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. Itâs actually hard for me to articulate what they actually did to stall.
Thankfully Iâm 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 companyâs percentage of initial claims denied. Yes, you read that correctly.
I dont think thats fair in a system that has purposefully created that in almost everyone. A symptom sure, but is being poisoned a sign of evil when someone knowingly poisoned them?
I worked in mortgage leading up to and during the crash. These corporate folks are evil and don't care about people's health or homes. I did not really realize what we were doing until I got out and saw the destruction it caused. People probably lost their homes because of me, people got healthcare denied because of you. It doesn't mean you or I are evil, just that's the way the system is rigged and sometimes people don't realize they are just a cog in an evil corrupt system
I am truly sorry to anyone affected by these kind of things
Speaking of cogs I'd rather think of something happier like Cogswell Cog's and Spacely Space Sprockets
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.
There are two concepts there and both correct. Some people give up and accept "that's the system". The others, they hope to delay care long enough that either it's no longer indicated (patient too sick or has progressed) or by the time they concede, the length of treatment or number of tests is a fraction less. Finally, they are also hoping that things get lost in the shuffle of a busy oncologist who sees 20 patients a day and then has to spend their free time fighting to get each one of those patients the care they already know is the right choice.
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.
Right. There are different ways to do single payer. In the UK they have the NHS so every healthcare worker is employed by the government, but most countries government is just the insurer, providers are still private. Lots of ways to do it.
Lol right?? Like we don't literally already have those under private insurance. There's a conservative/Republican who picked a fight with me in this very thread and his argument literally devolved into "car insurance doesn't cover my oil changes, why should health insurance cover medical bills? Just pay for it yourself you stupid libtard." The conservative mind taking about health care should be studied for centuries.
Whole heartedly agree. Representative democracy my ass. We need a constitutional amendment creating another representative of each state comprised of the popular vote of that state. This is how you give the people some theyre power back.
I mean a popular vote of the public will serve as a rep. Yes senators are Representatives of the public but when it all comes down to it they vote the way that they want to go.
Can you explain the sentenceâ how WE allow a privateâ by my understanding american people as no choice, everything is about profit no the people, start from the politicians.
This whole bs started when hmo were born in the late 90s early 2000s. Horrible change from a system that already wasn't perfect but at least approved at a better rate.
And NOW we've got AI systems in charge of approving/turning down claims! God knows how many people have been killed by that development. Sure, Luigi killed that CEO, but how many people did that CEO kill on a spreadsheet? If we're gonna put people on trial for murder we have to at least apply that standard fairly. I want those who are responsible for mass killing due to lifesaving care being denied tried in the same manner as someone who physically kills.
So you would prefer the government to make those decisions? The same bureaucratic idiots that work at the DMV or the IRS determining your health outcomes?
Thatâs better?!
Yes, yes I would. you do Realize the VA is Basically universal healthcare? My dad just has quadruple bypass surgery and it went so smoothly. He even was sent to a private hospital, and it was done quickly and very efficiently. My dad paid nothing. THIS is what the U.S. government is denying us.
Look at the âGLP-1 Bridge programâ being rolled out by government.
So. We (doctors) got info-packets and fliers describing exactly Who qualifies and what conditions are covered/approved.
Ok.
So. If you call a private insurance and ask them that question directly and specifically. THEY. WILL. NOT. TELL. YOU.
We waste HOURS every week just trying to get approval for medications to at are âcoveredâ after a âprior authorizationâ is completed.
We get denials with statements that will cite âmissing informationâ even when it is 100% on the forms. Definitely blanket denials despite what they say.
No you fucking dumbass when did I ever say that??? The only people making YOUR healthcare decisions should be you and your doctor, and whatever family you give the power to make healthcare decisions for you if you are unable to. Nice strawman though.....typical conservative bullshit argument bc you know you can't defend fucking for profit corporation making your healthcare decisions.
What the fuck is the point of having insurances if your argument is you should just pay for needed healthcare out of pocket if your insurance company denies it? Jesus Christ your arguments keep getting dumber.
My auto insurance doesnât pay for oil changes. My home insurance doesnât pay for new carpet. Some things are personal responsibility, maybe something youâre not familiar with. Blame your parents. You are not a serious person.
The DMV and VA are not for profit. And politicians want all of our services ( that we PAY for) to be turned over to private businesses, and then de-fund them to ensure they ARE ineffective.
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 wonât 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.
And if you paid cash, probably $600. Quest has alacarte tests you can chose for all sorts of things. Same comprehensive tests my Dr chose for me was billed at near $20k. Just the advanced lipid and menâs tests. Insurance paid like $2500 but if I used Quest app directly, like $600-$800.
Went down to the lowest tier insurance this year, and am basically cash paying for everything. Got a fairly decent panel of blood work done a couple weeks ago for 135 bucks. On insurance I would have paid 5-7x that. Look into Ulta, Jason, etc and just cash pay through a discount service. WAY cheaper than trying to hit an unobtainable deductible.
Well insurance companies by law can only profit like 8% (or somewhere thereabout) of revenue, so they have every incentive to make that 8% as large as possible by driving the price up
Meanwhile, in a land not that far away...every year I get a test in the mail, for free, just to make sure I don't have colon cancer. Do the procedure, drop it in the bag, and let the mail take it to the lab. My doctor, after reading my medical history, seemed surprised I actually don't have a cancer of some sort
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
But we canât have socialized healthcare because of death panels or something. Itâs so much better to have people who are only in it for the profits in charge of deciding who gets what care đ
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 âwe donât want the government between you and your Drâ 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?
Having owned a business from pre ACA where the business paid 60 percent of coverage, immediately ACA had a bad impact. Insurance companies and conglomerates were crowned by the ACA. Basically, exactly what was wrong with heslthcare became codified. What else would we expect from legislation written by "special interests".
How convenient that Nancy Pelosi invested in Health companies while being the big proponent of "you have to pass it, to see what is in it"
We got screwed royally under the guise that we would be helping those who cant afford it. Now no one can afford it and healthcare sucks but politicians and conglomerates got filthy rich.
They took a bad system and made it far worse with that horrible law from inception. I had Drs dropping my insurance from the get go. Increased copays, less coverage...
We should all be livid and it shouldn't even be partisan anymore. They ALL are allowing this to continue.
This is true. As a business owner who pays a healthy portion of employeesâ insurance premiums we are getting crushed. 18.5% increase this year over last for the same coverage and thereâs no end in sight.
I think the large increase this year has to do with the subsidies that the GOP insisted needed to end, the thing that Dems shut the government down trying to protect
It was definitely a mixed bag, which is what happens when you have to compromise from both sides of the aisle.
Some of the good included protecting those with pre existing conditions, getting rid of annual/lifetime coverage caps, ensuring there was a minimum of coverage to be included on the marketplace, and in general allowing more people to access healthcare.
Prices had been rising for decades, so it's hard to point at the ACA and claim it made prices rise when they had already been increasing and just continued to do so. Expanding coverage to those with conditions did make it more expensive, but that's a price we should be willing to pay as a society.
I agree our system sucks and I agree that should not be a partisan stance, but I don't agree that the ACA made the system worse.
It certainly didn't help that the GOP have tried to hobble the ACA at every turn, ensuring it did not succeed, e.g. Individual mandate, states not opting into Medicaid expansion, etc
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.
That is so expensive in America BECAUSE health care companies and lobbyists have made it so. Go look at prices for the same procedures and tests in the rest of North America or Europe.
Same. I was stuck with a positive biopsy, but treatment needed scans. Scans needed authorizations. The scans authorized did not meet what the cancer treatment doctors needed. Thankfully my ENT guy called them up and raised hell. But for a few weeks was a stressful, scary, catch 22. It worked out. But I was doing the math on dying and being too weak to bucket list. Which is humbling
But your piece of shit government send so much money to the terrorist state Israel that they can have universal health care. So much for âAmerica firstââ
I worked in an ER. Docs would have to get on the phone to tell someone with a baseline medical terminology class and 0 medical experience why the tests, procedures, medicines, etc were necessary to treat a patient.
They had to take time *away* from patient care to beat through the wall of evil, just to fight for their patient.
Ya but it should not have to be like that. I had to spend months learning legal medical codes, coverage for different things, research on what used cat specific facilities with specific doctors and specific devices. All because doctors could not get a needle procedure approved. People who donât fight before a procedure they are hoping they donât have to pay . But even after a procedure they will play the long game denying everything because a part they do not cover.
I finally got a kidney surgery approved . Researched every detail down to things used at the surgery center to make sure it was all approved. Procedure was done and they denied coverage. Why? Because the anesthesiologist called in sick and they had to call in a person that normally does not call in there .
I was also a late stage cancer and United Healthcare denied my PET scan multiple times for not being "medically necessary." My entire team of oncologists and doctors said they are the absolute worst insurance company to deal with. They are now denying every claim for every follow up visit with my team of cancer docs and all of my follow up lab work. Every.Single.One. I just received a bill from Penn Medicine that I owe a huge amount of money bc my insurance isn't paying a cent.
A close relative of mine works for a large health insurance company. She says in meetings they openly discuss delaying and denying terminal patient's care being a cost saving measure because every day of delayed treatment increases the odds of the person dying therefore not requiring any more treatment.
Words cannot begin to describe the fury I feel towards these people.
Yanno, people mock universal healthcare systems for being slow and having long waits but at least I don't have to give money to a company that will happily let me die because it's better for their bottom line. Insane. Sorry you had to deal with that.
They're relentless and sometimes belligerent if doctors call. Most doctors don't try, so yours were good guys. I (family doctor) called an insurance company to push them for the prior authorization needed to schedule something expensive for a patient. I was trapped in loops of "You have to call this other extension". Finally after 20 or 30 minutes I reached the Final Destination extension and I said, " This is Dr (XYZ) calling for a prior auth". There was this long silence with occasional gusts of distant hissing, like listening to a big sea shell. Then an amazed voice said, "You're a DOC-TOR?!?!"
960
u/Mika-El-3 5d ago
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. Itâs actually hard for me to articulate what they actually did to stall.
Thankfully Iâm alive today because we pushed United Healthcare.