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My husbands suicide shows theres something very wrong with US insurance industry

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Re: My husbands suicide shows theres something very wrong with US insurance industry

#161
post #62

In my experience, one can always continue care if one is willing to pay. Insurance companies do not deny care; they deny claims for care. In fact, numerous times they make mistakes and deny valid claims. Only the healthcare provider can choose to not provide care: either because they believe they will not get paid or they believe you don’t need it or some other such reason. Considering this person has a high-paying j…

> One isn’t charged until afterwards This is not a universal billing practice, often clinic visits are billed upfront before meeting with the provider.

[deleted]

Re: My husbands suicide shows theres something very wrong with US insurance industry

#162

I’ve been through this situation with family members. I understand the frustration and agony. I also understand the hesitancy to pay for two months at a “retreat-like inpatient psychiatric facility.” In publicly funded system, it’s likely facilities like this would not exist or would be strictly private pay. I’m not aware of any country that makes such a thing available on short notice like this. I also understand th…

I will note that in a lot of places in the US, the role of medium term acute psychiatric care is taken by partial hospitalization programs, where patients go to a facility (usually a few conference rooms in an office building) during the workday for intensive therapy and medication management, but go home with family in the evenings. These programs are a lot cheaper than inpatient programs, and the standard workflow…

Me too! I’ve seen such good come from these sorts of programs!

I didn’t want to mentioned it my initial post, but these sorts of programs seem a happy combination of keeping costs down and maximizing autonomy, while focusing on full-time on mental illness.

Some is these are technically “in-patient” at home programs, which are growing in popularity in all fields on medicine.

But they’re not appropriate all the time, and I don’t want to “recommend” them. Talk to your doctor.

Sadly it seems these sorts of programs are simply unavailable in much of the country.

Re: My husbands suicide shows theres something very wrong with US insurance industry

#163
post #7

Yes, there is something wrong with the insurance industry. But there is something wrong with the hospitals, doctors and drug companies too. The whole system is broken. Hospitals try to eke out the most out of insurance companies, often providing services that are unnecessary. Pharmaceutical companies charge US patients significantly higher rates than in other countries. Don't put all the blame on insurance companies.

John Stossel explained in _Give Me A Break_ that the US once had a variety of pharmaceutical labs researching different cures and conducting trials. But US courts allowed a frenzy of frivolous lawsuits to extract astronomical payouts on behalf of former trial participants, even demanding payouts from the companies that stocked the supply and janitorial cabinets of research companies. One by one, we bankrupted our com…

Our country is run by lawyers for the benefit of laywers. This explains much of what we see around us.

Re: My husbands suicide shows theres something very wrong with US insurance industry

#164
Since we're all sharing terrible insurance stories, I'll throw in my partner's. Of course this is not as bad as the OP, but it is still extremely frustrating.

We are graduate students and get a pretty good health insurance through our university's BCBS plan. She is financially independent from her parents, but she is additionally involuntarily insured on her father's EmblemHealth plan with no right to remove herself (her father could do this for her, but has refused to).

Last year she had some medical bills, and neither insurance company is willing to pay: the issue is that both plans have a clause that makes them secondary to any other insurance (this is apparently very common for student plans, and is also also somewhat common for additional family members on regular plans). For over a year now we have been sending certified mail to both insurers' coordination-of-benefits offices, but neither will acknowledge being the primary insurer and EmblemHealth has been ignoring us altogether for the last ~5 months.

The generally recommended strategy in this situation is apparently to involve regulators. However, regulation is state-by-state and and our university is in Massachusetts while her father lives in New York. Massachusetts' Division of Insurance found that the Massachusetts insurer (BCBS) was correct that the New York insurer (EmblemHealth) should be primary, but they have no jurisdiction to force the New York insurer to accept this finding.

The New York regulators were even more useless. New York's Department of Financial Services---the only state regulator for health insurance---responded that they had no jurisdiction to regulate the plan since it was self-funded (meaning that it is not technically insurance for regulatory purposes). The only remaining regulator was the US Department of Labor, but they eventually got back to us saying that they had no jurisdiction either: the problem is that my partner's father is a municipal employee of New York City, and for some complicated constitutional/political reasons the DoL isn't able to enforce labor laws on state/local governments.

I basically don't know what to do now. We have been on a waitlist for a legal clinic for about 4 months with no end in sight, and in the meantime regularly get mail from medical debt collectors. This is despite having insurance and making considerable effort to do everything "right." Clearly something here is extremely broken.

Re: My husbands suicide shows theres something very wrong with US insurance industry

#165

Earlier quoted context omitted.

Insurance refused to cover imaging to identify my spouse's squamous cell carcinoma on an ovary because initial bloodwork didn't come back positive for ovarian cancer (squamous cell required different bloodwork, at least at the time). It took a doctor offering to misdiagnose it as a dermoid cyst to get the imaging and hysterectomy ordered and approved, and that still took 2 months. By the time it happened, the cancer…

Which insurance firm was this? Fwiw, if one has a passport and some funds, one can travel abroad for cheaper surgery abroad. It won't guarantee an outcome, but it ought to be better than delaying it. Of course this in no way excuses the insurance firm.

> Which insurance firm was this?

Any of them.

They all behave in this exact same fucking way. Every single one has horror stories like this.

Sometimes you get lucky, and they don't fuck your particular case over, sometimes you don't.

Re: My husbands suicide shows theres something very wrong with US insurance industry

#166

Earlier quoted context omitted.

Insurance refused to cover imaging to identify my spouse's squamous cell carcinoma on an ovary because initial bloodwork didn't come back positive for ovarian cancer (squamous cell required different bloodwork, at least at the time). It took a doctor offering to misdiagnose it as a dermoid cyst to get the imaging and hysterectomy ordered and approved, and that still took 2 months. By the time it happened, the cancer…

Which insurance firm was this? Fwiw, if one has a passport and some funds, one can travel abroad for cheaper surgery abroad. It won't guarantee an outcome, but it ought to be better than delaying it. Of course this in no way excuses the insurance firm.

Or get the international plan from Cigna and they will happily pay for just about anything from any non-US provider.

So far over $5M into complex cancer care at the fanciest clinics in the world and never been questioned on a single claim.

Re: My husbands suicide shows theres something very wrong with US insurance industry

#167

Earlier quoted context omitted.

> It's hard for me to believe that a doctor couldn't afford medical care for her husband Why's that? Between mortgage, repaying education debt, supporting children, recovering from a husband's failed business venture...what is hard to believe about having trouble paying for another expense, especially after you've been reassured that the expense would be at least partially recompensated and that turns out to not be t…

At a high income level, you should have more buffer for life’s events if you’ve made good decisions in your life. Generally speaking. For example, that mortgage, did you stretch the very limit of your income or did you buy something reasonable? Nobody forced you to buy a house, you could also rent or commute longer. I lived in a crappy rental for five years and commuted and was able to fully pay off my student loans…

yeah well I make top 1% of income earners in my country, but yet I don't have any liquid(able) assets worth high five figures. House, if I'd sell it, would likely be worth less than I paid for it before pandemic. I couldn't really pay for lets say $200k treatment for next week. It might be the string that broke camel's back, a sinkhole I could never climb out of.

Re: My husbands suicide shows theres something very wrong with US insurance industry

#168

This is a far cry from the gravity of the post, but here's my personal anecdote about trying to navigate health care and insurance. A month or two ago, I was trying to set up a pediatric dentist visit for my son. Not a medical emergency, but a matter of some urgency. I spent about three hours on a total of a dozen phone calls or so. Some to the insurer, and some to various dentist offices in the region to inquire abo…

In France, land of free helthcare, the problem is ultimately the same but for different reasons. We do not have enough doctors (they lobbied a law to set quotas) and finding a specialist is a near miracle.

Then the doctors complain that they are overworked because of what their seniors put in place.

The problem is never the money, though.

Re: My husbands suicide shows theres something very wrong with US insurance industry

#169
post #36

Earlier quoted context omitted.

> you might have a catastrophic loss and have your finances wrecked. If you have health insurance (in the US) and you have a catastrophic event, your finances are going to be totally wrecked anyway. You're likely to have to declare bankruptcy unless you are pretty wealthy. At least, that's how it's gone with every friend and family member of mine that had to navigate such an event. That's on top of the painful nightm…

Depends. I got $300,000 in coverage for a catastrophic event and wound up paying $ 3,100. But I did have good insurance with United Healthcare.

Quick numbers that I found suggest lifetime healthcare costs of >$300k even if you're 65 already (with current yearly spending trending more towards $600k-ish).

So even with a (single) catastrophic event just paying yourself might save you money still (which seems insane to me).

Re: My husbands suicide shows theres something very wrong with US insurance industry

#170
post #73
post #36

Earlier quoted context omitted.

> you might have a catastrophic loss and have your finances wrecked. If you have health insurance (in the US) and you have a catastrophic event, your finances are going to be totally wrecked anyway. You're likely to have to declare bankruptcy unless you are pretty wealthy. At least, that's how it's gone with every friend and family member of mine that had to navigate such an event. That's on top of the painful nightm…

[flagged]

I'm just reporting my personal observations here. In several cases of major medical episodes I've personally witnessed, not a single person emerged from it without catastrophic financial damage. Most of these people had insurance plans that were considered very good or excellent.
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