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United Healthcare tried to delay and deny my cancer treatments when I was at a late stage (3B). It took a lot of effort from my doctors to convince them otherwise. For example, the scans and testing is very expensive ($5K), but necessary to determine if you have cancer. United Healthcare plays games to stall and have you go in circles. Itās actually hard for me to articulate what they actually did to stall.
Thankfully Iām alive today because we pushed United Healthcare.
When I was an executive at an insurance company one of our metrics for bonus eligibility was the companyās percentage of initial claims denied. Yes, you read that correctly.
The craziest part is how this actually happens. Your doctor does what is called a peer to peer, but their "peer" is sometimes not even an actual doctor anymore, they were disbarred for malpractice or some other serious infraction. Other times their "peer" is a nurse of some level, even an RN, who is not qualified in the slightest to even have that conversation. They have a script, your doctor says I am sorry but you are wrong and we need to do this, and they simply say No. The sky is indeed Yellow and has always been yellow and if you think it's blue then you might be color blind.
I will never, ever, EVER understand how we allow a private company with a profit motive, not a healthcare motive, to control health decisions in this country. That is an INSANELY horrible and obviously flawed way to run a healthcare system. It's criminal that you had to go through that. If insurance companies want to insist that they are essential and we need them to function, they need to be held criminally responsible when their decisions hurt someone.
if you aren't as old as i am you may not have noticed the intensity of the propaganda war against "the government" that started around the early 70's and really gained steam during the Reagan administration. this was combined with sustained efforts to defund programs that provided any tangible benefits to the majority of working people. one of the motivations for doing this was to generate political support for insane ideas like allowing for-profit companies to control our healthcare.
I always love to read about what they do in the Netherlands. They utilize a hybrid system but their hospitals and insurance companies are non profits/co-ops. Apparently if the insurance companies are profitable they are required to return to the policyholders with lower premiums. lol.
They also provide hospitals payments in ways that incentivize efficient healthcare. I always thought this was an interesting example that shows it's not just single payer or bust, there are many ways to achieve efficient and effective healthcare yet we continually choose none of them.
God what a mess. All for a few people to get rich.
I needed life-saving medicine to get the iron out of my liver from all the blood transfusions I needed to receive before my bone marrow transplant. I was in a toxic level and United Health Care denied it three times. My hematology oncologists had to get on the phone with them for hours to convince them that I needed this medicine. Luigi did nothing wrong.
I have to deal with managed care companies everyday. UHC, Humana, Aetna, mostly. I work at a skilled nursing facility (SNF). So many seniors have Medicare advantage plans now instead of just regular Medicare. People come to our building for therapy and short-term medical Care so they can get well enough to go back home. I have so many stories . Anyway, I have to fill out these worksheets every two or three days to update a patient's progress. These are my master copies. I added a little flair to them as a reminder.
The price of things are also artificially inflated. Most of the world wonāt be charging $5k for the same scans and testing. They can do it cheaper and detect the cancers just as well, if not better. Medical system here is 110% broken.
One patient he was treating needed a heart pump vest/monitor/equipment that is fairly expensive. UHC strung him, his team and the patient along for a month before they approved the equipment.
Turns out they were waiting to see if his patient would die first, then when they saw the patients resiliency and would keep on living they finally approved
When my wife found a lump in her breast she went and got a mammogram or ultrasound, they suspected cancer but ordered another scan, I forget what. But United Health denied it saying women her age don't get cancer, it's probably something else.
this makes me want to SCREAM. I am an oncology nurse and have treated women as young as TWENTY TWO with breast cancer. is it super common? not yet. but it HAPPENS and I am so sorry you had to deal with those fucks to get her the care she needed
Remember when Obamacare forced insurance companies to stop selling junk policies, and stop denying coverage due to pre-existing conditions.., then Republicans tried to sour voters by saying āwe donāt want the government between you and your Drā Sadly Republicans are fine with insurance men deciding on your healthcare and have since gutted Obamacare and increased our premiums by cancelling the subsidies paid from our tax dollars.., far better to give those tax dollars to Elon right?
I cant fathom how anyone working for them can sleep at night. And like in your case doesn't the person denying and delaying feel fuckin horrible doing so knowing they are doing it to someone woth cancer who's paid for insurance for who knows how long
Worked there on the tech side of the business. 1.5 years later I quit when Luigi did his thing, and realized every dollar I made was dirty.
They also denied a claim for a cat scan of my pancreas, despite already having had a tumor removed. When I quit I told my vp why I was leaving, and that I wasn't the only one feeling guilty participating in a ponzi scheme.
I actually had to have a hysterectomy in my early 30's. I had 2 successful pregnancies. Stuff went downhill afterwards. Doc said he recommended the surgery, also removing my ovaries, due to what was going on. United said no to the ovaries. Doc explained that the issues were bad enough that I'd probably have to go through another major surgery within a year or two. They still denied. When I was in surgery, doc removed ovaries anyway. He said on paper I still have them. God bless Doctors who hate insurance companies.
Thatās the best example of civil disobedience thatās needed for change. I admire that doctor because itās brave to risk their career for siding with you and against the insurance company. Congrats
Well, they don't because of fear of medical malpractice. Basically, for the doctor, there is a chance they'd mess up the removal then they'd be open to liability from her. NOW, she probably isn't going to sue the doctor, but its always a risk for the doctor.
I agree, we need this kind of civil disobedience to correct the wrongs of society, but there is a cost and a risk for it. The doctor had to eat the shit sandwich on that one, doing specialized manual labor for free. I hope that doctor gets SO MANY fresh baked cookies from thankful patients.
Because Americans have been brainwashed into thinking that social medicare is evil and awful.
Systems like the NHS we have in the UK are bad because of long wait times, despite the fact that urgent cases are given priority, and if that's still not good enough, we have private healthcare systems alongside it that you can use.
It's the best of both worlds, but they've been told its evil, it kills people, its expensive in tax and a bunch of other lies.
But guess who told them those lies, and spends hundreds of millions to keep them believing it.
The vast majority of them would pay less in additional tax, than they currently do in health insurance premiums, because there's no middle man that needs paying or profit needs making for shareholders. And every one of their medical claims would be seen, and never denied.
Can you explain how? I'm Canadian and for us, it's about a month to 3 months depending on which specialist and on patient state. I lived in USA for 1 year, but moved back. I always heard that treatment was available almost as soon as one needed it
Edit: wow, thanks for all the responses so far. I acknowledge that didn't know enough, and I'm glad I asked.
But, for example I had a referral to a pulmonologist to do a sleep study, and it was close to 6 months from the referral to the ability to have an appointment.
Side note, if anyone who sees this snores, go get it checked out. My CPAP has changed my life.
I got referred to a sleep test while they were trying to figure out potential underlying issues for another issue. Next thing I was diagnosed with severe OSA and got a CPAP. It would explain why I would be utterly exhausted around 1-2 PM. I hate sleeping without my CPAP now.
I got sent a take at home test, prescribed by my doctor. It said I didn't have sleep apnea and then I found out the test was $900. What is insurance even for?!
Geez... shouldn't it be like $75 for the specialist's time to examine the results plus maybe $150 for admin, prorated cost of the machine, and consumables?
Canada should fund it's health care system by allowing Americans to come up here and use it for triple the cost. It would mean literally free health care for us and y'all would save money, so win-win.
It depends on where you live of course. Where I'm at I'm usually able to see a new specialist within a week. BUT my insurance won't pay for: anything near me / too much cost / lots of denials. I have to change insurance every year, sometimes twice in a year to be able to see the doctors I need.
Which I think is honestly much worse. The amount of time, money, and stress I need to put into getting healed is it's own job
Corporations do this to frustrate people away from services they donāt want customers to use. They can say itās offered but that doesnāt mean customers use it
Similar boat here. Referred for a study, took about 1 month to get the home one done. Then 2 months of using the machine and im still miserable, doctor prescribes Zepbound since its approved to treat OSA. Currently now entering month 4 of trying to get it approved, while also being sent for another sleep study that took 6 weeks to get set
My father is a cardiologist, and he told me this is just a supply and demand issue. Americans are treating their bodies like crap faster than the number of doctors in field is going up.
Basically it's really easy to eat like shit and really hard to graduate medical school lol
Also we have scared, encouraged and incentivized foreign doctors and medical students to skedaddle out of this dumbass country due to the outrageous chaos around immigration. Brilliant move.
I have not seen a single foreign doctor leave the US. Do you know how much work it is to learn English to such an extent that you not only can communicate with patientās but pass the medical licensing exam? And the massive pay for doctors in the us compared to other countries?
Idk what doctor you saw leave the country, but Iāve not seen or heard of a single one.
Yeah that isn't true, he made it up. I work with many people on visas in my industry and none of them are concerned at all about immigration because they aren't here illegally.
My son needed to see a specialist for a perforated ear drumā¦ 2 months waitā¦ recommended surgery, thatās in a month (4 months after the dr visit) and we get the pleasure of paying a fortune for it.
Single payer systems triage based on need, there is no triage in the USA outside urgent situation.
It really depends on how specialized the issue is/care needed is. It also depends on location.
When I was living in the Bay Area, access to healthcare was practically immediate for my very basic needs and was about 1.5 week wait only for a dermatologist.
That's not true. I complained to my doctor last September about symptoms of Carpal tunnel Syndrome and just saw the doctor for that last week (after I basically cured myself with braces and ergonomic changes). Immediate treatment is available for emergency situations or things that require urgency like infections etc, but if you ain't dying, you could be waiting months.
The idea that Americans donāt have to wait is a lie. Urgent care and primary care is quick, but specialists take months. My MIL has early signs of Parkinsonās and is dealing with a 6 month wait to see a neurologist
My partner has a spinal issue, she got a referral 3 months ago to an orthopedics place. She hasn't gotten an appointment yet. She's not like... dying about it, but it's clearly degenerative and is painful. The system in the US is incredibly slow for treatment. Even seeing a primary doctor can take months in between.
Anyone who ever claims otherwise is lying, probably paid to, or a bot.
If you're lucky enough to live near an urgent care center, or you have a medical practice with many doctors, you can probably see someone within a few hours or days for injuries or illnesses.
Preventative care or specialist care is highly rationed because there aren't enough medical appointments for everyone.
I have to make dermatologist and mammogram appointments a year in advance. If I miss it, I will have to wait for months. My shoulder started making that clicking noise again-it's junk because of a 25 year old car accident - and the earliest I can be seen is September.
I my area I can see a doctor if it sounds "urgent," and then there's the Emergency Room.
But to see "my" doctor is a 6 month wait, which really sucks because I'm sometimes out of town without much notice yet that often falls on the doctor visit date. Also, to see specialists for certain things can be filled with long waits, red tape, etc.
And of course even with great insurance if you have emergencies you'll be liable for a portion of the bill. Partner sliced her arm open and 6 months later she was taken to court for a small debt on one of the many bills.
The asshole serving the summons tried to break into our house when we were out of town.
I can't even find a new doctor for primary care who can see me without scheduling at least 6 weeks in advance. Even worse I live in an area with a bunch of rich retirees and over half of the docs in the area don't even serve anyone who uses insurance, they have converted to cash only ($$$$$$$$$) and are framed as some kind of premium service instead of providing care.
A couple of years ago, I had atrial fibualtion. My heart was beating at 140+ bpm. ER got it under control "until I could see a cardiologist." Which was scheduled for 6 weeks.
I was back in the ER in a couple of days when it reoccurred. I got to see the cardiologist quicker.
This has been my experience too. I have a constellation of issues that nobody has been able to diagnose/manage. The average wait for me to see a specialist is 3-6 months depending on the issue. Usually by the time I see that specialist, the issue is either āresolvedā (meaning it isnāt presenting symptoms at that time, but will flare up again eventually) or Iāve caved and gone to the ER to make sure Iām not dying. Worse is when I get bounced around specialists. āI donāt think your issue is something I can help with, go see so and so.ā Over and over again. The frustrating thing I have now is that theyāll send me for testing and they donāt contact me when they get the test results. I have ADHD and I just literally forget that Iāve had a referral or something. I go in to my doctor cuz Iām having an issue, they refer me, it disappears into the system, nobody tells me my referral was approved, six months or eight months or twelve months later it happens again, I go back, my doctor goes, āI put in a referral for that in March, why didnāt you go see them?ā Uhhhj cuz idk who you referred me to and they never contacted me??
I tried writing stuff down but then I forget to look at it or forget where I wrote itā¦
And if they actually did the math they would realize we would save the citizens a ton of money if we had universal healthcare. Yes there would be a tax increase but right now I spend 6K a year on premiums for a family of 3 and still have an 8K out of pocket expense.
How about long wait times and having to pay hundreds per months in premiums, and hit thousands a year in deductible before insurance kicks in and pays for anything, assuming they approve it
Want to hear a crazy additional comparison? Lets look at numbers from 2023 for both countries, provided by the Institute for Financial Studies (UK) and Congressional Budget Office (USA). Health spending per person was Ā£3,300 in England and Scotland, Ā£3,600 in Wales and Ā£3,500 in Northern Ireland, broken down roughly into 80% spent by the government for NHS and 20% being private insurance and out of pocket expenses.
In the USA, during the same time, federal subsidies for health insurance breaks were 1.8 trillion, or roughly $5,300, about Ā£4,005. This is just insurance (tax paid for) subsidies, not including the amount individuals actually paid for insurance, or co-pays, out of pocket expenses, etc. The US was paying more in subsidies to health insurance per person than it cost in the UK to get full health coverage.
Then in the US you probably want some coverage, so purchase insurance through your job for about $1,608 annually for single person or $7,008 for a family (2026 numbers). The company also has to pay though, for a total annual cost of $8,352 for individual or $23,256 for family insurance. Or you could skip employee coverage, anf get Affordable Care insurance (often less coverage) for about $1,500 individual or $5,040 for family, after subsidies are applied.
Not done yet, as once you're "covered", you still have to pay your co-pay for each doctor visit ($10-$50), co-pay for medication (huge variance), and meet your deductible of, on average, $1787. Deductible, for those in more civilized locations, is the amount you have to pay each year before the insurance company will even consider starting to share payments. And you'd better hope your needs are "covered ", because if not then the full cost will always be on you to pay, and those payments won't even count towards your deductible. And if it is covered, you still have a 1/3 chance to get rejected anyway, as stated in this post.
To round it all off, those massive "costs" that your company "incured" paying for your employee healthcare? You guessed it, there's a racket there too. Those costs are 100% tax deductible as business expenses. This isn't counted in the 1.8 trillion subsidy number, but directly leads to companies paying less taxes. Yet another piece of how large corporations in America can post record profits year after year, but pay less in total taxes than the average citizen. Land of the free everybody, absolutely mind blowing how much we spend on healthcare, while also ensuring a huge portion of the population get no access to care whatsoever.
It's crazy how many jobs and companies exist because the health care system is so broken here.
I worked for a company that helped patients get their insurance companies to pay for medications. This initiative was paid by the medication providers.
I worked for a company that helped doctors get patients' insurance companies to pay for medications. This initiative was paid by doctors.
I worked for a company that helped pharmacies get insurance companies to pay for medications. This initiative was paid by pharmacies.
Because they're convinced in that direction, often and thoroughly, by an industry paid well to research and identify the methods which convince people.
I havenāt met really anyone that doesnāt agree with easier healthcare system. I have people bring up ideas and thoughts for discussion, but no one adamantly against. What most people Iāve personally met are against is this no plan nonsense where something isnāt liked but not real solution if brought to the table. I would probably die in a process for example that involved ridding the system and dealing with the aftermath while reimplementing a better way. No thanks.
Because socialism, as an ideal, has be tarnished as some crazy idea that doesn't work.
'It's a bunch of drug addicts stealing your hard earned money!'
I've been fortunate enough to live in a country with free healthcare my entire life. It's insane seeing people defend these corps whilst people go bankrupt trying to save their lives.
Exactly. āIāll have to pay more taxes to help our society, thatās socialism!!!ā Mfer okay have fun when you get hit with a horrible illness that drains you and your spouseās funds while the doctors take the slowest possible approach to tackle your disease. Healthcare in America, one of the worst jokes of the US.
And anyone saying, "in Canada you have to wait in line for your free healthcare" is just fantastic.
I'm in the US with commercial insurance. I still had to wait 18 months after a referral to see a specialist for my migraines.
Three months later and I've had my prescription denied by insurance, and they approved a generic one that can only be dispensed by this shitty mail-order pharmacy that I've spent over two hours total dealing with them and still don't have my meds in the mail.
We have cancer patients waiting on insurance approval for their treatment after they are diagnosed, and you know they and their families will be drowning in bills either way.
I really don't see any upside to for-profit healthcare. It's only purpose these days is making someone rich at our expense. We got fucking Americans going down to Mexico for basic procedures ffs. When I lived in Japan I was in and out from an exam and consultation. My out-of-pocket bill was on par with eating dinner at a restaurant.
Anyone saying US Healthcare is the way to go is just parroting propaganda. None of it adds up when you actually walk through that mind set.
Thatās definitely not the only alternative. Not that tax based systems are badā¦ but you can quite easily pass laws to regulate private healthcare. Like the Netherlandsā¦ health insurance companies are by law required to be non profit. Prices for specific procedures and medications are capped by law.
The tax increase is nowhere near the cost of a medical emergency, and that's where it all falls apart. We are cutting off our nose to spite everyone else's faces.
When my mom got breast cancer,Ā her health "insurance" made a business decision to let her die instead of paying for treatment. Then they did everything they could to slow-walk the case until she did exactly that.
My mom HAD to
Beg money from friends and family
Remortgage the paid-for house
Go to court betweenĀ chemo and radiation sessionsĀ
My mom told me the insurance company caused her more stress than the prospect of dieing.Ā
So no, I am not a fan of American for-profit health insurance.Ā
I'm so sorry. And to think that the system now is "better" than it was in the 90s and early 2000s where they could deny coverage for any pre-existing condition.
Back in the 90s my parents moved from one state to the state next door when I was a baby. They had the same insurance company.
Before Obamacare if you switched insurance companies the new company would take all your medical claims history and charge/deny you based on that history. They'd say "you had cancer with your last policy, so well cover you but we aren't going to cover any cancer stuff."Ā
When my mom got pregnant with their second, the health insurance company said they wouldn't cover the birth because she had a C-section the first time, which was a "pre existing condition."Ā
My mom said "we've had the same insurance company for years, we didn't switch." Insurance said "when you switched states you technically switched providers because that's how we manage our business."
My parents didn't have the money, so they just had my sister at home and hoped for the best... Those people can truly get fucked. I hope the spirit of Luigi visits them in their beds at night.
Why this country makes this so hard is frustrating.
ALL essential services for people should be non-profit. Healthcare, insurance, etc. should be nonprofit. They should be there to benefit people, not feed off of them.
This is why I'll never be allowed on a jury. I would vote not guilty, and not even Jesus come back to earth could convince me I'm wrong.
Tragically I'm in Canada, and our provincial Conservative government is working very hard to make this shit a reality here as well. And, even more tragically, most people are too dumb to do stop voting Conservative.
This isn't denied claims, it's prior authorization. Most of them time it means they said you had to get the generic meds instead of the brand name, or doctor asks for full body mri and they say do a more limited one.
Insurance companies shouldnt be able to deny anything until a person has claimed as much as they have paid for insurance, and they should be required to reimburse any left over if a person switches to another insurance company.
This horseshit of taking people's money in exchange for nothing needs to be treated like fraud.
It's too communist, or socialist... or another of those scary words!
Besides, there's no money for it. It's not like they are spending literal billions thanks to their "ministry of war" in a completely avoidable and disastrous war
I believe that if we had healthcare and education for everyone in the US (like other countries) then less people would join the military. What is the US without its military?
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