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health insurance rant
Posted by: Fritz
Date: April 26, 2021 09:19AM
6 months ago, I had to get approval for an MRI prior to surgery.
Took a day to get and scheduled for the next day in a minute.

That facility has been absorbed by another.
Took 3 days to get insurance approval.
I'm on the phone nearly an hour to get scheduled.
Nothing open for 5 days locally.

And yet another company calls back to confirm insurance info.
More gold time.

Progress



!#$@@$#!

If there are spelling issues, please pardon, Owen the cat is walking, standing or sleeping on my keyboard.



Edited 1 time(s). Last edit at 04/26/2021 09:23AM by Fritz.
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Re: health insurance rant
Posted by: cbelt3
Date: April 26, 2021 09:38AM
Amen. The big fish eating little fish action has been incredible here in NE Ohio, where healthcare is the #1 employer. All the little regional doctor's practices and hospitals have been eaten. And we now deal with giant corporate entities with their complete lack of give a damn for human beings.

Health insurance has always been a soulless operation. Now it's one big corporation vs. another big corporation, and we are being pulled apart in the middle.
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Re: health insurance rant
Posted by: S. Pupp
Date: April 26, 2021 09:40AM
Yep. Healthcare in this country @#$%ing sucks, and is just getting worse.

Costs are skyrocketing, in line with rise in number of administrators being hired to avoid paying for healthcare. This is what happens when healthcare becomes a business.

It is a tragedy, and people are dying as a result.

What do you say when insurance refuses to pay for life-saving treatment, or a patient has no insurance and is diagnosed with lung cancer, and hospital "compassionate care" services are too overwhelmed to help? "Sorry dude, you're just going to have to die. Welcome to healthcare in America." ? It's enough to give a physician disabling chronic migraines and drive him to unemployment, spending his time on forums complaining about it rather than doing what he wants to do, which is working and helping people (not that I'm necessarily referring to anyone in particular). More and more physicians are getting sick or burning out, leaving in practice the ones who just don't give a damn.

It's a sick industry driven by greed.
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Re: health insurance rant
Posted by: Paul F.
Date: April 26, 2021 10:12AM
Some people whine and complain that "competition drives prices down"... They'd be right, except for one thing; the patient isn't the customer for healthcare. The insurance company PAYING for the healthcare is the customer.
Find a way to change that back to the PATIENT being the CUSTOMER (the one making payment decisions) and we'll be way better off.
And no, that doesn't mean replacing an overpaid insurance company functionary who doesn't care about patients with an overpaid government functionary who doesn't care about patients... I don't have all the answers, but I can recognize a BAD one.



Paul F.
-----
A sword never kills anybody; it is a tool in the killer's hand. - Lucius Annaeus Seneca c. 5 BC - 65 AD
----
Good is the enemy of Excellent. Talent is not necessary for Excellence.
Persistence is necessary for Excellence. And Persistence is a Decision.

--

--

--
Eureka, CA
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Re: health insurance rant
Posted by: Sarcany
Date: April 26, 2021 10:27AM
Quote
Fritz
6 months ago, I had to get approval for an MRI prior to surgery.

Took a day to get and scheduled for the next day in a minute.

That facility has been absorbed by another.
Took 3 days to get insurance approval...

When I went to an indie place for a scan, this was my experience: I could make an appointment immediately, but they wouldn't confirm until it was approved by my insurance company. I had to call the insurance company for pre-approval and wait 2-3 days for a call back or fax with an approval. Then, I had to convey this to the facility, either by faxing the paperwork or dropping it off. Then I'd finally have a confirmation for the appointment.

Since then, I've found it advantageous to utilize a physician affiliated with a major hospital system.

She makes a referral for a MRI, it immediately gets posted on the computer (and I see the referral in MyChart with a reminder to schedule it), and if I haven't called yet to make an appointment the radiology scheduler will call me with in 48hrs.

They can usually get me in within a week and they pre-approve on my behalf with the insurance company.

If it seems urgent, my doctor can check me in through the ER and I'll get the scan within 2hrs or so.

Whenever I go in for a scan, the woman who checks me in confirms coverage on her computer and if I ask she'll provide me with an estimated co-pay and patient-responsibility portion.



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Re: health insurance rant
Posted by: Fritz
Date: April 26, 2021 10:54AM
it continued when the radiology giant called to say they had an error come up regarding my insurance.
called them back. disconnect,
called back, waited.
"No sir, I don't see an error here. "
Feh!

With every merger and gobble-up, there are less people manning the phones that are knowledgeable and in this country.

Soon it'll be concierge health care and everyone else can go screw.

And It's not like I'm paying nothing for unused healthcare for the last 40 years. When It's finally needed "huh, what, who? ha ha ha!



!#$@@$#!

If there are spelling issues, please pardon, Owen the cat is walking, standing or sleeping on my keyboard.
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Re: health insurance rant
Posted by: Zoidberg
Date: April 26, 2021 11:01AM
The amount of money I pay each month for my family to have healthcare is obscene. Pile onto that the co-pays, the deductible each member has to reach before anything kicks in, and the fact that they won't cover anything 'catastrophic' (that's a separate policy) and, yes, the US system is a big steaming pile of dog @#$%& that is long overdue to be obliterated. I'm all in on MedicareForAll.

And if by some chance my uncle-in-law happens onto this page and starts with his "I ain't paying for that [girl's] pregnancy" or "why should I pay because someone else gets sick?" @#$%&, he can go suck a rock.



YMMV (Your Mileage May Vary)
TETO (To Each Their Own)

(BTW, it's spelled < y'all >.)
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Re: health insurance rant
Posted by: Wags
Date: April 26, 2021 11:10AM
I'm on Kaiser and have no complaints. They quite literally saved my life last year. Part of it is now I'm old as dirt and have Medicare to supplement. Still, they provided a very comprehensive treatment plan for me that is still ongoing. The personnel has been very professional and supportive throughout. I had some copays but it was quite marginal compared to what I would have had to pay without coverage. My rates have remained the same for the last 3 years.

That said, I agree that our system is long overdue for serious reform. The costs are absurd if you don't have good coverage and completely out of line with what all other countries are paying. It can't be sustained much longer.
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Re: health insurance rant
Posted by: deckeda
Date: April 26, 2021 11:28AM
Clearly Fritz, they aren't making enough of a profit to provide better service.






RollingEyesSmiley5
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Re: health insurance rant
Posted by: Dennis S
Date: April 26, 2021 11:54AM
This is a little off-topic, but a piece on NPR said that for some people the ACA premiums have come way down, even free in some cases. I think enrollment goes into August buy you should verify that.
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Re: health insurance rant
Posted by: Fritz
Date: April 26, 2021 12:00PM
right?

[www.nytimes.com]

"Just this Wednesday, CVS Health, which owns Aetna, the big insurer, posted much higher earnings. CVS, which also owns a large pharmacy benefit manager and a drugstore chain, said net income for the second quarter reached $3 billion, about $1 billion more than it reported for the same period of 2019, on revenues of $65 billion.

Others had already trumpeted blockbuster results, ensuring that their stocks weathered swings in the markets. Anthem’s net income soared to $2.3 billion for the second quarter, from $1.1 billion in 2019, while UnitedHealth reported net earnings of $6.7 billion, compared to $3.4 billion for the same three months last year."

but in all fairness, my year will be just as big ........



!#$@@$#!

If there are spelling issues, please pardon, Owen the cat is walking, standing or sleeping on my keyboard.
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Re: health insurance rant
Posted by: davester
Date: April 26, 2021 12:16PM
I also have Kaiser and am quite happy with it. There is never a requirement to get a claim or referral approved. My doctor sends me to radiology or to a specialist (often just down the hall or across the street) and that is that. No insurance company claims adjuster to interfere. It functions on a completely different model than all of the for-profit insurance plans and medical corporations. This is because it was created by Beth Kaiser, wife of industrialist Henry Kaiser, with the aim of providing health care for all of Kaiser Corporation's workers and families. As such, its roots are as a comprehensive healthcare organization, NOT a moneygrubbing insurance company or hospital corporation like all of the other "healthcare organizations".

I grew up in England under the NHS, and as a result have always been shocked and astonished at how Americans put up with having for-profit corporations control whether or not they get any healthcare. Kaiser is closer to the NHS than anything else offered in the US, which is why I am one of their customers.



"In science it often happens that scientists say, 'You know that's a really good argument; my position is mistaken,' and then they would actually change their minds and you never hear that old view from them again. They really do it. It doesn't happen as often as it should, because scientists are human and change is sometimes painful. But it happens every day. I cannot recall the last time something like that happened in politics or religion." (1987) -- Carl Sagan
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Re: health insurance rant
Posted by: lost in space
Date: April 26, 2021 12:29PM
Another vote for non-profit Kaiser. I've gotten high dollar referrals to specialists far outside of Kaiser, though some referrals needed a little push. If it weren't for them, I'd be without retirement, life savings, or dead--or all three.

What's even more despicable is that health insurance company shares are publicly traded.



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Re: health insurance rant
Posted by: Ombligo
Date: April 26, 2021 03:07PM
You want real insurance fun - join me on the midway ride called Workers Comp.

The wife was assaulted at school by a student and suffered a concussion. First we had to get a school district administrator to approve the WC before the hospital would do anything, then she diagnosed and sent home for five days at 66% salary - the max WC has to pay in Florida. Then a second Dr had to examine her, he agreed it was a concussion but his employer does not allow their physicians to require home rest for any WC cases. So she was home for two days at 0% pay and told to take ibuprofen and hold an ice pack to her head. Then we finally got her to a neurologist he said the second doctor bordered on malpractice. He gave her new meds (It took six hours to get her prescriptions filled because each required the pharmacist to call the insurance company to get approval) and after arguing with WC, agreed she could return to work, but not in a classroom and only if seated. She also cannot drive but I work at the school too so I can drive her. So now she is in a room by herself grading student work at 80% salary - they won't pay full salary because she is only doing reduced job duties. She will be out at least two more weeks at a reduced salary

So at that rate, we will essentially lose a week's salary. We can't even sue the kid's family for anything because she is a ward of the state - and if we win the insurance company can take it to reimburse their expenses.

All because she was attacked.



“No persons are more frequently wrong, than those who will not admit they are wrong.”
-- François de La Rochefoucauld

Growing older is mandatory. Growing up is optional.
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Re: health insurance rant
Posted by: DavidS
Date: April 26, 2021 06:18PM
As a Primary Care Physician (Internal Medicine) with The Southeast Permanente Medical Group, the Permanente part of Kaiser Permanente Georgia, I'm happy to read the above comments by lostinspace, davester, and Wags. I'm in my 20th year with this group, both as an employee and a patient. While our integrated healthcare model doesn't work 100% of the time, it is more hassle-free for my patients and for me than what I see with other for-profit insurance companies (my wife is in private practice and deals with all the issues noted above). If I have a concern about a referral or coverage for a patient, I'm calling a colleague who I know, not some name-less, face-less MD or RN in another city.

Today I had my first Colonoscopy (no polyps, yeah!!). Easy to schedule, no co-pay, and I am actually the primary care physician for the Gastroenterologist who I chose to perform the procedure.
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Re: health insurance rant
Posted by: DavidS
Date: April 26, 2021 06:27PM
Quote
davester
This is because it was created by Beth Kaiser, wife of industrialist Henry Kaiser, with the aim of providing health care for all of Kaiser Corporation's workers and families. As such, its roots are as a comprehensive healthcare organization, NOT a moneygrubbing insurance company or hospital corporation like all of the other "healthcare organizations".

Not to nitpick, but KP was formed by Henry Kaiser and Sidney Garfield, MD for the purposes you state. Besides approving of the name (Permanente comes from Permanente Creek in Santa Clara County), BESS (not Beth) Kaiser was not involved in it's beginnings. winking smiley
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Re: health insurance rant
Posted by: JoeH
Date: April 26, 2021 08:12PM
I see the positive statements about Kaiser, wish I could say the same. Kaiser came into the Northeast in the late '80s, acquired a number of existing HMOs and PPOs in the area. Then around 2000 Kaiser suddenly left the entire Northeast and left behind a mess of fractured medical practices and other problems. They also did the exit with less than the required notifications in many states. In some states Kaiser did sell off their stakes in practices, but not at all in MA.
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Re: health insurance rant
Posted by: davester
Date: April 27, 2021 12:54AM
Quote
DavidS
Quote
davester
This is because it was created by Beth Kaiser, wife of industrialist Henry Kaiser, with the aim of providing health care for all of Kaiser Corporation's workers and families. As such, its roots are as a comprehensive healthcare organization, NOT a moneygrubbing insurance company or hospital corporation like all of the other "healthcare organizations".

Not to nitpick, but KP was formed by Henry Kaiser and Sidney Garfield, MD for the purposes you state. Besides approving of the name (Permanente comes from Permanente Creek in Santa Clara County), BESS (not Beth) Kaiser was not involved in it's beginnings. winking smiley

I stand corrected, partly. My father-in-law worked with Henry Kaiser (and even owned one of the first Kaiser cars!). He told my wife that the health plan for the workers was Bess's idea. So, perhaps she didn't create it, but without her it might not have happened.



"In science it often happens that scientists say, 'You know that's a really good argument; my position is mistaken,' and then they would actually change their minds and you never hear that old view from them again. They really do it. It doesn't happen as often as it should, because scientists are human and change is sometimes painful. But it happens every day. I cannot recall the last time something like that happened in politics or religion." (1987) -- Carl Sagan
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Re: health insurance rant
Posted by: AllGold
Date: April 27, 2021 02:23PM
Kaiser is not available in much of the country.



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Re: health insurance rant
Posted by: DavidS
Date: April 27, 2021 02:34PM
Quote
AllGold
Kaiser is not available in much of the country.

Correct. Northern and Southern California, Seattle and Portland areas, Georgia, Colordo, MD/VA/DC, and Hawaii (b/c Henry Kaiser had a vacation home there).

At one time, we were also in NC, MA, TX, and OH (Cleveland area).
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Re: health insurance rant
Posted by: JoeH
Date: April 28, 2021 01:56AM
Quote
DavidS
Quote
AllGold
Kaiser is not available in much of the country.

Correct. Northern and Southern California, Seattle and Portland areas, Georgia, Colordo, MD/VA/DC, and Hawaii (b/c Henry Kaiser had a vacation home there).

At one time, we were also in NC, MA, TX, and OH (Cleveland area).

...and NY and CT, maybe RI. I don't recall any expansion into southern VT or NH, but it was under consideration as some of the organizations they provided health plans to in MA had employees who lived in those areas.

The health care locations Kaiser had acquired in NY and CT were sold off to other health care companies at the time they exited the Northeast. The ones in MA were not.

P.S. They announced their exit late in the afternoon on the last Friday in June of that year. From what the MA State AG determined at the time, Kaiser was in violations of several statutes related to required notifications that they were going to exit as a health care provider. The AG required them to continue coverage longer than announced for a number of contracts Kaiser had signed already before the announcement. The state however pulled all of its contracts and had state employees that had selected Kaiser go through another selection period in the Fall after everyone had just finished going through the process in May for plans that ran from July 1 to June 30.



Edited 1 time(s). Last edit at 04/28/2021 02:04AM by JoeH.
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Re: health insurance rant
Posted by: wowzer
Date: April 28, 2021 07:41AM
As doctors become employed by larger groups and hospitals, we lose our voice in advocating for patients. As an ED doctor, I have decided to leave the NY area because it has gone completely corporate. It’s an awful mix of understaffed and overwhelmed ED’s dominated by a few bad non-profit players who are entirely focused on the return on investment. Many questionable decisions have been made during the pandemic and has upended the practice of medicine. It’s a bad time.



All I ever really needed to know, I learned from watching Star Trek.
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Re: health insurance rant
Posted by: Fritz
Date: April 28, 2021 10:10AM
"It’s a bad time."

that it is.



!#$@@$#!

If there are spelling issues, please pardon, Owen the cat is walking, standing or sleeping on my keyboard.
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