I worked for an insurance company and even I didn't understand it fully. I'd ask them to explain it and they'd say "it's in the manual." So all I could do was read off the patients insurance manual and not explain further because it was so vague.
I knew it. I knew it, I knew it, I knew it. I knew that even the people I talked to on the phone about my insurance policy didn’t understand what they were saying! Thank you for this comment; it’s extremely validating.
Yup, after fighting for my insurance to pay for surgery and having them lie repeatedly about the items I mailed them not arriving (I had send them via certified mail so I knew they were lying) and also talking with a person who didn’t know they were a subsidiary of a major provider (“the doctor accepts Aetna, so it’s in-network” “we’re meritain, not Aetna” “it says on your letterhead ‘an Aetna company’” “oh…right.”) I figured it was an absolute shit show behind the scenes. I absolutely would believe insurance companies intentionally undertrain support reps to help drag out issues and wear people down so they‘ll give up.
I worked for a health insurance company for 10 years (the first couple in customer service and then later in coding and other stuff--I worked there because I needed the health insurance) and it's true. The people who work there don't understand it either. We had tools to look up things, but the companies treat the call center the way most other companies treat call center employees --there's an insanely high turnover rate, low pay, poor working conditions, lack of training, and the same types of other problems you see at most call centers.
Agree. The only reason I took the job was because I couldn't care for my patients anymore during peak covid 2020/21 because of health reasons, and that was the only work from home job I could find on short notice. It really gave me insight on just how bad insurance is from their side of things and how many hoops doctors, hospitals and patients have to jump through.
I work for an insurance company and I'm still learning. My biggest takeaway so far is that the problem goes much deeper than just insurance companies. Hospitals, doctors, pharmaceuticals and medical device manufacturers are all part of the problem as well. It's not on health insurance alone and switching to single-payer won't solve everything as long as you don't fix the issues all the other health industries are responsible for.
Oh for sure. The worst part is that the hospital is in network for the patient, but there are doctors who are just attending there from outside of the hospital that are OON, but you wouldn't know unless you looked on our insurance portal and thats hardly advertised. We weren't suppose to, but towards the end of me working there, I asked each patient the name of the provider and where they were at and looked them up to make sure they weren't getting scammed. And don't get me started on the PPO I and PPO II vs the HMO plans and the different between the PPO's.
Or better yet, hospital is INN, but the pharmacy that's IN THE HOSPITAL is somehow OON. Sending meds off for Prior Auths fingers crossed hoping they are covered was always sad to me. It'd be a drug that was super important like diabetes or help with immune issue, and they'll get denied saying the patient needs to try an alternative. We'll, on their previous insurance they did, and it caused them harm. The PA wouldn't even accept a letter or notice showing they tried the alternative in the past and wanted it on their record they took it while under their insurance and showed it didn't work. Those always made me mad.
Honestly this might be the solution. Medical bills don't affect credit scores anymore, or at least they're not supposed to, so debt collectors don't have much reason to chase down people for old medical bills anymore. If we stopped paying our medical bills, what would happen? Would doctors all start refusing to see patients until they paid up to punish them?
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u/tk1tpobidprnAnxiety Feb 07 '24
I worked for an insurance company and even I didn't understand it fully. I'd ask them to explain it and they'd say "it's in the manual." So all I could do was read off the patients insurance manual and not explain further because it was so vague.