This isn’t news, but I’ll accept that there are people who still haven’t learned this and suppose that it’s still worth publishing.
What is the point of this comment then?
Of course there are people that haven’t heard of this or don’t understand this. The world didn’t freeze and people didn’t stop being born, new humans growing up and becoming adults and just learning about various parts of the world everyday don’t know about these sorts of things.
Education and information is a perpetual struggle and a perpetual effort.
It’s getting worst though. A lot worst. They keep adding more and more layers to make it so difficult and convoluted you give up. Last year my insurance started using an external pharmacy for my meds. Fine. But my meds to need to be administered by a nurse in a hospital. So I need to get prior authorization from my doctor to my insurance who then approves the pharmacy to do the meds. But there are 30% copays now so I use a third party company that works with the company that makes the meds to comp the 30%. Then I need to get the hospital to call the pharmacy to order meds on my behalf and send it to the hospital, not me. Then I can finally schedule my appointment to actually get the shot in the hospital. I do this circus once a year, every year because they change one layer every year and so I have to figure out the new rules. It’s pure madness.
This is exactly me trying to get ahold of immunosuppressants to treat my Crohn’s Disease. I have to go through a specialty pharmacy owned by the insurance company. They bill to SaveOn, an assistance program, because my 30% copay works out to over $8K. They additionally bill against a discount/coupon program. If anything gets screwed up between the five systems of record I have to keep my data in (via phone calls, of course, because the self-service web portals are designed to give you incorrect data and accomplish nothing), then I spend weeks trying to correct everything and wind up getting my meds late.
Someone let me know if the article has any value beyond what is already heavily studied and known — that the profit motive and racketeering between all middlemen (insurers, big pharma, banking/finance sector, and health care providers) is a calculated effort to dramatically inflate the profits of each at the expense of the most vulnerable. Insurers don’t make money by paying claims. They make money deny them, so do everything in their power to deny as many claims as possible.
The insurance companies use computer algorithms to deny claims and most people won’t fight it.
Most people can’t fight it. Fighting a claim, depending on insurance, requires multiple different Doctors recommending the same thing. Sometimes the insurance requires prior steps taken that are unavailable to individuals (I was required to take antibiotic that I’m allergic to before a surgery). Getting into a specialist can take months, and the costs of seeing a specialist are not often covered at all (goes towards deductible), and unless you live in or near a city you may not be able to find specialists you don’t need to get a hotel to see (travel expenses and time off work are not covered). Not to mention, if fighting a denied claim rolls over to the next year, everything starts over, even if you have the same insurance it’s considered a new policy because it’s a new year.
Unless you have unlimited time and money, fighting a denied claim is pretty difficult and goes nowhere fast. That’s how the system was designed.
We do stings in restaurants (for servering underagers) all the time. The fines are significant for the server and the restaurant. I wish they would do stings on mechanics, dentists, and most importantly health care. Wrongfully denied claims should be devastating to the company.
Oh yeah dentists for sure. The dentist who removed my wisdom teeth was a total quack. He did it in two sessions, used novocaine even though I told him it didn’t work well on me, and actually crushed a tooth to get it out. And yes, I felt the pain of him crushing a tooth. We should have sued him.
This was when I was 19. I’m 46 now. A few months ago, I had a terrible pain back where my wisdom teeth were and it got worse and worse. I have some nerve issues, so scheduling a dentist is a big deal right now because I need to be totally out. So we scheduled it, but a few days later, a little sliver of tooth from the space where he crushed the wisdom tooth worked its way out and the pain stopped.
Remember all the hysteria over “death panels” during the ACA debates? Fooled you, they were already here, invented by insurance companies.
