*rant* insurance companies and the US healthcare industry can kiss it

[Homerboy]

My kid has struggled with mental health issues for the past 6+ years. It's been a really rough road for them (and us) but we're getting by as best as we can. That being said, after countless therapy sessions, different medications etc etc, we've finally found a program that seems to be making some inroads to helping them manage their days and their issues (still early, but it seems there's been more progress in 2 weeks than in the past 2+ years of other therapy).

The bad news is, a lot of therapists just flat out don't take insurance anymore as they do nothing but deny claims, struggle with getting their money etc etc. So, if you want care, you basically have to pay out of pocket because the insurance companies are assholes and rather than provide you and your family that you pay them WAY too much for every month, they do everything in their power to NOT give you services you deserve.

So now I'm looking at two sessions a week at $140 a session for (at least) the next 3 months. It's at the edge of our "affordability" and certainly takes away all of our "extra money". But rest assured, I will still be paying my grotesque monthly premiums to United Health Care for basically nothing.

It's infuriating and deflating. You just can not get ahead.

/rant

PS: I have a $2,300 bill from an ER visit that my son needed over the winter while he's away at school. Ridiculous.

 

[sandorski]

Not sure why they exist.

 

[Homerboy]

Not sure why they exist.

To make LOTS of money

The health insurance industry continued its tremendous growth trend as it experienced a significant increase in net earnings to $31 billion and an increase in the profit margin to 3.8% in 2020 compared to net earnings of $22 billion and a profit margin of 3% in 2019.

 

[Shmee]

Yeah I don't like insurance. Not a big fan of hospitals/clinics either. If I were you, I might cancel your insurance plan, if it is doing you no good.

 

[ponyo]

You're preaching to the choir.

 

[nakedfrog]

I've had extensive dealings with them between my ex's medical issues, my son, and my own transition-related care, and yes, it's very, very, very clear that profit is king.
Currently I have an ongoing procedure that's explicitly covered in the documentation from my insurance, submitted by an in-network provider, with the correct diagnosis code and CPT code (things that as a consumer I shouldn't probably even have to know), and it's rejected on the initial claim every single time, and they have an assigned customer service agent watching my claims (because I was a squeaky wheel) who goes in and marks it for re-processing, and then it gets paid out. I asked a number of times if we could skip the whole "rejection and reprocessing" step since it sure seems like a waste of time, but I've been told that's "just how some procedures work". This is just one example.

 

[Captante]

I've said it before .... healthcare in America as constituted is a total disgrace and makes this country kind of a crap place to live unless you can afford to pay for treatment completely out of pocket. (and considering our prices only the MEGA-rich can really afford to do this just being "well off" won't cut it!)

"For profit" medicine is an experiment that has failed when bankruptcy has to be the plan to handle any serious medical expense for a normal person often even WITH rip-off "health-insurance".

 

[herm0016]

yep. My insurance would rather I go blind than get a 50 dollar tube of eye ointment.

 

[ponyo]

I've had extensive dealings with them between my ex's medical issues, my son, and my own transition-related care, and yes, it's very, very, very clear that profit is king.
Currently I have an ongoing procedure that's explicitly covered in the documentation from my insurance, submitted by an in-network provider, with the correct diagnosis code and CPT code (things that as a consumer I shouldn't probably even have to know), and it's rejected on the initial claim every single time, and they have an assigned customer service agent watching my claims (because I was a squeaky wheel) who goes in and marks it for re-processing, and then it gets paid out. I asked a number of times if we could skip the whole "rejection and reprocessing" step since it sure seems like a waste of time, but I've been told that's "just how some procedures work". This is just one example.

Initial claim rejection is a feature and not a bug. How many do you think have the spare time or the know-how to fight back like you?

 

[Homerboy]

yep. My insurance would rather I go blind than get a 50 dollar tube of eye ointment.

It's not even so much that, it's that it's SO BAD that many therapists are just flat out not even accepting insurance anymore. So to see them you have to pay direct out of pocket. I can't even fight/complain to the insurance company in this case. The doctor (rightfully) is sick of dealing with insurance themselves and now to get the care my kid needs, I basically and forced to pay twice.

I'm just fucking sick of it. My wife and I make good money, live modestly, and ENTIRELY due to medical bills just can not truly "get ahead"

 

[MrSquished]

Yeah this country is a disgrace, an absolute disgrace when it comes to so many social issues, of which healthcare is a big one.

I am diagnosed bipolar and take medication for that and insomnia, and essentially no therapists take insurance ,and I am quite sure my once every three month psychiatrist appointments are not covered. I'd have to submit all the paperwork and I'm pretty sure from what I read in my silver level policy, it's not covered. As in unless you are in a ward or something, there is no hope for mental healthcare coverage. So I haven't bothered. I just pay out of pocket for everything. Just my one mood stabilizer and sleeping pill, that's a $10 co-pay.

 

[Captante]

I'm just glad I'll be eligible for Medicare in roughly 6 more years.... hopefully I'll survive until then!



AND the travesty is that unless you buy expensive "gap" insurance Medicare doesn't fully cover a whole lot of stuff, however usually it's the care-PROVIDER (Doc and/or hospital) that gets screwed by this after the fact.

 

[nakedfrog]

Yeah this country is a disgrace, an absolute disgrace when it comes to so many social issues, of which healthcare is a big one.

I am diagnosed bipolar and take medication for that and insomnia, and essentially no therapists take insurance ,and I am quite sure my once every three month psychiatrist appointments are not covered. I'd have to submit all the paperwork and I'm pretty sure from what I read in my silver level policy, it's not covered. As in unless you are in a ward or something, there is no hope for mental healthcare coverage. So I haven't bothered. I just pay out of pocket for everything. Just my one mood stabilizer and sleeping pill, that's a $10 co-pay.

Even IF you end up in a ward, you're still paying out the ass even with a silver plan.
Your psychiatrist appointments should actually be covered (for medication management, I would guess?), I would think, at the specialist level.
I was able to locate therapists for my son in the Midwest who were covered, again at the specialist level, and I've helped people here in WA find therapists who are in-network for them.

 

[kt]

There's a solution but no one wants to talk about it.

 

[Homerboy]

There's a solution but no one wants to talk about it.

Many people do. But not those that can actually do anything about it and/or are getting their pockets lined with "donations" that are paid for by my and millions of others' premium payments.

 

[herm0016]

It's not even so much that, it's that it's SO BAD that many therapists are just flat out not even accepting insurance anymore. So to see them you have to pay direct out of pocket. I can't even fight/complain to the insurance company in this case. The doctor (rightfully) is sick of dealing with insurance themselves and now to get the care my kid needs, I basically and forced to pay twice.

I'm just fucking sick of it. My wife and I make good money, live modestly, and ENTIRELY due to medical bills just can not truly "get ahead"

yes. we have been lucky. and we just pay out of pocket for our weekly therapist apt, and don't have a lot of other healthcare expenses.

good on you for taking mental health seriously.

 

[Homerboy]

yes. we have been lucky. and we just pay out of pocket for our weekly therapist apt, and don't have a lot of other healthcare expenses.

good on your for taking mental health seriously.

Well, our youngest has lots of severe problems, and for lack of a better phrase, we have no choice. It's been a long hard 6 years and I fully admit that the burden has really fallen on my wife's shoulders and she now needs help as well. But just to make things worse for everyone adding to all the stress, anxiety and depression, insurance companies above and beyond to make it as difficult as possible to make things better.

 

[kt]

Many people do. But not those that can actually do anything about it and/or are getting their pockets lined with "donations" that are paid for by my and millions of others' premium payments.

I don't doubt what you're saying is true. We also have many people who see it as "freeloading" although all of us are already paying for it one way or another. Like you said, it's just going in to the wrong pockets. I will admit that I grew up in a country with universal healthcare, so my view may be bias.

 

[Captante]

I will admit that I grew up in a country with universal healthcare, so my view may be bias.

MAY be? (btw lucky you!)

 

[StinkyPinky]

You can imagine my shock when I moved here from NZ back in 2004. $500 ER bills WITH good insurance....wtf. Oh, and let's not forget those surprise bills a year after your visit because someone somewhere decided in a random fashion something was undercharged.

No one seems interested in changing anything though. People seem to think it's normal to be billed $800 to have a freckle on your second nutsack looked at.

 

[Aikouka]

It just seems problematic to have an industry whose job is to support the people also have a focus on profit. Sure, you could have more humanitarian individuals that are willing to sacrifice some of their profit for the benefit of the people, but at least from what I've seen, it's the shrewd ones that are willing to walk a fine line that tend to reap the profits. Having that profit is usually what gives you an edge to grow and become a behemoth in your space.

 

[ponyo]

I don't doubt what you're saying is true. We also have many people who see it as "freeloading" although all of us are already paying for it one way or another. Like you said, it's just going in to the wrong pockets. I will admit that I grew up in a country with universal healthcare, so my view may be bias.

"Freeloaders" will exist with or without universal healthcare. We already have plenty of "freeloaders" in this country. Poor people who qualify for Medicaid pay zero for healthcare. And almost all get some sort of health insurance premium subsidy through work, state health insurance exchanges, or through Medicare. The truly fucked are the subset that don't fit into any of these while still subsidizing the rest.

 

[StinkyPinky]

Dare I say it....but bills could be capped. So no more than $200 for an ER visit, or $300 to see a specialist, or $3k for surgery. The govt covers the rest of the bill.

But of course that would require more tax and that would be socialist and evil. It's almost like extremely wealthy elites that run the country are out of touch and don't care or understand the problems the rest of us plebs face...

...or that these mega insurance company's "lobby" politicians to keep the status quo. Incidentally lobbying is heavily regulated in most of the developed world because let's face it, it's just another word for bribery.

 

[nakedfrog]

Dare I say it....but bills could be capped. So no more than $200 for an ER visit, or $300 to see a specialist, or $3k for surgery. The govt covers the rest of the bill.

But of course that would require more tax and that would be socialist and evil. It's almost like extremely wealthy elites that run the country are out of touch and don't care or understand the problems the rest of us plebs face...

...or that these mega insurance company's "lobby" politicians to keep the status quo. Incidentally lobbying is heavily regulated in most of the developed world because let's face it, it's just another word for bribery.

I guess we'll see how it goes with the insulin price cap?

 

[Captante]

I guess we'll see how it goes with the insulin price cap?

That particular pricing issue is enough to make your blood boil!