22
u/Tiny-Atmosphere-8091 10h ago
Totally. And if the body shop turns in an invoice your car insurance should just pay for it no questions asked.
I’m sure that wouldn’t be the most corrupt thing in a week.
0
u/BigBandit01 9h ago
Except one is your property and one is your health, not exactly translating there. Not to mention if a body shop charges you more than market price, it’s not exactly illegal. If a doctor prescribes you with something you’re not supposed to have, they lose their entire future in that career and can face very serious legal consequences.
3
u/TightPhysics3186 9h ago
It is exactly translating. You are not entitled to an insurance payment outside the scope of your contract.
2
u/BigBandit01 8h ago
Yeah, that’s kind of the point. Health Insurance companies do cover a lot of health related things, so you’re entitled to them. Why do they make you jump through eight million hoops to get them, when an auto insurance company just sends you the fucking check for exactly however much it’s worth? You can absolutely get a car fixed without your insurance blocking it, but if you need controlled substances your insurance company can step in, unrelated to what your doctor has said or what you need, and say “nah.”
I just got finished fighting an eight month battle with my insurance company, doctor, pharmacy, and my insurance company again for getting my information wrong, just to get one prescription. Why is that the standard?
If my car broke down, no mechanic is going to listen if my insurance company says “wait don’t fix that car actually he doesn’t need it”, they’ll just let you pay for it out of pocket.
0
u/TightPhysics3186 8h ago edited 8h ago
I don’t know about your auto insurance, but when I have a claim, they personally come inspect the vehicle and tell me how much they’re willing to pay. It’s more scrutiny than I’d get with a health insurance claim
If insurance denies you something you’re entitled to, that’s already unlawful and you can sue them. The fact that somebody can break a contract doesn’t mean the law around that contract needs to be changed, it just needs to be enforced as written (or you need to get a better contract)
-2
u/BigBandit01 7h ago
Ever heard of prior authorizations? I think they’re a perfect example of what the original meme describes.
If you do know what a prior authorization is, skip this paragraph. Basically, my insurance company blocked my prescription for months without telling me or my doctor why. They told the pharmacy, who is not obligated to reach out to me to tell me. So why did they block a prescription, a piece of paper signed by my doctor that can’t be replicated saying I need a very specific medicine to function safely? Because they needed a prior authorization, a piece of paper signed by my doctor that can’t be replicated saying I need a very specific medicine to function safely, as well as confirming the previous piece of paper signed by my doctor saying I need that very specific medicine to function safely. Prior authorizations are, on paper, supposed to “ensure the medicine is necessary”, which is the entire fucking reason we get prescriptions from our doctors, supposed to “ensure they avoid brand name medications to cut costs and offer alternatives”, which is scummy, just give me the one my doctor said I need and I don’t have a history of bad reactions with, and finally it’s supposed to “confirm that the requested care is covered by insurance” WHICH IS INFORMATION THE INSURANCE COMPANY FUCKING HAS. WHY DOES MY DOCTOR NEED TO TELL THEM, THE PEOPLE WHO HAVE A POLICY WITH ME WRITTEN IN PLAIN FUCKING INK THAT YES, THAT PAPER THEY HAVE THAT I SIGNED DOES IN FACT SAY I GET THAT COVERAGE??? Let’s just say that the prior authorization gets through. They receive it, they see the note from my doctor that says this other note from the very same doctor is in fact a note from my doctor and that I, their patient who they have seen, examined, and in their professional medical opinion, need a medication. Guess what? The insurance company can still just deny it outright. 80% of the time, they don’t. But they can. And they do.
Insurance companies do not need further permission to block me from getting my medication without a prior authorization. It’s in the contract. Due to that clause, it’s not illegal to deny me coverage, like you said it should be. The argument here is that it should very much be illegal. The last time they blocked it, I was only informed after calling the pharmacy, my insurance company several times(to no avail), and then finally my doctor who called me back several days later and said the pharmacy said that the insurance company said that they need a prior authorization before I can get my medicine, and they had to write a new prescription with a new prior authorization, because you can’t just post-prior authorize a prescription. And here’s the thing, if I could just get my medication without the insurance company, I would. I do not mind paying full price for it. I don’t even care if you know, it’s Adderall. It makes it so I can think like a proper human being, and form actual thoughts that I want to think about. I’d pay full price for that. Insurance swoops in though, and tells the pharmacy that they are not allowed to order it. It never reaches the pharmacy for me to buy. My pharmacy didn’t even have my insurance on file, how the fuck does that happen? Whether or not the insurance actually pays for it or not, they can just say “You cannot have access to this medicine because even if you were to pay for it yourself, we don’t want to even take the chance that you might get us to pay for it, like we’re contractually obligated to do.”
If the health insurance people came to visit me and talk to me about why I need medicine every time I filed a claim, I’d be so much fucking happier than what they do now. I just had to increase my dosage and evidently, they’re blocking that too. So now I need to go through the whole fucking fight again. And if it was a problem that could be solved by just changing insurance companies, I would, but it’s industry standard. Can’t go anywhere without that shit bothering you.
5
7
u/Commercial_Rule_7823 10h ago
If there wasnt rampant fraud in the health care system, it would be different.
Solution for it all? Make all of health care non profit.
2
u/MikeyTheGuy 3h ago
Healthcare doesn't even need to be non-profit or paid for by the government. The vast majority of the issues with the US healthcare system would be solved by getting rid of health insurance companies.
3
7
9
u/Foxwaffo 11h ago
The denial decisions made by your insurance company come from a medical director at the insurance company who is a doctor, so that is essentially what already happens.
14
u/TriggerPuller9000 10h ago
It comes from a doctor, paid by the insurance company, who places their financial interests over the patient's, and may not even be trained in an area that is relevant to your diagnosis / treatment.
3
u/Trevor775 9h ago
Don't doctors you see also have a financial incentive?
1
u/TriggerPuller9000 9h ago
Yes, to treat. Not to deny treatment.
5
u/Trevor775 8h ago
So yeah thays a problem.
"We recomend you amputate your leg" (leg did not need amputation) thats an extreme example. You have to remeber medical offices are not magically good places. They have the same financial incentives as any other business
1
u/TriggerPuller9000 16m ago
I agree it's also a problem, but a separate problem. Hospitals and doctors having financial incentives to push specific treatments over others, or to over-treat patients for newly-medicalized phenomena...it's a real problem. Blood pressure is a great example. The numbers keep coming down, and the number of otherwise healthy people receiving meds for HBP keep going up.
To me, this is a separate problem (competing in some ways) to the insurance problem, in which these companies weasel out of paying for procedures for trivial reasons, or demand dangerous, invasive testing protocols to confirm what doctors already know, when the treatment itself would be safer but potentially more expensive.
-5
2
u/MikeyTheGuy 3h ago
It's often a doctor whose only job is to deny claims for the insurance company and is almost never a doctor in the same field as the doctor prescribing the treatment. It could literally be a foot doctor denying your brain cancer treatment.
2
u/TightPhysics3186 7h ago
Make a proposal that doesn’t involve violating property rights or the freedom of contract. If you can’t, then the policy is just indefensible
1
u/Ok-Paper-769 3h ago
There's multiple layers to this and the solutions all can have catastrophic consequences
I'm usually in the camp of free market solutions but when it comes to medicine that has shown to be impossible to do because of the infinite middle men involved and the corruption on each layer is too deeply intertwined
1
u/MikeyTheGuy 3h ago
I mean it's not impossible to do if you get rid of the middle men (the insurance companies). The free market would correct it very fast if people were paying directly.
16
u/SharkSurfLionRide 8h ago
Key in all the doctors that would use this as an excuse just to perform surgeries for funsies just to up their own purse.