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.
This happened to me today. Dreading the hold times tomorrow.
One of the biggest advantages I see from living under single payer health care is that I don’t have to put in extra clerical work like you describe. Sure, the insurance company should be able to pick up a phone, but In my opinion, the responsibility should rest on the hospital - they are the ones demanding a payout.
I disagree. The hospital is employed to provide medicine. I pay a medical insurance company to pay for my medicine. If a doctor says I need medicine the insurance company should respond and pay because why else am I paying them.
Just to offer another perspective, this covers just how difficult the burden of administrative tasks already is for physicians: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8522557/
Not all physicians work for a hospital, so I don’t think they all have much access to large departments that can take up the slack for them. It’s difficult to ask them to chase our insurance for us when the paperwork they already do is driving them insane and taking them away from their patients.
The solution, as you said, is single payer. The overwhelming administrative overhead is a symptom of a very broken system. Nobody directly rendering or receiving care is benefiting from how things currently are in the United States.
I do feel sorry for the admin staff that have to deal with it, and my ire is 90% directed at insurance. However, when they can’t even read the back of the insurance card to follow the instructions to properly file a claim, it just gets tiring.
I completely agree about it being the providers responsibility. The problem is, they don’t want to do anything to resolve the issue either. Other times, it doesn’t even involve the provider, they did everything right but for some byzantine reason it didn’t go through the insurance system correctly and you have to call them and tell them to process it the same way they have processed every other exact same bill from the exact same provider.
Just wanted to vent. I should clarify I live in the US (as if that wasn’t clear from my post LOL!)
they don’t want to do anything to resolve the issue either.
In any other line of work, that’s an excellent way of forfeiting any right to getting paid.
In the jobs I’ve had where I’ve had to bill someone, I’m having a hard time imagining that I could expect to get paid if I just sent a bill to someone who didn’t owe me.
The patient is ultimately liable to make the payment. You sign that when you get the service. So if the insurance company isn’t forking out, the provider may send the bill to collections.
I worked in healthcare tech for a long time and I would say that healthcare facilities should focus on delivering healthcare. We had so much administrative overhead from dealing with this insurance bullshit that it drove up costs to staff a ton of people to deal with insurance bullshit and thus increased costs. If we had single payer it would be a single process that couldn’t possibly be more convoluted than what we have now. Sending shit to insurance clearing houses with exact ordering of diagnosis matching procedures so that they don’t get kicked back. The hospital doesn’t want you dealing with this shit either they just want the money that the insurance provider said it would pay for your treatment. It’s 90% insurance bullshit all the way down.
I wish I could Thanos-snap the entire health insurance industry out of existence. It’s a giant, bloated, bureaucratic middle-man that makes the whole process more expensive, time-consuming, and complicated.
I’d imagine we’d see insurance invest money into making offers to providers. They’d refer the patient to a health insurance company instead of negotiating, and in exchange they’d get a large one time payout for a successful referral. This would please investors in the providers, because they’d see short term gains, and it’d please the insurance company because patients would be forced to have insurance again. Everyone (with money) wins!
Another post to feed America Bad and EU Good circlejerk on Lemmy.
Yes, the system is bad and we should have universal healthcare but I never had to call anyone to figure anything out in the past 15 years. The hospital sends me the bills after getting it through insurance. Not sure who your insurance provider is but this issue is not common.
Because if they pay out, they make less money, far cheaper to get you to give up trying - which is what a lot of people will do because it’s designed to be an exhausting system.
Healthcare practices vary in how much they are willing to run interference for you on insurance. Most of them will at least try “pretty hard” to help with the claims because it’s good for their income stream to do so. However, sometimes you’ll find yourself using a provider who can’t be bothered with staffing up and/or supervising it to make sure it gets done. In my (limited, anecdotal) experience, this seems to happen more often with specialists or niche providers.
Or sometimes it’s your insurance plan. It might have so many byzantine rules and/or shitty admins that it’s just too much work for even a crackerjack provider staff to deal with it. So they end up kicking it back to you and saying “good luck”. If this happens enough, the practice may stop accepting that plan in the future.
What you really need on top of that insurance is supplemental insurance! That way you can pay two insurance companies and they can both say no!
Haha exactly! I mean, I know this is how it works, it just feels like it’s gotten way worse in the last few years.
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
Corporations are all about stepping over dollars to pick up pennies.
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.
I hope you don’t have any long term consequences of that
Once I got into PT things seemed to go well, it was just a month of suck getting there.
This is a feature, not a bug. We have all become unwilling, unpaid employees of every company in their pursuit of higher profits.
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.
Living in Europe with single payer health care, this sounds crazy. I just go to the doctor, leave, pick up my drugs, etc. It’s all handled by the insurance except maybe a few bucks on some drugs. Worst case I have to show my insurance card but that rarely even happens.
It is crazy because OPs case is not very common, at least in my experience. The hospital sends the bills to the insurance and later I get a bill for what I owe. I don’t need to make any calls.
Oh no, it’s very common, especially with large bills
The amount of inefficiencies in the healthcare system is staggering. Like, you almost wouldn’t believe it kind of staggering. I can’t go into much detail without doxing myself, but it’s bad.
Same with HSA cards. I quit paying into mine because they wanted proof I got work done after using at a dentist.
Yeah, because dentists usually sell fun things. Fuckin morons
I never had an issue with my HSA card. Paid into one from 2016-2020 when I had a state job. Then switched off a high deductible to a standard plan with an FSA. Left the state job in August 2021 to go private. finally burned through the last of the HSA money in June 2023. Switched jobs back to the state last August and started paying into the FSA. They hassled me over every charge that wasn’t a copay. Go go the eye doctor. Prove it. Buy contacts. Prove it. Go to a chiropractor. Prove it. They deactivated my FSA card over $1.60 that the insurance said was over the standard amount.
Sorry, I pay into the account for medical purposes. I go to a doctor and you pay it. You have no business knowing WHAT the doctor did to me. They were demanding stuff as documentation from my wife that was a blatant privacy violation.
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
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.
Same with my MS. It’s frustrating to know that if they fuck around and feah their feet one year, i could be getting further brain damage without my meds l.
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.
It means they have to compare your request to a list of allowances that change annually at the whim of Corporate
It’s beyond belief, but insurance companies do the same thing to amputees.
Oh I know, I had a family member make the joke about suddenly regrowing a limb
It’s disgusting and absolutely should result in anyone who’s ever approved that being put against the wall for their pure evil
Any hassle they can create to manufacture a reason to deny coverage.
It’s not “beyond belief” it’s disgustingly evil.
It’s the first time they’ve ever done a claim. Take it easy on them.
I don’t know if I should say this but I will.
The last time it was an issue for my kids I conferenced called the insurance and the doctor’s office. I then laid into the insurance adjuster saying things that were truly revolting with as much profanity as I could cram into it.
Haven’t had an issue since. Turns out the system only works if they think you are unstable enough to make it work.
