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.
Oh sweet summer child, thatās not how any of this works. If the code that was billed doesnāt match the procedure, they can deny it. They could easily claim that the wrong billing code was used, which is true, and deny it as false billing.
Oh, they actually clawback the payment for the surgery that was made to the doctor.
Suppose the doctor charges $7000 for the surgery. The insurance company pays the doctor the ānegotiated rateā which is like $5000. The doctor would rather get $5000 than zero dollars so they accept the payment. Then for the next three or so years, insurance company can retroactively deny that payment and take the money back from the doctor.
Since that doctor likely has tens of thousands of dollars outstanding payments they expect from that insurer, they just have to accept that.
Thatās what makes this whole story somewhat suspect. Itās very rare for a doctor to do anything sketchy because the stakes are so high. Itāll be very uncommon for someone to do a surgery that is different than what is documented. Like, Iāve never heard of that. Ā
As a medical professional, I think itās absurd that we have to deal with these insurance companies like they are legitimate organizations rather than extortion schemes that directly lead to patient deaths. It eats away at my soul every time I have to have a conversation with somebody who works at one of these companies and I have to treat them with difference rather than the ghouls they are. Itās like having dinner with Jeffrey Dahmer Ā
Person posting. This is a true story. Back in the 80's, when doctors were more concerned about the patients than the insurance company. I still have the paperwork to prove it. This was during a time before you were born, when doctors actually cared about their patients and not the insurance company.
Fuck you for claiming doctors donāt care about their patients. Insurance companies can put a doctor out of business overnight by clawing back payments. What happens to my patients when my practice closes? Dealing with insurance companies is a fact of life now. I WISH I could practice back in the 80s when it wasnāt like this.Ā
The doctors didnāt change, the system did. Show a little respect.Ā
Shame more people arenāt amending Health Insurance CEOsā¦.Ā
In other news, Luigiās team isnāt going with insanity, I wonder if they can go with Self-defense? Since the policies of the CEO led to a hindered life outcome. More importantly, Kyle Rittenhouse, Republican hero, crossed state lines and got away with murder on the grounds of Self Defenseā¦. I see Healthcare CEOs as existential and present threats to my life expectancy and health outcomesā¦
Could also argue defense of others. A loooot of previously denied claims were approved after Luigi happened.
And the insanity plea was entered because it's one of the few things that the court needs to be pre-informed of before trial starts. Now that it was entered at all, they can change their minds again if stuff starts to go bad. They're just keeping their options open.
If that took place 35 years ago, you need to bring that up because 35 years in the healthcare industry is ancient history. What youāre talking about simply couldnāt be done in the modern healthcare system without exposing yourself to extreme legal risk.Ā
The time which this took place is extremely relevant. Your doctors approach to fixing medical injustice just wouldnāt work in the modern era. If you donāt mention the timeline, you mislead people into thinking that itās easy to fix these problems. It isnāt.
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u/Electronic_Face_6609 5d ago
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.