The Biggest Medical Insurance Scam
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- เผยแพร่เมื่อ 20 มิ.ย. 2024
- Hello, I'm Dr. Antonio Webb, and today's video is a must-watch for anyone navigating the healthcare system. We're exposing the critical issues and dangerous delays caused by the insurance prior authorization process, which prioritizes profit over patient needs.
Join us as we uncover the shocking realities behind these practices, including United Healthcare's flawed AI model with a 90% error rate, which wrongfully denies essential health coverage to our elderly population.
In this video, we discuss:
The misuse of prior authorization by insurance companies to control costs.
The dangers of having non-specialist doctors make decisions on specialized surgeries.
Effective strategies for managing prior authorizations and securing the medical treatments you deserve.
As your advocate in healthcare, I'm here to help you understand these complex processes and empower you with the knowledge to advocate for your rights.
Stay informed and take control-watch now to learn how to address and overcome the challenges of insurance prior authorization.
#HealthcareReform #PatientCare #DrWebb #MedicalEthics #InsuranceReform
0:00 Prior Authorization Explained
1:07 Dr Antonio Webb Intro
2:24 Insurance AI Bots
4:08 Dr Webb Patient Story
6:26 Weaponized Insurance
8:03 Tip 1 Learn
8:27 Tip 2 Document
9:04 Tip 3 Communicate
If you want to learn how to start, grow, and monetize your brand/social media - check out my new online course at: socialmediafordoctors.com/
To see Dr Webb as a patient, please contact:
Antonio J. Webb, MD
Orthopedic Spine Surgeon
South Texas Spinal Clinic
9150 Huebner Road Suite 290
San Antonio, Texas 78240
Office: 210-614-6432
Fax: 210-293-4171
www.spinaldoc.com
antoniowebbmd.com
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thewebbfamilyfoundation.org/
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MEDICAL DISCLAIMER
The information provided is not intended to be a substitute for professional medical advice, diagnosis or treatment. Never disregard professional medical advice, or delay in seeking it, because of something you have read on this website. Never rely on information on this website in place of seeking professional medical advice.
Let’s see…. insurance companies charge expensive premiums, have high deductibles, make the doctor jump through hoops, but can then deny authorizing your necessary treatment. The system needs a huge overhaul. Great video!
Correct
Dont forget the government subsidies them, meaning we all contribute to putting money in the pockets of big pharma/ insurance companies (some insurance companies get up to 95% of their costs payed by the government)
Hospital administration isn't innocent either though. They are the ones who negotiate and agree to contracted rates /discounts for procedures with these networks. Hospitals and physicians wont take certain insurance/networks because they want to be paid more than what the network will agree to pay. They might or might not see a patient, then slap them with an egregious balance bill and not care. The American healthcare system is a business that is not centered around overall patient accessibility and care.
Dr. Webb isn't pregnant but he always delivers
Yesssssssss
😎
I will grade this comment from A-F I will give it a C in this Section.
this sent me
Excellent presentation!!!!
As a medical student, it is very disheartening to see what lies ahead for my patients.
Trust me insurance is why healthcare in America sucks and medical greed in hospitals is really high.
I'd worry more about what they'll put you through.
Become an advocate for change!
Healthcare needs to be revamped. Insurance companies definitely need to be held accountable!
Prior auth is a joke.
I once had to get a cheilectomy procedure approved via peer-to-peer with a non-physician representative that couldn't even tell me what the procedure entailed or how to even pronounce it. How come this individual is responsible for approving this? Once it was approved, the surgery was complete and without surprise the claim was denied and the approval letter was lost by the insurance company. Ultimately paid once we sent THEIR letter to THEM!
Another silly example: limb salvage case, patients need NPWT. The VAC device was approved and shipped to patients house. I applied VAC and it was denied because vac application code was not approved. So device is approved, but application of it is not....
Ultimately just a waste of time, preventing timely and appropriate care for what patients need by people making medical decisions only to be denied by people without a license to practice medicine.
Wow, I had no idea that AI robots were responsible for determining the approval of patient surgeries. This is a must share for me. Thank you, Dr. Webb.
I made a post on my channel and shared throughout our different radiology communities. This is definitely a must-watch for anyone navigating our healthcare system. Thanks again for shedding light on these topics, Dr. Webb!
@@MRIPETCTSupportEngineerhi buddy!
Good video. So so frustrating. I have nearly given up on all pre-auth denials and peer to peer discussions because it costs me significant time and causes significant stress and frustration. The process is broken. I don't intend to play their games. The prior auth process needs to be completely revamped or banned by state and federal governments. The corrupt physicians/surgeons working for the insurance industry also need to be called out- stop working for the enemy and making money by denying or delaying care. The insurance companies will continue to deny care and create obstacles until the patient and surgeon tire from the process. I always tell my patients to be their own advocates and if their insurance company continues to deny or delay care to switch insurance carriers or ask for assistance from their HR director at work.
Reality of prior authorization is a wreck and makes me wish America had a different healthcare system. I had a lot of grief trying to get dental implants approved. Finally decided to pay for it myself without insurance but lots of people can't afford that
I’m happy you are calling it what it is…a scam
All insurance is a scam.
I found out yesterday my insurance carrier rejects 1/3 of claims 🤦♂️
In my role handling pharmacy prior authorization requests, I deal with a frustrating business model where each party involved shifts the blame to another. The insurance company blames the manufacturer, the manufacturer blames the research, the physician blames the insurance company, and so on. This cycle of blame leaves the patient as the only one suffering financially.
I review for physical therapy. There’s so much overuse from patients wanting nonstop therapy all year and therapy clinics wanting to bill you when you’re not showing progress. Prior authorization is needed, but it’s not a perfect solution.
Huh, I used to yearly or biyearly get my medication denied to me because of prior authorization reasons. And then I moved to Washington State, and my problems disappeared. No wonder. Even though it was just a once or twice a year occurrence, it was always so stressful. Wonder why just two states have done something about this !!
I’ve been a nurse 20 years. My biggest headache are medical insurance companies. These people are not doctors, nurses, or have any medical background but still dictate how patients should be treated. I’ve seen patients suffer because there insurance delayed or refused treatment authorization. Even Myself I have Crohn’s disease I have been refused or had my treatments delayed many times even though my doctors wanted me to have these procedures or medication
S. These insurance companies are definitely a big scam and really don’t care about there patients.
This is so false. To be in UM it requires a clinical license and all denials are approved by multiple MDs. These are the individuals that actual deal with PA
As a healthcare worker, it's a nightmare dealing with these different insurance carriers in billing and advocating for my patients and clients. The insurance companies have too much power. There needs to be federal intervention for the interest and protection of the people.
Thank you for speaking out on this very important issue in our deeply flawed healthcare system Dr. Webb. We need a single-payer healthcare system in this country - when it comes to folks getting the care they need, the profit motive does not belong in healthcare delivery.
Thanks for your spotlight on this, Dr. Webb!
My pleasure
Prior Authorization really is "We will pay for this service, if we pay for this service" and yes, many find out afterwards that its not a covered service or it has to be performed at a certain location. Thank you sir for this valuable information. I've been on the wrong side of too many calls with upset patients because their test?procedure was denied and they thought the hospital decided that. I had to kindly describe the process and referred to their insurance and occasionally to the provider.
I always laugh in Dutch (and European) whenever I see something about healthcare in the US. We are really fortunate over here
My L5-S1 artificial disc replacement was denied by insurance 2 days before surgery so I had to go with fusion which I didn’t want. Next day, insurance denied the fusion. My surgeon was able to get the authorization just the night before. As a result of the fusion, I now have adjacent segment disorder and am looking at an SI fusion in the near future. What a nightmare!
That's horrible.. Maybe think of going to Germany if adjacent segment is affecting the disc above. 2 level lumbar L4/5 L5/S1 disc replacement with Lp-Esp, best decision of my life!
With insurance I have been denied treatment to my ankle and told to just do physical therapy. I was on it for 6 weeks and the therapist said there is something more deep and wrong with my ankle. But every Dr I've been to I guess knows the insurance will deny any treatment and so they just flat out tell me they can't help me. Except for one he was rude and told me the pain is in my head and there is nothing wrong with my ankle. 😐
This is very sad. For me as a german, this makes me appreciate our healthcare system, although we also have some big issues there, this is incomparable. I want to become a surgeon in the us and do my residency there but stuff like this is really giving me doubts...
Thank you, Dr. Webb.
So true. I’ve been doing prior authorization for 20 years now and it’s not getting any better. 😞
This is a very serious issue affecting lots of people! Thank you for giving us a deep look into this issue.
Reading the title of this video got my blood pressure up
As premed in college before medical school this is frightening what I will face as a doctor.I see this with my generic albuterol caused me a trip to the hospital which my insurance denied.Tell Dr Cellini to start making videos again particularly for premed and med students.
This is a sad process. If a person has multiple medical conditions and need medical care 24/7, 365. That person is always in Jeopardy of losing their lives. There needs to be legislation done to overall this prior authorization process. I have so many times then close to having to take my daughter to the hospital because of the prior authorization that pad to be completed to be done between the doctors office, the pharmacy, and the insurance company. This is very frustrating for anyone that has to deal with this and if you have many medical conditions I need medical help to stay alive. United Healthcare is one of the worst with this process even though I have a primary insurance . I have been dealing with this process since she was age 3.
Thank you for this video Dr. Webb!
I am a health care worker and insurance companies suck! They will deny a 80 year hip fracture to rehab and here goes the appeal process which is a bunch of B.S.
This is so facts. I’ve been working in healthcare admin for 4.5 years and I recently had a case where a patients IPA carved out an auth for lidocaine infusion to the payor but then the payor denied the damn auth bc they said the IPA is supposed to handle it and now I have to get the patient involved which sucks bc they’re dealing with chronic pain from other conditions and might now need to file a grievance. I’m literally mind blown that SOME insurance company UM depts are this incompetent.
And I majored in economics.
It angers me that someone who has never met the patient and may not have a medical degree (or not specialize in that particular field) is given the authority to deny medically necessary treatment. Only a doctor who has spent time examining a patient should have final authority to determine what is medically necessary.
I had no idea of these great problems with health insurance. They rely on people not knowing how the process works and what their options are.
thank you for the encouragement and heads up. I aspire to become a physician someday but my greatest concern is dealing with the insurance. It might be tough for physicians to deal with mentally because physician understand how certain conditions may become acute and even lethal if not handled in time. I wish the system gets better, especially for underprivilege patients. God bless America!
Thank you Dr. Webb! Your videos are always informative. I never knew about the AI robot sifting through prior authorizations.
Thank you for shiny light on this topic. I work for a big hospital in Los Angeles as a administrative assistant unfortunately it is up to administrative assistance for this particular hospital to be 100% responsible to complete prior authorizations with no medical clinic experience or even being clinically licensed, it is unfortunate that the healthcare system is broken to wear. There is no license clinician that can help us an administrative assistance to fill out these prior authorizations because they have so many questions about dosages contractions to other medication’s, patient diagnosis so sad that patient’s medication’s get denied because we simply don’t know how to answer these clinical questions
Did realize I could appeal I just thought only doctors could so that. Thanks for making that clear and that i can do more...
thank you for speaking and thank you for the so much needed information
Thank you Dr. Webb. Regarding my 2nd to last fusion, i was told that "if the insurance company doesnt approve of the scheduled surgery, I will call you the night before and you need to go to the ER, pretend like you have debilitating pain in your back, they will more than likely do an image, and i will be the neurosurgeon on call, then i will suggest emergency surgery and they will be forced to pay for it."
Crazy stuff.
Lol 💪 I love it! 😂😂
Agree very well done Doc ✅
Your advocacy is helpful. Well done.
I i got denied for a sleep meds i was already taking it was approved twice then i was told i wasnt doing enough to get to sleep without medication
A friend of mine had a comp injury, carpal tunnel. The insurance insisted on PT for six weeks with re eval. Then they wanted to try meds and treat conservatively. After many months, the injury worsened and now she had nerve damage going up to her elbow. They finally approved her surgery but denied surgery for the elbow component because that wasn’t the initial injury even though the delay in authorizing surgery caused the elbow nerve issue. Her primary insurance then was used to pay for the ulnar nerve issue. Because she had two different ins carriers for the injuries, the Dr only did one at a time which caused the pt to have to go under anesthesia twice and have to pay some out of pocket for a work comp injury that was complicated by insurance delays.
Totally agree about prior authorizations. My doctor should be the only one with the authority to help me make healthcare decisions. Not a freaking for-profit corporation.
Insurance is the one paying for it, why should your doctor be allowed to abuse the system in your favor?
Insurance is the one paying for it, why should your doctor be allowed to abuse the system in your favor?
Thank you for sharing Dr. Webb. I am from Central Asia and came to US as an international student. It blew my mind how complicated the healthcare system is and how many people have to wait to get basic necessarily care. Now I work in healthcare as an Image Analyst and see so many patients suffering without proper accessible care and lack of coordination. One of my goals is to bring change to community and make our services faster and more affordable. Do you happen to need any volunteers to help you with projects?
THANK YOU 💐. Explaining the prior auth. process helped me to move forward I plan on a visit to the doc on Monday instead of continuing to wait on the sidelines for an authorization
Glad it was helpful!
That’s so frustrating
Yep. Utilization management. All it does is provide a wall of denial, that if bypassed, can provide you the care you need. As a former broker, I hated it. At the same time, one of the few things it does is provide a barrier against fraud and abuse.
Health Care Insurance companies are DESPICABLE...why are they not being held accountable for their deceitful practices?
Even in the MSK medicine world, insurance just seems to be a barrier between the doctor and the patient.
Thank you doctor 👊🏿 so much for the amazing information make sure you get some rest for yourself God bless you and your family continue taking care of people they need you 👍🏿✌🏿
Insurance is not really insurance…. It’s almost like a casino-the house always wins. If the house is not winning then that’s a serious problem. It is a scam… and it has gotten worse last year with spinal orthosis requiring preauth and getting even worse with exempting jardiens and ozempic from insurance payments as costing too much money.
You can also look up the clinical policy bulletin for that insurance carrier if possible. It should be able to tell you exactly what codes are needed and any other services that are needed before the procedure can be approved. It's 100% fail proof because they'll still deny it for whatever reason. However, you should be successful upon appeal. Good luck, Doctors!!
Thx
@antoniowebbmd I meant it's *not 100% fail proof 🤦my claim would have been denied because of this simple mistake! Dang, UHC!! 🤣
It's an absolute nightmare. This is from a European living in the US
In reality, the prior authorization process is a legal way for insurance companies to practice medicine without a license or credentials to do so. And nobody seems to think this is a huge problem???
I have had too many horrible experiences with insurance companies to get started, obviously they take no responsibility nor accountability for the death of others. Too many friends and family have died because the insurance company denied a basic chemo that normally would take care of certain cancers without other issues. Things are far worse than 10 years ago and I feel that the opiate war was a side show to not allow physicians to properly handle them and the pendulum is swinging against those who have no other recourse and don’t wish to ever take street drugs. If you take such things know that the daily dose was dropped lower and I think we will see more suicides. It was a great idea to have a database for sure but a robot making decisions for those whose pain makes them have seizures and puts their BP through the roof are not just in danger of finding pain medicine somewhere else but of death. I would never blame my physicians because I worked in the medical field but faceless people bear the accountability and unfortunately despite how hard our surgeons and physicians work, they too bear PTSD. It’s not your fault. 😊
Medical insurance was originally drafted around the desease treatment; not the patient.
But , unnecessary care is no stranger to our profession. Due to Irresponsible practices, the system is plagued with frustrating Prior auths. A comprehensive solution is urgent to fix healthcare but we know how that goes.
DR WEBB MAN GREAT STUFF 😮WOOW DO I HAVE STORIES TO TELL ON WORK DONE ON ME HOPE MEET AND CHAT SOMETIME 👍 HOWS THE TRAINING YOU GETTING IT👍💯THANKS FOR CARING BEST TO YOU AND THE FAMILY AMEN🙏💯♥GOD BLESS
Basically, what this video is saying is that Insurance companies are a fucking scam. They also are full of people who have no idea what they're talking about and make choices based purely on money and profits. Right?
I work in billing… insurance is an absolute joke. That’s it’s lol
Alogorithms 😂😂
Original Medicare Part A and B are much better than PPO, HMO. That little credit card for food that you get puts you into managed care.
guys from the USA if you can just come to the Europe. Even at the weaker part of the EU this shit doesn't happen.
Two issues, how can a physician make a decision on what is medically necessary on issues outside of his scope of practice? It's dangerous & unethical. Number two, if you were vaxed & boosted, how did you get covid 🤣?
2:25
Insurance company is scam
universal healthcare makes you a subject tho
/s
"best country in the world" and have to go through hell and back to get proper medical care. a joke really.
The judge and the system should be sue