I age the more I want to move to Canada.
As a Canadian, you may want to look into the current MAID scandal and rethink that option.
theres aways Norway
If you like warmer weather there's always Mediterranean Europe
Our system isn’t perfect and still needs a lot of adjustments, but even with MAID it’s a lot better than the states
@@ruxbin333 That's the joke
At this point I think there should be a law where if the doctor who actually examined the patient says something is necessary, then insurance MUST cover it. Regardless of whether they think it's necessary or not.
Me when I finally found a prescription that worked for my chronic medical issue after years of trying other drugs to treat the condition, had been on it for 6 months, and THEN the insurance decided I would need to get off of it and try a bunch of other things AGAIN before they would pay for it. You know. The issue I had been hospitalized before with multiple times.
Been there too. Wrote back with there list of meds and costs,compared to what worked. Asked for peer reviewed paper that supports that treatment.Reminded them of hospital costs for crisis, LTC if catastrophic fall but if they insist send letter of financial responsibility for change signed by MD and will do it. Next day approved.
Yep, I have said for years that if they looked at the total cost of treating a patient, vs each silo monitoring it’s cost (hospital cost vs dr office vs pharmacy, etc) it would reveal way more is being paid through our fragmented system than if they paid for what works. I remember when a patient was hospitalized while all testing was done and a diagnoses and treatment plan determined. Within a few days the months of various outpatient visits (in the 1980s). I refuse to believe that wasn’t more cost efficient and better for the patient. Sorry about the rant! 😂
That always made me livid. When that generic form of remicade came out, my hospital was flooded with ibd patients in flares. All because insurance forced a ton of people to try it.
@@cherylcarlson3315 smart.
The problem is, most people don't know you can do that or have the knowledge to pull it off.
And you're right, a single hospitalization is expensive enough to wipe the cost savings of most medications.
@@rcranes2227 that is why I posted here, hopefully it helps someone
My mom has spent so many hours on the phone fighting insurance companies on behalf of patients. And recently only had time to fight with them for herself because she’s retired.
When my spouse started working from home a lot he was amazed when he realized how much time I spend dealing with insurance appeals. Like, hours a day for weeks at a time.
"I'm going to hell, you want anything?" Yeah, how about some actual healthcare reform in this country?
"I said I'm going to Hell... Michigan! Hell, MI - sadly you're already in the same region and country as Hell. If you want reform, you're gonna have to escape Hell."
As long as they are legally allowed to buy off representatives, it will never happen.
So you want me to check if it's frozen over, got it.
We get what we vote for and we vote based on the education levels of our communities.
@@lijohnyoutube101 It's almost like the United States only has one political party, and it is only concerned with preserving capital.
Memory trip here. In 2021 my then 55 year-old husband with treated uveal melanoma left eye was following up with medical Oncology every year or so (from 2017 onward) when all of the sudden the CT scan of chest, abdomen, and pelvis were "not medically necessary." Fought it, tried appeals (HAHAHA). Fast forward to this January 2023 and he has mets to liver (not surprising) since that is where 90% of the time uveal melanoma metastasizes. But according to insurance, it was "not medically necessary."
I hate insurance companies for that very answer.
They told me chemotherapy wasn’t covered and trying to get me to pay a $400,000 bill
When can we sue them for negligence ?
@@zelousfoxtrot3390 It's not negligence. They know people die when they do this. They bank on it and profit off it. Then they spend those profits lobbying politicians, mostly Republicans, to rig the system further in their favor.
We need legislation that health insurance companies have a fiduciary duty to their insured patients.
One of these days they're gonna push somebody too far, and shit will really hit the fan.
I had a severe, multi-day migraine and the neurologist wanted to do three days of outpatient IVs. The insurance took 7 business days (12 days total with weekends) to make a decision on the IVs, then ultimately denied it because “how do we know she still has a migraine after all this time?” The neurologist’s office explained they could know I still had one because they had been sending Urgent requests every single day because of how sick I was. The insurance then went with “We have no way of knowing if it is the same migraine or a new one.” Still denied. The neurologist sent me to the Emergency Room, which the insurance had to cover and was ultimately more expensive. It still didn’t break the migraine after all that time, but I at least got a couple hours of sleep finally.
I read the propublica report on this last night, and one wonders how these people can live with themselves, and what they think will happen when it's their turn as the meat in the grinder---which, statistically, and given COVID, will happen.
They don’t care until it happens to them. Some people have no compassion.
Indeed! You cannot do something bad on behalf of your employer and still call yourself a good person. NOPE!
@@cleementine That's the same reason why I often return the credit card solicitations with outrageous interest rates in the reply envelope with the rate circled and a note pointing out that Christianity, Islam, and Judaism all condemn usury and no one claiming to follow them should participate in it.
You know that ethics question of “if you press a button you’ll receive $10,000 but one random person will die?” That’s health insurance execs in a nutshell.
This is my biggest fear living in the US right now. I have a great health insurance... but it is worthless if I mistakenly or unknowingly go to an out of network doctor.
What happens if I am unconcious and the ambulance just drives me to the nearest hospital, which happens to be out of network? Suddenly, instead of having a great health insurance, I am bankrupt.
This is exactly the situation im in right now…
Great health insurance in the US is equivalent to mediocre health insurance elsewhere
Aetna was by far the worst for me. I’d call them to make sure a doctor or a procedure would be covered. Aetna would tell me that they were covered. Then I’d see the doctor or have the procedure, after which I’d get a letter telling me that the doctor or procedure wasn’t covered. I’d call them up and they’d lie, saying that no one would have ever told me something of that nature was approved.
When I switched to my employer's health insurance, they refused to cover a medication that I had been on for nearly two years, claiming it "wasn't medically necessary". I spent over a month fighting them on this. I filed THREE appeals, all of which were rejected, my endo went to a peer-to-peer review where the insurance doc just told her to shut up (I wish that was a joke), and after enough calling and bitching, an external investigation was launched and my medication was quietly approved a week later.
I am a hospital housekeeper. This was *hospital insurance* that forced me to pay out of pocket for the meds that keep me alive.
If only there were laws were a untimely wrongful denial would cost them more than a rightful approval.
The issue is "wrongful" is so vague, just like the idea of "medical necessity". A doctor/qualified medical professional doesn't practice medicine without medical necessity, so to deny a claim based on it is absurd. I hate it so much and I work in appealing medical denials
Or you know, just tear it all down, and fix the entire things since it is not salvageable anyways.
@@jintsuubest9331 I like your style
@@emilymoxie what I was trying to say, is that if they denied a 1000$ test or treatment that is medically reasonable, they should be fined a 1000,000$ or something. Something to encourage them to be more reasonable and responsible.
yes, the purpose of laws is to deter socially harmful behavior, and the only deterrent for an easy to commit, immediately profitable fraud is to make it cost significantly more than the upside of getting away with it.
they should also make at least a portion of the fine over the actual denied claim (which must be refunded in any case) payable to the patient and payable to the provider, to incentivize billing offices actually going to bat for clients to get claims correctly submitted and processed and to join them in suing the insurer for these illegitimate denials. hospitals have a lot more resources to advocate for patients (and themselves) after all.
I’ve been fighting insurance companies for over a quarter of a century, since my oldest child was born. I’m so tired. But I keep fighting because insurance companies suck and my kids need medical care. We have Anthem, and they blame their subgroups for our denials. I hate all of them. I cannot understand how anyone can work for an insurance company knowing how corrupt they are and how sadistic they are toward people in dire need.
Just move bro. To France. Everything is free
@@radumeirosu6251 lol. You don’t know much. Someone like me would never be allowed to immigrate to another country. 1) you need money to get yourself there, 2) If you are disabled or you kid is disabled they won’t let you. Seriously, such a lame, uneducated, and unhelpful comment.
I spend the majority of my day fighting these denials with the Worker's Compensation Insurance companies. They'll deny visits saying "the doctor or treatment was not authorized by the adjuster" when the adjuster is the one who scheduled the appointment. Though my personal favorites are when they change a code to "better reflect services rendered" then deny it for being the wrong code, or the "in order to review this charge please send a copy of the invoice" right above "this charge was reviewed per the attached invoice"
The industrial strength gaslighting, though 🙃
I just had a PET scan denied today. I didn’t order it ( the pulmonologist did) but the appeal process has been given to me as the primary MD. Because the specialists are too busy making money to deal with this time wasting crap so they leave it to the primary MD, along with refills for the medications they prescribe. Not that I’m bitter or anything today.
Don't you love it when non doctors tell you what's medically necessary and the doctor they pay to deni what you need agrees.
Not to mention the insurance company’s doctor that is agreeing with the denial makes the patient’s doctor schedule an appointment with THEM, and denies the approval anyway even though the insurance’s doctor is from some other random specialty than the requesting (patient’s) doctor.
I can't wait until Jimothy just decks him one day
The rebellion is coming.
Careful-actual medical insurance providers may implement this revolutionary response device into their absolutely logical and sympathetic patient-care system 😂
They already do on their phone transfer systems. Why not?
@@OrigamiShinigami lol
I have endometriosis. It was really bad in my early 20's. The insurance denied this hormone shot that was the treatment. So after exploratory surgeries and maybe 4 surgeries to keep cleaning out the endometriosis. Then the pain was so different. But my Dr just prescribed me pain killer . He never touched my stomach, did an ultrasound or a pap smear. This went on for a few months. My stomach looked like I was 5 months pregnant and I walked hunched over because of the pain. At work I made friends with a Dr. He came in and said this was too much. He told me I had to go see the specialist put of town. So I did. He felt my stomach and said he could feel something. Then an ultrasound showed a mass. I met him I'm his actual office. Took down noted on how my general practitioner was saying. He was livid. I had to have an emergency hysterectomy the next day. Before they were calling the insurance to get it approved. They said nope but now they pay for the hormone treatment now. The Dr was pissed sternly saying it was too late. They removed a tumor the size of a grapefruit. And took all my intestines out and cleaned me up. My bladder and colon were fused together. My liver and rib are connected. That they couldn't fix. Worst recovery ever. I was 23.
I feel so bad for you, you had to pay the consequences of their negligence 😢
When you are on medical leave from work and going through surgeries and trying to get better. You still have to work 40+ hours a week just fighting the insurance companies.
*The "Mystery Bag" is ALOT more fun than the flow chart they actually use.*
I'll have you know, its a decision tree
As a Psych nurse, I once had an insurance person question my desire to admit a patient because they ‘didn’t have enough sutures’ when they cut themselves in a stated suicide attempt.
I’ve gone through this so many times with Anthem Blue Cross. I caught them denying a claim saying they had reviewed “the entire medical record” when it hadn’t been completely sent to them yet.
I’m a doctor, and hold myself to the highest standards of professionalism. With that being said, I dream of the day I spend a night in jail for punching a CEO of an insurance company in the face.
Health insurance industry needs fucking dismantled. And about 10,000 execs made examples of.
Driving around in their Ferraris and Lamborghinis to one of their mansions or yachts…sickens me
I had a insurance claim denied at an urgent care because there was "professional charge" to see the doctor and a "facility charge" to be in the building and that it wasn't REALLY an urgent care but a hospital adjacent building. Like I'm supposed to fucking know that before I go in. And this all came up a year and a half AFTER the visit due to an insurance company audit.
This is exactly how it goes down. Except Dr G saved us the 45 mins on hold and being transferred from one bureaucrat to another, plus or minus the calls being dropped and having to call back. Oh and the waiting room full of people whose appointments are being backed up because of this.
I love the “dropped” calls.
This feels a lot like how it truly goes down. It’s a shame that this is how it is at times
It’s not a shame. It’s an abject policy failure and an abject moral failure by politicians bought and paid for by corporate profit interests over the interests of the citizens and communities they are supposed to be serving.
As a pediatric nurse, I wish this wasn’t painfully accurate 😢.
I worked in medical billing, and this is all true. Also yes, United is the absolute worst and would deny everything. After telling dying patients that their treatment was denied for all the reasons listed above, I went back to get my master's in public health in Sweden because I didn't want to be told that single payer wasn't possible. Anyways, long story short, I work in global health now, implementing health systems improvements in Africa. Do you know how much money the US government spends on improving free access to healthcare in every other country besides the US????
We are slaves.
At least outright denying the claim is a step up from what one of my patients went through recently. The pharmacy I work at isn't contracted to bill for compounded medications, so patients have to submit forms to their insurance for reimbursement on compounds. One patient's insurance company called us every other day more than 2 weeks, asking for the exact same clarifying information every time. They kept saying whoever we'd spoken to the last time didn't record the info properly when we gave it to them. Toward the end of this ordeal, they started mentioning how the deadline to get these claims processed was coming up soon. Putting two and two together, I suspect the insurance company was just trying to run out the clock so they could say, "Sorry, we weren't able to get the information needed to process this claim before the deadline, and now that the deadline is passed your claim is no longer eligible for reimbursement."
Every time I'm mad about the stupid things my country does, I watch something about the USA and feel much luckier 😊
👆
Yes. I wasn't going to say it as it seems a little bit rude, but admittedly, I agree. I hope Americans understand it doesn't have to be this way?
We are do it...
Unfortunately you aren’t spared issues in other countries with wait times so long that people die waiting to be seen and yet budgets for said health care remains the same or gets cut because the world is just that cruel
As an American, I'm glad that international relations can be fostered by such things.
What kind of things does your country do? Maybe I can feel a bit less depressed.
I admit to working for a health insurance company for about a year. Less than 10 years later I became fully disabled with multiple disease that have almost no covered treatments. I honestly believe it is karma. I did my best to screw the system from within, I really did.... but now I fight for coverage of off label meds, non covered procedures, and the yearly battle to get exceptions and quantity limitations through.
I worked for an insurance company for 5 years, back when pre-existing conditions could legally be used by insurance companies to deny claims. That was my job. Of the 4 people within my cubicle square, 2 of us ended up with severe depression and 1 started having panic attacks. The fourth left went on medical leave.
You are akin to veterans they send to kill innocent people abroad and come back fucked up beyond repair. Not a hero nor a villain, but like everyone else except for an inconceivably small minority, a victim.
The shit thing is, most insurance companies have an in-house doctor who's never actually seen or treated a patient in their lives, and they have the audacity to sit there in their office and tell me on the phone that I should not give oxygen therapy to a COPD patient with 80% oxygen saturation because the patient is still conscious, or that I should not schedule an urgent PCI for a heart attack patient because they need to examine the ECG themselves first to decide whether it is actually necessary.
I am an atheist, but whether it be God, or Karma, or whatever it is, I hope it gives them just 10% of the pain that they caused. Not even the whole thing, just 10%, and they will be crying and screaming in agony, I swear to you.
Ahahahahahaha! This is my favorite one so far! I once was told insurance companies were going to com after me for a video I did about winning insurance appeals....
Have you had their team show up?
......-whispers- but where's the video
As a UR nurse this explains so much. Thanks for the clarification
Just got my spine fused (T6-L2) and my insurance denied the study-backed, commonly used for post-op fusion patients, bone growth stimulator because, wait for it, it’s not “medically necessary” in my case. Oh, I almost forgot: they also refused to approve a refill of pain meds for me post-op so I got to stand there at the pharmacy counter with my walker like an idiot trying to figure out how I’ll manage my pain without the prescription from my doctor. Thanks American Health Insurance, for adding more pain to the healing process than the actual healing process.
I am barely ambulatory. I mostly use a wheelchair but, I am able to walk very short distances with assistance or a walker. But, it's always a bit scary because of balance issues and sudden spasms. I don't get much warning and if I can't immediately sit, I fall. My cardiologist ordered a (chemical) stress test because of my issues with standing let alone walking. Denied. So, they tried again. Denied.They would only cover a treadmill test. The cardiologist personally called and explained the patient, me, wasn't physically able to do a treadmill test. Their response was, that I wasn't paraplegic, I was able to stand and take a few steps so they would only cover the treadmill test. So....I show up for the treadmill test, the Dr monitoring the test takes a look at me and saysto the tech, "this guy can't do this". I say, " according to the insurance company I can". So, short story, they put a gait belt on me. The doctor has a running monologue about the evils of insurance company that included multiple F bombs. I do the treadmill test with the tech standing ready to try and grab the gaitbelt if I fall. He grabs me and basically throws me up on the table. Dude is sweating almost as much as me. When its over Dr. Is still steaming mad and says he's thankful I didn't fall and break my hip or worse but now unfortunately the mother effing insurance company can say "look we were right, he could do it".
I used to work with UHC and Aetna as a customer service rep...and I always feel bad about these denials... esp Ive seen cancer patients unable to get reimbursed bec of these bs.
I LITERALLY had United Health Care deny part of my claim because of that EXACT wording. Their “cardiologist, a ‘board certified’ thoracic surgeon” said that my overnight stay for my outpatient procedure was “medically unnecessary”, even though the doctors wanted to monitor me overnight due to my chronic heart disease and congenital heart defect. He apparently “looked over my records” and determined that the stay wasn’t necessary and could monitor myself at home. 🤦🏼♂️🙄
I swear jimothy is Actually the devil testing the insurance people for true evilness. If they know exactly what they are doing there is no way getting out of hell later
I used to work back office for a company that worked for an insurance company (I know it's a mouthful), but one tiny thing that slightly speeds up the process is to fill out the forms nurses give you as completely as you can. Insurance companies would make every excuse to delay payments, including incomplete forms.
as someone who worked for a 3rd party that handled cases. this is ACCURATE. although they do have written out standards and guidelines you can look up why they came up with it is by hiring some Dr's and making up their own rules. and yes medical necessity and out of network were COMMON denials
I had a patient who was progressively paraparetic (paralysis of the legs). Over 3-4 months, their insurance refused an MRI request three times including after a peer-to-peer. They didn’t show up for follow ups because they could no longer walk or get into the car. After the last denial I asked them to call an ambulance and show up at an ER instead.
Meanwhile in my country i had to go for a surgical procedure, (healthcare isnt free but insurance covers it all) Hospital submits, pre-authorisation, insurance calls me a day later to confirm the procedure and the nature of my condition, tells me not to worry and they will get it approved asap, gets it approved 1 day later and at the end of the week i got my procedure done and paid $0.
I thought this was the standard of insurance claim experience until i see the horrors of American health insurance.
Yea like having cancer and being told chemotherapy isn’t covered and saying you’re responsible for a $400,000 bill
It is with some companies, but not with others and often one doesn't realize which they have until it's too late :(
I literally go through this with united almost annually. They will deny my chemotherapy because we are using more than one drug, and they're costly. They wanted my doctor to lower my dose to which she said it wasn't effective at a lower dosage and without the addition of another drug that works differently. It's difficult to treat chronic lymphocytic leukemia and sometimes takes multiple drugs. United always tells me that treatment decisions are between my provider and me but try to play doctor and dictate my treatment plan without ever having examined me so no. If I had another option I would go with it pretty quickly.
One of my top two reasons for leaving the US. I was getting sick from the stress of dealing with the medical/insurance system. It's so much less stressful back home in Canada. Thankful that was an option for me.
Friend, any tips on how to leave USA to actually get healthcare in a country with human rights?
My Mother was in desperate need of lifesaving heart surgery. She was denied 5 times by United healthcare. They said it wasn't medically necessary. She died of a massive heart attack new years day of this new year. I hope they burn in hell.
Sorry for your loss
You made me hate those bastards more than I already did.
I live for Jimothy trying to fight the power from the inside! We see you Jimothy. We appreciate you!
As a person whose family (me included) has made an incredibly extensive (and necessary) use of my country's medical system, you can't believe how thankful I am I don't live in US, coz I am not at all sure that I and my relatives would be alive nowadays
It's 7am and I've laughed and died a little inside. Bravo!
This happened to me with Cigna. My doctor ordered a CT scan to rule out pulmonary embolism.
Truly heartbreaking. 💔😥
I know this is supposed to be a parody, but it's honestly so accurate that it makes me so frustrated and upset. I've spent hours appealing on behalf of patients because of ridiculous denials.
Actual conversation between me and my health insurance when they denied me a nerve block for debilitating migraines. “It was determined to be Not medically necessary, it’s an experimental procedure, you can file an appeal”
It would be really funny (and uplifting) to see a video where Jimothy goes rogue and actually helps someone ... like Mr. Incredible. And, speaking of super heroes, it'd also be awesome to see a Jimothy + Jonathan crossover video!
omg what if they're the same person?? And Jonathan has been deep undercover this whole time?
OK so I've been thinking about this and I think in the GCU (the glaucomfleken cinematic universe) Jimothy needs a redemption arc. He becomes a healthcare vigilante superhero who's sole purpose in life is to spite United Healthcare.
The reason this is so funny, is it is SO true, says me a fellow ophthalmologist
This is one of the main reasons that, despite all the horror stories surrounding VA, I just get my care through them and don't even bother with health insurance (yes, I qualify as 100% covered). A hell of a lot less red tape dealing with the government.
"Practicing medicine without a medical license I see ..."
Shit like this makes me realise that £300 a month for National Insurance isn't that bad of a trade off for me and others not having to worry about this.
This is exactly how it is. And UHC is especially despicable.
We need a system where district attorneys prosecute these insurance company scams and levy huge fines and restitution. Patients are simply too ill to pursue the civil suits that are their only real recourse in some states. Of course, patients can’t even sue their insurance companies in most jurisdictions. And state boards of insurance are rarely helpful.
I remember the American boyfriend of my cousin. He came here for a year, they weren't engaged or anything, to study German. Dislocated his shoulder (for the 5th time or so), went to the hospital to get it sorted. They gave him a surgery appointment. He was a student, said he couldn't afford it. They laughed and told him that of course he doesn't have to pay a cent since his insurance, that he didn't even know he had as an American in Germany, would pay it all.
My health insurance accepts my local hospital as in-network, but not that same hospital's lab tests.
Sounds like my week. I'm a physical therapist who has a patient who was denied her neck MRI 3 times. She needs to fail PT in order to get her MRI, but I can't treat her neck because she has a bunch of red flags that require her to get an MRI. So I got her an x-ray to rule out instability but it came back positive. So she needs an MRI right? Not according to the insurance company! So an orthopedic surgeon, NP, and PT all ask for an MRI but the dude at the computer says no. Why aren't they liable?
My insurance has been denying a lumbar mri for neuro involvement for over a year because I haven’t seen a CHIROPRACTOR. I’ve had four rounds of pt and they say I haven’t done enought because they instantly deny the claim and take so long to process the appeal until they deny because it’s been so long we’re out of the “completed round within the past six weeks” window.
I still can't believe something like this can happen in a developed country.
The US is corrupt. You find that out real quick if you either work for the government or have a serious medical condition
👏👏👏 I was shocked when I came to the US and saw this. How come no one does anything about it?? It seems like we are trapped creatures dominated by insurances. 😓 Can someone kindly please enlighten what chain of events led us to this point?
I hate how this can happen even if you get pre-authorized and call ahead to make sure that everything should be all right.
I’m so tempted to get as many of these jobs as possible, just so I can approve everything handed to me before I can fired and move to the next one
I had to take a leave of absence, ironically from medical school, because Aetna refused to cover a drug that I'd taken daily for years - despite appeals by my doctor, who was literally a professor of neurology at UT Southwestern. It's wildly unethical, and it should be illegal.
I am 65.
When I was born, in a hospital, my mother stayed in that hospital for a week.
I asked once and my father said the entire bill was around $50.
Things were pretty much that way until "healthcare insurance" raised it's ugly head and asked, "How can I help you today?"
Was hoping Jimothy was gonna go ballistic lmao. Maybe the - imothys are planning an uprising soon, just like the Jonathans.
I once has an ortho surgeon fight to get a cortisol injection covered for me for about two months and by the time it was finally approved, I'd finished college and moved away 😢
I do appreciate how much he went to bat for me though
I’m a T1D and have to deal with this all the time. I HATE insurance companies
Premed here, applying this cycle. I'm watching this right after my shift as MA at a small medical center - and the last task I got was that a PET scan was denied was a patient with prostate cancer and to submit an appeal. This video hit me right in the feels...
im interested in seeing real life convos and stories about how this works. just like some healthcare workers have dark humor to help them get through a difficult day, I wonder how it goes from the insurance perspective.
You’ll NEVER see the insurance side of this.
They wipe their tears away with their stacks of money presumably
Hi. I work medical denials for two large practices in Southern Arizona. AMA lol
@@emilymoxie why do you do it?
@C. J. well originally, I had hoped to work in a museum. I have a masters degree in art history. However with covid and the economy being poor after graduation, I didn't have any job opportunities. My mom is a medical coder, so I went to her bosses and said can I help out? They assigned me to do accounts receivable on two large practices. Basically I see why the insurance has denied a claim, and tell the insurance "you're a crock of dung, and here's why." Often times it's fixing "mistakes" that the insurance companies deem happened. Such as they thing the medical record support a lower level of service, which just means they believe the doctor/medical professional spent less time than they billed for. I submit appeals as well to say "pay me because you're dumb and here's why." Sometimes it works and they pay me what is owed, sometimes it doesn't. 🤷 it kinda depends on the procedures being done.
Ultimately, I don't work at the insurance company. I work with them, begrudgingly, to make sure my patients don't pay more than they absolutely have to. I rarely drop a full charge bill to a patient.
I'm starting to think this is Jimothy's villain-to-hero story arc and that shit's about to go down at HQ🤣
For some reason when he asked where jimothy was going, I was sure that he was going to take a excuse from another bag