Nothing exemplifies “weaponized incompetence” like health insurance companies trying to avoid claims by citing minor bureaucratic issues they could resolve at any time on their own
My favorite true insurance story:
A small town bought a health policy for its city employees. As a reward, the agent received a $50,000.00 bonus and a stipend of $7500.00/ month.
Just think how many claims were denied so ONE person could reap the benefits and still make profit for the company.
I had an MRI for a torn Achilles denied, while I was in the waiting room, because I hadn't gotten an xray on my first visit to urgent care.
I didn't get xray because it was so obviously torn.
So insurance denied me because I hadn't wasted more of their money initially.
I have good insurance and every doctor's visit comes with a 'check the system when they tell me they processed the claim, because while they always fix the shit when I tell them, I haven't ever tried "not telling them and refusing to pay" and would prefer not to'
That seems to be the BEST case
why doesn't every one have standing for an insanely large class action lawsuit against every insurance company for gross negligence and unjust enrichment breach of contract etc
isn't something like 25% of the USA economy healthcare related and of that about half is gross economic inefficiency?
Recently had coverage of my kid’s dental x-rays denied bc although a full series is covered, the dentist did only a partial series because his mouth is too small for the full set. No “lesser included” provision, apparently.
Every. Single. Time. We see a doctor we get dozens of letters from our insurance company asking if there are any other insurers or possibly a workers compensation claim that can pay it instead of the insurance company that gets a massive cut of my paycheck.
"No there isn't. Fuck you."
Blue Cross MA’s online claim submission system has been “temporarily” down for almost a year, meaning I now have to compile print and mail all my out of network claims, which takes more time than I often have, which works out super well for Blue Cross MA.
I work at a pharmacy and I can sympathize so hard.
I’m slowly turning every single customer into a M4A believer by explaining that insurance companies are why we can’t help them with the meds their doctor prescribed.
Ooooooh. Don't get me started on that.
My "favorite" was when they couldn't figure out how to reimburse me for an out of network claim because the charge was LESS than the average for the area.
"awww, there's a checkbox here that is blank. That means your hospital visit is out of pocket, but don't worry! One you've filled out like 37 other forms the insurance company can reimburse you in 6-12 weeks*!
*Maybe, depends on those checkboxes
Tom Scocca’s essay last week got me especially wound up with the “every specialist is in a different part of town and uses different non-interoperable billing software”
Also known as “growing shareholder value”. A process of transferring costs away from the organization onto any possible alternative, responsibly or not.
Recently an urgent care decided I owed an extra $50 just for fun (I had already paid onsite!) It took weeks to get a itemized bill, and when they finally emailed it, the total there was $35. It took a month to get someone to acknowledge that 35 and 50 are not the same number.
Most health insurance companies maintain lists of providers who take their insurance. I routinely find on follow-up that these providers in fact *don't* accept the insurance.
Makes sense: The harder it is for you to find a provider, the harder for you to access care that they will have to pay for.
“Please wait 4 to 6 weeks for processing.”
Waits patiently for 5 weeks before inquiring.
“Oh we need X piece of additional info to process this.”
Tracks down info they could have easily gotten themselves.
“Thank you please wait 4 to 6 more weeks for processing.”
Rinse and repeat for months.
Fun story: Had a cyst the size of a baseball in my neck that could have killed me. The doc requested for me to spend a night in the hospital after the procedure. Insurance tried to deny it on the grounds that the procedure comes with a night in the hospital automatically. Can't make this shit up.