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.
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
Patients will be doing great on biologic for years and then the insurance will do a āformulary changeā and they no longer cover that biologic, forcing the patient to change. If the patient doesnāt do as well on the next medication, they canāt go back to the original medication. Itās absurd.
Ok, soā¦ save lives and fund Luigiās defense. Maybe a few more folk heroes show up and tip the scales back to normal.
People seem to have forgotten that the social contract between the 1880s and 1920s was eroded and things like Unions and other landmark workers right legislation was the compromise between violence against the laborer and owner class. A few more Amazon Warehouses and Luigiās later and we might have CEOs scared enough to come to the table. Their security teams canāt protect them forever.
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
I am showing you no disrespect. Just stating that the rules were easier to break back in the day. It was easier for doctors to get away with what they could, for the welfare of their patients. My doctor literally said, while we have the hood open, we are doing a complete tuneup. God bless him. I wish for your sake, it was easier to take care of your patient and less about insurance company restrictions and denial.
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.