[deleted]
How often do health insurers say no to patients? (2023)
11–20 of 103 posts
Re: How often do health insurers say no to patients? (2023)
#12So far this year I'm seeing basically "We got $100 off! $0 paid by plan. You owe $xxx" I barely use it, but so far insurance isn't covering anything except basic $x refills
You are on a high deductible plan. With those plans you pay the first $X and after that a percentage of costs (coinsurance) up to $Y. Sometimes certain things are covered before you hit your deductible other times not.
Yes, but you'll often find that in a high-deductible plan the insurance company gets a "discount" of your $1k med down to $200, which they brag about in your EOB… but the medication's cash price for uninsured people would be $20.
You're out of pocket $180 more than you should be, and paying the $20 cash price out of pocket means your deductible doesn't budge.
Re: How often do health insurers say no to patients? (2023)
#13Is there any hope to clean up the US health system in any foreseeable future? How did the health lobby get so much power and get away with all this abuse?
There's a lot of problems you can point at: - Through extensive lobbying, the US passed the HMO act of 1973 which requires that all employers offer an HMO plan to employees. HMOs were created to keep costs down, but United really took this to the extreme, making it as hard to use your health insurance as possible, and creating vertical monopolies like OptumRX. United takes so long to pay providers for the work they d…
> and creating vertical monopolies like OptumRX
Aetna "forces" you into using its pharmacy by refusing to authorize any prescription with more than a 30-day supply unless through its wholly-owned pharmacy-by-mail subsidiary.
Re: How often do health insurers say no to patients? (2023)
#14All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300.
The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for.
I was raised a die-hard capitalist and in many ways still am. When it comes to healthcare these days, I’m somewhere to the left of Marx. What we have now is a failed system. It simply does not work. The turnip has been squeezed and there’s no blood left to wring from it.
Re: How often do health insurers say no to patients? (2023)
#15Earlier quoted context omitted.
There's a lot of problems you can point at: - Through extensive lobbying, the US passed the HMO act of 1973 which requires that all employers offer an HMO plan to employees. HMOs were created to keep costs down, but United really took this to the extreme, making it as hard to use your health insurance as possible, and creating vertical monopolies like OptumRX. United takes so long to pay providers for the work they d…
> and creating vertical monopolies like OptumRX Aetna "forces" you into using its pharmacy by refusing to authorize any prescription with more than a 30-day supply unless through its wholly-owned pharmacy-by-mail subsidiary.
I’d much rather go to the pharmacy once a month with Aetna than with UHC, because at least Aetna actually pays for things. They’re both awful in their own ways; don’t read that as me endorsing Aetna.
Re: How often do health insurers say no to patients? (2023)
#16I thought I saw a meme about denail rates when that healthcare CEO got shot? Where did those numbers come from?
Re: How often do health insurers say no to patients? (2023)
#17I thought I saw a meme about denail rates when that healthcare CEO got shot? Where did those numbers come from?
That's an estimate, not hard numbers.
https://www.yahoo.com/news/no-one-knows-often-health-2020566...
> At the same time, posts on social media have been claiming that UnitedHealthcare’s claim denial rate is the highest in the industry at 32%. This figure comes from the personal finance website Value Penguin, which said it calculated that rate from available in-network data from plans sold on the marketplace.
Re: How often do health insurers say no to patients? (2023)
#18Earlier quoted context omitted.
You are on a high deductible plan. With those plans you pay the first $X and after that a percentage of costs (coinsurance) up to $Y. Sometimes certain things are covered before you hit your deductible other times not.
Yes, but you'll often find that in a high-deductible plan the insurance company gets a "discount" of your $1k med down to $200, which they brag about in your EOB… but the medication's cash price for uninsured people would be $20. You're out of pocket $180 more than you should be, and paying the $20 cash price out of pocket means your deductible doesn't budge.
What if the medicine costs 100$ to produce, should uninsured have to pay that rather than a subsidized 20$?
Re: How often do health insurers say no to patients? (2023)
#19All the time is not a number but in Germany it's common that your legitimate insurance claim gets rejected at first and then you appeal once or twice and do the paperwork and document the proof again, citing all terms & conditions that apply and you get what you are owed or you get a lawyer to do the whole thing again and get what you are owed then. "Arbeitsbeschaffungsmassnahmen" ( German for "employment creation sc…
I have had this experience, but not with healthcare insurers (in Germany). I cannot remember the last time I had to contact them - the last two times they contacted me, was to explain to me, that they have expanded their preventive care offerings and they recommend I go and get them.
Blanket rejections are an extremly efficient measure from the perspective of an entity when the consumer has nowhere else to go and you don't care about ethics. Just tell them no and many people will just give up. If they appeal, you can invest the work to fob them off properly or just pay and not deal with the hassle. I can barely tell the difference with the many public healthcare insurers in germany - if my insurer were to try this nonsense, I would be gone the next month. Universities, some agencies and especially the god-damned GEZ on the other hand...
What frustrates me more, is that it often turns into a class indicator: Do you know how to word your letters or to handle yourself in a way that indicates, that it will be more annoying to not-deal-with-you than to deal-with-you? And if you don't: Do you have a access (network/money) to someone who does?
Re: How often do health insurers say no to patients? (2023)
#20All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300. The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. I was raised a die-hard ca…
These are completely human systems that can be changed any time for any reasons. The current system is achieving exactly what it was designed for: wealth extraction.
There’s no reason why this system has to exist. We can make it better any time we want.