Whistleblower Exposes Health Insurers' Most Evil Scheme
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- เผยแพร่เมื่อ 7 มิ.ย. 2024
- A health insurance whistleblower is exposing their most appalling practice. It’s called prior authorization - and it’s part of a money-making scheme based on denying and delaying patients care. But doctors are fighting to reform it.
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I'm a nurse, and I met another nurse, who tried to convince me that taking care of the shareholders, was more important than taking care of the patient.
In nursing school they make us call our patients, our "clients" :(
Meanwhile we’re stretched so thin that the actual care that patients get continues to decrease. Shame on that nurse that said that to you.
I wish shareholders would just get real jobs
Thank you for not going along with her. I'm disabled and have a lot of problems. I depend on my entire medical team, especially since I have 11 Drs. All my Drs are through the same hospital so they can all just look at the computer and see all my records and send messages to each other and most of all the nurses and staff are totally awesome, but I have met a few that I think are more like the one you met. There are to many of us out here that depends on people like you. You probably don't get told this enough but thank you for all you do. Thank you for caring. And thank you for telling people like that to go away. You are a true hero.
@@Sho_Ishto
More profits into HCA CEO pockets.
Rick Scott, R-FL became a multimillionaire after being forced to resign from his HCA after engaging in major Medicare fraud. Scott received a pretty nice severance.
Healthcare in america is working exactly as designed. It just wasn't designed to help human beings.
It was designed to help the shareholders stock value
Agreed. Shareholders of insurance companies are inhuman.
It's profits over people, they have no soul.
@@Melissa-pd5hr In other words, once again, as always, the problem is capitalism.
@@iExplodernow you’re getting it
Selling a product then refusing to give the customer what they paid for would be considered fraud in any other industry. Healthcare is a basic human right.
There are no rights. That is the reality.
What exactly defines what a basic human right is?
In America, there's simply no such thing as "rights". Everything in America is a money-based privilege, amd always has been since the country's inception.
Lol healthcare is a basic right? Ok. Tell me. If doctors stop being doctors, who provides this basic human right? Funny, almost like you can’t call something a human right, if you require other human beings to provide their service. So what will you do? Force people to become doctors??? NOTHING is a human right, if you require the labor of others, in order to provide that right.
@@zeal9442ah yes. That’s why we spend 1.8 TRILLION a year, just on FREE healthcare . More than very many countries spend, on EVERYTHING. But let’s keep pretending American healthcare is for profit while everyone else’s isn’t. We create more than half of all medical patents. That those other countries take for free.
Imagine my surprise and great comfort during my first pregnancy when I received a letter from my insurance company notifying me that I’d been approved to GIVE BIRTH to my child. I hadn’t realized that it was optional at that point.
yeah GOP lawmakers push real hard to ban abortions yet refuse to make giving birth an easier process on the wallet and mind. at this point ALL OF US should just have kids and not pay them anything. they cant take us all to court and jail.
I like how it's totally legal to be denied coverage that you pay for. Can you imagine if we did that with something like groceries? Like, oh, you have to pay upfront, and then the store gets to decide what groceries you actually get to take home with you. Also, there's no way of knowing beforehand what groceries you'll be allowed to keep until you try to leave with them.
Great analogy!
It's like college.
All the better if you’re allergic to some of them too.
This is the fourth time you've confiscated the milk in a row, why won't you just let me have some calcium?
"Well, you see, you could be rushing home to pour it on Trix, which is for kids; and you're obviously an adult."
I'm sixteen, even _if_ that was a valid reason, why didn't you ever card me?
"It's not our jobs to fact check, it's yours to provide all the information in whatever arbitrary manner we want."
Even if you don't tell me?
*_"ESPECIALLY_* if we don't tell you!"
Careful, don't give them any ideas...
US health insurance companies need to face criminal charges for practicing medicine without a license and also pay out to the people who have been harmed for the delay.
That second part is kinda hard to do from a box in the ground and that’s what their hoping for.
@@wrenchaholic_ -- (THEY'RE)
you meant doctors got arrested for practicing medicine and not following the insurance companies rules about covid right 👍?😅
but people that have no insurance go to the hospitaland get mris instantly, you are better off not even having insurance
They have De-Facto Qualified Immunity from our Elected Lawmakers.
'Prior authorization' is what bankrupted me at age 25. I had an emergency cesarean, followed by a week stay in the hospital due to complications from the surgery. It wasn't pre-authorized to have this emergency while trying to push out a kid for 2 days.
Now, I'm 38 and can't get my adhd meds without getting a prior authorization every 3 months from my doctor. It's DISGUSTING. I have to take time off work, losing $$, to keep my meds - they need to make sure my adhd hasn't magically been cured.
The prior auth for adhd meds is because they're a controlled substance. Not because they expect you to be cleared. It's to make sure you aren't a drug dealer.
@madmagdelena Every 3 months for the rest of my life, with my limited refills? I can't refill until I only have 2 days' worth of meds. There are other controls in place to prevent me from selling my meds and becoming a drug dealer. Prior authorization causes me to lose $$ from taking a day off work every 3 months for that specific appointment, plus gas to get to her office 1.5 hours away. Don't forget my co-pays to see the dr too.
But yeah, sure, it's that 'prior authorization' that keeps me from going to the dark side and dealing 🙄
Prior authorization is nothing but getting your insurance company's permission to follow your doctor's orders - giving them an opportunity to deny coverage, find cheaper options, or find YOU at fault for your health. Otherwise, why would I have needed 'prior authorization' for my emergency cesarean? Are babies controlled substances as well?
@@cryschanel32 I have adhd and agree with you and have to do the same checkups every 3 months. I'm just staying the reason for them even though the reason is hella stupid.
@@madmagdelenano, that's not why. Most of this stuff can be traced back to the employer if you receive insurance thru work.
@@itsme3k That's exactly it!
My grandfather was a paraplegic. He had been in a wheelchair for over 40 years. Like most appliances they wear out. It was time for him to get a new wheelchair. The insurance company denied his request for a new wheelchair. When my mother called to find out why they told her that he had been in wheelchair long enough and didn't need one anymore. I'm not actually sure what steps my mother took, but after she was done with the insurance company, not only did he have a new wheelchair they also provided him with a wheelchair accessible van.
Go momma, what a warrior! My mom had to do the same for my brother lost his leg on our farm an awful accident. This was in Ireland 1970s. The lies, denials, derision, suspicion, refusals would make any grown up cry and throw in the towel. Absolute evil. We never got the wheelchair but finally got him a prosthetic and crutches. Getting a new leg is a nightmare. He mcgivers it until its practically sawdust and glued and screwed like a science fair experiment to dodge dealing with these monsters. I get it.
Ignoring everything, it's crazy that NON-MEDICAL PROFESSIONALS are deciding whether treatment is necessary and often OVERRIDING MEDICAL PROFESSIONAL'S JUDGEMENT.
I've been screaming this exact thing since 2016 when those unqualified individuals were in charge of my case.
True story.
Legally they can't actually do that in the US, only medical professionals are allowed to make medical decisions.
They work around that by hiring the worst doctors they can find, the failures and creeps, use an algorithm (these days they're turning more an more to AI-driven systems) to deny patient care, and then pay these worthless doctors to sign off on all these denials without even reading the case notes.
IMO any doctor who works for one of these insurance companies or outsource agencies deserves to have their medical licenses permanently revoked for malpractice.
@@EphemeralTao same for any doctor who does "independent medical exams" for the insurance companies.
I've been to 5 and they're awful too.
People should be able to file complaints to the licensing board and have it actually result in something.
@@EphemeralTaoI heard they hire a doctor to click a computer mouse. The computer just pops up procedures and approve or deny, and the doctor just has to click "yes" all day so they can say a doctor approved or denied it.
My partner went to a doctor about a lump they had found. The doctor had them get a mammogram and testing which showed to be benign. Later we got a large bill for the mammogram even though the insurance site said the cost was fully covered. I called them to figure it out. Turns out that mammograms are only covered for regular screening, but because there was concern of an issue that wasnt covered. Insurance is a scam.
It's a double scam. They want to run the procedure is the key, so money gets made. lawyers writing these guidelines make sure they screw the patient, not the company that provides the service. If you saw it isn't covered, at least you'd have the option to not get the procedure.
@@Rene-uz3eb And, if you don't get the procedure? And, if it turns out not to be benign? Schrödinger's cat. You're damned if you do? You're damned if you don't! 😒✌🏽
Hehehe haha gotcha with a little loophole here's your 100k bill. I love the free market. 🤠
Yep I hear ya. Broke my shoulder this last March. Seen the orthopedic 4 times. Surgery was not needed. Just a sling, then PT for a couple months. After my insurance, 6k is my copay! I pay 75 bucks a week for insurance! What a bunch of horse shit 😡
@@stickysdennot to be rude but the phrase you are looking for is "catch 22" or "lose-lose situation". The cat is a metaphor for quantum science and parallel states as well as a real life example of both the concept and of animal cruelty. But the image of titties existing only when you look at them is hilarious.
I don't want to live in this country anymore
11:40 oh thank goodness for medicare
Medicare getting worse, contracts out denials of service/claims appeals and other disputes between patient and provider to Quality Improvement Organization (QIO) companies which get patients to provide information about their case and in less than 72 hrs (sometimes in 24 hrs or less!) the QIO upholds the denial. It’s impossible for a Dr to review cases that contain thousands of pages of medical info, in addition to taking into consideration the patient’s input and in 72 hrs or less renders a decision! Now multiply such cases by the hundreds if not thousands that the Dr has to review as part of his/her job at the QIO. It’s an algorithm that spits out the decision and the dr then signs it😜 Just talk to Medicare beneficiaries that have gone the QIO route (sometime multiple times) and let them tell ya!
Went through the same thing last month was denied coverage for a one night hospital stay after a major surgery that ended late in the afternoon, tubes placed during surgery and hanging out, catheter, bloody urine, five incisions, fever, pain, in post sedation state. Payment was denied due to it “being not medically necessary.” The doctor has ordered a minimum of one night stay. Called Blue Cross and explained that what they are doing is denying payment of care hoping we would go away. The doctor that reviewed and denied the claim was listed on the back of the denial letter. I plan to write the medical board regarding the denial. What doctor would endorse that denial. Very stressful at a vulnerable time when you are already weak. The stress of it all could lead to death. Criminal greed. Insurers need to be held accountable and the doctors that are endorsing the denials held accountable too.
I’m a physician. I’ve been practicing since 1996. What has happened in the US over the past 15-20 years just disgusts me. What the insurance companies do is flat out fraud. Should be illegal. They look for the smallest loophole or tedious paperwork that a lot of people do not understand. This combined with nobody to speak to, and long hold times, drives people to just give up. I’m super surprised that more patients don’t go “postal” on insurance companies.
Thank you ❤
I don't understand how they can not be sued for medical malpractice.
@@galacticwarlock2271 because they have a lot of money to spend on good lawyers.
In any other industry, this would be considered thief of service: we enter into a contract in which we pay in exchange for coverage. Then coverage is denied. Breach of contract?
The insurance lobby is powerful. They must be paying well those who should be going after them.
@@michelem3360Exactly. They are bribing the regulators
The root of all of this is the fact that we’ve allowed insurance companies to use individuals who DO NOT HAVE medical degrees to override the doctors making the decisions about operations.
Maybe you missed it, but those prior authorizations were being denied by Drs, and Nurses that work for the subcontractor.
@@kevinbarnard355 They actually aren't most of the time. If you actually look at who on the payroll is performing the individual inquiries, it's generally people who's highest level of medical knowledge is the training they received from their job. They tend to look for "keywords" when looking over medical documents rather than properly understanding what the document is talking about and what the patient actually needs.
People should not be allowed to deny medical treatment to a patient without actually SEEING the patient.
If they want to audit/sue the doctor and the patient AFTER... that's fine. Or they could allow the procedure only on "preapproved" doctors...
When I say "preapproved" should be EVERY DOCTOR/HOSPITAL THAT ACCEPTS YOUR INSURANCE should be pre-approved. If you trust them enough to be part of your network, they should be trusted with the recommended procedures.
Either way, I'm happy I don't live in the shithole that USA is... people fight and argue to live a worst life there.
the #1 problem is that private [FOR PROFIT] companies are even allowed to provide health insurance and buy the republican party,, we need national health care just like ALL THE OTHER MODERN COUNTRIES !!
@@herchelleonwood7463Lol no. All of the problems we have now would be worse under a government run system. They'd just be doing what canada is doing right now and telling people to just go and die.
I have worked for a pharmacy that provides high-dollar medication. I was provided with the approval guidelines of every insurer in the Northwest. Dr would send me the patient notes and charts so I could handle getting the medication initially authorized and then maintained because authorizations are only good for a defined time. If I knew an insurer was looking for a specific word and it wasn't there, I let the doctor know. This helped the process, but it is a circus and we are all clowns. They don't want to pay for anything. And medical necessity is apparently subjective.
This is one of many examples of how white collar crime CAN negatively impact people’s lives; even to the point of actual death. These companies need to be served actual justice through jail time and NOT easily payable fines.
I have worked at many insurance companies around the country. These outsourced denials let the sociopaths in the board room sleep well on their giant piles of our cash. Medicare for All, today!
Please tell your friends and family prior authorization should be illegal, unless there is already evidence of fraud or abuse or misuse on that case.
Just because one other person in the country submitted the wrong procedure is not an excuse to require this prior authorization for everyone else.
Also, insurance companies are designed not to cover extended nursing care; only acute nursing care. Why? Profits. Don't believe it? Look at other industrialized countries
Tell your Congressman and don't accept their excuses. What is your Congressman, other than a representative of the insurance company's profit center?
So much of the hellscape of our country can be traced tracked to the soulless McKinsey consultants...
Vote blue!
@@hw-rg7gnMcKinsey is an institutional malignant tumor. That company(?)/conglomeration(?)/CIA front is e v i l.
@@novampires223voting blue isn't enough the Dems are complicit with this system. If you're gonna vote blue as your only method of change vote someone new not your same representative. How can we expect change with the same government officials.
If you believe that the Republicans are gonna try and stop anything the Dems do then shouldn't we at least get some new Dems in there to see if they fair better against the Republicans. Watching the current Democrats in Congress it seems like they aren't even trying to help us. They just say "oh we can because of the Republicans"
Congress should pass a LAW. ANY medication, procedure, surgery, or device that YOUR DOCTOR says that YOU NEED, MUST BE COVERED BY YOUR INSURANCE! PERIOD.
What if the doctor is committing fraud?
@@johnrussell267So what ? Are you saying the patient is a fraud or participating in fraud also ??
Can you have one without the other ?
Easy solution is asking for an itemized statement from the Dr.
@@jessiejohnson6424 Asking for an itemized statement from the doctor is literally what a prior authorization is. 😆
@@johnrussell267 No it isn't.
The subject was fraud.... I gave the answer to that subject.
Plus an itemized statement is for after the surgery or hospital stay. Therefore it is not used as an prior authorization.
@@johnrussell267 even with the insurance companies working the way they do lots of Dr. still commit fraud. It’s usually caught by the FBI or police, though not the insurance companies themselves. So I’m assuming more supervision in the hospital and by law enforcement would stop that.
I don't work for healthcare but I work for a company that's contracted by a large healthcare conglomerate. They make every step incredibly complicated and often pointless to try to refuse more claims. Like one support ticket will have multiple departments working it. They'll go back and forth requesting pointless information stalling the process. Information they already have they demand of the member even when unrealistic for them to have it. If they don't "oh well... nothing we can do." They make sure the people calling have no involvement in the ticket process so that they can't help the member.
They're evil. 100%.
I feel like you may be talking about my insurance called Healthgram. Worst I've ever seen, and I work in healthcare. I've seen a lot.
This endless amount of clerical and paperwork and staff needed. It's some of the huge amount of waste of healthcare dollars and it's so inefficient. Multiply this one example by millions. Then add to this the CEO salaries, bonuses and stock options. Our healthcare dollars by the 10s of billions of dollars annually, wasted. And just to reward shareholders and CEOs, etc.
Phasing in improved Medicare for all/single-payer (while phasing out corporate health insurance) would then funnel these otherwise wasted dollars directly into our healthcare insurance. Covering everybody with comprehensive health insurance. It's the most conservative use of our dollars! But not very likable by the health insurance industry and big pharma.
We're America. United We Stand! Haaa? We can do so many things well. We can do something like this, right?
I signed up for a Medicare advantage program after double and in some Triple checking that all my doctors were covered and my medications were too. Turns out 4 of my doctors and multiple medications were not covered. Not only was I unable to go to the doctor it cost me thousands of dollars to pay for medication. To top it off I battled 9 months to get out of the program. They changed what I had to do 3 times to be unenrolled. Even then they claimed twice they did not get my unenrollment fax. I used two different fax machines. The third time I faxed I used a government agency that one finally went through. It turns into a year of nightmare, and endangered my life.
This is mass murder. We need a retroactive law which makes it illegal for insurance companies to commit medical malpractice. And the settlements need to include court costs.
Why are you OK with money payouts, those people should be in jail, let them sit in there. Payouts will just be a cost of business
@@PropheticShadeZ I was thinking of all those people who went to court over insurance malpractice deaths, and being told "hey, it ain't illegal." But you're right. Nothing will change until the people who create these policies pay for their crimes. If there's no downside for them, they'll keep doing it, even if it is illegal.
In the US retroactive law is unconstitutional. That said non-sensical denials should be liable for malpractice and severe penalties for these folk going forward would be a good stop-gap measure until we implement proper health care. For profit health care like this is a recipe for tragedy.
Retroactive law is an even more immoral idea than what the insurance companies are doing
Nope, don't allow settlements. Instead it should be a law that makes it hilariously easy to win against insurance companies if any kind of medical malpractice is committed, and make the punishments harsh enough. Then, outlaw Prior Authorization.
I was thinking about something like this: the doctor that reviewed the case in the insurance company has to be published in every approval/denial, and if the company is found to have committed malpractice, the doctor that reviewed has their license revoked, so they're no longer allowed to work at reviews, the company gets fined for 200% of the total cost of the entire treatment (so the company always loses more money would they deny someone unfairly), and everyone from HR (because they hire employess) to upper management that allowed that review's result to face the client will be put on a watchlist such that enough offenses will have them jailed, retroactive and effective after about a month.
This would *immediately* make insurance companies restructure themselves. There's a time window for them to redeem themselves by effectively firing everyone that they know has denied unfairly in the past. There's no point on making it effective immediately because they will just shut down and everyone is left without insurance. The time window ensures that they still run, but they have to restructure. The punishments are harsh enough to make them want to hire the best doctors they can find so the reviews will be fair.
I worked in a doctor's office where EVERY YEAR one of a pair of identical twin girls would get deleted from their parents' insurance policy because *clearly* two kids couldn't have the same birthday.
They must have not heard of the birthday paradox.
Someone needs to sue
Heard of similar with twins born on different days(3 minutes to midnight and 1 minute past midnight), insurance refuses to believe you could have two kids born on sequential days, itq must clearly be either fraud or a mistake.
Same insurance also refuses to let you enter 0 as an age when an incident occurred which made reporting birth defects or conditions occurring before 12 months impossible; which was fine for them, it just gave them grounds to blanket deny any claim because you didn't report previous issues(even though you physically couldn't report it to them because of their terrible system).
can't wait for time when AI rule the world
@@bluedragontoybash2463lol
I just got switched to aetna ins. My meds were denied for a heart transplant. They were approved,then denied,then approved all within two weeks. The dates on the letters were a day apart. I was so frustrated with them i have a stack of letters sitting on my desk. I think they are trying to stop my heart. I started shaking more then ever. 😢
Prior authorization does not work for the patient. The accuracy of the video is spot on.
I kind of wish I could go to law school to constantly sue insurance companies.
You would fail. They are way too powerful. They have many lobbyists & EVERY politician take money from them guess who was #1, yeah, Joe fucking Biden. He even said if a universal healthcare ever made it to his desk, he would veto it anyway.
I wish you could. Health insurance companies should be legally held responsible for their decisions regarding their clients. Its honestly insane that they aren't. Its no surprise that a company, whose only responsibility is to their share holders, would make patient outcomes secondary.
Or better yet, be an FBI agent and arrest all the upper management of insurers for fraud and racketteering under the RICO act.
Unfortunately there's no money in it since they're never found to be liable. You'll go to law school and end up working FOR the insurance companies in order to pay off the student loans. Quite a system we have!
@@Ge1Ri4He said that there are no laws holding insurance companies liable for the harm they cause, i. e., they are unregulated.
They are so comically inept that they end up losing money sometimes. Which I'm sure just raises premiums. When my ex-wife was pregnant, she needed a specific medication every morning. Insurance refused to cover it. But they _would_ cover it if the ER administered it. So every morning we had to drive to the ER for meds. Eventually we had a standing order worked out, so that we didn't have to check in and wait 5 hours every time. They'd just run out and give her the shot in the lobby. Each ER visit cost like $10,000, and the IV version of the drug cost $1,500 a dose (the pill from the pharmacy was $80). For like 6 months, they paid for that _every day_. We appealed twice, there were MULTIPLE committee meetings where they decided that the current arrangement was fine. They are not only evil, but stupid and wasteful as well.
They raise premiums regardless of money. The line MUST go up.
They are not inept. These policies make them money. That's the goal
@@richardkatz8713Did you not read the comment that literally states in not changing it to what she asked, they spent more?
@@arandomcommenter412 maybe someone is scratching someone else's back.
how do you find this loophole ? asking for a sick friend.
The Rawling Group is another company that works with insurance companies to deny claims. I had to fight with them for over a year trying to get them to pay a claim, finally getting my states department of insurance involved, before they would pay it. Its inexcusable the stress they put us under and were unapologetic when we pointed out their error.
Start suing for pain and suffering.
The people you pay $1000/month to for health care have no legal duty to provide you with healthcare.
We live in a predatory system. This is just one of the corrupt entities that exercise abuses at the cost of the citizen...
The sooner the majority accepts this fact the better
I am being slandered and abused by the health care system because it is infiltrated by Org. Crime!!!! I reported criminal activity.
It's the medical labs and doctor offices and sometimes the doctors. They take good care of REAL prostitute.
@@jen-cy6wj I doubt they ever will as this has happened because of their complacency...
@@jen-cy6wj Sheep accept the unacceptable
@@Zeus-dw1cxwhom are these sheep?
My wife died of cancer that could have been caught far sooner, and could have been treated far more effectively, if not for the insurance company denying and delaying treatment for horrifically specious excuses. She wasn't allowed to get the tests that would have caught it early, and had her treatment delayed multiple times, because of these sorts of garbage technicalities. From the time the cancer was caught to the time she died was 7 months. If her insurance had not denied the testing and treatment she needed, she could have lived years longer. Medical insurance companies in the US are literally killing people to keep their insanely high profit margins that only a tiny handful of people will benefit from.
I feel like that could definitely be grounds for a lawsuit against the insurance company. Esp if it was a type of cancer that when caught early can be treated and go into remission for several years/decades (a lot of cancers tend to come back eventually). And they've got all the paperwork proving that she was trying to get tested and treated, so the discovery process should basically make your case for you that they're responsible for her death.
But then you've probably already explored those options and the stupid statutes of limitations on these things are ridiculously short to keep ppl from suing in the first place.
this is exactly what the fuck i’m talking about and what i have been screaming about. i am so beyond sorry for your loss. it’s unacceptable. it’s abhorrent. as a healthcare worker it makes me sick. you are so right this is LITERALLY killing people.
That would make me go postal. An eye for an eye.
@@brucesim2003Law Abiding Citizen
@@bokc_nonpopularsalt1011 Yes, I know what you mean, and I do agree with you. But when the law protects organisations that are willing doing this sort of thing, and the victim has no legal recourse whatsoever, do you expect people to just roll over and take it?
There are limits to the amount of abuse that people can take. I'm just saying that situation would cross my line.
My roommate used to work as an insurance analyser where she would comb through all the requests and see how much she can deny them. They had it down to a science
The more I learn about the corruption going on in every industry of this country, the more disgusted and ashamed I am to be American….
it's because we live under unfettered capitalism and have no nationalized healthcare system like most of the world does
I had to pull away for a moment after hearing that the insurance companies couldn't be found liable in ANY of this. Downright disgusting and brutally honest display of the American healthcare system.
De-Facto "Qualified Immunity" for Medical-Insurers purchased with Campaign Ca$h Contribution$. VOTERS must wake up..
Health insurance is a multi-billion dollar business whose sole source of revenue is preventing their clients from receiving health care.
These businesses aren't doctors, so why are they even allowed to make medical decisions in the first place?
@@Marco_Onyxheart An excellent question. Technically, the explanation is that they aren't making medical decisions, but monetary ones-that they only decide what they're willing to pay for, not what you are permitted to receive.
However, that ingores entirely the fact that the system they've created is so expensive that paying for it is impossible without third-party coverage.
The actual reason is because no one who's in a position to stop them gets elected without taking a substantial amount of money from them.
Yet the government doesn't give money for healthcare only mostly to the army even though they just waste the money and that's one reason why there's scams like this for insurance
Ban insurance, and ban usury again while we're at it.
@@Marco_Onyxheart Because judges that get lifetime appointments with no way to remove them get paid by interest groups of the 30bn dollar insurance companies. No judge is out of reach. See: Clarence Thomas on the Supreme Court
I hear about this all the time from big, decades old insurance companies. Especially the big three. Im glad, even proud to be a part of a great, affordable health coverage company. No shareholders to placate as it is a non-profit. It was specifically designed for people or small businesses that get run around or denied by big insurance companies.
Feds (or someone) needs to hold these companies accountable
For... What? None of this is illegal.
Nationalize health care now. Make congress and the rich use the same system the rest of us use. Standards would immediately rise.
so true.
Sound like communism
@@Mr.H333 Only Charles Koch and a handful of United Health, Blue Cross Blue Shield, and Cigna bribery liaisons would that kind of McCarthyism on you or me.
LOL. That isn’t going to happen in next 50 years. Healthcare and insurance companies give millions in money
@@Mr.H333 Then it sounds good.
Yup. My son has Type 1 diabetes. We have 3 different insurances, but one won't cover his insulin, one won't cover anything if they can't be the primary, and the third wouldn't admit him to the hospital until he either was unconscious or his glucose levels were uncontrolled in the ER for more than 12 hours. And after everything, and paying over $30k per year for insurance, his insulin is still over $700/month.
It's $15 in Mexico, or free if you're on their universal healthcare system.
Insurance is the biggest scam in the US, hands down.
So why pay insurance? I jus don't get it.
@@dmo848😂
And in Sweden I have free insulin, free wireless glucose sensors that connect to my phone, and visiting the doctor costs me $30.
That SHOULD be the standard, a type 1 diabetic never asked to recieve the disease, nor did anything wrong, its just bad luck. That is where society is supposed to step in and even out the inequalities to make sure everyone gets a fair chance at life.
Yeah, I really wanna ditch this country because of the horror of it's ableism.
@@dmo848 We used to have that option. Obamacare took it away from us. It is now federally mandated that all US citizens have health insurance, which for most means paying for it; if you don't have insurance, you get fined.
I fell into a deep depression almost to the point of no return because of a denied claim. The Dr got prior authorization and all that before a surgery. A few months later I got a letter from the insurance company that they wouldn't pay. I was already struggling financially but this put me over the edge.
The doctor should be able to fight this without you needing to be involved. Most states have laws forcing insurers to pay pre approved/authorized services under threat of fraud charges. If they refuse one of the docs medical billers just has to give them a nasty call. Most of the time this happens they “couldn’t find” the pre auth but magically can after they get chewed out. Sometimes they failed to coordinate with the third party they contract to process pre auths. Either way this can almost always be fixed with an angry phone call from the doc. If the doctor’s office won’t call you can call yourself with the reference number the doc got for the pre auth. If they still don’t want to pay most states have a department of health or government entity you can appeal to or you can appeal to the US department of health. Its a massive pain but if you become enough of a nuisance no one wants to deal with you and they just pay it. I hope your doc has already gotten on your insurance and fixed this but if they haven’t I hope this helps.
Healthcare and housing should not be commodities to be profited from
We need universal healthcare like EVERY OTHER developed nation on earth.
Healthcare isn't a commodity, but an essential service. As long as our system is based on profits people will continue to suffer and die.
We don't need "affordable" healthcare. We need healthcare period. Ironically universal healthcare is far less costly and provides better outcomes.
But artificially restricting your access to basic necessities is great for maximizing profits.
But universal healthcare cuts into corporate profits, and big corporations have _zero tolerance_ for a reduction in profits.
Boomers will never vote for it...because THEY have socialized healthcare, but will do everything in their power to stop the rest of the country from getting it.
We're in a developing nation
@@dingbop963 Developing those profits boi!!! For our capitalist overlords to spend on what they please.
It takes a special type of evil to exploit vulnerable and hurt people’s health for profit.
Absolutely disgusting.
Try submitting an expedited pre auth, or have your Dr. request a Dr. to Dr consultation, and you can submit your own expedited appeal, esp to send a copy to your state insurance commision. As a nurse you can abstract your own medical record to go with the appeal letter. The person who reviews your pre auth may not work for Aetna and have all your medical records. The legal jargon the reviewer uses is "Based on the information received, criteria is not met"" Also it helps to look up the URAC criteria for your procedure and quote it in your appeal. ( another old nurse)
what's never mentioned but is worse is having your insurance through your job- whatever you do, don't get too sick to work because if you're no longer working for them, they cancel your insurance.
and don't even think about the 'portability' act, because you'll have to come up with thousands a month in premiums- when you're, as i said, too sick to work.
A special type of evil… you mean, a corporation.
Welcome to America.
Have you heard about the food pyramid and seed oils etc?
Had a painful nerve related problem in my foot. Went to orthopedic, where we did an x ray to be sure it wasn't bone related. They recommended MRI to see where problem was. Cigna said "no" they said I needed to go back to the Dr. and get an injection. Huh? And where exactly would you put this injection without an MRI? I called Cigna myself and the conversation just went around in circled. I said, so, basically, you are denying me care. And I pay a premium for this. I then asked the Ortho how much the MRI was - $400. Ok, so why can't I just pay for it? Well, if you do that, and they find something wrong, they won't pay for the further care because I didn't get authorization for the MRI. Well, yes, because they won't give it. Needless to say, I never got the problem treated. Thank you Cigna . You can be sure that when time came for renewal it wasn't with them. Not that it matters., they are all rip off.
I’ve been denied many medications but my son was recently denied a different medication for his adhd because there were so many shortages for the one he was currently prescribed. He went from honor roll to failing and it went on for almost a year! I tried to fight the denial but I got nowhere. He is actually still suffering from this issue.
I have it, made it to 64yrs. No meds. Use vitamins and food to bring the relaxed mind and progress he needs, vit b family especially. He will become his own brilliant advocate. You'll see. When one door closes another opens. Western medicine is not all that. Nature for nurture. Keep a diary to find the best results and then hang on to it and go fly into the future with success. Food is your starting block. Watch out for no nutrition gmos. Herbs, vitamins, light, temperature, music. It all counts. Sleep is the key too. Lottsa luck you two!
Legalized fraud, yo.
Also, essentially practicing medicine without a license. They’re making medical decisions but they aren’t doctors
You described the whole economy very concisely!
@@JeremiahTrue they hire real doctors to make the denials. Drunk pill addicted doctors.
UNIVERSAL healthcare NOW!! 😤😤😤😤
It'll be free, but it'll take a while before receiving help. Too much demand and a shortage of medical staff.
@@moresalad221how is that different from now? Most of my doctors, dentists, etc, have a minimum of a 3-6 month wait list
@@moresalad221but it's been found that medical staffing does increase over time. People say that people won't want to be Drs because they won't get paid as much. I guess they have never seen the deceased amount a Dr gets paid when the patient has medicare and or Medicaid. I know because I have both. Here's the other thing all my Drs all 11 of them want universal health care. I'm disabled and when my husband has insurance through his work and I'm on it they sometimes have to fight with the insurance companies. A few of my Drs have said F it and let insurance know they were doing it, they were billing them first like it should be before it goes to Medicare and if Medicare has a problem they let them know about the insurance. Medicare don't take kindly to that, by insurance companies. I get it because I'm disabled and have been since 07 .
Do not be fooled into thinking Universal Healthcare will fix this. I am fully insured with Medicaid and Medicare. United Health is my Medicare gap provider. I still need prior authorizations and approvals before most non-routine tests and equipment. They refused to pay for a walker and compression socks, for example, even though my meds cause extreme swelling of the legs and feet to the point that I cannot walk at all. They do pay for the commode rental and monthly ongoing supplies that I need because I can't walk to the bathroom anymore. I expect to see the same if we ever get Universal Healthcare.
i disagree, but i appreciate you sharing your stance@@moresalad221
Years ago, I was hit by a car as a pedestrian. My injuries were serious, but because three insurance companies were fighting to pin the responsibility on each other, all they did was stitch my head up and send me home from the hospital. I didn’t even get one night in the hospital because none of the insurance companies would accept responsibility. Because of the lack of care, I will be affected by those injuries for the rest of my life. The other woman who was hit was on welfare, so MediCal (California Medicaid) kicked in immediately and she was well taken care of, but because I paid for medical insurance and it was deemed a ‘third party liability clause” issue, I laid there in pain for a month before I could see a doctor, and that doctor saw me pro bono outside of my medical insurance. By that time, it was too late to fix some of my injuries properly.
I submit prior authorizations all day. The health insurance companies do not care about the patient, they care about profits.
I worked in prior auth for 2 years and it has never made me hate healthcare more. I loathe and despise Cigna and the rest of those bastards to Hell and back. I pray for the downfall of the insurance industry starting with healthcare because all it is is elaborate money laundering with zero care for if patients breathe or not.
I assume you aren’t a physician, so what you did was practice medicine without a license and that should be a crime. How the hell does somebody with an AA from the Junior college override MDs (generalizing not necessarily you)? It’s bonkers, but good on you for getting out.
@@FallenEmpireCitizen idk how to tell you this, buddy, but that’s not how prior authorization works. Like to any extent lol
No, I’m not an MD and no, you’re not required to have any healthcare knowledge/certification at all to work in health insurance. So whatever crime you’re thinking of is not real and cannot hurt you.
We as frontline workers spoke directly WITH MDs and their assistants to get the info needed to process a prior auth but 8/10 had no interaction with the patients at all. All the Dr had to do was fill out a questionnaire about the med they were trying to get, we fed that criteria into the digital questionnaire and it would give us a denial/approval depending on the answers. The Dr could then appeal and it would likely go to one of our on site pharmacists who also had criteria they had to follow in order to deny/approve and it would escalate from there. So your incredibly condescending comment about people with junior college degrees overriding MDs is so woefully out of scope that it doesn’t even exist on this planet. I only got out because I had a nervous breakdown after a patient with a late stage illness begged me for help getting a med and I had zero power to do anything for them.
I would advise you consider your words more carefully in the future, especially on topics of which you may be ignorant on.
"Zero care whether patients breathe or not" ... I believe this is inaccurate.
When you, as a patient and client, get to that point, they'd prefer you didn't breathe. It costs them much less.
@@FallenEmpireCitizen The shit republicans i assume you logically voted for are the problem. Hopefully, some day, this thought will occur to you.
Its fucked up they just sent back request for more info on a patient that cant walk and she is in need of a hospital bed , they need it specified in the notes , it doesn matter if they received an order signed by the doctor . Its been going on for a month.
I've always held that the biggest issue with the American healthcare system is the insurance. There is absolutely no excuse for people who aren't doctors to deny care for something and someone that they know nothing about.
It is because the insurance, like you, has every right to approve or deny payment for anything. I can not force you to buy a bicycle. You can not force and insurance company to pay for xyz.. insurance companies are owned by people. People have rights. There is no such thing as good insurance. It’s all a scam.
Not insurance - private insurance. Every other developed country does insurance - but it's public and it works just fine.
That's not exactly right. I've been in IT 40+ years and over that time contracted for two BCBS. The C-Suite, VPs and AVPs are almost all medical professionals.
@@justasimpleguy7211 But they're not the ones making the individual case decisions, are they?
it's how the country runs politicians have no clue about scientific tops in general yet they write laws on it. It has never made any sense to me.
The current market/economy is unnecessarily tougher for boomers/senior citizens, I’m used to just buying and holding assets which doesn’t seem applicable to the current rollercoaster market plus inflation is catching up with my portfolio. I’m really worried about survival after retirement.
Just buy and invest in Gold or other reliable stock , the government has failed us and we cant keep living like this.
That’s why I make it a point to speak with a financial advisor before choosing any investments. I’ve been using one since the pandemic, using profits oriented tactics and minimizing risks as a buffer against inevitable downtrends. In addition they have access to insider knowledge and analysis, making failure virtually impossible for them. I’ve made about millions working with my advisor for over three years now.
@@mariaguerrero08Mind if I ask you to recommend how to reach this particular coach you using their service? Seems you've figured it all out unlike the rest of us.
Credits to "Gertrude Margaret Quinto", she maintains an online presence. Just make a simple search for her name online.
Thanks a lot for this recommendation. I just looked her up, and I have sent her an email. I hope she gets back to me soon.
I am a physician and in 2018 I had 6 weeks of vertigo with blurred vision, nausea and vomiting.My BP kept shooting in over 200 systolic. My 3rd ED visit I could not stand up without falling, I was admitted after the ENT doc identified papilloma. The CT was normal but opening pressure was slightly elevated. I was hospitalized because of elevated BP that could not be stabilized in the ED. United healthcare denied payment to the hospital. I appealed and they still denied payment stating my condition is to be expected in a 60 some year old woman with hypertension. I called NYS dept over the health plans. I was told nothing they could do because I appealed and got a final denial decision from United Health Care. So that was it. No recourse. Imagine what our poor patients go through! This is ridiculous and criminal.
Papilledema not papilloma
I remember having to talk to my insurance company about a prior authorization I needed for a new medication. The lady on the phone told me that the prior auth was for my benefit, to make sure my doctor *really* wanted me on this medication. I said "isn't that what a prescription already is?"
She did not have an answer for me, obviously 🙄
Medications are fictional. You being kept as a slave?
they act ignorant when they are there to make every effort deny a claim
I have a story kinda like these.
My granny was born with one arm. One day the housing association sent a letter which said that her house was gonna stop being paid for due to a problem with her doctor. So, she goes to the housing office and talks to the woman on the desk. The problem was that housing hadnt received a letter from the doctor to update her status. You know, just in case she'd grown her arm back in the past year. After about 20 minutes of going back and forth, my granny was told she MUST go to her doctors to get the letter sent, even though she was standing in front of the woman with only one arm. Some red tape can be dumb as hell.
Id like to add (after reading one of the comments):
This was about 10 years ago, making her, at the time ~ 74.
It looks dumb, but it is intentional.
Would you say she needed a "helping hand"? 😂🙏love u granny💕
@@zonzogonzo1427 Yeah, my wee granny would find that funny ;) :)
Red tape creates jobs and controls to protect the corporation and its bottom line. Soon your health will depend totally on algorithims or logic flows for approving or disproving treatments. Doctors will become useless for diagnoses or writing prescriptions. The world only understands profit as the impetus and life of the artificial entity know as a corporation which is an aritifical person created by the plutocracy to protect their wealth from unforseen losses at sea, but has been moved onto the land and has largely replaced common law.
Bureaucracies........getting less done with more since their inception
Healthcare should not be a for-profit vertical. It should be regulated, controlled, and paid for by the government. Healthcare Insurance companies are the scourge of the earth.
We have to call this, and prosecute for, Malpractice or Practicing Medicine Without a License.
"We don't want to dip into our billions-sized wallet to fix problems because sometimes, rarely, we lose a few cents on fraud."
Is what I feel prior authorization boils down to.
Prior auth is about corrupt sociopathic money ADDICTS being given a GOVERNMENT-FUNDED system or service to run. You know, like healthcare, war companies, big pharma and vax companies, etc. Then they OVERBILL whatever they dare, providing massive exec salaries and huge profits, because the corrupt liars all know that government money is FIAT, it is NOT "our taxes" - they just need us duped so they can keep embezzling.
This embezzling scam is "privatization", also called "public-private partnerships" and other cloaking terms. NEVER let the liars get away with saying "private" health insurance, that is a blatant LIE.
And money ADDICTS will keep getting as much of their "fix" as they can, letting people suffer and die rather than doing their DUTY.
And they can do this because of CORRUPT GOVERNNENT, since government issues the money and makes the laws.
The US sociopaths have been taking over countries since before WW2 to EMBEZZLE from more and more governments via "privatization". The reason such entities are typically on the stock market is because Wall Street knows that profits are guaranteed via fiat government money! In fact, it was two Wall Street lawyers, the Dulles brothers, who were appointed to help take over many Latin American countries as the lying US embezzlers began to build their corruption cartel long ago - the Dulles brothers were appointed as head of the CIA and as Secretary of State.
So the criminal gangs in government just PRETEND to fight each other as they collude to keep this massive embezzling scam going.
We have called about surgeries that were paid for but never done and insurance said they didn't care.
Then our pulmonologist told us our insurance will deny respiratory supplies until the person dies if they can
It's even more ironic when you realize that the same people that control our insurance companies also own the money printing machines.
When fraud happens it is not made by the small guys. If there is fraud it is done by organized crime and made on masse.
@@goodolearkygal5746I think the whole death panel fear mongering done by the right has come to fruition on their preferred method of healthcare.
This is the story of my life, nothing so lost as amputation, but permanent impairments and prior-authorizations delaying care, ESPECIALLY with PAID insurance (On state healthcare now) caused me to lose an uncountable number of jobs. It now means I'm fully destitute and need to get disability to be able to survive anymore. Health Insurance destroyed my ability to work.
This is the untold cost of our healthcare system. We have people saying single payer would be too expensive or wait times would be too long, but the real kicker is that people waiting until they are on the verge of death to go to a doctor takes us from a treatable sickness, to a crippling disability. Those people cant work anymore when they could and should have just been able to go to a doctor stress free and get the medication and treatment they need to stay healthy and working. I would bet my life savings that it is costing tens of billions a year to keep people from getting the care they need when they need it.
@@TheModdedwarfare3But how's an employer supposed to extract surplus value from my employee's work if they're at the doctor? Shareholders don't care about long-term sustainability. They want immediate value, so if they have to grind employees to be point of being completely unable to work (or live, for that matter) so their stock value can go up a fraction of a percent, then so be it.
@@evilsheepmaster1744 It's worse than that. If you need to keep a job in order to have health insurance, then employers can treat you any way they choose--because they have something you need. Sure, you could leave and go find another job, but many jobs don't come with benefits like health care, or some have a wait before you qualify. Then, you get to start all over with choosing from the ones offered, and whittling down your deductible. You might need to change doctors if they don't accept the new insurance--made tougher if your doctor knows your treatment plan.
My first thought when reading this was how stupid of a system this is to delay treatment and then have your customer unable to work and thus lose the ability to be a customer.
But I worked in insurance for years (not healthcare but briefly in workers compensation and then commercial.) Insurance companies hate when you ask them to think about long term solutions. They want big profits now.
Why? Stocks mostly. Stock value rising means shareholders are happy, the boards happy, and executives ... Well most of their bonuses and net worth comes from the stocks. If they're to get a good payout year to year they need short term gains, not long term business security.
People turned occupy wallstreet into a joke but at least those people knew where to lay a good portion of the blame. Literally gambling on our lives.
I am a public servant now making almost nothing, on medicaid, and I'm happier. But I don't know if I'll be able to afford to not go back into insurance. Go back to working for the devil. Because I need money to live too. And the breadcrumbs are slightly more appealing in profiteering.
Which is why we don't fight it as much as we should.
I’ve been battling with the VA for 10 years for treatment of nerve impingement. I’m one of the ones who is now permanently disabled because they keep refusing to fix the problem even though it’s very fixable.
When I first heard of this, many years ago, I asked a prominent surgeon in the Canadian universal health service how it worked there. He said that he ordered whatever his patients needed and they got it. I think he was surprised by the question.
My brother in law had a cancer specific policy for his family. His son was diagnosed with a yolk sac tumor, aka cancer. The insurance company originally denied their claim because the Dr. didn't use the specific term "malignant" in the report. My Brother in law's family had to go back and have the Dr. rewrite the report using the specific terminology required by the insurance company. All this took time while my Nephew had cancer growing in his body. Luckily his story had a happy ending and he is cancer free, but these companies are predatory and evil.
Cancer is fictional. Did you learn that healthcare is fictional in [school]?
I don't understand, if the tumor was benign, the policy wouldn't cover it as there would be no problem to address, so not really sure this is a good example.
@@guy0116 It wasn't benign and the Insurance companies attempt to circumvent their responsibility over semantics slowed down my Nephew's treatment. Seems like a pretty good example to me.
@strangeravenoutdoors4650 how would the insurance company know it wasn't benign without somebody, i.e. the Dr, attesting to as much?
@@guy0116 If they had a Doctorate in medicine they probably would have known. Since insurance companies aren't typically staffed by brain surgeons, maybe they should defer people who know what they are doing. Everyone who has ever dealt with insurance knows this to be true. I had to do physical therapy over a bone spur before I could get insurance to cover the procedure the Dr actually recommended. Can you tell me how stretching fixes a bone spur pinching a nerve? No? Neither could my Dr, yet that's what insurance required so that's what we did. Luckily, I wasn't dying while insurance was having me do nonsense treatments and denying what my Dr actually wanted done. Many people aren't so lucky.
I went to my doctor when I broke a bone in my foot. He ordered a "boot," and sent me to the hospital to get it. They informed me that if I had come to the ER they could have fitted me, but since I went to my primary, my insurance wouldn't pay. I called the insurance company and asked them what I was supposed to do and they told me their approved provider was in another city, 2.5 hours away. I explained that I had a broken foot and asked them if they were going to drive me there and back, and they told me that I was _choosing_ not to get the boot because I wouldn't drive there with a broken foot.
They didn't explain how I could use the accelerator and brake pedals without involving my foot, but it was still "my choice."
Tell them your lawyer said to call an ambulance to take you there, that he is eager to meet them in court. I bet they either authorize the boot payment or an emergency room visit at your local hospital.😊
@@borountree4539like the video pointed out they're not liable. Threats of suits don't work on them
In my experience, insurance companies HATE any orthotics-type services - that's your boots, your shells, your braces, your casts, etc. - and half the time they need to be authorized because ooo just imagine if the doctor charged you for a cast you didn't need!
@@DamiesEvilTwin if I had hobbled into ER instead of into my primary's office, they would have paid, no problem. My mistake was going to the Dr first.
@@TheByrd I just love calling somebody who knows I live alone and explaining that I can't get there, only to have them ask, "well, can't you get a ride?"
With whom? Santa Claus? My county only very recently got "senior transportation," but then, I only recently became senior. Neither of which was applicable when I broke my foot.
Years ago when I was still working, my employer switched health insurers. When I went to settle a bill he told me he would no longer accept that insurer because a patient in his office was having a stroke and when he called for authorization for immediate hospitalization it was denied. Fortunately, he sent the patient to the hospital anyway and saved his life.
Prior authorization creates a lot of unneeded care. If you do an MRI and there’s something needed to be done, you don’t need to waste $ on 6 weeks of physical therapy and an xray that do nothing
Healthcare should be nationalized. Medicare for All for just single payer for everything.
In what way would that address the problems brought up in this video?
@@janetamerasinghe7824 No profit motive. These "healthcare" companies employ teams of people, especially lawyers, to come up with entire systems that support the denial of claims. They do this to save money. Because it's all about money to them, not at all about care. A public system would have to be concerned about costs, but not about paying CEOs nor about being sued by shareholders.
I'm all for a free market but there is just too much of a conflict of interest to not. I feel the same about jails and prisons.
@@janetamerasinghe7824it’s a lot harder to steal from the government than it is from a sick/injured/dying person.
@@sixteenornumberSchools too. The existence of private schools incentivizes the reduction of public school services and increases social stratification. Utilities are pretty sketch too.
Denial for a wheelchair for a double amputated individual wtf.
So what am I paying for if they don't have a duty to pay for care? It's a scam, a racket.
This is such a real problem! I’m a social worker at a hospital who has to send referrals to these insurance companies, and it’s disgusting what they are doing to patients with these prior authorizations. They claim that when they deny these auths that something isn’t medically necessary, but it’s really just to save them money. I cannot tell you how many of my patients needed to go to rehab facilities, just to gain their strength back, and were denied for something as simple as walking one foot to far from an expected distance for some who “actually qualifies for rehab” And don’t get me started on the doctors who deny and approve the auths. They are usually doctor who hasn’t practiced in 20+ years, with little to no knowledge of technical advances in modern medicine or prevention methods. Just terrible.
all medical decisions should be ONLY up to our doctors and ourselves, not non medical personnel or "doctors" that the Ins companies pay.
And not government bureaucrats who have no stake in the game. Yes, I'm talking about women's healtcare and trans healthcare.
@@user-te4jr8sb5c ♥preach!
"Your health insurance company has no obligation to care for your health". How f*cking dystopian is that?
The police don't have an obligation to help you either. Just to add more to this dystopia
@--..-...-..-.--.... indeed it does add to it. Luckily I live in a country that follows Peelian principles of policing, something the US should absolutely adopt
I was a medical assistant in charge of prior authorizations. And sometimes patients in need were denied medications they really needed. Like life or death meds. So I'd call the insurance companies and do them over the phone again. They'd lie and say it would take longer. But after talking to me and knowing the patient's backgrounds they'd feel bad and push it through. There was one time one of them laughed at me. This patient is diabetic, about to get his feet amputated. And this lady was laughing at me because I was fighting for my patient. I really wish she would of laughed in front of my face. So I could teach her a lesson or two. Some insurance companies are just evil! They are the biggest legal scammers!
I take, and have been taking for YEARS, 2 medications each month that, with insurance, could cost approximately $1200 each month. I’m retired and receive just over $2600\month. My husband’s work insurance and the pharmaceutical company’s largesse makes them affordable. A few months ago I received a letter from my insurance company that didn’t make any sense to me. I took it to my pharmacy and my doctor and they assured me that they would take care of it. Then the pharmacy told me coverage for one of the meds was rejected. I was closing in on the day I would be out of that med. Nothing was happening. The insurance simply would not approve the coverage because they need prior authorization. It took calling the state insurance regulatory agency to get the insurance company to pull their head from their nether regions.
I dealt with insurance and their prior authorization, and it almost killed me. I had to wait a year for a necessary surgery. It was so outrageous that my doctor closed her practice.
Yes an excellent Dr I saw, people from all over came to see him because of his credentials & knowledge! ❤ He sadly told me he would be stepping out under Obama's new Healthcare plan that cuts the throat of true providers! They support the doctors that are the pill pushers though! Seems intentional destruction of a society to me!
Surgery is fictional.
I’m a pharmacy tech and I’ve seen prior authorizations for the stupidest things, and sometimes patients have to get prior authorizations for medications they’ve been on for years already. I just wish more people knew that we hate insurance companies too, we want you to get your medications on time :(
My insurance forced my pharmacy to switch my medication to a generic because otherwise, they wouldn't cover it. Not only was I not informed of this, but this was last week and I already had prior authorization for the medication in question. The generic doesn't work (psych meds). It's like they're trying to kill people.
then offer the common meds for less! this will reduce the risk of triggering a prior auth for funding. get rid of your Profits also, you don't need them anyway, LESS profit taxes in the process.
The Lawmakers could fix the problem, if they Had the Will, to do it.
@@maximilian19931the pharmacists and techs have no say in drug costs.
@@johndoe-ss9bz If they weren't already sold out to big pharma and the corporate thugs ruining our country.
I agree, my family members have had medications prescribed by our family physicians and the insurance company denied it because they claimed it was not needed!
As a person with severe illness, it's honestly discouraging that able-bodied people are surprised by this. You get denied for everything the first time. It doesn't matter what it is. It's just like absolutely everyone gets denied when they first apply for SSDI. I thought this video would be informative but it's the most entry level stuff
"procedures like medications" are ableds ok? like are they able to think
Sometimes, it's a stupid number for billing code. You're right about being denied for disability. My ex was denied. My friend who got ran over by a car was denied. But my husband's aunt, who lied about disability, was approved. She was cheating the system. Those who really need it. Can't get it. It's just shameful
We need to push for federal law on medical insurance companies to where they can be held liable for negligence when it comes to proper treatment that's been needed and is being denied!
The thing is, most people at the congress are in favor of this.
@MrPenetroso well if they were on the same kind of health insurance that they would have to pay for out of their own pocket like the rest of us, then maybe they would actually be doing the right thing
PLEASE NOTE: Always Appeal Denials of Private Health Insurers as the act of appealing places the insured in the category of a 'Highly Engaged Client' who, Insurer's have learned, is likely to continue fighting/appealing which can cause additional expenses, thus the 1st or 2nd appeal has a far more likely chances of success than the original submission.
simple yet effective advice "always appeal"
Dealing with Madre in a nursing home, I'm on my 7th appeal for extending the stay and adding physical therapy. These insurance companies are a scam.
Speaking from experience, this is true.
Good luck with that. My mom is on narcotic pain killers for advanced rheumatoid arthritis and has been responsibly using them since her diagnosis 50 years ago. She has never misused or abused them, never run out early, yet she gets treated like an addict and has to spend time without medication several times a year the last few years fighting her insurance company alongside her GP, rheumatologist, and pain management doctor, all saying she needs it.
Our insurers have teams of people whose sole purpose is to obstruct appeals until the customer gives up. I know people who spent years fighting their insurer and made absolutely no progress.
Healthcare seems to have gone from one extreme (over prescribing tests and/or care) to fear of their own shadow manifested by denial of care.
Insurance companies demanding physical therapy is what delayed the MRI for my herniated disc. During the delay I even had to make a hospital trip when the pinched nerves started causing urinary issues. Four years after spine surgery to fix my severely herniated disc, I have a strip of permanent numbness running down the back of my leg, including my heel and the outside edge of my foot. I have muscle weakness in that leg and my lower back due to the nerve damage. Yes, it could have been worse, but it didn't have to be this bad.
All of this is quite common, and as Whistleblower Dr. Linda Peeno testified before Congress, medical reviewers get raises and promotions based on the dollar value and volume of claims they deny. In some cases, denials are a death sentence.
This is nothing new, Aetna and many others paid settlements over purposeful arbitrary denials. The processors were paid bonuses based on the how many denials. I remember cases from ~15 years ago. Can't even google them, there's just too many
The 80% that just walk away and don't get treatment? That's why. That's the point. The entire business model of medical insurance is that you pay in and they never pay out. That's how they make their profits. That's their purpose.
that's why insurance is universally a scam. we need free healthcare, like every civilized nation has
Together we stand, and divided we fall.
Really insurance in general. Cause if they had to pay out for everything? We'd never have any insurance companies...or at the very least extremely high insurance where the profit margin is baked into cost....including the cost to pay out coverage.
Oh no, if it’s an emergency they HAVE to treat you. Just walk out after that. The hospitals are getting paid for this too. That’s why they tried to charge me a thousand dollars, that’s right $1,000 for a CUP OF ICE WATER. Nah, it’s all a racket.
@@willyboy7141they have to treat you, but for some reason insurance doesn’t have to cover it.
I went through similar situation. Thankfully it was not cancer but I was run in these circles for a year and a half before I got the necessary MRI and finally got to see a neurologist which is what I actually needed.
I believe there is a federal law that states it is illegal to impersonate a physician.
Private health insurance companies are in the business of making money not insuring healthcare to patients, it's capitalism 101.
Rather Kochism 101. Neoliberalism holds that promises of payment for health treatments, medication, and equipment are to be sold like cars, real estate, or burgers. But the rest of the 1st world considers health care one of the public commons, wherein the idea of running it like a corporation is off the table on principle.
The very name capitalism should raise red flags to capitalize on others
Dictionary example "capitalize on an opponent's mistake"
Which is why medical care should be considered infrastructure to be administered and maintained, not trade goods to be monetized.
Capitalism 101 usually says profit comes from providing a good or service that someone else wants. The more the government mandates involvement, the less incentive there is to actually provide that service.
you clearly don't understand what capitalism is @@IcicleFerret
This is why I am glad for my union backed health insurance. I had cancer, and it was handled properly.
I think the primary problem, though, was just barely touched on, and is a severe problem in everything in the world today. Companies, no matter what their base industry is, are catering to stockholders first. Instead of providing the service they are ostensibly created to provide, they are extracting value for an essentially uninvolved third party. This is directly taking money out of the pockets of the people who need that service, and transferring it to "investors", who are expecting double digit percentage growth year over year.
And since the US is a capitalist dictatorship, that will never change.
Imagine what your union could get you if they didn't have to fight to get you decent insurance. Better pay? More time off? Better working conditions? Better C-Suite people?
Eh depends on your specific union I guess. Our union insurance isn't worth the $30k we pay for it every year.
The problem is that an insurance company's purpose is to generate value for the shareholders, not care for their insured clients.
The clients are just the source of the money and an annoyance when they need money from the company for a medical issue.
@@anonymouse9833 That's a terrible insurance. The most I ever paid was $12k annually for a family of five, and my insurance now is part of the contract at no cost.
Don’t even get me started for VA patients. the VA Prior Auth Department is just as bad. I worked for a psychiatric clinic and by what the VA had told us was that we HAVE to fax all the requested documents to them 30 days Before the Expiration of the existing Authorization for it to be renewed to continued care. I faxed it and it came with no response. After thirty days the patients next appointment was close so I called and they said they never got it. So I faxed again and labeled urgent with the patients next appointment. No response. Due to clinic policy which I disagree with, we have to postpone the appointment until the VA confirms the patient can be seen. We postponed it another month, then I called as we still got no response. They said THEY STILL DONT HAVE IT, I confirmed the number I faxed it to twice and said I wanted her to stay on the phone with me and CONFIRM if they receive it.
Thankfully she said they confirmed but they need another 3 weeks for processing. So we had to postpone the patient another 4 weeks. Just to be sure.
Well it’s been 4 weeks and they still haven’t gotten back to us. So I called again, they said it’s STILL processing and that it was an error in my end for not sending it 30 days before expiration. I reminded her it’s been 3 months since I originally faxed and then refaxed. She then suddenly changed saying it must be 30days before the patients LAST APPOINTMENT?! Which I immediately called out and she tried to gaslight me on the phone saying they never said 30 days before expiration.
The entire system from top to bottom is a joke.
Doctors swear an oath to put the immediate health of their patients first. It is 100% misrepresentation if the goals and practices of a profit driven business model are instead considered before medical necessity.
We all need to take action, individually, then as a whole.
i was uninsured for awhile, sprained my ankle badly and needed an xray to make sure it wasnt broken. took them all of 2 mins to do that, and gave me crutches. no pain meds or a wrap or anything. just the xray and crutches and they wanted to charge almost $1,000.
my friend had a weird episode where he passed out unexpectedly (as in not drinking or anything that would maybe cause it) so we called an ambulance. at first when he woke up, he refused to ride in it because he knew he’d be charged so much money. HE HAD PASSED OUT DUE TO AN UNKNOWN REASON AND INSTEAD OF BEING WORRIED ABOUT HIS HEALTH, HE WAS WORRIED ABOUT THE MONEY. we had to convince him to go and get checked out.
insured or not, our system is beyond broken!!!!
This is why I don't have insurance. It's simply not worth the hassle. There are deep discounts for self pay and they can't refuse a payment plan no matter how small. I don't need prior authorization for anything.
Only $1,000 bucks?! They charge $3,000 just for a look over today.
@@MrTwinkieeater _"...they can't refuse a payment plan, no matter how small."_
Are you sure about that? That doesn't sound correct. Do you have a source for that?
@@Milesco to be clear(er), they should negotiate with you about how much is to be paid in installments. Non profit hospitals legally have to offer financial assistance. Look up the No Surprises Act.
I became disabled as a result of this exact practice.
They denied surgery I needed 3 times because the injury I had is called a "sports hernia" for some reason and according to them hernias are cosmetic surgery.
For the record, a sports hernia is a torn tendon. In my case it was in my groin so I walked in it for 3 years while fighting the insurance people.
To this day every step is excruciating.
Hernia...a cosmetic surgery...
That's unfortunately a new one for me.
How is a hernia a cosmetic surgery
@@jormungarden5816 that's a good question. Unfortunately the insurance company never had an answer.
Awesome video. I am commenting to boost the exposure on algorithm. You’ve done an awesome job of exposing this and I don’t have much to add. Well done!
Health insurance companies should not be able to dictate. I started complaining about this over 30 years ago and it's just gotten worse over time. They don't know the patient. They don't know what's going on first hand.
I worked in the health insurance field for nearly a decade. From working phones, investigating cases, communicating between doctors offices, trying to resolve cases, and even creating health insurance plans alongside CEO and CFO and pitching it to employers and tribal leaders.
Our for profit health insurance is absolutely hostile to the people wanting to receive service.
Most shocking of this story is here is why the insurance company is medically necessary. They are getting in the way of health care.
That is our own fault for wanting something for nothing. We didn't want to pay for our office visits. When I was a kid you paid the doctor out of pocket, and doctors came to the house. There was no huge company between you and the doctor that required billions in extra dollars to make it's massive profits. We did it to ourselves out of our own greed. We are the ones who signed up for that insurance so we wouldn't have to pay our doctor bills. We were so stupid we actually thought we could get something for nothing. Insurance is now wrecking the veterinary business the exact same way.
@@coop5329 It's greedy to want medical care without a financial hit?
The point of insurance is that you pay a predictable amount, and it makes sure you never have a giant, unpredictable cost that you can't account for. And it pools many people's money together to use for that. It's a lot like taxes.
If you insist on seeing human righs as transactional, there's still a gain from it. People get health care and in return, they are able to perform their jobs better.
School and roads are provided for free because they benefit society as a whole. Are they "wanting something for nothing"?
@@coop5329Wanting something for nothing??? The last I checked, we pay a monthly premium. I don’t know about you, but my premium isn’t what I’d consider cheap, or nothing. We are expected to pay that premium, religiously, and on time. Why then, are they allowed to throw in time consuming, unnecessary, steps, by some clueless layperson that they hired??? We went to our doctor, who has years of education in medicine, to be treated. No Joe blow should even be involved in our doctor’s decision!
@@coop5329why the FUCK are you so determined to defend a system that treats HEALTHCARE like a privilege ????? why do you WANT people to pay these absurd out of pocket costs for treatment that you need or you will quite literally die? how dare people ask to be treated regardless of their ability to pay and not be left to fucking die!! you’re content to put a price tag on someone’s life and as a healthcare worker i think that world view is extremely fucked up. you think i care if someone is poor when they go into septic shock ????? no because i’m not a fucking sociopath 😭 you shouldn’t have to be able to afford to pay the full price of expensive ESSENTIAL treatments just to earn the right to continue living. that’s super fucked up, man.
Blame the politicians that make the regulations.
Lately, all my kids medications have needed prior authorization. It took months to get and they had been taking it for years. If I hadn’t remained so persistent, I would have never gotten them approved. I had to jump through so many hoops, it was ridiculous. Imagine for something bigger. I can understand why most people give up! Corruption is rampant in this country in more ways than one. Other than moving to another country, I don’t know what else to do with everything else going on.
I have a SI joint problem that insurance will not approve surgery that has proven 87% cure/ relief from pain, despite MRIs, RFAs, multiple joint injections, physical therapy, acupuncture, TENs unit, topical therapy, you name I’ve done it. All this to be denied and told “just don’t walk up stairs or across uneven surfaces.” Live with it
I retired from decades of practice as a psychotherapist. Insurance companies put providers and patients through nothing less than bureaucratic torture on a daily basis. I am so glad to be out of it all.
This another good reason why I loathe my species. If I took out my telescope and found a large asteroid that no one else saw but we would have the time to destroy or divert it? I wouldn't tell you. I wouldn't tell a single one of you.
Psychotherapists are fictional. You lie and/or are tortured into appearing to lie about slaves including yourself?
I am currently practicing and don’t accept insurance.
You are ruled by those you cannot criticize. Most of our congress has dual citizenship, all with one specific country. To mention that they created laws in America that directly oppose the laws they make in their own country would be considered anti - "s e met ik". Just follow the money and laws. The truth is in plane sight.
How does that work though? Do you do like a sliding scale for those who can't afford@@davidfromky
You should have just started with caused by a "McKinsey Recommendation" then I would have just filed it under PURE EVIL.
Companies just use consultants to take the blame for ideas that would be unpopular. The evil is always the company management.
This is actually the second video that I've watched this week which connected McKinsey to unethical business practices.
@@royalfool0230 I was thinking the same thing. This is a companion piece to John Oliver's very well needed expose on their horrific practice.
Thank you, MPU.
Absolutely incredible that u need to go to court to get healthcare. My whole body hurts. 🤕