You're right Mr A, this was recommended to me also.. I'm glad it serves as a wake up call. For us to do something together and not merely look at this as oh yeah this is really bad. fighting for healthcare is not a spectator sport.. Well sooner or later it will affect us all if it hasn't already. Like Pericles one set over 2,000 years ago when you might not be interested in politics but politics is very interested in you.. just change it to healthcare insurance.. they're interested in us because they see us as cash cows to the CEO and their shareholders.. these two things should never be together it's a marriage consecrated only by Satan. It's not healthcare it's Deny Care either we fight to change this now it's going to come back and haunt us
US health insurance companies need to face criminal charges for practicing medicine without a license and also pay out to the people who have been harmed for the delay.
But doctors scam patients and insurance companies too. Read the book Coronary. A hospital was doing a steady business of major heart surgery. Many turned out to be completed unnecessary. The management was all in favor of the doctors because they were bringing in a lot of money. The medical profession is just as much based on greed as is the insurance companies and pharmaceutical companies.
I’m a physician. I’ve been practicing since 1996. What has happened in the US over the past 15-20 years just disgusts me. What the insurance companies do is flat out fraud. Should be illegal. They look for the smallest loophole or tedious paperwork that a lot of people do not understand. This combined with nobody to speak to, and long hold times, drives people to just give up. I’m super surprised that more patients don’t go “postal” on insurance companies.
In any other industry, this would be considered thief of service: we enter into a contract in which we pay in exchange for coverage. Then coverage is denied. Breach of contract? The insurance lobby is powerful. They must be paying well those who should be going after them.
I like how it's totally legal to be denied coverage that you pay for. Can you imagine if we did that with something like groceries? Like, oh, you have to pay upfront, and then the store gets to decide what groceries you actually get to take home with you. Also, there's no way of knowing beforehand what groceries you'll be allowed to keep until you try to leave with them.
This is the fourth time you've confiscated the milk in a row, why won't you just let me have some calcium? "Well, you see, you could be rushing home to pour it on Trix, which is for kids; and you're obviously an adult." I'm sixteen, even _if_ that was a valid reason, why didn't you ever card me? "It's not our jobs to fact check, it's yours to provide all the information in whatever arbitrary manner we want." Even if you don't tell me? *_"ESPECIALLY_* if we don't tell you!"
My partner went to a doctor about a lump they had found. The doctor had them get a mammogram and testing which showed to be benign. Later we got a large bill for the mammogram even though the insurance site said the cost was fully covered. I called them to figure it out. Turns out that mammograms are only covered for regular screening, but because there was concern of an issue that wasnt covered. Insurance is a scam.
It's a double scam. They want to run the procedure is the key, so money gets made. lawyers writing these guidelines make sure they screw the patient, not the company that provides the service. If you saw it isn't covered, at least you'd have the option to not get the procedure.
@@Rene-uz3eb And, if you don't get the procedure? And, if it turns out not to be benign? Schrödinger's cat. You're damned if you do? You're damned if you don't! 😒✌🏽
Yep I hear ya. Broke my shoulder this last March. Seen the orthopedic 4 times. Surgery was not needed. Just a sling, then PT for a couple months. After my insurance, 6k is my copay! I pay 75 bucks a week for insurance! What a bunch of horse shit 😡
@@stickysdennot to be rude but the phrase you are looking for is "catch 22" or "lose-lose situation". The cat is a metaphor for quantum science and parallel states as well as a real life example of both the concept and of animal cruelty. But the image of titties existing only when you look at them is hilarious.
When my daughter needed an expensive biologic drug, and our insurance company tried to deny a claim for this medication, my daughter’s doctor called and just asked them, “what do you want me to write on this order to get this paid - just tell me what YOU want”. It’s ridiculous.
Ignoring everything, it's crazy that NON-MEDICAL PROFESSIONALS are deciding whether treatment is necessary and often OVERRIDING MEDICAL PROFESSIONAL'S JUDGEMENT.
Legally they can't actually do that in the US, only medical professionals are allowed to make medical decisions. They work around that by hiring the worst doctors they can find, the failures and creeps, use an algorithm (these days they're turning more an more to AI-driven systems) to deny patient care, and then pay these worthless doctors to sign off on all these denials without even reading the case notes. IMO any doctor who works for one of these insurance companies or outsource agencies deserves to have their medical licenses permanently revoked for malpractice.
@@EphemeralTao same for any doctor who does "independent medical exams" for the insurance companies. I've been to 5 and they're awful too. People should be able to file complaints to the licensing board and have it actually result in something.
@@EphemeralTaoI heard they hire a doctor to click a computer mouse. The computer just pops up procedures and approve or deny, and the doctor just has to click "yes" all day so they can say a doctor approved or denied it.
I'm a nurse, and I met another nurse, who tried to convince me that taking care of the shareholders, was more important than taking care of the patient.
Thank you for not going along with her. I'm disabled and have a lot of problems. I depend on my entire medical team, especially since I have 11 Drs. All my Drs are through the same hospital so they can all just look at the computer and see all my records and send messages to each other and most of all the nurses and staff are totally awesome, but I have met a few that I think are more like the one you met. There are to many of us out here that depends on people like you. You probably don't get told this enough but thank you for all you do. Thank you for caring. And thank you for telling people like that to go away. You are a true hero.
@@Sho_Ishto More profits into HCA CEO pockets. Rick Scott, R-FL became a multimillionaire after being forced to resign from his HCA after engaging in major Medicare fraud. Scott received a pretty nice severance.
the service isnt denied. it just isnt paid for by the insurance. realistically, I understand for most that would still prevent the pt from accessing the care but semantics
Well they should properly investigate before approving or denying. Unfortunately sometimes doctors do scam the insurance by over billing or ordering equipment or services that weren’t done
@@mercedes7566no. If you put a patient’s life in danger, a patient that has paid you in good faith that you would take care of in case they need it, then the possibility of a doctor trying to scam you should be the last thing you think about. And let’s be honest, they rather the patient dying is in their best interest.
@@miliarius.x the thing is that the whole American healthcare is de-facto built with reliance on insurance in mind, but this technicality is literally killing people.
@@mercedes7566 this should be between the fraudulent doctor and the insurance company. I'm sure this is much more rare than people dying or becoming disabled for insurance denials. After all, the doctor doing fraud is not invincible and most-likely will get punished and maybe get their license revoked.
This video is A YEAR OLD! But may as well have been produced in the past few days! Good for you, exposing this insanity ahead of time. Yours is the only video we need, surely used as a source for the more recent ones. Thank God I live in Canada...for the healthcare, which isn't the best but we don't have to deal w this shit. Makes paying taxes a joy
Denying Your Health Care is Big Business in America, is another UA-cam video by the New York Times that discusses the same topic and was posted a couple months ago. This issue has been festering for years. It's just that now, people are starting to take matters into their own hands because they realize the law is not changing any time soon.
If 80% of patients have abandoned treatment because of the prior authorization process, then the process is working exactly as intended. This is the truest form of corporate evil.
and then sometimes they literally choose the kind of care you get based on ur race/caste! Can you imagine the demographic that receives lesser care = no care! 😢 @@JessieMassoudi
@@coldfact.I think about this often. I’m mixed middle eastern and white but I look VERY white, and it’s sad to think that it’s even worse for others! 😣
The root of all of this is the fact that we’ve allowed insurance companies to use individuals who DO NOT HAVE medical degrees to override the doctors making the decisions about operations.
@@kevinbarnard355 They actually aren't most of the time. If you actually look at who on the payroll is performing the individual inquiries, it's generally people who's highest level of medical knowledge is the training they received from their job. They tend to look for "keywords" when looking over medical documents rather than properly understanding what the document is talking about and what the patient actually needs.
People should not be allowed to deny medical treatment to a patient without actually SEEING the patient. If they want to audit/sue the doctor and the patient AFTER... that's fine. Or they could allow the procedure only on "preapproved" doctors... When I say "preapproved" should be EVERY DOCTOR/HOSPITAL THAT ACCEPTS YOUR INSURANCE should be pre-approved. If you trust them enough to be part of your network, they should be trusted with the recommended procedures. Either way, I'm happy I don't live in the shithole that USA is... people fight and argue to live a worst life there.
the #1 problem is that private [FOR PROFIT] companies are even allowed to provide health insurance and buy the republican party,, we need national health care just like ALL THE OTHER MODERN COUNTRIES !!
@@herchelleonwood7463Lol no. All of the problems we have now would be worse under a government run system. They'd just be doing what canada is doing right now and telling people to just go and die.
They are so comically inept that they end up losing money sometimes. Which I'm sure just raises premiums. When my ex-wife was pregnant, she needed a specific medication every morning. Insurance refused to cover it. But they _would_ cover it if the ER administered it. So every morning we had to drive to the ER for meds. Eventually we had a standing order worked out, so that we didn't have to check in and wait 5 hours every time. They'd just run out and give her the shot in the lobby. Each ER visit cost like $10,000, and the IV version of the drug cost $1,500 a dose (the pill from the pharmacy was $80). For like 6 months, they paid for that _every day_. We appealed twice, there were MULTIPLE committee meetings where they decided that the current arrangement was fine. They are not only evil, but stupid and wasteful as well.
Could this be why the CEO of United healthcare was killed by Luigi? I have medication I will have to take for the rest of my life, and my insurance company requires a prior authorization every 6 months for each one. My doctor does not get paid for doing prior authorization. My heart doctor told me I needed a coronary stent, the insurance denied coverage, claiming they don't work. I had a spinal injury at work and workers compensation denied coverage. I had to hire an attorney to fight for treatment so that I could walk after having my back broken in several places. My lumbar spine is now fused and disc removed at 5 levels. After fighting for treatment for chronic pain, I got an intrathecal pain pump containing fentanyl. I need to get authorization each month to have it refilled, and this has been going on for 14 years and have had to pay out of pocket many times. Our insurance companies are completely corrupt and use the tactics of Deny, Delay and Defend to increase revenue.
I have worked at many insurance companies around the country. These outsourced denials let the sociopaths in the board room sleep well on their giant piles of our cash. Medicare for All, today!
Please tell your friends and family prior authorization should be illegal, unless there is already evidence of fraud or abuse or misuse on that case. Just because one other person in the country submitted the wrong procedure is not an excuse to require this prior authorization for everyone else. Also, insurance companies are designed not to cover extended nursing care; only acute nursing care. Why? Profits. Don't believe it? Look at other industrialized countries Tell your Congressman and don't accept their excuses. What is your Congressman, other than a representative of the insurance company's profit center?
@@novampires223voting blue isn't enough the Dems are complicit with this system. If you're gonna vote blue as your only method of change vote someone new not your same representative. How can we expect change with the same government officials. If you believe that the Republicans are gonna try and stop anything the Dems do then shouldn't we at least get some new Dems in there to see if they fair better against the Republicans. Watching the current Democrats in Congress it seems like they aren't even trying to help us. They just say "oh we can because of the Republicans"
I had to pull away for a moment after hearing that the insurance companies couldn't be found liable in ANY of this. Downright disgusting and brutally honest display of the American healthcare system.
Smaller everything, starting with the federal government, is needed. The larger the organization the more it costs and the less it does. Seems like very few exceptions.
@@fedupamerican296 so in this scenario of a small and limited federal government, who is holding the largest companies accountable? We've already been through trying a limited federal government, it led to the first Gilded Age of the late 1800s/early 1900s, and eventually, the crash of 1929 and the Great Depression. President Hoover, under a pro business & anti-government leadership, decided to give handouts to the richest people after the crash and allow the savings to "trickle down," to the poor. It was such a failed policy that they began calling the growing encampments of homeless "Hoovervilles," and called both of your pants pockets hanging out empty, "Hoover flags." Without federal safeguards against corporate greed and large scale fraud and theft, not to mention monopolies that crush fair market competition, there's no hope for rebuilding the middle class and tackling income inequality, homelessness due to lack of affordable housing and substandard healthcare for all but the wealthiest of Americans. The very reason you feel like your own government is working against you is because Republicans have been trying to undo the New Deal since its very inception. The New Deal is the reason why we have Medicaid, social security, and other social safety nets. Republicans adhered to the theory of a guy Sumner, who wrote a book called What the classes owe each other, and the conclusion he came to was that the wealthiest owed poor people nothing. So basically you have a right to starve and allow poor people to die, because you don't owe them shit. What a beautiful Christian sentiment that is for a country who brings up Jesus and God at every opportunity, yet seems to forget the entire tenet of Christianity is to protect the poor and vulnerable above all else and to shun material wealth. Sorry for the novel, but US history is just repeating itself, but most people have no idea how these ideas have already been tried and failed spectacularly. At least failed in the sense that everyone who isn't wealthy and powerful suffered greatly and unnecessarily because of corporate greed and cruelty. If you want a better Fed, vote for better people. Don't just vote straight down the party line, find out who these people are in business with and how they vote on issues that affect your ability to make a decent living without having to go into debt or work yourself to death for shit pay and no benefits.
I am being slandered and abused by the health care system because it is infiltrated by Org. Crime!!!! I reported criminal activity. It's the medical labs and doctor offices and sometimes the doctors. They take good care of REAL prostitute.
I just went through a prior authorization nightmare. I have a sciatic nerve impingement which was so painful at the time that I couldn't walk. I had 2 prior authorizations for an MRI denied. The last one required me to go to physical therapy. Who the hell goes to physical therapy while on pain to be put in more pain? The pain got so bad that I couldn't put any weight on my right leg at all. By the time the MRI was approved, I was damn near paralyzed. My doctor had to do some written finagling in order to get the MRI approved. I ended up having to have an epidural caudal injection and right after thecpain was so bad that I ended up in the emergency room. You're absolutely right, conditions worsen while they're busy denying claims and treatment.
Yup. My son has Type 1 diabetes. We have 3 different insurances, but one won't cover his insulin, one won't cover anything if they can't be the primary, and the third wouldn't admit him to the hospital until he either was unconscious or his glucose levels were uncontrolled in the ER for more than 12 hours. And after everything, and paying over $30k per year for insurance, his insulin is still over $700/month. It's $15 in Mexico, or free if you're on their universal healthcare system. Insurance is the biggest scam in the US, hands down.
And in Sweden I have free insulin, free wireless glucose sensors that connect to my phone, and visiting the doctor costs me $30. That SHOULD be the standard, a type 1 diabetic never asked to recieve the disease, nor did anything wrong, its just bad luck. That is where society is supposed to step in and even out the inequalities to make sure everyone gets a fair chance at life.
@@dmo848 We used to have that option. Obamacare took it away from us. It is now federally mandated that all US citizens have health insurance, which for most means paying for it; if you don't have insurance, you get fined.
I worked in prior auth for 2 years and it has never made me hate healthcare more. I loathe and despise Cigna and the rest of those bastards to Hell and back. I pray for the downfall of the insurance industry starting with healthcare because all it is is elaborate money laundering with zero care for if patients breathe or not.
I assume you aren’t a physician, so what you did was practice medicine without a license and that should be a crime. How the hell does somebody with an AA from the Junior college override MDs (generalizing not necessarily you)? It’s bonkers, but good on you for getting out.
@@FallenEmpireCitizen idk how to tell you this, buddy, but that’s not how prior authorization works. Like to any extent lol No, I’m not an MD and no, you’re not required to have any healthcare knowledge/certification at all to work in health insurance. So whatever crime you’re thinking of is not real and cannot hurt you. We as frontline workers spoke directly WITH MDs and their assistants to get the info needed to process a prior auth but 8/10 had no interaction with the patients at all. All the Dr had to do was fill out a questionnaire about the med they were trying to get, we fed that criteria into the digital questionnaire and it would give us a denial/approval depending on the answers. The Dr could then appeal and it would likely go to one of our on site pharmacists who also had criteria they had to follow in order to deny/approve and it would escalate from there. So your incredibly condescending comment about people with junior college degrees overriding MDs is so woefully out of scope that it doesn’t even exist on this planet. I only got out because I had a nervous breakdown after a patient with a late stage illness begged me for help getting a med and I had zero power to do anything for them. I would advise you consider your words more carefully in the future, especially on topics of which you may be ignorant on.
"Zero care whether patients breathe or not" ... I believe this is inaccurate. When you, as a patient and client, get to that point, they'd prefer you didn't breathe. It costs them much less.
Its fucked up they just sent back request for more info on a patient that cant walk and she is in need of a hospital bed , they need it specified in the notes , it doesn matter if they received an order signed by the doctor . Its been going on for a month.
My wife died of cancer that could have been caught far sooner, and could have been treated far more effectively, if not for the insurance company denying and delaying treatment for horrifically specious excuses. She wasn't allowed to get the tests that would have caught it early, and had her treatment delayed multiple times, because of these sorts of garbage technicalities. From the time the cancer was caught to the time she died was 7 months. If her insurance had not denied the testing and treatment she needed, she could have lived years longer. Medical insurance companies in the US are literally killing people to keep their insanely high profit margins that only a tiny handful of people will benefit from.
I feel like that could definitely be grounds for a lawsuit against the insurance company. Esp if it was a type of cancer that when caught early can be treated and go into remission for several years/decades (a lot of cancers tend to come back eventually). And they've got all the paperwork proving that she was trying to get tested and treated, so the discovery process should basically make your case for you that they're responsible for her death. But then you've probably already explored those options and the stupid statutes of limitations on these things are ridiculously short to keep ppl from suing in the first place.
this is exactly what the fuck i’m talking about and what i have been screaming about. i am so beyond sorry for your loss. it’s unacceptable. it’s abhorrent. as a healthcare worker it makes me sick. you are so right this is LITERALLY killing people.
@@bokc_nonpopularsalt1011 Yes, I know what you mean, and I do agree with you. But when the law protects organisations that are willing doing this sort of thing, and the victim has no legal recourse whatsoever, do you expect people to just roll over and take it? There are limits to the amount of abuse that people can take. I'm just saying that situation would cross my line.
@@independent-ts6ys Because the judges are bought off. There are such things as standards of care that every medical institution uses. It should make these issues easily prosecutable, but in light of the United Nations Eugenics dictates such as Agenda 21/30, the hospitals along with the insurance companies are allowed lots of slack because they are getting the desired outcome...death (population reduction) and transfer of wealth from strapped families. We will see a return of vigilantiism if our government continues to protect the bad guys. Why even have insurance if you cannot use it? Because we are slaves to the elite class that runs these corrupt corporations.
I worked in a doctor's office where EVERY YEAR one of a pair of identical twin girls would get deleted from their parents' insurance policy because *clearly* two kids couldn't have the same birthday.
Heard of similar with twins born on different days(3 minutes to midnight and 1 minute past midnight), insurance refuses to believe you could have two kids born on sequential days, itq must clearly be either fraud or a mistake. Same insurance also refuses to let you enter 0 as an age when an incident occurred which made reporting birth defects or conditions occurring before 12 months impossible; which was fine for them, it just gave them grounds to blanket deny any claim because you didn't report previous issues(even though you physically couldn't report it to them because of their terrible system).
My grandfather was a paraplegic. He had been in a wheelchair for over 40 years. Like most appliances they wear out. It was time for him to get a new wheelchair. The insurance company denied his request for a new wheelchair. When my mother called to find out why they told her that he had been in wheelchair long enough and didn't need one anymore. I'm not actually sure what steps my mother took, but after she was done with the insurance company, not only did he have a new wheelchair they also provided him with a wheelchair accessible van.
Go momma, what a warrior! My mom had to do the same for my brother lost his leg on our farm an awful accident. This was in Ireland 1970s. The lies, denials, derision, suspicion, refusals would make any grown up cry and throw in the towel. Absolute evil. We never got the wheelchair but finally got him a prosthetic and crutches. Getting a new leg is a nightmare. He mcgivers it until its practically sawdust and glued and screwed like a science fair experiment to dodge dealing with these monsters. I get it.
Call the insurance office, once you're speaking to an agent, demand to speak to the branch manager, they are almost always in office. Wait on hold until the inevitable meeting they are in is over, and go full Karen. Be persistent and get that manager's name and number.
@@Marco_Onyxheart An excellent question. Technically, the explanation is that they aren't making medical decisions, but monetary ones-that they only decide what they're willing to pay for, not what you are permitted to receive. However, that ingores entirely the fact that the system they've created is so expensive that paying for it is impossible without third-party coverage. The actual reason is because no one who's in a position to stop them gets elected without taking a substantial amount of money from them.
Yet the government doesn't give money for healthcare only mostly to the army even though they just waste the money and that's one reason why there's scams like this for insurance
@@Marco_Onyxheart Because judges that get lifetime appointments with no way to remove them get paid by interest groups of the 30bn dollar insurance companies. No judge is out of reach. See: Clarence Thomas on the Supreme Court
Presently, I am dealing with UHC , "prior authorization", for 2 years on my needing breathing devices for asthma, and living in my third, 24/7 second-hand smoke, SMOKE-FREE, apartment. UHC keeps leaving information of how my doctor needs to apply, or they loose my request, or delay, delay, delay.
You would fail. They are way too powerful. They have many lobbyists & EVERY politician take money from them guess who was #1, yeah, Joe fucking Biden. He even said if a universal healthcare ever made it to his desk, he would veto it anyway.
I wish you could. Health insurance companies should be legally held responsible for their decisions regarding their clients. Its honestly insane that they aren't. Its no surprise that a company, whose only responsibility is to their share holders, would make patient outcomes secondary.
Unfortunately there's no money in it since they're never found to be liable. You'll go to law school and end up working FOR the insurance companies in order to pay off the student loans. Quite a system we have!
I remember having to talk to my insurance company about a prior authorization I needed for a new medication. The lady on the phone told me that the prior auth was for my benefit, to make sure my doctor *really* wanted me on this medication. I said "isn't that what a prescription already is?" She did not have an answer for me, obviously 🙄
We don't have Healthcare in America. We only have sick care. My son is paralyzed below his shoulders from a spinal cord injury and suffers with constant severe neuropathic pain when seated. Been begging for a stand-up wheelchair for 4 years so he can get out of bed. Doctors claim that they are not covered by Medicare so they won't even try to do pre-authorization. So Medicare pays for home health, home physical therapy, mental health therapy so he doesn't want to commit suicide from uncontrolled pain, tons of medications that don't work, frequent UTIs, numerous doctor and hospital visits, wound care etc. Something is seriously wrong with this picture? He was also denied myopro hand and arm orthosis that would allow him to use his arms and hands to feed himself and use a computer. Every treatment that is known to be effective for my son's condition has been denied. We figure these denials have cost taxpayers well over a million dollars. And the saga continues to this day.
Pursue the prior authorizations yourself. When you call your insurance, ask to speak with the department that handles prior authorizations, and then ask them exactly what the PA needs to say to have the necessary healthcare covered. Then, you can ask your doctor to fulfill the necessary steps. I do this every time I need care and they deny it the first time around. Back before Lyrica had a generic, my doctor told me it would never be covered. I need Lyrica to be able to wear pants. I have allodynia on multiple parts of my legs. Just a gentle touch, repetitive touch, or cold will set off pain that sort of feels like extremely painful sunburn. I had no choice but to figure out how I could get the insurance company to pay for a nerve pain medication that actually works. I had my meds just a few days later. Unfortunately, you have to learn to work the system.
As a type one diabetic, I’ve got stories for days. When I turned 26 and lost my parents health insurance I went through a bunch of health insurance companies to try to figure out how to get my insulin covered, United was the worst because their customer service reps literally just told me to go to the ER and figure it out. There was nothing they could do when I was down to less than my last vial. Part of the problem is that medicine is so expensive because I believe that health insurance companies get a kickback from the pharmacy benefit managers, many journalist suspect this is the case, but have been unable to prove it as of yet. If my mom hadn’t fought insurance companies for my entire childhood and then taught me how to fight them as an adult I probably would not be alive today. There are some diabetics who are not alive today because they rationing their insulin due to its cost and lack of insurance coverage and/or high deductibles which are common no matter what state you live in or what job you have.
That said, because I wrote a public open letter to United exposing the issue a representative quickly reached out to me and let me know that they bypassed the prior authorization and approved the Insulin. I can’t say this enough you have to fight you have to ask for an exception of policy and it is exhausting and I totally empathize with people who don’t have the time, especially parents who work multiple jobs just to put food on the table for their children who need healthcare. This is why I became an advocate.
This is mass murder. We need a retroactive law which makes it illegal for insurance companies to commit medical malpractice. And the settlements need to include court costs.
@@PropheticShadeZ I was thinking of all those people who went to court over insurance malpractice deaths, and being told "hey, it ain't illegal." But you're right. Nothing will change until the people who create these policies pay for their crimes. If there's no downside for them, they'll keep doing it, even if it is illegal.
In the US retroactive law is unconstitutional. That said non-sensical denials should be liable for malpractice and severe penalties for these folk going forward would be a good stop-gap measure until we implement proper health care. For profit health care like this is a recipe for tragedy.
Nope, don't allow settlements. Instead it should be a law that makes it hilariously easy to win against insurance companies if any kind of medical malpractice is committed, and make the punishments harsh enough. Then, outlaw Prior Authorization. I was thinking about something like this: the doctor that reviewed the case in the insurance company has to be published in every approval/denial, and if the company is found to have committed malpractice, the doctor that reviewed has their license revoked, so they're no longer allowed to work at reviews, the company gets fined for 200% of the total cost of the entire treatment (so the company always loses more money would they deny someone unfairly), and everyone from HR (because they hire employess) to upper management that allowed that review's result to face the client will be put on a watchlist such that enough offenses will have them jailed, retroactive and effective after about a month. This would *immediately* make insurance companies restructure themselves. There's a time window for them to redeem themselves by effectively firing everyone that they know has denied unfairly in the past. There's no point on making it effective immediately because they will just shut down and everyone is left without insurance. The time window ensures that they still run, but they have to restructure. The punishments are harsh enough to make them want to hire the best doctors they can find so the reviews will be fair.
We need universal healthcare like EVERY OTHER developed nation on earth. Healthcare isn't a commodity, but an essential service. As long as our system is based on profits people will continue to suffer and die. We don't need "affordable" healthcare. We need healthcare period. Ironically universal healthcare is far less costly and provides better outcomes.
Boomers will never vote for it...because THEY have socialized healthcare, but will do everything in their power to stop the rest of the country from getting it.
Went through the same thing last month was denied coverage for a one night hospital stay after a major surgery that ended late in the afternoon, tubes placed during surgery and hanging out, catheter, bloody urine, five incisions, fever, pain, in post sedation state. Payment was denied due to it “being not medically necessary.” The doctor has ordered a minimum of one night stay. Called Blue Cross and explained that what they are doing is denying payment of care hoping we would go away. The doctor that reviewed and denied the claim was listed on the back of the denial letter. I plan to write the medical board regarding the denial. What doctor would endorse that denial. Very stressful at a vulnerable time when you are already weak. The stress of it all could lead to death. Criminal greed. Insurers need to be held accountable and the doctors that are endorsing the denials held accountable too.
"The doctor that reviewed and denied the claim was listed on the back of the denial letter." Yeah, that's the trick insurance companies use so they're not in violation of the law. They find some garbage doctor who barely graduated and not good enough to practice in the real world, and hire them to rubber-stamp all the decisions their accounts (and now AI bots) make about treatment. Almost none of them even bother to read the case notes, but just say whatever their employers tell them to say.
As a person who's worked years as a licensed pharmacy technician....thank you for covering this! My first lesson was to learn, they always refuse the first prior auth...you usually have to push it through twice every time. I've been left in tears after having to refuse patients for extremely important medication, like simple insulin for long term chronic diabetic patients smh...don't get me started on cancer meds....I've watched our pharmacy charge thousands per pill because prior auth refused and it was immediately necessary 😢....so many stories I couldn't help ..I eventually got in trouble for paying out of pocket myself and quit.
Try submitting an expedited pre auth, or have your Dr. request a Dr. to Dr consultation, and you can submit your own expedited appeal, esp to send a copy to your state insurance commision. As a nurse you can abstract your own medical record to go with the appeal letter. The person who reviews your pre auth may not work for Aetna and have all your medical records. The legal jargon the reviewer uses is "Based on the information received, criteria is not met"" Also it helps to look up the URAC criteria for your procedure and quote it in your appeal. ( another old nurse)
we are RULED by them rothschilds rockerfelelrs WEF eta eta..... good peaople RARLY seek pwoer, becuase peaople been tricked power is EVIL NO!.... power is GOD power is GOOD when used by someone not a P.o.S!!!
I went to my doctor when I broke a bone in my foot. He ordered a "boot," and sent me to the hospital to get it. They informed me that if I had come to the ER they could have fitted me, but since I went to my primary, my insurance wouldn't pay. I called the insurance company and asked them what I was supposed to do and they told me their approved provider was in another city, 2.5 hours away. I explained that I had a broken foot and asked them if they were going to drive me there and back, and they told me that I was _choosing_ not to get the boot because I wouldn't drive there with a broken foot. They didn't explain how I could use the accelerator and brake pedals without involving my foot, but it was still "my choice."
Tell them your lawyer said to call an ambulance to take you there, that he is eager to meet them in court. I bet they either authorize the boot payment or an emergency room visit at your local hospital.😊
In my experience, insurance companies HATE any orthotics-type services - that's your boots, your shells, your braces, your casts, etc. - and half the time they need to be authorized because ooo just imagine if the doctor charged you for a cast you didn't need!
@@TheByrd I just love calling somebody who knows I live alone and explaining that I can't get there, only to have them ask, "well, can't you get a ride?" With whom? Santa Claus? My county only very recently got "senior transportation," but then, I only recently became senior. Neither of which was applicable when I broke my foot.
I have worked for a pharmacy that provides high-dollar medication. I was provided with the approval guidelines of every insurer in the Northwest. Dr would send me the patient notes and charts so I could handle getting the medication initially authorized and then maintained because authorizations are only good for a defined time. If I knew an insurer was looking for a specific word and it wasn't there, I let the doctor know. This helped the process, but it is a circus and we are all clowns. They don't want to pay for anything. And medical necessity is apparently subjective.
This is the story of my life, nothing so lost as amputation, but permanent impairments and prior-authorizations delaying care, ESPECIALLY with PAID insurance (On state healthcare now) caused me to lose an uncountable number of jobs. It now means I'm fully destitute and need to get disability to be able to survive anymore. Health Insurance destroyed my ability to work.
This is the untold cost of our healthcare system. We have people saying single payer would be too expensive or wait times would be too long, but the real kicker is that people waiting until they are on the verge of death to go to a doctor takes us from a treatable sickness, to a crippling disability. Those people cant work anymore when they could and should have just been able to go to a doctor stress free and get the medication and treatment they need to stay healthy and working. I would bet my life savings that it is costing tens of billions a year to keep people from getting the care they need when they need it.
@@TheModdedwarfare3But how's an employer supposed to extract surplus value from my employee's work if they're at the doctor? Shareholders don't care about long-term sustainability. They want immediate value, so if they have to grind employees to be point of being completely unable to work (or live, for that matter) so their stock value can go up a fraction of a percent, then so be it.
@@evilsheepmaster1744 It's worse than that. If you need to keep a job in order to have health insurance, then employers can treat you any way they choose--because they have something you need. Sure, you could leave and go find another job, but many jobs don't come with benefits like health care, or some have a wait before you qualify. Then, you get to start all over with choosing from the ones offered, and whittling down your deductible. You might need to change doctors if they don't accept the new insurance--made tougher if your doctor knows your treatment plan.
My first thought when reading this was how stupid of a system this is to delay treatment and then have your customer unable to work and thus lose the ability to be a customer. But I worked in insurance for years (not healthcare but briefly in workers compensation and then commercial.) Insurance companies hate when you ask them to think about long term solutions. They want big profits now. Why? Stocks mostly. Stock value rising means shareholders are happy, the boards happy, and executives ... Well most of their bonuses and net worth comes from the stocks. If they're to get a good payout year to year they need short term gains, not long term business security. People turned occupy wallstreet into a joke but at least those people knew where to lay a good portion of the blame. Literally gambling on our lives. I am a public servant now making almost nothing, on medicaid, and I'm happier. But I don't know if I'll be able to afford to not go back into insurance. Go back to working for the devil. Because I need money to live too. And the breadcrumbs are slightly more appealing in profiteering. Which is why we don't fight it as much as we should.
My brother in law had a cancer specific policy for his family. His son was diagnosed with a yolk sac tumor, aka cancer. The insurance company originally denied their claim because the Dr. didn't use the specific term "malignant" in the report. My Brother in law's family had to go back and have the Dr. rewrite the report using the specific terminology required by the insurance company. All this took time while my Nephew had cancer growing in his body. Luckily his story had a happy ending and he is cancer free, but these companies are predatory and evil.
I don't understand, if the tumor was benign, the policy wouldn't cover it as there would be no problem to address, so not really sure this is a good example.
@@guy0116 It wasn't benign and the Insurance companies attempt to circumvent their responsibility over semantics slowed down my Nephew's treatment. Seems like a pretty good example to me.
@@guy0116 If they had a Doctorate in medicine they probably would have known. Since insurance companies aren't typically staffed by brain surgeons, maybe they should defer people who know what they are doing. Everyone who has ever dealt with insurance knows this to be true. I had to do physical therapy over a bone spur before I could get insurance to cover the procedure the Dr actually recommended. Can you tell me how stretching fixes a bone spur pinching a nerve? No? Neither could my Dr, yet that's what insurance required so that's what we did. Luckily, I wasn't dying while insurance was having me do nonsense treatments and denying what my Dr actually wanted done. Many people aren't so lucky.
The 80% that just walk away and don't get treatment? That's why. That's the point. The entire business model of medical insurance is that you pay in and they never pay out. That's how they make their profits. That's their purpose.
Really insurance in general. Cause if they had to pay out for everything? We'd never have any insurance companies...or at the very least extremely high insurance where the profit margin is baked into cost....including the cost to pay out coverage.
Oh no, if it’s an emergency they HAVE to treat you. Just walk out after that. The hospitals are getting paid for this too. That’s why they tried to charge me a thousand dollars, that’s right $1,000 for a CUP OF ICE WATER. Nah, it’s all a racket.
PLEASE NOTE: Always Appeal Denials of Private Health Insurers as the act of appealing places the insured in the category of a 'Highly Engaged Client' who, Insurer's have learned, is likely to continue fighting/appealing which can cause additional expenses, thus the 1st or 2nd appeal has a far more likely chances of success than the original submission.
Good luck with that. My mom is on narcotic pain killers for advanced rheumatoid arthritis and has been responsibly using them since her diagnosis 50 years ago. She has never misused or abused them, never run out early, yet she gets treated like an addict and has to spend time without medication several times a year the last few years fighting her insurance company alongside her GP, rheumatologist, and pain management doctor, all saying she needs it.
Our insurers have teams of people whose sole purpose is to obstruct appeals until the customer gives up. I know people who spent years fighting their insurer and made absolutely no progress.
Physical therapist here. I've seen NUMEROUS firsthand instances of prior authorizations and visit limits set by insurance companies that have actively ruined people's lives. It's the shame of the American Healthcare system.
Right insurance company pays for expensive prosthetic limb but won’t pay for the therapy to teach them how to use it. Then you have a very expensive clothes hanger
@--..-...-..-.--.... indeed it does add to it. Luckily I live in a country that follows Peelian principles of policing, something the US should absolutely adopt
I've always held that the biggest issue with the American healthcare system is the insurance. There is absolutely no excuse for people who aren't doctors to deny care for something and someone that they know nothing about.
It is because the insurance, like you, has every right to approve or deny payment for anything. I can not force you to buy a bicycle. You can not force and insurance company to pay for xyz.. insurance companies are owned by people. People have rights. There is no such thing as good insurance. It’s all a scam.
That's not exactly right. I've been in IT 40+ years and over that time contracted for two BCBS. The C-Suite, VPs and AVPs are almost all medical professionals.
I’m a pharmacy tech and I’ve seen prior authorizations for the stupidest things, and sometimes patients have to get prior authorizations for medications they’ve been on for years already. I just wish more people knew that we hate insurance companies too, we want you to get your medications on time :(
My insurance forced my pharmacy to switch my medication to a generic because otherwise, they wouldn't cover it. Not only was I not informed of this, but this was last week and I already had prior authorization for the medication in question. The generic doesn't work (psych meds). It's like they're trying to kill people.
then offer the common meds for less! this will reduce the risk of triggering a prior auth for funding. get rid of your Profits also, you don't need them anyway, LESS profit taxes in the process.
Every prior auth I have ever sent in, or my doctor has sent in, has been denied since I moved back to MN. And when you contest it, it gets denied again. It takes a full-time hospital admin employee to fight these rejections and get them approved.
To all those over age 65: Don't sign up for Medicare Advantage plans unless you like prior authorizations! You won't have Medicare anymore- you have insurance with an insurance company!
I used to work for a Medicare advantage company. Only lasted about 6 months before I couldn't take the soul crushing anymore. oh, and you still have Medicare, which also costs money. So now you have a double headache.
'Prior authorization' is what bankrupted me at age 25. I had an emergency cesarean, followed by a week stay in the hospital due to complications from the surgery. It wasn't pre-authorized to have this emergency while trying to push out a kid for 2 days. Now, I'm 38 and can't get my adhd meds without getting a prior authorization every 3 months from my doctor. It's DISGUSTING. I have to take time off work, losing $$, to keep my meds - they need to make sure my adhd hasn't magically been cured.
The prior auth for adhd meds is because they're a controlled substance. Not because they expect you to be cleared. It's to make sure you aren't a drug dealer.
@madmagdelena Every 3 months for the rest of my life, with my limited refills? I can't refill until I only have 2 days' worth of meds. There are other controls in place to prevent me from selling my meds and becoming a drug dealer. Prior authorization causes me to lose $$ from taking a day off work every 3 months for that specific appointment, plus gas to get to her office 1.5 hours away. Don't forget my co-pays to see the dr too. But yeah, sure, it's that 'prior authorization' that keeps me from going to the dark side and dealing 🙄 Prior authorization is nothing but getting your insurance company's permission to follow your doctor's orders - giving them an opportunity to deny coverage, find cheaper options, or find YOU at fault for your health. Otherwise, why would I have needed 'prior authorization' for my emergency cesarean? Are babies controlled substances as well?
@@cryschanel32 I have adhd and agree with you and have to do the same checkups every 3 months. I'm just staying the reason for them even though the reason is hella stupid.
I worked in the health insurance field for nearly a decade. From working phones, investigating cases, communicating between doctors offices, trying to resolve cases, and even creating health insurance plans alongside CEO and CFO and pitching it to employers and tribal leaders. Our for profit health insurance is absolutely hostile to the people wanting to receive service.
In the light of recent events, we need to hold these CEOs accountable in court of law. Doctors should get to decide what is medically necessary procedure not insurance companies who have never picked up a medical book in their lives.
Congress should pass a LAW. ANY medication, procedure, surgery, or device that YOUR DOCTOR says that YOU NEED, MUST BE COVERED BY YOUR INSURANCE! PERIOD.
@@johnrussell267So what ? Are you saying the patient is a fraud or participating in fraud also ?? Can you have one without the other ? Easy solution is asking for an itemized statement from the Dr.
@@johnrussell267 No it isn't. The subject was fraud.... I gave the answer to that subject. Plus an itemized statement is for after the surgery or hospital stay. Therefore it is not used as an prior authorization.
@@johnrussell267 even with the insurance companies working the way they do lots of Dr. still commit fraud. It’s usually caught by the FBI or police, though not the insurance companies themselves. So I’m assuming more supervision in the hospital and by law enforcement would stop that.
All of this is quite common, and as Whistleblower Dr. Linda Peeno testified before Congress, medical reviewers get raises and promotions based on the dollar value and volume of claims they deny. In some cases, denials are a death sentence.
This is nothing new, Aetna and many others paid settlements over purposeful arbitrary denials. The processors were paid bonuses based on the how many denials. I remember cases from ~15 years ago. Can't even google them, there's just too many
Thank you for bringing light to this immoral practice by health insurance companies . After 32 years of being a retail pharmacist , it was the most frustrating time wasting part of the job ~ dealing with the insurance companies.
We need to push for federal law on medical insurance companies to where they can be held liable for negligence when it comes to proper treatment that's been needed and is being denied!
@MrPenetroso well if they were on the same kind of health insurance that they would have to pay for out of their own pocket like the rest of us, then maybe they would actually be doing the right thing
I signed up for a Medicare advantage program after double and in some Triple checking that all my doctors were covered and my medications were too. Turns out 4 of my doctors and multiple medications were not covered. Not only was I unable to go to the doctor it cost me thousands of dollars to pay for medication. To top it off I battled 9 months to get out of the program. They changed what I had to do 3 times to be unenrolled. Even then they claimed twice they did not get my unenrollment fax. I used two different fax machines. The third time I faxed I used a government agency that one finally went through. It turns into a year of nightmare, and endangered my life.
Yeah, I've heard all the jibber jab about the Medicare Advantage program, but the one tell is it isn't medicare at all, it's private insurance. Health insurance is a scam. That's why they make it so complicated. It's a scam. The medical codes? Used to deny care.
This is why I am glad for my union backed health insurance. I had cancer, and it was handled properly. I think the primary problem, though, was just barely touched on, and is a severe problem in everything in the world today. Companies, no matter what their base industry is, are catering to stockholders first. Instead of providing the service they are ostensibly created to provide, they are extracting value for an essentially uninvolved third party. This is directly taking money out of the pockets of the people who need that service, and transferring it to "investors", who are expecting double digit percentage growth year over year.
Imagine what your union could get you if they didn't have to fight to get you decent insurance. Better pay? More time off? Better working conditions? Better C-Suite people?
The problem is that an insurance company's purpose is to generate value for the shareholders, not care for their insured clients. The clients are just the source of the money and an annoyance when they need money from the company for a medical issue.
@@anonymouse9833 That's a terrible insurance. The most I ever paid was $12k annually for a family of five, and my insurance now is part of the contract at no cost.
I was denied prior authorization for septoplasty surgery. My ENT had to fight with medicaid to approve my surgery even though i physically could not breath through my nose and there is a multitude of evidence that points to mouth breathing causing stroke and other conditions. I was eventually approved but not without a fight. I pray for those still fighting prior authorization to get the care they deserve.
I am a physician and in 2018 I had 6 weeks of vertigo with blurred vision, nausea and vomiting.My BP kept shooting in over 200 systolic. My 3rd ED visit I could not stand up without falling, I was admitted after the ENT doc identified papilloma. The CT was normal but opening pressure was slightly elevated. I was hospitalized because of elevated BP that could not be stabilized in the ED. United healthcare denied payment to the hospital. I appealed and they still denied payment stating my condition is to be expected in a 60 some year old woman with hypertension. I called NYS dept over the health plans. I was told nothing they could do because I appealed and got a final denial decision from United Health Care. So that was it. No recourse. Imagine what our poor patients go through! This is ridiculous and criminal.
I am California and thought laws and agencies were bad here... until I encountered NY. I am convinced that EVERYTHING in NY, whether it be healthcare, car insurance, or real estate law (probate) , that is government related or regulated, IS 100% CORRUPT !!!
I can tell you EXACTLY what it's like. Chronic pain that goes untreated. Nearly passing away in the ER from blood loss because you can't afford proper care for Endometriosis, TWICE. A hysterectomy, finally getting the proper diagnosis AFTER permanently loosing your fertility and ability to ever have a baby. and Stress stress STRESS and in my case, an overwhelming urge to try and see how far you can fly off the railing of a bridge before hitting the river below, knowing you'd be denied treatment for severe depression.
I dealt with insurance and their prior authorization, and it almost killed me. I had to wait a year for a necessary surgery. It was so outrageous that my doctor closed her practice.
Yes an excellent Dr I saw, people from all over came to see him because of his credentials & knowledge! ❤ He sadly told me he would be stepping out under Obama's new Healthcare plan that cuts the throat of true providers! They support the doctors that are the pill pushers though! Seems intentional destruction of a society to me!
"We don't want to dip into our billions-sized wallet to fix problems because sometimes, rarely, we lose a few cents on fraud." Is what I feel prior authorization boils down to.
Prior auth is about corrupt sociopathic money ADDICTS being given a GOVERNMENT-FUNDED system or service to run. You know, like healthcare, war companies, big pharma and vax companies, etc. Then they OVERBILL whatever they dare, providing massive exec salaries and huge profits, because the corrupt liars all know that government money is FIAT, it is NOT "our taxes" - they just need us duped so they can keep embezzling. This embezzling scam is "privatization", also called "public-private partnerships" and other cloaking terms. NEVER let the liars get away with saying "private" health insurance, that is a blatant LIE. And money ADDICTS will keep getting as much of their "fix" as they can, letting people suffer and die rather than doing their DUTY. And they can do this because of CORRUPT GOVERNNENT, since government issues the money and makes the laws. The US sociopaths have been taking over countries since before WW2 to EMBEZZLE from more and more governments via "privatization". The reason such entities are typically on the stock market is because Wall Street knows that profits are guaranteed via fiat government money! In fact, it was two Wall Street lawyers, the Dulles brothers, who were appointed to help take over many Latin American countries as the lying US embezzlers began to build their corruption cartel long ago - the Dulles brothers were appointed as head of the CIA and as Secretary of State. So the criminal gangs in government just PRETEND to fight each other as they collude to keep this massive embezzling scam going.
We have called about surgeries that were paid for but never done and insurance said they didn't care. Then our pulmonologist told us our insurance will deny respiratory supplies until the person dies if they can
Imagine my surprise and great comfort during my first pregnancy when I received a letter from my insurance company notifying me that I’d been approved to GIVE BIRTH to my child. I hadn’t realized that it was optional at that point.
yeah GOP lawmakers push real hard to ban abortions yet refuse to make giving birth an easier process on the wallet and mind. at this point ALL OF US should just have kids and not pay them anything. they cant take us all to court and jail.
The end game is the insurance company forcing you to abort during the third trimester and then not paying for it. I'm joking of course, but I've seen other absurdist nonsense jokes become reality lately.
My dad was a small town GP and surgeon, his patients were his friends and neighbors... and those bogus insurance companies killed him. When HMOs first came out, every day he'd come home and say those companies wouldn't let him treat his patients as they should be, he was disgusted and furious and stayed that way until he had a stroke from that stress.
Rather Kochism 101. Neoliberalism holds that promises of payment for health treatments, medication, and equipment are to be sold like cars, real estate, or burgers. But the rest of the 1st world considers health care one of the public commons, wherein the idea of running it like a corporation is off the table on principle.
Capitalism 101 usually says profit comes from providing a good or service that someone else wants. The more the government mandates involvement, the less incentive there is to actually provide that service.
How are insurance companies allowed to do business like this?! How is this legal?! How long are Americans going to put up with this?! We need to scrap this whole corrupt and evil system!
I'm convinced it's just propaganda brainwashing. As long as you can convince people that capitalism is the best possible system, they will defend absolutely everything that comes out of it.
@@chiplangowski3298 pretty sure just about all of those problems predate the affordable care act. The insurance lobby just kept those issues from being fixed.
i was uninsured for awhile, sprained my ankle badly and needed an xray to make sure it wasnt broken. took them all of 2 mins to do that, and gave me crutches. no pain meds or a wrap or anything. just the xray and crutches and they wanted to charge almost $1,000. my friend had a weird episode where he passed out unexpectedly (as in not drinking or anything that would maybe cause it) so we called an ambulance. at first when he woke up, he refused to ride in it because he knew he’d be charged so much money. HE HAD PASSED OUT DUE TO AN UNKNOWN REASON AND INSTEAD OF BEING WORRIED ABOUT HIS HEALTH, HE WAS WORRIED ABOUT THE MONEY. we had to convince him to go and get checked out. insured or not, our system is beyond broken!!!!
This is why I don't have insurance. It's simply not worth the hassle. There are deep discounts for self pay and they can't refuse a payment plan no matter how small. I don't need prior authorization for anything.
@@MrTwinkieeater _"...they can't refuse a payment plan, no matter how small."_ Are you sure about that? That doesn't sound correct. Do you have a source for that?
@@Milesco to be clear(er), they should negotiate with you about how much is to be paid in installments. Non profit hospitals legally have to offer financial assistance. Look up the No Surprises Act.
Last year I stepped on a nail. Got a tetanus shot and an xray to make sure the nail didn’t break off in my foot. Took maybe 40 minutes. I was billed almost 4k.
I was denied admittance to a pain rehab program due to "insufficient evidence" that the treatment was needed. I asked my insurance for the paperwork / name of the doctor who made the medical decision to say no to my treatment modality. They magically approved my treatment 2 days later....and still never gave me the doctors name at the Insurance company that was making medical decisions without seeing me as a patient.
I became disabled as a result of this exact practice. They denied surgery I needed 3 times because the injury I had is called a "sports hernia" for some reason and according to them hernias are cosmetic surgery. For the record, a sports hernia is a torn tendon. In my case it was in my groin so I walked in it for 3 years while fighting the insurance people. To this day every step is excruciating.
@@Mr.H333 Only Charles Koch and a handful of United Health, Blue Cross Blue Shield, and Cigna bribery liaisons would that kind of McCarthyism on you or me.
My friend worked for BC/BS in the 1970s. She and 9 others were in a board room with 100 claims each. In each "round" the worker fought for their claim. Only 1 claim per round was approved. So only 10% of the claims were initially paid. She quit after less than a year of working for BC/BS due to stress. She also worked the customer service line and then would advise customers on how to get that denied claim paid!
This is EXACTLY what Aetna has been doing to me for over a year. In 2019, a tumor was found in my spine after years of treatment for spinal problems. After new symptoms like falling all the time, pain radiating down my legs, and extreme weakness in my legs appeared, my Dr has submitted prior auth paperwork (each more detailed than the last) for an MRI 5 times. For more than a year now, they have repeatedly told him that they need more information. Ironically, because they're my insurer, they have ALL of the info that they're requesting. In another ironic twist, I've been an RN for 27 years. Thanks medical industry that I devoted my entire adult life to. You are AWESOME!!!
Oh well. It isn't right, but what you do is even worse. Covering up iatrogenic injuries and deaths your whole career. You lie to the patient (if still alive), lie to their families, and in the records. And never bothers you even a little bit. You just bury your mistakes as if we're trash. May you get all you deserve.
Thank you. You just made up my mind to turn down this Aetna Medicare Advantage plan that my former employer tried to force me into. I'll just bite the bullet and pay the premium for a Medigap plan, and keep original Medicare.
I am former nurse; used to be case worker. Case workers help patients navigate insurance, healthcare system and make sure they get meds and resources in a timely manner. I found it silly this job exists to solve a problem that insurance companies make for themselves. Insurance and healthcare is supposed to help but it was one of the most frustrating job ever. Like pulling teeth just to get what patient needs
These insurance companies should be fined for practicing medicine without a license. There should also be a federal law stating the doctor gets final say
This is one of many examples of how white collar crime CAN negatively impact people’s lives; even to the point of actual death. These companies need to be served actual justice through jail time and NOT easily payable fines.
Yea this has affected so many people. I had a hysterectomy and was sent home the same day, at 9pm at night no less, bc my insurance wouldn't cover it dispute my bleeding disorder. When I went to pick up my pain meds, the pharmacist says, they want a 48hour prior authorization, or you can self pay. Like I could go without pain meds after having surgery! What!? I had the authorization for the surgery but not the medications that follow? I had a bleed just like I told em when they sent me home I said it's too soon! I was back in emergency room with a 106temp, septic, and 2 liters of blood in my belly. I had to call my child and tell him I loved him bc the doc gave me 10%odds of making it. I woke up on life support. It was awful. The US health care sysytem spends more,covers less, and has more negative outcomes than any other developed country. These wouldn't be issues with a universal coverage plan. Its shameful, this country cares more about money than people.
I retired from decades of practice as a psychotherapist. Insurance companies put providers and patients through nothing less than bureaucratic torture on a daily basis. I am so glad to be out of it all.
This another good reason why I loathe my species. If I took out my telescope and found a large asteroid that no one else saw but we would have the time to destroy or divert it? I wouldn't tell you. I wouldn't tell a single one of you.
You are ruled by those you cannot criticize. Most of our congress has dual citizenship, all with one specific country. To mention that they created laws in America that directly oppose the laws they make in their own country would be considered anti - "s e met ik". Just follow the money and laws. The truth is in plane sight.
@@janetamerasinghe7824 No profit motive. These "healthcare" companies employ teams of people, especially lawyers, to come up with entire systems that support the denial of claims. They do this to save money. Because it's all about money to them, not at all about care. A public system would have to be concerned about costs, but not about paying CEOs nor about being sued by shareholders.
@@sixteenornumberSchools too. The existence of private schools incentivizes the reduction of public school services and increases social stratification. Utilities are pretty sketch too.
That is our own fault for wanting something for nothing. We didn't want to pay for our office visits. When I was a kid you paid the doctor out of pocket, and doctors came to the house. There was no huge company between you and the doctor that required billions in extra dollars to make it's massive profits. We did it to ourselves out of our own greed. We are the ones who signed up for that insurance so we wouldn't have to pay our doctor bills. We were so stupid we actually thought we could get something for nothing. Insurance is now wrecking the veterinary business the exact same way.
@@coop5329 It's greedy to want medical care without a financial hit? The point of insurance is that you pay a predictable amount, and it makes sure you never have a giant, unpredictable cost that you can't account for. And it pools many people's money together to use for that. It's a lot like taxes. If you insist on seeing human righs as transactional, there's still a gain from it. People get health care and in return, they are able to perform their jobs better. School and roads are provided for free because they benefit society as a whole. Are they "wanting something for nothing"?
@@coop5329Wanting something for nothing??? The last I checked, we pay a monthly premium. I don’t know about you, but my premium isn’t what I’d consider cheap, or nothing. We are expected to pay that premium, religiously, and on time. Why then, are they allowed to throw in time consuming, unnecessary, steps, by some clueless layperson that they hired??? We went to our doctor, who has years of education in medicine, to be treated. No Joe blow should even be involved in our doctor’s decision!
@@coop5329why the FUCK are you so determined to defend a system that treats HEALTHCARE like a privilege ????? why do you WANT people to pay these absurd out of pocket costs for treatment that you need or you will quite literally die? how dare people ask to be treated regardless of their ability to pay and not be left to fucking die!! you’re content to put a price tag on someone’s life and as a healthcare worker i think that world view is extremely fucked up. you think i care if someone is poor when they go into septic shock ????? no because i’m not a fucking sociopath 😭 you shouldn’t have to be able to afford to pay the full price of expensive ESSENTIAL treatments just to earn the right to continue living. that’s super fucked up, man.
This is why I always told everyone that Affordable Healthcare will never come out of pushing for more affordable insurance. Their goals are just too different.
@@07wrxtr1 that is mostly because the construction contracts are out to make huge sums of money building and selling the produced for as much money as possible. Also their clients are the wealthy who need another 10 realestate assets to lounder their dirty money and reduce tax burden.
I’m a provider and became friendly with one insurance company authorizer. She shared that one day a week, they would blankly deny all prior authorizations for a day. They know that statistically, some people will just give up.
My daughter, mom and husband all died because of denied medical procedures. For myself with numerous preexisting conditions insurance is a necessary evil.
Private health care is primarily for profit as such the share holders interests / profit is uppermost not the customers or the employee . It is the nature of capitalism .
@@willieverusethis your premiums are their potential profits /income it is their legal duty to maximise profit and minimise costs . It's the nature of capitalism profit is its god it demands human sacrifice and suffering .
@@odinallfarther6038it’s NOT the nature of capitalism. It’s entirely possible for companies to exist and not be publicly traded. There are even companies that practice profit sharing with their employees.
@@feanedhell they do have actual medically certified doctora that review these cases if either A) they require a higher degree of review or B) its gets appealed high enough or the members provider requests a peer to peer review. system sucks and needs reform, but you shouldn't spread misinformation
I had been denied for medical device for a broken knee relating to workers comp. I paid for out of pocket myself. And insurance kept delaying my case as long as they could for over 3 years, even having their doctors falsify reports. Only when i contest & videotape exam did they finally approved my claim!
Its mind blowing to me that lawyers and bureaucrats think they know better than doctors. Never has a company worked SO HARD to avoid doing what you pay them for.
The squeaky wheel gets oiled. I had a situation with insurance giving me the run-around. After a short bit, I just called the insurance fraud line and they got me in contact with someone who straightened it all out in less than 24 hours. In a nut-shell it was "ohh, this is what was supposed to happen, that's why it was denied". Don't be afraid to escalate. Remember, insurance fraud includes insurance companies not covering what they should cover, and insurance fraud is taken seriously(federal crime). If they're delaying too long, just make a big stink about it.
Back in the 1980's-1990's I was an insurance biller for both Medicare/Medicaid (as well Medi-Cal) for the state of California, for doctor offices, hospitals, clinics and ambulance companies. It was my job to make sure that PA's were properly written up with ICD-09 codes to backup the requests for services, DMEs, etc needed. We knew about the three D's of insurance denial for turnaround delays (to make the out of pocket costs double and triple in time delays) so insurance makes the money they were having to pay out. However this was before the now "perfected", delays also brought on in larger numbers because more and more procedures, Tiered Drugs (artificially increased often times) resulting in non-coverage, and less DME covered without a PA. The bottomline? Make patients pay out of pocket for as much as they can. It's a mess. Dual eligible patients (and I am now a member of this club) also known as "DSNP" the highly vulnerable disabled elderly, long term care elderly with medically fragile issues, are NEVER supposed to pay out of pocket for anything (a rule set up by Federal laws and CMS), but are being squeezed to do "just that": pay out of pocket, since they are making the client responsible for getting the PA requests, tracing them through their clinics to their insurance, and then back tracing the PAs to Medicaid. The doctor's offices are now telling patients to use "Good RX" or other plans so they can reduce their costs of medication (or other medical buy-in programs to reduce DME costs, etc) and pharmacies are also demanding credit card information on the clientele for "concierge" services to include for delivery, or door services when the patient is BED BOUND. Which is illegal as well. These additional fees make it impossible for those of the greatest needs to basically be at the mercy of the lack of concern by doctors (look at Optum buying out doctor co-op offices, pharmacies, etc which is a branch of United Healthcare). My story is simple: I can't get the doctor's office to allow me to talk to their PA department, and the doctor writing PAs that cannot get covered because they don't included diagnosis codes or rationale reasons for patient need. Your story of Kathleen has become almost "typical" and CMS teeth have been removed to place sanctions against the states who violate their laws and her story broke my heart. In the end, we are seeing the worst of insurance. My husband who has cerebral palsy and walks with closed arm crutches, cannot get crutch tips covered by our insurance, even with a bad PA. The doctor asked for the tips, without enough information like mobility, ICD-10 codes, etc. took 9 months of daily calls to get his crutch tips. Cost? $15.00. Why didn't we just pay it? Federal Law dictates that he is not allowed to pay out of pocket for real reasons: double dipping of suppliers asking for the $$ from patient, and then getting Medicare/Medicaid coverage. It's fraud. In the end, it became negligence for us and Raymond was artificially house bound because he can't WALK without these crutches. Then there is a larger issue with insurance not covering life long conditions (thyroid being one, Diabetes another, etc) for medication without periodic demands of PAs that are absolutely frivolous: there will be at no time when the patient will suddenly "get well", so why harass the doctors and patients taking up 60 or more hours a week trying to push through costs that the medical managers don't want to have covered? In the end, I find that no one benefits (other than the corporations) for these needless delays and as you state, the medically necessary tests....It's a waste of patient time, doctors, offices and pharmacy hours. Single payer system would simplify all these conundrums. Thanks for listening, I know this is long. Both of us have found we receive substandard care because of corporate greed, mistakes in pharmaceutical filling (some drugs do not work as generics), and delays in very important medications simply because of spending hours NOT filling scripts by sending paperwork to wrong offices, that in the end the burden is on me to fix all these errors, since I know what needs to be done and isn't.
Single payer systems are a monopoly and would make prices worse. Sorry, a single payer system is not the answer. We'd end up with all of the same problems as now, with the "system" keeping as much money as it could for itself. Insurance is a scam, I'll give you that.
Are ICD-09 codes the same thing as CPT codes? I was able to find a list of CPT codes to verify against what my doctors office was billing, and let me tell you it was not easy at all getting them (plus they change them all the time phasing some out or changing them). I was amazed/mortified by how many mistakes there were that triggered denials. I usually didn't see them because they would go back to the practice and they would have to correct them, but that system is a mess and it is no wonder that so many mistakes are made.
@@IcicleFerretno, actually, because the prices would be regulated. That’s part of the reason why healthcare is so much cheaper AND more effective in Europe than the USA.
UA-cam's algorithm does a great job recommending me this, in light of the recent event
@@TheMrAdhitya and if we keep commenting, it'll do even better
This aged quite spectacularly.
You're right Mr A, this was recommended to me also.. I'm glad it serves as a wake up call. For us to do something together and not merely look at this as oh yeah this is really bad. fighting for healthcare is not a spectator sport.. Well sooner or later it will affect us all if it hasn't already. Like Pericles one set over 2,000 years ago when you might not be interested in politics but politics is very interested in you.. just change it to healthcare insurance.. they're interested in us because they see us as cash cows to the CEO and their shareholders.. these two things should never be together it's a marriage consecrated only by Satan. It's not healthcare it's Deny Care either we fight to change this now it's going to come back and haunt us
Yup. Same.
Same!!
Healthcare in america is working exactly as designed. It just wasn't designed to help human beings.
It was designed to help the shareholders stock value
Agreed. Shareholders of insurance companies are inhuman.
It's profits over people, they have no soul.
@@Melissa-pd5hr In other words, once again, as always, the problem is capitalism.
@@iExplodernow you’re getting it
US health insurance companies need to face criminal charges for practicing medicine without a license and also pay out to the people who have been harmed for the delay.
That second part is kinda hard to do from a box in the ground and that’s what their hoping for.
@@wrenchaholic_ -- (THEY'RE)
you meant doctors got arrested for practicing medicine and not following the insurance companies rules about covid right 👍?😅
but people that have no insurance go to the hospitaland get mris instantly, you are better off not even having insurance
They have De-Facto Qualified Immunity from our Elected Lawmakers.
That’s the root of the problem. Insurance companies should NEVER have power and authority over doctors
If they could replace doctors with AI, telephone visits, etc., they would. Capitalists hate paying wages to anyone but themselves.
Hell, they shouldn't even exist.
That's a major problem with private insurance.
But doctors scam patients and insurance companies too. Read the book Coronary.
A hospital was doing a steady business of major heart surgery. Many turned out to be completed unnecessary. The management was all in favor of the doctors because they were bringing in a lot of money. The medical profession is just as much based on greed as is the insurance companies and pharmaceutical companies.
Yeah, like doctors are infallible and never corrupted...
I’m a physician. I’ve been practicing since 1996. What has happened in the US over the past 15-20 years just disgusts me. What the insurance companies do is flat out fraud. Should be illegal. They look for the smallest loophole or tedious paperwork that a lot of people do not understand. This combined with nobody to speak to, and long hold times, drives people to just give up. I’m super surprised that more patients don’t go “postal” on insurance companies.
Thank you ❤
I don't understand how they can not be sued for medical malpractice.
@@galacticwarlock2271 because they have a lot of money to spend on good lawyers.
In any other industry, this would be considered thief of service: we enter into a contract in which we pay in exchange for coverage. Then coverage is denied. Breach of contract?
The insurance lobby is powerful. They must be paying well those who should be going after them.
@@michelem3360Exactly. They are bribing the regulators
I like how it's totally legal to be denied coverage that you pay for. Can you imagine if we did that with something like groceries? Like, oh, you have to pay upfront, and then the store gets to decide what groceries you actually get to take home with you. Also, there's no way of knowing beforehand what groceries you'll be allowed to keep until you try to leave with them.
Great analogy!
It's like college.
All the better if you’re allergic to some of them too.
This is the fourth time you've confiscated the milk in a row, why won't you just let me have some calcium?
"Well, you see, you could be rushing home to pour it on Trix, which is for kids; and you're obviously an adult."
I'm sixteen, even _if_ that was a valid reason, why didn't you ever card me?
"It's not our jobs to fact check, it's yours to provide all the information in whatever arbitrary manner we want."
Even if you don't tell me?
*_"ESPECIALLY_* if we don't tell you!"
Careful, don't give them any ideas...
My partner went to a doctor about a lump they had found. The doctor had them get a mammogram and testing which showed to be benign. Later we got a large bill for the mammogram even though the insurance site said the cost was fully covered. I called them to figure it out. Turns out that mammograms are only covered for regular screening, but because there was concern of an issue that wasnt covered. Insurance is a scam.
It's a double scam. They want to run the procedure is the key, so money gets made. lawyers writing these guidelines make sure they screw the patient, not the company that provides the service. If you saw it isn't covered, at least you'd have the option to not get the procedure.
@@Rene-uz3eb And, if you don't get the procedure? And, if it turns out not to be benign? Schrödinger's cat. You're damned if you do? You're damned if you don't! 😒✌🏽
Hehehe haha gotcha with a little loophole here's your 100k bill. I love the free market. 🤠
Yep I hear ya. Broke my shoulder this last March. Seen the orthopedic 4 times. Surgery was not needed. Just a sling, then PT for a couple months. After my insurance, 6k is my copay! I pay 75 bucks a week for insurance! What a bunch of horse shit 😡
@@stickysdennot to be rude but the phrase you are looking for is "catch 22" or "lose-lose situation". The cat is a metaphor for quantum science and parallel states as well as a real life example of both the concept and of animal cruelty. But the image of titties existing only when you look at them is hilarious.
When my daughter needed an expensive biologic drug, and our insurance company tried to deny a claim for this medication, my daughter’s doctor called and just asked them, “what do you want me to write on this order to get this paid - just tell me what YOU want”.
It’s ridiculous.
Ignoring everything, it's crazy that NON-MEDICAL PROFESSIONALS are deciding whether treatment is necessary and often OVERRIDING MEDICAL PROFESSIONAL'S JUDGEMENT.
I've been screaming this exact thing since 2016 when those unqualified individuals were in charge of my case.
True story.
Legally they can't actually do that in the US, only medical professionals are allowed to make medical decisions.
They work around that by hiring the worst doctors they can find, the failures and creeps, use an algorithm (these days they're turning more an more to AI-driven systems) to deny patient care, and then pay these worthless doctors to sign off on all these denials without even reading the case notes.
IMO any doctor who works for one of these insurance companies or outsource agencies deserves to have their medical licenses permanently revoked for malpractice.
@@EphemeralTao same for any doctor who does "independent medical exams" for the insurance companies.
I've been to 5 and they're awful too.
People should be able to file complaints to the licensing board and have it actually result in something.
@@EphemeralTaoI heard they hire a doctor to click a computer mouse. The computer just pops up procedures and approve or deny, and the doctor just has to click "yes" all day so they can say a doctor approved or denied it.
I'm a nurse, and I met another nurse, who tried to convince me that taking care of the shareholders, was more important than taking care of the patient.
In nursing school they make us call our patients, our "clients" :(
Meanwhile we’re stretched so thin that the actual care that patients get continues to decrease. Shame on that nurse that said that to you.
I wish shareholders would just get real jobs
Thank you for not going along with her. I'm disabled and have a lot of problems. I depend on my entire medical team, especially since I have 11 Drs. All my Drs are through the same hospital so they can all just look at the computer and see all my records and send messages to each other and most of all the nurses and staff are totally awesome, but I have met a few that I think are more like the one you met. There are to many of us out here that depends on people like you. You probably don't get told this enough but thank you for all you do. Thank you for caring. And thank you for telling people like that to go away. You are a true hero.
@@Sho_Ishto
More profits into HCA CEO pockets.
Rick Scott, R-FL became a multimillionaire after being forced to resign from his HCA after engaging in major Medicare fraud. Scott received a pretty nice severance.
Insurers should never have the power to deny what a doctor prescribed.
the service isnt denied. it just isnt paid for by the insurance. realistically, I understand for most that would still prevent the pt from accessing the care but semantics
Well they should properly investigate before approving or denying. Unfortunately sometimes doctors do scam the insurance by over billing or ordering equipment or services that weren’t done
@@mercedes7566no. If you put a patient’s life in danger, a patient that has paid you in good faith that you would take care of in case they need it, then the possibility of a doctor trying to scam you should be the last thing you think about. And let’s be honest, they rather the patient dying is in their best interest.
@@miliarius.x the thing is that the whole American healthcare is de-facto built with reliance on insurance in mind, but this technicality is literally killing people.
@@mercedes7566 this should be between the fraudulent doctor and the insurance company. I'm sure this is much more rare than people dying or becoming disabled for insurance denials. After all, the doctor doing fraud is not invincible and most-likely will get punished and maybe get their license revoked.
This video is A YEAR OLD! But may as well have been produced in the past few days! Good for you, exposing this insanity ahead of time. Yours is the only video we need, surely used as a source for the more recent ones.
Thank God I live in Canada...for the healthcare, which isn't the best but we don't have to deal w this shit. Makes paying taxes a joy
Denying Your Health Care is Big Business in America, is another UA-cam video by the New York Times that discusses the same topic and was posted a couple months ago. This issue has been festering for years. It's just that now, people are starting to take matters into their own hands because they realize the law is not changing any time soon.
If 80% of patients have abandoned treatment because of the prior authorization process, then the process is working exactly as intended. This is the truest form of corporate evil.
Until we wind up in the ER from not getting timely treatment, then they have to foot a much larger bill, and sometimes much more long term as well.
Well said.
It's worse when they treat you with adverse events
and then sometimes they literally choose the kind of care you get based on ur race/caste! Can you imagine the demographic that receives lesser care = no care! 😢 @@JessieMassoudi
@@coldfact.I think about this often. I’m mixed middle eastern and white but I look VERY white, and it’s sad to think that it’s even worse for others! 😣
The root of all of this is the fact that we’ve allowed insurance companies to use individuals who DO NOT HAVE medical degrees to override the doctors making the decisions about operations.
Maybe you missed it, but those prior authorizations were being denied by Drs, and Nurses that work for the subcontractor.
@@kevinbarnard355 They actually aren't most of the time. If you actually look at who on the payroll is performing the individual inquiries, it's generally people who's highest level of medical knowledge is the training they received from their job. They tend to look for "keywords" when looking over medical documents rather than properly understanding what the document is talking about and what the patient actually needs.
People should not be allowed to deny medical treatment to a patient without actually SEEING the patient.
If they want to audit/sue the doctor and the patient AFTER... that's fine. Or they could allow the procedure only on "preapproved" doctors...
When I say "preapproved" should be EVERY DOCTOR/HOSPITAL THAT ACCEPTS YOUR INSURANCE should be pre-approved. If you trust them enough to be part of your network, they should be trusted with the recommended procedures.
Either way, I'm happy I don't live in the shithole that USA is... people fight and argue to live a worst life there.
the #1 problem is that private [FOR PROFIT] companies are even allowed to provide health insurance and buy the republican party,, we need national health care just like ALL THE OTHER MODERN COUNTRIES !!
@@herchelleonwood7463Lol no. All of the problems we have now would be worse under a government run system. They'd just be doing what canada is doing right now and telling people to just go and die.
They are so comically inept that they end up losing money sometimes. Which I'm sure just raises premiums. When my ex-wife was pregnant, she needed a specific medication every morning. Insurance refused to cover it. But they _would_ cover it if the ER administered it. So every morning we had to drive to the ER for meds. Eventually we had a standing order worked out, so that we didn't have to check in and wait 5 hours every time. They'd just run out and give her the shot in the lobby. Each ER visit cost like $10,000, and the IV version of the drug cost $1,500 a dose (the pill from the pharmacy was $80). For like 6 months, they paid for that _every day_. We appealed twice, there were MULTIPLE committee meetings where they decided that the current arrangement was fine. They are not only evil, but stupid and wasteful as well.
They raise premiums regardless of money. The line MUST go up.
They are not inept. These policies make them money. That's the goal
@@richardkatz8713Did you not read the comment that literally states in not changing it to what she asked, they spent more?
@@arandomcommenter412 maybe someone is scratching someone else's back.
how do you find this loophole ? asking for a sick friend.
Could this be why the CEO of United healthcare was killed by Luigi? I have medication I will have to take for the rest of my life, and my insurance company requires a prior authorization every 6 months for each one. My doctor does not get paid for doing prior authorization. My heart doctor told me I needed a coronary stent, the insurance denied coverage, claiming they don't work. I had a spinal injury at work and workers compensation denied coverage. I had to hire an attorney to fight for treatment so that I could walk after having my back broken in several places. My lumbar spine is now fused and disc removed at 5 levels. After fighting for treatment for chronic pain, I got an intrathecal pain pump containing fentanyl. I need to get authorization each month to have it refilled, and this has been going on for 14 years and have had to pay out of pocket many times. Our insurance companies are completely corrupt and use the tactics of Deny, Delay and Defend to increase revenue.
I have worked at many insurance companies around the country. These outsourced denials let the sociopaths in the board room sleep well on their giant piles of our cash. Medicare for All, today!
Please tell your friends and family prior authorization should be illegal, unless there is already evidence of fraud or abuse or misuse on that case.
Just because one other person in the country submitted the wrong procedure is not an excuse to require this prior authorization for everyone else.
Also, insurance companies are designed not to cover extended nursing care; only acute nursing care. Why? Profits. Don't believe it? Look at other industrialized countries
Tell your Congressman and don't accept their excuses. What is your Congressman, other than a representative of the insurance company's profit center?
So much of the hellscape of our country can be traced tracked to the soulless McKinsey consultants...
Vote blue!
@@hw-rg7gnMcKinsey is an institutional malignant tumor. That company(?)/conglomeration(?)/CIA front is e v i l.
@@novampires223voting blue isn't enough the Dems are complicit with this system. If you're gonna vote blue as your only method of change vote someone new not your same representative. How can we expect change with the same government officials.
If you believe that the Republicans are gonna try and stop anything the Dems do then shouldn't we at least get some new Dems in there to see if they fair better against the Republicans. Watching the current Democrats in Congress it seems like they aren't even trying to help us. They just say "oh we can because of the Republicans"
I had to pull away for a moment after hearing that the insurance companies couldn't be found liable in ANY of this. Downright disgusting and brutally honest display of the American healthcare system.
De-Facto "Qualified Immunity" for Medical-Insurers purchased with Campaign Ca$h Contribution$. VOTERS must wake up..
and our Judicial System
Smaller everything, starting with the federal government, is needed. The larger the organization the more it costs and the less it does.
Seems like very few exceptions.
Agreed. I've had to pause a few times. This is infuriating.
@@fedupamerican296 so in this scenario of a small and limited federal government, who is holding the largest companies accountable? We've already been through trying a limited federal government, it led to the first Gilded Age of the late 1800s/early 1900s, and eventually, the crash of 1929 and the Great Depression. President Hoover, under a pro business & anti-government leadership, decided to give handouts to the richest people after the crash and allow the savings to "trickle down," to the poor. It was such a failed policy that they began calling the growing encampments of homeless "Hoovervilles," and called both of your pants pockets hanging out empty, "Hoover flags." Without federal safeguards against corporate greed and large scale fraud and theft, not to mention monopolies that crush fair market competition, there's no hope for rebuilding the middle class and tackling income inequality, homelessness due to lack of affordable housing and substandard healthcare for all but the wealthiest of Americans.
The very reason you feel like your own government is working against you is because Republicans have been trying to undo the New Deal since its very inception. The New Deal is the reason why we have Medicaid, social security, and other social safety nets. Republicans adhered to the theory of a guy Sumner, who wrote a book called What the classes owe each other, and the conclusion he came to was that the wealthiest owed poor people nothing. So basically you have a right to starve and allow poor people to die, because you don't owe them shit. What a beautiful Christian sentiment that is for a country who brings up Jesus and God at every opportunity, yet seems to forget the entire tenet of Christianity is to protect the poor and vulnerable above all else and to shun material wealth. Sorry for the novel, but US history is just repeating itself, but most people have no idea how these ideas have already been tried and failed spectacularly. At least failed in the sense that everyone who isn't wealthy and powerful suffered greatly and unnecessarily because of corporate greed and cruelty. If you want a better Fed, vote for better people. Don't just vote straight down the party line, find out who these people are in business with and how they vote on issues that affect your ability to make a decent living without having to go into debt or work yourself to death for shit pay and no benefits.
We live in a predatory system. This is just one of the corrupt entities that exercise abuses at the cost of the citizen...
The sooner the majority accepts this fact the better
I am being slandered and abused by the health care system because it is infiltrated by Org. Crime!!!! I reported criminal activity.
It's the medical labs and doctor offices and sometimes the doctors. They take good care of REAL prostitute.
@@jen-cy6wj I doubt they ever will as this has happened because of their complacency...
@@jen-cy6wj Sheep accept the unacceptable
@@Zeus-dw1cxwhom are these sheep?
I just went through a prior authorization nightmare. I have a sciatic nerve impingement which was so painful at the time that I couldn't walk. I had 2 prior authorizations for an MRI denied. The last one required me to go to physical therapy. Who the hell goes to physical therapy while on pain to be put in more pain? The pain got so bad that I couldn't put any weight on my right leg at all. By the time the MRI was approved, I was damn near paralyzed. My doctor had to do some written finagling in order to get the MRI approved. I ended up having to have an epidural caudal injection and right after thecpain was so bad that I ended up in the emergency room. You're absolutely right, conditions worsen while they're busy denying claims and treatment.
Yup. My son has Type 1 diabetes. We have 3 different insurances, but one won't cover his insulin, one won't cover anything if they can't be the primary, and the third wouldn't admit him to the hospital until he either was unconscious or his glucose levels were uncontrolled in the ER for more than 12 hours. And after everything, and paying over $30k per year for insurance, his insulin is still over $700/month.
It's $15 in Mexico, or free if you're on their universal healthcare system.
Insurance is the biggest scam in the US, hands down.
So why pay insurance? I jus don't get it.
@@dmo848😂
And in Sweden I have free insulin, free wireless glucose sensors that connect to my phone, and visiting the doctor costs me $30.
That SHOULD be the standard, a type 1 diabetic never asked to recieve the disease, nor did anything wrong, its just bad luck. That is where society is supposed to step in and even out the inequalities to make sure everyone gets a fair chance at life.
Yeah, I really wanna ditch this country because of the horror of it's ableism.
@@dmo848 We used to have that option. Obamacare took it away from us. It is now federally mandated that all US citizens have health insurance, which for most means paying for it; if you don't have insurance, you get fined.
I worked in prior auth for 2 years and it has never made me hate healthcare more. I loathe and despise Cigna and the rest of those bastards to Hell and back. I pray for the downfall of the insurance industry starting with healthcare because all it is is elaborate money laundering with zero care for if patients breathe or not.
I assume you aren’t a physician, so what you did was practice medicine without a license and that should be a crime. How the hell does somebody with an AA from the Junior college override MDs (generalizing not necessarily you)? It’s bonkers, but good on you for getting out.
@@FallenEmpireCitizen idk how to tell you this, buddy, but that’s not how prior authorization works. Like to any extent lol
No, I’m not an MD and no, you’re not required to have any healthcare knowledge/certification at all to work in health insurance. So whatever crime you’re thinking of is not real and cannot hurt you.
We as frontline workers spoke directly WITH MDs and their assistants to get the info needed to process a prior auth but 8/10 had no interaction with the patients at all. All the Dr had to do was fill out a questionnaire about the med they were trying to get, we fed that criteria into the digital questionnaire and it would give us a denial/approval depending on the answers. The Dr could then appeal and it would likely go to one of our on site pharmacists who also had criteria they had to follow in order to deny/approve and it would escalate from there. So your incredibly condescending comment about people with junior college degrees overriding MDs is so woefully out of scope that it doesn’t even exist on this planet. I only got out because I had a nervous breakdown after a patient with a late stage illness begged me for help getting a med and I had zero power to do anything for them.
I would advise you consider your words more carefully in the future, especially on topics of which you may be ignorant on.
"Zero care whether patients breathe or not" ... I believe this is inaccurate.
When you, as a patient and client, get to that point, they'd prefer you didn't breathe. It costs them much less.
@@FallenEmpireCitizen The shit republicans i assume you logically voted for are the problem. Hopefully, some day, this thought will occur to you.
Its fucked up they just sent back request for more info on a patient that cant walk and she is in need of a hospital bed , they need it specified in the notes , it doesn matter if they received an order signed by the doctor . Its been going on for a month.
My wife died of cancer that could have been caught far sooner, and could have been treated far more effectively, if not for the insurance company denying and delaying treatment for horrifically specious excuses. She wasn't allowed to get the tests that would have caught it early, and had her treatment delayed multiple times, because of these sorts of garbage technicalities. From the time the cancer was caught to the time she died was 7 months. If her insurance had not denied the testing and treatment she needed, she could have lived years longer. Medical insurance companies in the US are literally killing people to keep their insanely high profit margins that only a tiny handful of people will benefit from.
I feel like that could definitely be grounds for a lawsuit against the insurance company. Esp if it was a type of cancer that when caught early can be treated and go into remission for several years/decades (a lot of cancers tend to come back eventually). And they've got all the paperwork proving that she was trying to get tested and treated, so the discovery process should basically make your case for you that they're responsible for her death.
But then you've probably already explored those options and the stupid statutes of limitations on these things are ridiculously short to keep ppl from suing in the first place.
this is exactly what the fuck i’m talking about and what i have been screaming about. i am so beyond sorry for your loss. it’s unacceptable. it’s abhorrent. as a healthcare worker it makes me sick. you are so right this is LITERALLY killing people.
That would make me go postal. An eye for an eye.
@@brucesim2003Law Abiding Citizen
@@bokc_nonpopularsalt1011 Yes, I know what you mean, and I do agree with you. But when the law protects organisations that are willing doing this sort of thing, and the victim has no legal recourse whatsoever, do you expect people to just roll over and take it?
There are limits to the amount of abuse that people can take. I'm just saying that situation would cross my line.
These insurance companies should be sued for fraudulently denying patients necessary care.
A class action law suit.
They have been, as the video shows. They just never lose a case.
Were you not listening?
@@independent-ts6ys Because the judges are bought off. There are such things as standards of care that every medical institution uses. It should make these issues easily prosecutable, but in light of the United Nations Eugenics dictates such as Agenda 21/30, the hospitals along with the insurance companies are allowed lots of slack because they are getting the desired outcome...death (population reduction) and transfer of wealth from strapped families. We will see a return of vigilantiism if our government continues to protect the bad guys. Why even have insurance if you cannot use it? Because we are slaves to the elite class that runs these corrupt corporations.
Government is in on it too...don't think law makers aren't aware. They get campaign funds from these big companies!
Nah, I think they’re all getting lead poisoning at this point
I worked in a doctor's office where EVERY YEAR one of a pair of identical twin girls would get deleted from their parents' insurance policy because *clearly* two kids couldn't have the same birthday.
They must have not heard of the birthday paradox.
Someone needs to sue
Heard of similar with twins born on different days(3 minutes to midnight and 1 minute past midnight), insurance refuses to believe you could have two kids born on sequential days, itq must clearly be either fraud or a mistake.
Same insurance also refuses to let you enter 0 as an age when an incident occurred which made reporting birth defects or conditions occurring before 12 months impossible; which was fine for them, it just gave them grounds to blanket deny any claim because you didn't report previous issues(even though you physically couldn't report it to them because of their terrible system).
can't wait for time when AI rule the world
@@bluedragontoybash2463lol
My grandfather was a paraplegic. He had been in a wheelchair for over 40 years. Like most appliances they wear out. It was time for him to get a new wheelchair. The insurance company denied his request for a new wheelchair. When my mother called to find out why they told her that he had been in wheelchair long enough and didn't need one anymore. I'm not actually sure what steps my mother took, but after she was done with the insurance company, not only did he have a new wheelchair they also provided him with a wheelchair accessible van.
Go momma, what a warrior! My mom had to do the same for my brother lost his leg on our farm an awful accident. This was in Ireland 1970s. The lies, denials, derision, suspicion, refusals would make any grown up cry and throw in the towel. Absolute evil. We never got the wheelchair but finally got him a prosthetic and crutches. Getting a new leg is a nightmare. He mcgivers it until its practically sawdust and glued and screwed like a science fair experiment to dodge dealing with these monsters. I get it.
And you still refuse to vote for Bernie 😂
Call the insurance office, once you're speaking to an agent, demand to speak to the branch manager, they are almost always in office. Wait on hold until the inevitable meeting they are in is over, and go full Karen. Be persistent and get that manager's name and number.
Did they think he fused to his wheel chair and it couldn't be replaced or what? 😂
I "love" the common sense insurances display.
What a woman 🫶🫶🫶🫶
Health insurance is a multi-billion dollar business whose sole source of revenue is preventing their clients from receiving health care.
These businesses aren't doctors, so why are they even allowed to make medical decisions in the first place?
@@Marco_Onyxheart An excellent question. Technically, the explanation is that they aren't making medical decisions, but monetary ones-that they only decide what they're willing to pay for, not what you are permitted to receive.
However, that ingores entirely the fact that the system they've created is so expensive that paying for it is impossible without third-party coverage.
The actual reason is because no one who's in a position to stop them gets elected without taking a substantial amount of money from them.
Yet the government doesn't give money for healthcare only mostly to the army even though they just waste the money and that's one reason why there's scams like this for insurance
Ban insurance, and ban usury again while we're at it.
@@Marco_Onyxheart Because judges that get lifetime appointments with no way to remove them get paid by interest groups of the 30bn dollar insurance companies. No judge is out of reach. See: Clarence Thomas on the Supreme Court
Presently, I am dealing with UHC , "prior authorization", for 2 years on my needing breathing devices for asthma, and living in my third, 24/7 second-hand smoke, SMOKE-FREE, apartment. UHC keeps leaving information of how my doctor needs to apply, or they loose my request, or delay, delay, delay.
I kind of wish I could go to law school to constantly sue insurance companies.
You would fail. They are way too powerful. They have many lobbyists & EVERY politician take money from them guess who was #1, yeah, Joe fucking Biden. He even said if a universal healthcare ever made it to his desk, he would veto it anyway.
I wish you could. Health insurance companies should be legally held responsible for their decisions regarding their clients. Its honestly insane that they aren't. Its no surprise that a company, whose only responsibility is to their share holders, would make patient outcomes secondary.
Or better yet, be an FBI agent and arrest all the upper management of insurers for fraud and racketteering under the RICO act.
Unfortunately there's no money in it since they're never found to be liable. You'll go to law school and end up working FOR the insurance companies in order to pay off the student loans. Quite a system we have!
@@Ge1Ri4He said that there are no laws holding insurance companies liable for the harm they cause, i. e., they are unregulated.
I remember having to talk to my insurance company about a prior authorization I needed for a new medication. The lady on the phone told me that the prior auth was for my benefit, to make sure my doctor *really* wanted me on this medication. I said "isn't that what a prescription already is?"
She did not have an answer for me, obviously 🙄
Medications are fictional. You being kept as a slave?
they act ignorant when they are there to make every effort deny a claim
We don't have Healthcare in America. We only have sick care. My son is paralyzed below his shoulders from a spinal cord injury and suffers with constant severe neuropathic pain when seated. Been begging for a stand-up wheelchair for 4 years so he can get out of bed. Doctors claim that they are not covered by Medicare so they won't even try to do pre-authorization. So Medicare pays for home health, home physical therapy, mental health therapy so he doesn't want to commit suicide from uncontrolled pain, tons of medications that don't work, frequent UTIs, numerous doctor and hospital visits, wound care etc. Something is seriously wrong with this picture? He was also denied myopro hand and arm orthosis that would allow him to use his arms and hands to feed himself and use a computer. Every treatment that is known to be effective for my son's condition has been denied. We figure these denials have cost taxpayers well over a million dollars. And the saga continues to this day.
@@loveusa56 insurance algorithms deny first
I'm sorry you and your son are going through this
All of it
😋🙏🙏🙏🙏🙏🙏 for your son…
It's actually Insurance Management, not Health Care or even Sick Care.
This is what the republican party has done to all of its citizens VOTE BLUE The republicans are the enemy of all hard working citizens
Pursue the prior authorizations yourself. When you call your insurance, ask to speak with the department that handles prior authorizations, and then ask them exactly what the PA needs to say to have the necessary healthcare covered. Then, you can ask your doctor to fulfill the necessary steps. I do this every time I need care and they deny it the first time around.
Back before Lyrica had a generic, my doctor told me it would never be covered. I need Lyrica to be able to wear pants. I have allodynia on multiple parts of my legs. Just a gentle touch, repetitive touch, or cold will set off pain that sort of feels like extremely painful sunburn. I had no choice but to figure out how I could get the insurance company to pay for a nerve pain medication that actually works. I had my meds just a few days later. Unfortunately, you have to learn to work the system.
As a type one diabetic, I’ve got stories for days. When I turned 26 and lost my parents health insurance I went through a bunch of health insurance companies to try to figure out how to get my insulin covered, United was the worst because their customer service reps literally just told me to go to the ER and figure it out. There was nothing they could do when I was down to less than my last vial. Part of the problem is that medicine is so expensive because I believe that health insurance companies get a kickback from the pharmacy benefit managers, many journalist suspect this is the case, but have been unable to prove it as of yet. If my mom hadn’t fought insurance companies for my entire childhood and then taught me how to fight them as an adult I probably would not be alive today. There are some diabetics who are not alive today because they rationing their insulin due to its cost and lack of insurance coverage and/or high deductibles which are common no matter what state you live in or what job you have.
That said, because I wrote a public open letter to United exposing the issue a representative quickly reached out to me and let me know that they bypassed the prior authorization and approved the Insulin. I can’t say this enough you have to fight you have to ask for an exception of policy and it is exhausting and I totally empathize with people who don’t have the time, especially parents who work multiple jobs just to put food on the table for their children who need healthcare. This is why I became an advocate.
This is mass murder. We need a retroactive law which makes it illegal for insurance companies to commit medical malpractice. And the settlements need to include court costs.
Why are you OK with money payouts, those people should be in jail, let them sit in there. Payouts will just be a cost of business
@@PropheticShadeZ I was thinking of all those people who went to court over insurance malpractice deaths, and being told "hey, it ain't illegal." But you're right. Nothing will change until the people who create these policies pay for their crimes. If there's no downside for them, they'll keep doing it, even if it is illegal.
In the US retroactive law is unconstitutional. That said non-sensical denials should be liable for malpractice and severe penalties for these folk going forward would be a good stop-gap measure until we implement proper health care. For profit health care like this is a recipe for tragedy.
Retroactive law is an even more immoral idea than what the insurance companies are doing
Nope, don't allow settlements. Instead it should be a law that makes it hilariously easy to win against insurance companies if any kind of medical malpractice is committed, and make the punishments harsh enough. Then, outlaw Prior Authorization.
I was thinking about something like this: the doctor that reviewed the case in the insurance company has to be published in every approval/denial, and if the company is found to have committed malpractice, the doctor that reviewed has their license revoked, so they're no longer allowed to work at reviews, the company gets fined for 200% of the total cost of the entire treatment (so the company always loses more money would they deny someone unfairly), and everyone from HR (because they hire employess) to upper management that allowed that review's result to face the client will be put on a watchlist such that enough offenses will have them jailed, retroactive and effective after about a month.
This would *immediately* make insurance companies restructure themselves. There's a time window for them to redeem themselves by effectively firing everyone that they know has denied unfairly in the past. There's no point on making it effective immediately because they will just shut down and everyone is left without insurance. The time window ensures that they still run, but they have to restructure. The punishments are harsh enough to make them want to hire the best doctors they can find so the reviews will be fair.
We need universal healthcare like EVERY OTHER developed nation on earth.
Healthcare isn't a commodity, but an essential service. As long as our system is based on profits people will continue to suffer and die.
We don't need "affordable" healthcare. We need healthcare period. Ironically universal healthcare is far less costly and provides better outcomes.
But artificially restricting your access to basic necessities is great for maximizing profits.
But universal healthcare cuts into corporate profits, and big corporations have _zero tolerance_ for a reduction in profits.
Boomers will never vote for it...because THEY have socialized healthcare, but will do everything in their power to stop the rest of the country from getting it.
We're in a developing nation
@@ding9633 Developing those profits boi!!! For our capitalist overlords to spend on what they please.
Went through the same thing last month was denied coverage for a one night hospital stay after a major surgery that ended late in the afternoon, tubes placed during surgery and hanging out, catheter, bloody urine, five incisions, fever, pain, in post sedation state. Payment was denied due to it “being not medically necessary.” The doctor has ordered a minimum of one night stay. Called Blue Cross and explained that what they are doing is denying payment of care hoping we would go away. The doctor that reviewed and denied the claim was listed on the back of the denial letter. I plan to write the medical board regarding the denial. What doctor would endorse that denial. Very stressful at a vulnerable time when you are already weak. The stress of it all could lead to death. Criminal greed. Insurers need to be held accountable and the doctors that are endorsing the denials held accountable too.
"The doctor that reviewed and denied the claim was listed on the back of the denial letter."
Yeah, that's the trick insurance companies use so they're not in violation of the law. They find some garbage doctor who barely graduated and not good enough to practice in the real world, and hire them to rubber-stamp all the decisions their accounts (and now AI bots) make about treatment. Almost none of them even bother to read the case notes, but just say whatever their employers tell them to say.
Honestly I'd call lawyers at that point
A doctor that has a financial stake in endorsing the denial.
As a person who's worked years as a licensed pharmacy technician....thank you for covering this! My first lesson was to learn, they always refuse the first prior auth...you usually have to push it through twice every time. I've been left in tears after having to refuse patients for extremely important medication, like simple insulin for long term chronic diabetic patients smh...don't get me started on cancer meds....I've watched our pharmacy charge thousands per pill because prior auth refused and it was immediately necessary 😢....so many stories I couldn't help ..I eventually got in trouble for paying out of pocket myself and quit.
It takes a special type of evil to exploit vulnerable and hurt people’s health for profit.
Absolutely disgusting.
Try submitting an expedited pre auth, or have your Dr. request a Dr. to Dr consultation, and you can submit your own expedited appeal, esp to send a copy to your state insurance commision. As a nurse you can abstract your own medical record to go with the appeal letter. The person who reviews your pre auth may not work for Aetna and have all your medical records. The legal jargon the reviewer uses is "Based on the information received, criteria is not met"" Also it helps to look up the URAC criteria for your procedure and quote it in your appeal. ( another old nurse)
A special type of evil… you mean, a corporation.
Welcome to America.
Have you heard about the food pyramid and seed oils etc?
we are RULED by them rothschilds rockerfelelrs WEF eta eta..... good peaople RARLY seek pwoer, becuase peaople been tricked power is EVIL NO!.... power is GOD power is GOOD when used by someone not a P.o.S!!!
I went to my doctor when I broke a bone in my foot. He ordered a "boot," and sent me to the hospital to get it. They informed me that if I had come to the ER they could have fitted me, but since I went to my primary, my insurance wouldn't pay. I called the insurance company and asked them what I was supposed to do and they told me their approved provider was in another city, 2.5 hours away. I explained that I had a broken foot and asked them if they were going to drive me there and back, and they told me that I was _choosing_ not to get the boot because I wouldn't drive there with a broken foot.
They didn't explain how I could use the accelerator and brake pedals without involving my foot, but it was still "my choice."
Tell them your lawyer said to call an ambulance to take you there, that he is eager to meet them in court. I bet they either authorize the boot payment or an emergency room visit at your local hospital.😊
@@borountree4539like the video pointed out they're not liable. Threats of suits don't work on them
In my experience, insurance companies HATE any orthotics-type services - that's your boots, your shells, your braces, your casts, etc. - and half the time they need to be authorized because ooo just imagine if the doctor charged you for a cast you didn't need!
@@DamiesEvilTwin if I had hobbled into ER instead of into my primary's office, they would have paid, no problem. My mistake was going to the Dr first.
@@TheByrd I just love calling somebody who knows I live alone and explaining that I can't get there, only to have them ask, "well, can't you get a ride?"
With whom? Santa Claus? My county only very recently got "senior transportation," but then, I only recently became senior. Neither of which was applicable when I broke my foot.
I have worked for a pharmacy that provides high-dollar medication. I was provided with the approval guidelines of every insurer in the Northwest. Dr would send me the patient notes and charts so I could handle getting the medication initially authorized and then maintained because authorizations are only good for a defined time. If I knew an insurer was looking for a specific word and it wasn't there, I let the doctor know. This helped the process, but it is a circus and we are all clowns. They don't want to pay for anything. And medical necessity is apparently subjective.
you are an angel for being proactive! God bless you always!
Deny, Delay, Defend... OmG Luigi was so prepared
This is the story of my life, nothing so lost as amputation, but permanent impairments and prior-authorizations delaying care, ESPECIALLY with PAID insurance (On state healthcare now) caused me to lose an uncountable number of jobs. It now means I'm fully destitute and need to get disability to be able to survive anymore. Health Insurance destroyed my ability to work.
This is the untold cost of our healthcare system. We have people saying single payer would be too expensive or wait times would be too long, but the real kicker is that people waiting until they are on the verge of death to go to a doctor takes us from a treatable sickness, to a crippling disability. Those people cant work anymore when they could and should have just been able to go to a doctor stress free and get the medication and treatment they need to stay healthy and working. I would bet my life savings that it is costing tens of billions a year to keep people from getting the care they need when they need it.
@@TheModdedwarfare3But how's an employer supposed to extract surplus value from my employee's work if they're at the doctor? Shareholders don't care about long-term sustainability. They want immediate value, so if they have to grind employees to be point of being completely unable to work (or live, for that matter) so their stock value can go up a fraction of a percent, then so be it.
@@evilsheepmaster1744 It's worse than that. If you need to keep a job in order to have health insurance, then employers can treat you any way they choose--because they have something you need. Sure, you could leave and go find another job, but many jobs don't come with benefits like health care, or some have a wait before you qualify. Then, you get to start all over with choosing from the ones offered, and whittling down your deductible. You might need to change doctors if they don't accept the new insurance--made tougher if your doctor knows your treatment plan.
My first thought when reading this was how stupid of a system this is to delay treatment and then have your customer unable to work and thus lose the ability to be a customer.
But I worked in insurance for years (not healthcare but briefly in workers compensation and then commercial.) Insurance companies hate when you ask them to think about long term solutions. They want big profits now.
Why? Stocks mostly. Stock value rising means shareholders are happy, the boards happy, and executives ... Well most of their bonuses and net worth comes from the stocks. If they're to get a good payout year to year they need short term gains, not long term business security.
People turned occupy wallstreet into a joke but at least those people knew where to lay a good portion of the blame. Literally gambling on our lives.
I am a public servant now making almost nothing, on medicaid, and I'm happier. But I don't know if I'll be able to afford to not go back into insurance. Go back to working for the devil. Because I need money to live too. And the breadcrumbs are slightly more appealing in profiteering.
Which is why we don't fight it as much as we should.
No, your mental conditions were what affected your ability to work. This blame shifting is ridiculous.
My brother in law had a cancer specific policy for his family. His son was diagnosed with a yolk sac tumor, aka cancer. The insurance company originally denied their claim because the Dr. didn't use the specific term "malignant" in the report. My Brother in law's family had to go back and have the Dr. rewrite the report using the specific terminology required by the insurance company. All this took time while my Nephew had cancer growing in his body. Luckily his story had a happy ending and he is cancer free, but these companies are predatory and evil.
Cancer is fictional. Did you learn that healthcare is fictional in [school]?
I don't understand, if the tumor was benign, the policy wouldn't cover it as there would be no problem to address, so not really sure this is a good example.
@@guy0116 It wasn't benign and the Insurance companies attempt to circumvent their responsibility over semantics slowed down my Nephew's treatment. Seems like a pretty good example to me.
@strangeravenoutdoors4650 how would the insurance company know it wasn't benign without somebody, i.e. the Dr, attesting to as much?
@@guy0116 If they had a Doctorate in medicine they probably would have known. Since insurance companies aren't typically staffed by brain surgeons, maybe they should defer people who know what they are doing. Everyone who has ever dealt with insurance knows this to be true. I had to do physical therapy over a bone spur before I could get insurance to cover the procedure the Dr actually recommended. Can you tell me how stretching fixes a bone spur pinching a nerve? No? Neither could my Dr, yet that's what insurance required so that's what we did. Luckily, I wasn't dying while insurance was having me do nonsense treatments and denying what my Dr actually wanted done. Many people aren't so lucky.
The 80% that just walk away and don't get treatment? That's why. That's the point. The entire business model of medical insurance is that you pay in and they never pay out. That's how they make their profits. That's their purpose.
that's why insurance is universally a scam. we need free healthcare, like every civilized nation has
Together we stand, and divided we fall.
Really insurance in general. Cause if they had to pay out for everything? We'd never have any insurance companies...or at the very least extremely high insurance where the profit margin is baked into cost....including the cost to pay out coverage.
Oh no, if it’s an emergency they HAVE to treat you. Just walk out after that. The hospitals are getting paid for this too. That’s why they tried to charge me a thousand dollars, that’s right $1,000 for a CUP OF ICE WATER. Nah, it’s all a racket.
@@willyboy7141they have to treat you, but for some reason insurance doesn’t have to cover it.
Algo helping Luigi look like a hero with every video
Working in healthcare for 20 years here and this assessment is spot on. Our system is a racket. Period.
and youre a racketeer.
@@chinaboss6683 and you’re a douche
PLEASE NOTE: Always Appeal Denials of Private Health Insurers as the act of appealing places the insured in the category of a 'Highly Engaged Client' who, Insurer's have learned, is likely to continue fighting/appealing which can cause additional expenses, thus the 1st or 2nd appeal has a far more likely chances of success than the original submission.
simple yet effective advice "always appeal"
Dealing with Madre in a nursing home, I'm on my 7th appeal for extending the stay and adding physical therapy. These insurance companies are a scam.
Speaking from experience, this is true.
Good luck with that. My mom is on narcotic pain killers for advanced rheumatoid arthritis and has been responsibly using them since her diagnosis 50 years ago. She has never misused or abused them, never run out early, yet she gets treated like an addict and has to spend time without medication several times a year the last few years fighting her insurance company alongside her GP, rheumatologist, and pain management doctor, all saying she needs it.
Our insurers have teams of people whose sole purpose is to obstruct appeals until the customer gives up. I know people who spent years fighting their insurer and made absolutely no progress.
Physical therapist here. I've seen NUMEROUS firsthand instances of prior authorizations and visit limits set by insurance companies that have actively ruined people's lives. It's the shame of the American Healthcare system.
Right insurance company pays for expensive prosthetic limb but won’t pay for the therapy to teach them how to use it. Then you have a very expensive clothes hanger
This so appropriate today considering what happened to the UHellC CEO in NY
"Your health insurance company has no obligation to care for your health". How f*cking dystopian is that?
The police don't have an obligation to help you either. Just to add more to this dystopia
@--..-...-..-.--.... indeed it does add to it. Luckily I live in a country that follows Peelian principles of policing, something the US should absolutely adopt
What next? The fire department has no obligation to put out fires? 🔥
I've always held that the biggest issue with the American healthcare system is the insurance. There is absolutely no excuse for people who aren't doctors to deny care for something and someone that they know nothing about.
It is because the insurance, like you, has every right to approve or deny payment for anything. I can not force you to buy a bicycle. You can not force and insurance company to pay for xyz.. insurance companies are owned by people. People have rights. There is no such thing as good insurance. It’s all a scam.
Not insurance - private insurance. Every other developed country does insurance - but it's public and it works just fine.
That's not exactly right. I've been in IT 40+ years and over that time contracted for two BCBS. The C-Suite, VPs and AVPs are almost all medical professionals.
@@justasimpleguy7211 But they're not the ones making the individual case decisions, are they?
it's how the country runs politicians have no clue about scientific tops in general yet they write laws on it. It has never made any sense to me.
I’m a pharmacy tech and I’ve seen prior authorizations for the stupidest things, and sometimes patients have to get prior authorizations for medications they’ve been on for years already. I just wish more people knew that we hate insurance companies too, we want you to get your medications on time :(
My insurance forced my pharmacy to switch my medication to a generic because otherwise, they wouldn't cover it. Not only was I not informed of this, but this was last week and I already had prior authorization for the medication in question. The generic doesn't work (psych meds). It's like they're trying to kill people.
then offer the common meds for less! this will reduce the risk of triggering a prior auth for funding. get rid of your Profits also, you don't need them anyway, LESS profit taxes in the process.
The Lawmakers could fix the problem, if they Had the Will, to do it.
@@maximilian19931the pharmacists and techs have no say in drug costs.
@@johndoe-ss9bz If they weren't already sold out to big pharma and the corporate thugs ruining our country.
Every prior auth I have ever sent in, or my doctor has sent in, has been denied since I moved back to MN. And when you contest it, it gets denied again. It takes a full-time hospital admin employee to fight these rejections and get them approved.
To all those over age 65: Don't sign up for Medicare Advantage plans unless you like prior authorizations! You won't have Medicare anymore- you have insurance with an insurance company!
I have 0 points lol worked for Opers wow 😮
After many years of working in home health, I whole heartedly agree.
💯💯
I used to work for a Medicare advantage company. Only lasted about 6 months before I couldn't take the soul crushing anymore.
oh, and you still have Medicare, which also costs money. So now you have a double headache.
And you can’t go back to Medicare either. My MiL did this and they have run her ragged trying to get a life necessary surgery
'Prior authorization' is what bankrupted me at age 25. I had an emergency cesarean, followed by a week stay in the hospital due to complications from the surgery. It wasn't pre-authorized to have this emergency while trying to push out a kid for 2 days.
Now, I'm 38 and can't get my adhd meds without getting a prior authorization every 3 months from my doctor. It's DISGUSTING. I have to take time off work, losing $$, to keep my meds - they need to make sure my adhd hasn't magically been cured.
The prior auth for adhd meds is because they're a controlled substance. Not because they expect you to be cleared. It's to make sure you aren't a drug dealer.
@madmagdelena Every 3 months for the rest of my life, with my limited refills? I can't refill until I only have 2 days' worth of meds. There are other controls in place to prevent me from selling my meds and becoming a drug dealer. Prior authorization causes me to lose $$ from taking a day off work every 3 months for that specific appointment, plus gas to get to her office 1.5 hours away. Don't forget my co-pays to see the dr too.
But yeah, sure, it's that 'prior authorization' that keeps me from going to the dark side and dealing 🙄
Prior authorization is nothing but getting your insurance company's permission to follow your doctor's orders - giving them an opportunity to deny coverage, find cheaper options, or find YOU at fault for your health. Otherwise, why would I have needed 'prior authorization' for my emergency cesarean? Are babies controlled substances as well?
@@cryschanel32 I have adhd and agree with you and have to do the same checkups every 3 months. I'm just staying the reason for them even though the reason is hella stupid.
@@madmagdelenano, that's not why. Most of this stuff can be traced back to the employer if you receive insurance thru work.
@@itsme3k That's exactly it!
I worked in the health insurance field for nearly a decade. From working phones, investigating cases, communicating between doctors offices, trying to resolve cases, and even creating health insurance plans alongside CEO and CFO and pitching it to employers and tribal leaders.
Our for profit health insurance is absolutely hostile to the people wanting to receive service.
In the light of recent events, we need to hold these CEOs accountable in court of law. Doctors should get to decide what is medically necessary procedure not insurance companies who have never picked up a medical book in their lives.
Congress should pass a LAW. ANY medication, procedure, surgery, or device that YOUR DOCTOR says that YOU NEED, MUST BE COVERED BY YOUR INSURANCE! PERIOD.
What if the doctor is committing fraud?
@@johnrussell267So what ? Are you saying the patient is a fraud or participating in fraud also ??
Can you have one without the other ?
Easy solution is asking for an itemized statement from the Dr.
@@jessiejohnson6424 Asking for an itemized statement from the doctor is literally what a prior authorization is. 😆
@@johnrussell267 No it isn't.
The subject was fraud.... I gave the answer to that subject.
Plus an itemized statement is for after the surgery or hospital stay. Therefore it is not used as an prior authorization.
@@johnrussell267 even with the insurance companies working the way they do lots of Dr. still commit fraud. It’s usually caught by the FBI or police, though not the insurance companies themselves. So I’m assuming more supervision in the hospital and by law enforcement would stop that.
Legalized fraud, yo.
Also, essentially practicing medicine without a license. They’re making medical decisions but they aren’t doctors
You described the whole economy very concisely!
@@JeremiahTrue they hire real doctors to make the denials. Drunk pill addicted doctors.
All of this is quite common, and as Whistleblower Dr. Linda Peeno testified before Congress, medical reviewers get raises and promotions based on the dollar value and volume of claims they deny. In some cases, denials are a death sentence.
This is nothing new, Aetna and many others paid settlements over purposeful arbitrary denials. The processors were paid bonuses based on the how many denials. I remember cases from ~15 years ago. Can't even google them, there's just too many
Yes I saw that movie 15 years ago at least . I think she worked for Humana.
Thank you for bringing light to this immoral practice by health insurance companies . After 32 years of being a retail pharmacist , it was the most frustrating time wasting part of the job ~ dealing with the insurance companies.
We need to push for federal law on medical insurance companies to where they can be held liable for negligence when it comes to proper treatment that's been needed and is being denied!
The thing is, most people at the congress are in favor of this.
@MrPenetroso well if they were on the same kind of health insurance that they would have to pay for out of their own pocket like the rest of us, then maybe they would actually be doing the right thing
I signed up for a Medicare advantage program after double and in some Triple checking that all my doctors were covered and my medications were too. Turns out 4 of my doctors and multiple medications were not covered. Not only was I unable to go to the doctor it cost me thousands of dollars to pay for medication. To top it off I battled 9 months to get out of the program. They changed what I had to do 3 times to be unenrolled. Even then they claimed twice they did not get my unenrollment fax. I used two different fax machines. The third time I faxed I used a government agency that one finally went through. It turns into a year of nightmare, and endangered my life.
Yeah, I've heard all the jibber jab about the Medicare Advantage program, but the one tell is it isn't medicare at all, it's private insurance. Health insurance is a scam. That's why they make it so complicated. It's a scam. The medical codes? Used to deny care.
Medicare Take Advantage plan.... How do they get away with this bunk?
That's exactly why I refused to get an Advantage plan. You're so much better off with traditional Medicare.
This is why I am glad for my union backed health insurance. I had cancer, and it was handled properly.
I think the primary problem, though, was just barely touched on, and is a severe problem in everything in the world today. Companies, no matter what their base industry is, are catering to stockholders first. Instead of providing the service they are ostensibly created to provide, they are extracting value for an essentially uninvolved third party. This is directly taking money out of the pockets of the people who need that service, and transferring it to "investors", who are expecting double digit percentage growth year over year.
And since the US is a capitalist dictatorship, that will never change.
Imagine what your union could get you if they didn't have to fight to get you decent insurance. Better pay? More time off? Better working conditions? Better C-Suite people?
Eh depends on your specific union I guess. Our union insurance isn't worth the $30k we pay for it every year.
The problem is that an insurance company's purpose is to generate value for the shareholders, not care for their insured clients.
The clients are just the source of the money and an annoyance when they need money from the company for a medical issue.
@@anonymouse9833 That's a terrible insurance. The most I ever paid was $12k annually for a family of five, and my insurance now is part of the contract at no cost.
I was denied prior authorization for septoplasty surgery. My ENT had to fight with medicaid to approve my surgery even though i physically could not breath through my nose and there is a multitude of evidence that points to mouth breathing causing stroke and other conditions. I was eventually approved but not without a fight. I pray for those still fighting prior authorization to get the care they deserve.
I am a physician and in 2018 I had 6 weeks of vertigo with blurred vision, nausea and vomiting.My BP kept shooting in over 200 systolic. My 3rd ED visit I could not stand up without falling, I was admitted after the ENT doc identified papilloma. The CT was normal but opening pressure was slightly elevated. I was hospitalized because of elevated BP that could not be stabilized in the ED. United healthcare denied payment to the hospital. I appealed and they still denied payment stating my condition is to be expected in a 60 some year old woman with hypertension. I called NYS dept over the health plans. I was told nothing they could do because I appealed and got a final denial decision from United Health Care. So that was it. No recourse. Imagine what our poor patients go through! This is ridiculous and criminal.
Papilledema not papilloma
Congrats. Health care is a privilege not a right.
@@adamjankowski4315 They're just upset that they pay people to tell them how much they're owed instead of just paying for the care.
I am California and thought laws and agencies were bad here... until I encountered NY.
I am convinced that EVERYTHING in NY, whether it be healthcare, car insurance, or real estate law (probate) , that is government related or regulated, IS 100% CORRUPT !!!
I can tell you EXACTLY what it's like.
Chronic pain that goes untreated. Nearly passing away in the ER from blood loss because you can't afford proper care for Endometriosis, TWICE. A hysterectomy, finally getting the proper diagnosis AFTER permanently loosing your fertility and ability to ever have a baby. and Stress stress STRESS and in my case, an overwhelming urge to try and see how far you can fly off the railing of a bridge before hitting the river below, knowing you'd be denied treatment for severe depression.
I dealt with insurance and their prior authorization, and it almost killed me. I had to wait a year for a necessary surgery. It was so outrageous that my doctor closed her practice.
Yes an excellent Dr I saw, people from all over came to see him because of his credentials & knowledge! ❤ He sadly told me he would be stepping out under Obama's new Healthcare plan that cuts the throat of true providers! They support the doctors that are the pill pushers though! Seems intentional destruction of a society to me!
Surgery is fictional.
"We don't want to dip into our billions-sized wallet to fix problems because sometimes, rarely, we lose a few cents on fraud."
Is what I feel prior authorization boils down to.
Prior auth is about corrupt sociopathic money ADDICTS being given a GOVERNMENT-FUNDED system or service to run. You know, like healthcare, war companies, big pharma and vax companies, etc. Then they OVERBILL whatever they dare, providing massive exec salaries and huge profits, because the corrupt liars all know that government money is FIAT, it is NOT "our taxes" - they just need us duped so they can keep embezzling.
This embezzling scam is "privatization", also called "public-private partnerships" and other cloaking terms. NEVER let the liars get away with saying "private" health insurance, that is a blatant LIE.
And money ADDICTS will keep getting as much of their "fix" as they can, letting people suffer and die rather than doing their DUTY.
And they can do this because of CORRUPT GOVERNNENT, since government issues the money and makes the laws.
The US sociopaths have been taking over countries since before WW2 to EMBEZZLE from more and more governments via "privatization". The reason such entities are typically on the stock market is because Wall Street knows that profits are guaranteed via fiat government money! In fact, it was two Wall Street lawyers, the Dulles brothers, who were appointed to help take over many Latin American countries as the lying US embezzlers began to build their corruption cartel long ago - the Dulles brothers were appointed as head of the CIA and as Secretary of State.
So the criminal gangs in government just PRETEND to fight each other as they collude to keep this massive embezzling scam going.
We have called about surgeries that were paid for but never done and insurance said they didn't care.
Then our pulmonologist told us our insurance will deny respiratory supplies until the person dies if they can
It's even more ironic when you realize that the same people that control our insurance companies also own the money printing machines.
When fraud happens it is not made by the small guys. If there is fraud it is done by organized crime and made on masse.
@@goodolearkygal5746I think the whole death panel fear mongering done by the right has come to fruition on their preferred method of healthcare.
Crazy that this video is being recommended after the "incident" that happened a few days ago
We boosted the algorithm a lot. Boost it more please.
Imagine my surprise and great comfort during my first pregnancy when I received a letter from my insurance company notifying me that I’d been approved to GIVE BIRTH to my child. I hadn’t realized that it was optional at that point.
yeah GOP lawmakers push real hard to ban abortions yet refuse to make giving birth an easier process on the wallet and mind. at this point ALL OF US should just have kids and not pay them anything. they cant take us all to court and jail.
Did you respond with violence at the mere suggestion?
The end game is the insurance company forcing you to abort during the third trimester and then not paying for it.
I'm joking of course, but I've seen other absurdist nonsense jokes become reality lately.
@@CreativityNull Many a true thing said in jest
Sometimes there is a waiting period for a pregnancy if you have signed up recently.
My dad was a small town GP and surgeon, his patients were his friends and neighbors... and those bogus insurance companies killed him. When HMOs first came out, every day he'd come home and say those companies wouldn't let him treat his patients as they should be, he was disgusted and furious and stayed that way until he had a stroke from that stress.
Private health insurance companies are in the business of making money not insuring healthcare to patients, it's capitalism 101.
Rather Kochism 101. Neoliberalism holds that promises of payment for health treatments, medication, and equipment are to be sold like cars, real estate, or burgers. But the rest of the 1st world considers health care one of the public commons, wherein the idea of running it like a corporation is off the table on principle.
The very name capitalism should raise red flags to capitalize on others
Dictionary example "capitalize on an opponent's mistake"
Which is why medical care should be considered infrastructure to be administered and maintained, not trade goods to be monetized.
Capitalism 101 usually says profit comes from providing a good or service that someone else wants. The more the government mandates involvement, the less incentive there is to actually provide that service.
you clearly don't understand what capitalism is @@IcicleFerret
So much fraud at the expense of peoples' lives! I am extremely outraged!
How are insurance companies allowed to do business like this?! How is this legal?! How long are Americans going to put up with this?! We need to scrap this whole corrupt and evil system!
Obama made it legal when he made it illegal to not have health insurance.
Insurance is only the start of the problem, the US healthcare system is one of the more messed up systems on earth.
I'm convinced it's just propaganda brainwashing. As long as you can convince people that capitalism is the best possible system, they will defend absolutely everything that comes out of it.
How? The Affordable Care Act allows them to. It is a law written by the insurance lobby.
@@chiplangowski3298 pretty sure just about all of those problems predate the affordable care act. The insurance lobby just kept those issues from being fixed.
all medical decisions should be ONLY up to our doctors and ourselves, not non medical personnel or "doctors" that the Ins companies pay.
And not government bureaucrats who have no stake in the game. Yes, I'm talking about women's healtcare and trans healthcare.
@@MonicaNikel ♥preach!
It might shock you, but that's exactly how it is. You and your doctor make all the medical decisions - the insurer only decides on payment.
i was uninsured for awhile, sprained my ankle badly and needed an xray to make sure it wasnt broken. took them all of 2 mins to do that, and gave me crutches. no pain meds or a wrap or anything. just the xray and crutches and they wanted to charge almost $1,000.
my friend had a weird episode where he passed out unexpectedly (as in not drinking or anything that would maybe cause it) so we called an ambulance. at first when he woke up, he refused to ride in it because he knew he’d be charged so much money. HE HAD PASSED OUT DUE TO AN UNKNOWN REASON AND INSTEAD OF BEING WORRIED ABOUT HIS HEALTH, HE WAS WORRIED ABOUT THE MONEY. we had to convince him to go and get checked out.
insured or not, our system is beyond broken!!!!
This is why I don't have insurance. It's simply not worth the hassle. There are deep discounts for self pay and they can't refuse a payment plan no matter how small. I don't need prior authorization for anything.
Only $1,000 bucks?! They charge $3,000 just for a look over today.
@@MrTwinkieeater _"...they can't refuse a payment plan, no matter how small."_
Are you sure about that? That doesn't sound correct. Do you have a source for that?
@@Milesco to be clear(er), they should negotiate with you about how much is to be paid in installments. Non profit hospitals legally have to offer financial assistance. Look up the No Surprises Act.
Last year I stepped on a nail. Got a tetanus shot and an xray to make sure the nail didn’t break off in my foot. Took maybe 40 minutes. I was billed almost 4k.
Luigi Mangione should be acquitted or pardoned, and universal healthcare needs to be introduced
I was denied admittance to a pain rehab program due to "insufficient evidence" that the treatment was needed. I asked my insurance for the paperwork / name of the doctor who made the medical decision to say no to my treatment modality. They magically approved my treatment 2 days later....and still never gave me the doctors name at the Insurance company that was making medical decisions without seeing me as a patient.
I became disabled as a result of this exact practice.
They denied surgery I needed 3 times because the injury I had is called a "sports hernia" for some reason and according to them hernias are cosmetic surgery.
For the record, a sports hernia is a torn tendon. In my case it was in my groin so I walked in it for 3 years while fighting the insurance people.
To this day every step is excruciating.
Hernia...a cosmetic surgery...
That's unfortunately a new one for me.
How is a hernia a cosmetic surgery
@@jormungarden5816 that's a good question. Unfortunately the insurance company never had an answer.
Nationalize health care now. Make congress and the rich use the same system the rest of us use. Standards would immediately rise.
so true.
Sound like communism
@@Mr.H333 Only Charles Koch and a handful of United Health, Blue Cross Blue Shield, and Cigna bribery liaisons would that kind of McCarthyism on you or me.
LOL. That isn’t going to happen in next 50 years. Healthcare and insurance companies give millions in money
@@Mr.H333 Then it sounds good.
My friend worked for BC/BS in the 1970s. She and 9 others were in a board room with 100 claims each. In each "round" the worker fought for their claim. Only 1 claim per round was approved. So only 10% of the claims were initially paid. She quit after less than a year of working for BC/BS due to stress. She also worked the customer service line and then would advise customers on how to get that denied claim paid!
My mom worked for BC BS in the 90's and said same thing.
This is EXACTLY what Aetna has been doing to me for over a year. In 2019, a tumor was found in my spine after years of treatment for spinal problems. After new symptoms like falling all the time, pain radiating down my legs, and extreme weakness in my legs appeared, my Dr has submitted prior auth paperwork (each more detailed than the last) for an MRI 5 times. For more than a year now, they have repeatedly told him that they need more information. Ironically, because they're my insurer, they have ALL of the info that they're requesting. In another ironic twist, I've been an RN for 27 years. Thanks medical industry that I devoted my entire adult life to. You are AWESOME!!!
Oh well. It isn't right, but what you do is even worse. Covering up iatrogenic injuries and deaths your whole career. You lie to the patient (if still alive), lie to their families, and in the records. And never bothers you even a little bit. You just bury your mistakes as if we're trash. May you get all you deserve.
Thank you. You just made up my mind to turn down this Aetna Medicare Advantage plan that my former employer tried to force me into. I'll just bite the bullet and pay the premium for a Medigap plan, and keep original Medicare.
Aetna is one of the worst.
I am former nurse; used to be case worker. Case workers help patients navigate insurance, healthcare system and make sure they get meds and resources in a timely manner. I found it silly this job exists to solve a problem that insurance companies make for themselves. Insurance and healthcare is supposed to help but it was one of the most frustrating job ever. Like pulling teeth just to get what patient needs
@@argusfleibeit1165Good Choice! Because when you get sick you need REAL health insurance!
These insurance companies should be fined for practicing medicine without a license. There should also be a federal law stating the doctor gets final say
This is one of many examples of how white collar crime CAN negatively impact people’s lives; even to the point of actual death. These companies need to be served actual justice through jail time and NOT easily payable fines.
Yea this has affected so many people. I had a hysterectomy and was sent home the same day, at 9pm at night no less, bc my insurance wouldn't cover it dispute my bleeding disorder. When I went to pick up my pain meds, the pharmacist says, they want a 48hour prior authorization, or you can self pay. Like I could go without pain meds after having surgery! What!? I had the authorization for the surgery but not the medications that follow? I had a bleed just like I told em when they sent me home I said it's too soon! I was back in emergency room with a 106temp, septic, and 2 liters of blood in my belly. I had to call my child and tell him I loved him bc the doc gave me 10%odds of making it. I woke up on life support. It was awful.
The US health care sysytem spends more,covers less, and has more negative outcomes than any other developed country. These wouldn't be issues with a universal coverage plan. Its shameful, this country cares more about money than people.
You didn't happen to have either Endometriosis or Adenomyosis, did you? 😢
I had both and I know what dealing with those kinds of issues are like.
I retired from decades of practice as a psychotherapist. Insurance companies put providers and patients through nothing less than bureaucratic torture on a daily basis. I am so glad to be out of it all.
This another good reason why I loathe my species. If I took out my telescope and found a large asteroid that no one else saw but we would have the time to destroy or divert it? I wouldn't tell you. I wouldn't tell a single one of you.
Psychotherapists are fictional. You lie and/or are tortured into appearing to lie about slaves including yourself?
I am currently practicing and don’t accept insurance.
You are ruled by those you cannot criticize. Most of our congress has dual citizenship, all with one specific country. To mention that they created laws in America that directly oppose the laws they make in their own country would be considered anti - "s e met ik". Just follow the money and laws. The truth is in plane sight.
How does that work though? Do you do like a sliding scale for those who can't afford@@davidfromky
Healthcare should be nationalized. Medicare for All for just single payer for everything.
In what way would that address the problems brought up in this video?
@@janetamerasinghe7824 No profit motive. These "healthcare" companies employ teams of people, especially lawyers, to come up with entire systems that support the denial of claims. They do this to save money. Because it's all about money to them, not at all about care. A public system would have to be concerned about costs, but not about paying CEOs nor about being sued by shareholders.
I'm all for a free market but there is just too much of a conflict of interest to not. I feel the same about jails and prisons.
@@janetamerasinghe7824it’s a lot harder to steal from the government than it is from a sick/injured/dying person.
@@sixteenornumberSchools too. The existence of private schools incentivizes the reduction of public school services and increases social stratification. Utilities are pretty sketch too.
This info should be comes viral, in a way people can be educated especially young generations
Most shocking of this story is here is why the insurance company is medically necessary. They are getting in the way of health care.
That is our own fault for wanting something for nothing. We didn't want to pay for our office visits. When I was a kid you paid the doctor out of pocket, and doctors came to the house. There was no huge company between you and the doctor that required billions in extra dollars to make it's massive profits. We did it to ourselves out of our own greed. We are the ones who signed up for that insurance so we wouldn't have to pay our doctor bills. We were so stupid we actually thought we could get something for nothing. Insurance is now wrecking the veterinary business the exact same way.
@@coop5329 It's greedy to want medical care without a financial hit?
The point of insurance is that you pay a predictable amount, and it makes sure you never have a giant, unpredictable cost that you can't account for. And it pools many people's money together to use for that. It's a lot like taxes.
If you insist on seeing human righs as transactional, there's still a gain from it. People get health care and in return, they are able to perform their jobs better.
School and roads are provided for free because they benefit society as a whole. Are they "wanting something for nothing"?
@@coop5329Wanting something for nothing??? The last I checked, we pay a monthly premium. I don’t know about you, but my premium isn’t what I’d consider cheap, or nothing. We are expected to pay that premium, religiously, and on time. Why then, are they allowed to throw in time consuming, unnecessary, steps, by some clueless layperson that they hired??? We went to our doctor, who has years of education in medicine, to be treated. No Joe blow should even be involved in our doctor’s decision!
@@coop5329why the FUCK are you so determined to defend a system that treats HEALTHCARE like a privilege ????? why do you WANT people to pay these absurd out of pocket costs for treatment that you need or you will quite literally die? how dare people ask to be treated regardless of their ability to pay and not be left to fucking die!! you’re content to put a price tag on someone’s life and as a healthcare worker i think that world view is extremely fucked up. you think i care if someone is poor when they go into septic shock ????? no because i’m not a fucking sociopath 😭 you shouldn’t have to be able to afford to pay the full price of expensive ESSENTIAL treatments just to earn the right to continue living. that’s super fucked up, man.
Blame the politicians that make the regulations.
This is why I always told everyone that Affordable Healthcare will never come out of pushing for more affordable insurance. Their goals are just too different.
Just like “affordable housing”… same scam
@@07wrxtr1 that is mostly because the construction contracts are out to make huge sums of money building and selling the produced for as much money as possible. Also their clients are the wealthy who need another 10 realestate assets to lounder their dirty money and reduce tax burden.
Everything they label means the EXACT OPPOSITE of what they label it. Remember that.
It's intentional. One might call it Orwellian.
I’m a provider and became friendly with one insurance company authorizer. She shared that one day a week, they would blankly deny all prior authorizations for a day. They know that statistically, some people will just give up.
Dear god
My daughter, mom and husband all died because of denied medical procedures. For myself with numerous preexisting conditions insurance is a necessary evil.
Private health care is primarily for profit as such the share holders interests / profit is uppermost not the customers or the employee . It is the nature of capitalism .
🤮
So? 🤨
@@Jessica-gy6kr So people die, even though they have paid their premiums.
@@willieverusethis your premiums are their potential profits /income it is their legal duty to maximise profit and minimise costs . It's the nature of capitalism profit is its god it demands human sacrifice and suffering .
@@odinallfarther6038it’s NOT the nature of capitalism. It’s entirely possible for companies to exist and not be publicly traded. There are even companies that practice profit sharing with their employees.
You should have just started with caused by a "McKinsey Recommendation" then I would have just filed it under PURE EVIL.
Companies just use consultants to take the blame for ideas that would be unpopular. The evil is always the company management.
This is actually the second video that I've watched this week which connected McKinsey to unethical business practices.
@@royalfool0230 I was thinking the same thing. This is a companion piece to John Oliver's very well needed expose on their horrific practice.
I’m surprised no lawyer tried to get them for practicing medicine without a licence, after all, it was a medical decision.
Lawyers are fictional. Healthcare is fictional. You learned how to lie about slaves in the death camp system in [school] right?
You realize they hire licensed physicians to deny these, right?
@@LeeHawkinsPhotothey don’t though. They might have physicians setting guidelines, but the people processing the authorisations are not doctors.
Members of the Senate and House are mostly lawyers.
@@feanedhell they do have actual medically certified doctora that review these cases if either A) they require a higher degree of review or B) its gets appealed high enough or the members provider requests a peer to peer review. system sucks and needs reform, but you shouldn't spread misinformation
I had been denied for medical device for a broken knee relating to workers comp. I paid for out of pocket myself. And insurance kept delaying my case as long as they could for over 3 years, even having their doctors falsify reports. Only when i contest & videotape exam did they finally approved my claim!
Prior authorization does not work for the patient. The accuracy of the video is spot on.
Its mind blowing to me that lawyers and bureaucrats think they know better than doctors. Never has a company worked SO HARD to avoid doing what you pay them for.
The squeaky wheel gets oiled. I had a situation with insurance giving me the run-around. After a short bit, I just called the insurance fraud line and they got me in contact with someone who straightened it all out in less than 24 hours. In a nut-shell it was "ohh, this is what was supposed to happen, that's why it was denied". Don't be afraid to escalate. Remember, insurance fraud includes insurance companies not covering what they should cover, and insurance fraud is taken seriously(federal crime). If they're delaying too long, just make a big stink about it.
OMG these stories are horrifying those insurance companies are evil to the core.
Back in the 1980's-1990's I was an insurance biller for both Medicare/Medicaid (as well Medi-Cal) for the state of California, for doctor offices, hospitals, clinics and ambulance companies. It was my job to make sure that PA's were properly written up with ICD-09 codes to backup the requests for services, DMEs, etc needed. We knew about the three D's of insurance denial for turnaround delays (to make the out of pocket costs double and triple in time delays) so insurance makes the money they were having to pay out. However this was before the now "perfected", delays also brought on in larger numbers because more and more procedures, Tiered Drugs (artificially increased often times) resulting in non-coverage, and less DME covered without a PA.
The bottomline? Make patients pay out of pocket for as much as they can. It's a mess. Dual eligible patients (and I am now a member of this club) also known as "DSNP" the highly vulnerable disabled elderly, long term care elderly with medically fragile issues, are NEVER supposed to pay out of pocket for anything (a rule set up by Federal laws and CMS), but are being squeezed to do "just that": pay out of pocket, since they are making the client responsible for getting the PA requests, tracing them through their clinics to their insurance, and then back tracing the PAs to Medicaid.
The doctor's offices are now telling patients to use "Good RX" or other plans so they can reduce their costs of medication (or other medical buy-in programs to reduce DME costs, etc) and pharmacies are also demanding credit card information on the clientele for "concierge" services to include for delivery, or door services when the patient is BED BOUND. Which is illegal as well. These additional fees make it impossible for those of the greatest needs to basically be at the mercy of the lack of concern by doctors (look at Optum buying out doctor co-op offices, pharmacies, etc which is a branch of United Healthcare).
My story is simple: I can't get the doctor's office to allow me to talk to their PA department, and the doctor writing PAs that cannot get covered because they don't included diagnosis codes or rationale reasons for patient need. Your story of Kathleen has become almost "typical" and CMS teeth have been removed to place sanctions against the states who violate their laws and her story broke my heart. In the end, we are seeing the worst of insurance. My husband who has cerebral palsy and walks with closed arm crutches, cannot get crutch tips covered by our insurance, even with a bad PA. The doctor asked for the tips, without enough information like mobility, ICD-10 codes, etc. took 9 months of daily calls to get his crutch tips. Cost? $15.00. Why didn't we just pay it? Federal Law dictates that he is not allowed to pay out of pocket for real reasons: double dipping of suppliers asking for the $$ from patient, and then getting Medicare/Medicaid coverage. It's fraud. In the end, it became negligence for us and Raymond was artificially house bound because he can't WALK without these crutches.
Then there is a larger issue with insurance not covering life long conditions (thyroid being one, Diabetes another, etc) for medication without periodic demands of PAs that are absolutely frivolous: there will be at no time when the patient will suddenly "get well", so why harass the doctors and patients taking up 60 or more hours a week trying to push through costs that the medical managers don't want to have covered? In the end, I find that no one benefits (other than the corporations) for these needless delays and as you state, the medically necessary tests....It's a waste of patient time, doctors, offices and pharmacy hours.
Single payer system would simplify all these conundrums. Thanks for listening, I know this is long. Both of us have found we receive substandard care because of corporate greed, mistakes in pharmaceutical filling (some drugs do not work as generics), and delays in very important medications simply because of spending hours NOT filling scripts by sending paperwork to wrong offices, that in the end the burden is on me to fix all these errors, since I know what needs to be done and isn't.
Such valuable information! Thank you!
I looked up dsnp and found it under medicare advantage. I already heard how Medicare advantage trys to screw you out of care to lower their costs.
Single payer systems are a monopoly and would make prices worse. Sorry, a single payer system is not the answer. We'd end up with all of the same problems as now, with the "system" keeping as much money as it could for itself. Insurance is a scam, I'll give you that.
Are ICD-09 codes the same thing as CPT codes? I was able to find a list of CPT codes to verify against what my doctors office was billing, and let me tell you it was not easy at all getting them (plus they change them all the time phasing some out or changing them). I was amazed/mortified by how many mistakes there were that triggered denials. I usually didn't see them because they would go back to the practice and they would have to correct them, but that system is a mess and it is no wonder that so many mistakes are made.
@@IcicleFerretno, actually, because the prices would be regulated. That’s part of the reason why healthcare is so much cheaper AND more effective in Europe than the USA.