Just so tired of almost every time a doctor submits stuff to insurance, we have to be the ones to make multiple phone calls to both the doctor’s office and insurance to iron everything out, figure out what the issue is (it’s always a different issue), and basically be the go-between for the office and insurance. What am I paying $500+/month for?! It’s like paying for the privilege of having an exhausting part-time job.
And yes, I understand that insurance wants to weasel out of paying anything, but this isn’t even shadiness, just straight up incompetence and lack of communication/following procedures. The amount of emotional energy we have to spend untangling this stuff leaves us drained.
We have all become unwilling, unpaid employees of every company in their pursuit of higher profits. It’s a feature, not a bug.
Corporations have discovered that there is no real downside (for them) when they don’t function. Customer satisfaction no longer has much of an impact on their profits because the few companies left in each sector are doing the exact same thing.
IMO this is yet another side effect of unchecked corporate power. It’s the same reason prices have risen so rapidly and corporate profits have reached 70 year highs. We are dealing with near monopolies and the billionaire class who created them. Until our government addresses the problem it’s not going to get any better.
In other words it’s not going to get better in our lifetimes.
In one example of this, during one job interview / recruitment process I essentially had to do all of the background check company’s work for them.
That makes literally no sense at all, and I’m not surprised when there’s cases of people just pretending to be doctors or whatever for decades. The “doctors” probably verified their own employment history and credentials.
They get paid when the least amount of people they insure use their services. They’re not incentivized to help those they’ve insured. The less they have to pay out to providers, the better the executive bonuses. Thus, they are diligent in collecting premiums, but can just sit on their hands when it comes to paying out.
The more the system denies and delays a claim, the fewer insured people are willing or able to put themselves through the bureaucracy gauntlet, the fewer pay outs.
They’re not in the business of insurance, they’re in the business of making money from the business of insurance. It’s over-complicated on purpose.
And what might be the most important part cannot be elided over: market capitalism is HIGHLY efficient at solving optimization problems, but it only responds to incentives.
So if you can create the right incentives to reward the result you want and punish results you don’t want, a market solution is going to do a marvelous job. It’s great at, say, price discovery. But if the incentives do not align with the desired result, it’s going to grind you under heel.
The incentives the insurance companies are responding to, frankly, are the ones you have outlined and essentially no others. Collect more premiums, make fewer payouts. There’s no “breaking point” here because they have an absolutely vast customer base that has no choice to opt out of the system for a variety of reasons (ranging from the ACA individual mandate to the fact that it is not possible for an individual to make fully-informed financial decisions about their health even WITH advanced knowledge and training that nearly no one has).
Health insurance is pretty much a textbook example of the kind of service that shouldn’t be on private markets.
So over time, market capitalism is going to make them collect endlessly-increasing premiums and pay out less and less. It is going to continue to get worse because the incentives of the system have defined ‘worse’ as being the optimal result. Period. It will eventually get nationalized. Period. All the argument in the meantime is just over how long we want to continue to let people be sick and broke before we apply the only fix.
You’d think that the doctor’s office would at least be motivated to fix the problem so they get paid, though, 'cause I’m sure as Hell not going to!
My favorite is pre-authorization.
I need a pre-auth before my insurance will cover the Adderall for my ADHD. Every year I must renew this pre-auth or I will not get covered for my prescription.
What is a pre-auth, exactly? It’s a Dr. Promising that yes, this medicine they prescribed is medically necessary. No, prescription alone does not count. Yes, it can come from the same Dr. who prescribed it.
And yes, I have to do it yearly to “ensure it’s still medically necessary” because my ADHD could magically go away one day, apparently
It’s beyond belief, but insurance companies do the same thing to amputees.
Wow. This is similar to what disabled people have to deal with in Russia. Like arm will grow back.
Oh don’t worry, disabled vets deal with it all the time in America too. Oh, that leg you lost during your deployment? Gotta prove it’s still missing, and that you’re still disabled every year. And if you fail to get personal copies of everything in triplicate, the VA will magically “lose” your paperwork and you’ll be stuck without benefits until you start the entire process all over again.
I have to do it quarterly for some reason. Annually would be…better, but still stupid. My doctor even thinks it’s dumb, so he usually just asks me all the rote questions…
…no he doesn’t, he usually goes blahblahblah you’ve been doing this for 10+ years we know the routine. Unfortunately I still have to make an appointment, have an appointment, pay the deductible for said appointment, just to get 3mos of a medication that, thus far, I have a medical need for.
I tore an achilles tendon last year. Doc wanted me in physical therapy, but PT wouldn’t take me because they needed an MRI showing the position and size of the tear.
PT was very clear. Tendons don’t show up on xrays.
Doctor was very clear. Tendons don’t show up on xrays.
Podiatrist was very clear. Tendons don’t show up on xrays.
Aetna: “You didn’t do an xray first, MRI denied.”
They try to spend less so aggressively that they end up actually spending more
Fought them for a month, meanwhile I’m in pain, limping with a busted tendon.
Finally we just gave in and did the xray, which - surprise! - showed nothing! Then they approved the MRI.
