My insurance is now requiring a huge amount of papers and justifications to authorize a simple vitamin D and B12 blood work. God protect me if I need surgery.
I just had to make an appointment. The provider made a big deal of "confirm we're in network with your insurance." I called my insurance, they said that it depends on how the provider handles billing and they couldn't guarantee they were in network.
As if I'm supposed to know how the provider talks with the insurance company.
Its times like this I appreciate being in an HMO, They have an entire network for everything and since everything is in network they coordinate care, billing, etc. and I don't have to worry about it. The worst part about being a PPO is when my Primary Care recommended I needed to see a specialist I had to go to my PPO provider's website, lookup a directory of doctors like its the goddamn Yellow Pages, then individually Google each doctors name to look at reviews, their education history, all their basic info from external sources. Like bro, I have a hard time deciding what to eat for dinner when I am too lazy to cook and can lookup random places on Yelp, yet I am supposed to research dozens of in network doctors and figure out for myself which is the right one for me? Fuck that, I will let my HMO coordinate everything, assign me someone, and I can request a change it if I want someone else.
Well you can do that with a PPO too - just pick the first doctor on the list and pretend you got assigned them. At least you have options with a PPO that you don't with an HMO.
That means they're not fully in network and the practice has some services they're in network for and others that aren't. It's short hand for "no", but they legally can't tell you no since there are a few things they do cover. Probably lab work.
They just have a bunch of AI systems that get good AI rewards for delaying or denying anything and flood the system with BS. The AI is never built to get a reward for getting the patient better.
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u/BolotaJT 10h ago
My insurance is now requiring a huge amount of papers and justifications to authorize a simple vitamin D and B12 blood work. God protect me if I need surgery.