Why do we have to do the health insurance company's job for them?

Submitted ⁨⁨8⁩ ⁨months⁩ ago⁩ by ⁨Klanky@sopuli.xyz⁩ to ⁨mildlyinfuriating@lemmy.world⁩

Just so tired of almost every time a doctor submits stuff to insurance, we have to be the ones to make multiple phone calls to both the doctor’s office and insurance to iron everything out, figure out what the issue is (it’s always a different issue), and basically be the go-between for the office and insurance. What am I paying $500+/month for?! It’s like paying for the privilege of having an exhausting part-time job.

And yes, I understand that insurance wants to weasel out of paying anything, but this isn’t even shadiness, just straight up incompetence and lack of communication/following procedures. The amount of emotional energy we have to spend untangling this stuff leaves us drained.

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thurstylark@lemm.ee ⁨8⁩ ⁨months⁩ ago
They get paid when the least amount of people they insure use their services. They’re not incentivized to help those they’ve insured. The less they have to pay out to providers, the better the executive bonuses. Thus, they are diligent in collecting premiums, but can just sit on their hands when it comes to paying out.

The more the system denies and delays a claim, the fewer insured people are willing or able to put themselves through the bureaucracy gauntlet, the fewer pay outs.

They’re not in the business of insurance, they’re in the business of making money from the business of insurance. It’s over-complicated on purpose.

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- admiralteal@kbin.social ⁨8⁩ ⁨months⁩ ago
  And what might be the most important part cannot be elided over: market capitalism is HIGHLY efficient at solving optimization problems, but it only responds to incentives.
  
  So if you can create the right incentives to reward the result you want and punish results you don't want, a market solution is going to do a marvelous job. It's great at, say, price discovery. But if the incentives do not align with the desired result, it's going to grind you under heel.
  
  The incentives the insurance companies are responding to, frankly, are the ones you have outlined and essentially no others. Collect more premiums, make fewer payouts. There's no "breaking point" here because they have an absolutely vast customer base that has no choice to opt out of the system for a variety of reasons (ranging from the ACA individual mandate to the fact that it is not possible for an individual to make fully-informed financial decisions about their health even WITH advanced knowledge and training that nearly no one has).
  
  Health insurance is pretty much a textbook example of a service that the free market is ill-suited to provide.
  
  So over time, market capitalism is going to make them collect endlessly-increasing premiums and pay out less and less. It is going to continue to get worse. Period. It will eventually get nationalized. Period. All the argument in the meantime is just over how long we want to continue to let people be sick and broke before we apply the only fix.
  
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  - captainlezbian@lemmy.world ⁨8⁩ ⁨months⁩ ago
    Also it’s not like you can change insurers when they do this. First it almost certainly didn’t happen during open enrollment but also your insurance provider is probably decided by your employer.
    
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- Klanky@sopuli.xyz ⁨8⁩ ⁨months⁩ ago
  Completely agree. Just had to vent.
  
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- UltraMagnus0001@lemmy.world ⁨8⁩ ⁨months⁩ ago
  They actually use algorithms to deny claims. Also, remember the scene when Mr incredible was an insurance salesman?
  
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- grue@lemmy.world ⁨8⁩ ⁨months⁩ ago
  You’d think that the doctor’s office would at least be motivated to fix the problem so they get paid, though, 'cause I sure as Hell aren’t going to do it!
  
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  - AA5B@lemmy.world ⁨8⁩ ⁨months⁩ ago
    But you probably signed that you are liable for all bills regardless of insurance, and before you got any treatment. Read through all the paperwork sometime: it may not be reasonable or fair and you don’t have a choice but somehow it’s legal
    
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spaghettiwestern@sh.itjust.works ⁨8⁩ ⁨months⁩ ago
This is a feature, not a bug. We have all become unwilling, unpaid employees of every company in their pursuit of higher profits.

Corporations have discovered that there is no real downside (for them) when they don’t function. Customer satisfaction no longer has much of an impact on their profits because the few companies left in each sector are doing the exact same thing.

IMO this is yet another side effect of unchecked corporate power. It’s the same reason prices have risen so rapidly and corporate profits have reached 70 year highs. We are dealing with near monopolies and the billionaire class who created them. Until our government addresses the problem it’s not going to get any better.

In other words it’s not going to get better in our lifetimes.

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- aesthelete@lemmy.world ⁨8⁩ ⁨months⁩ ago
  In one example of this, during one job interview / recruitment process I essentially had to do all of the background check company’s work for them.
  
  That makes literally no sense at all, and I’m not surprised when there’s cases of people just pretending to be doctors or whatever for decades. They probably verified their own employment history and credentials.
  
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gamermanh@lemmy.dbzer0.com ⁨8⁩ ⁨months⁩ ago
My favorite is pre-authorization.

I need a pre-auth before my insurance will cover the Adderall for my ADHD. Every year I must renew this pre-auth or I will not get covered for my prescription.

What is a pre-auth, exactly? It’s a Dr. Promising that yes, this medicine they prescribed is medically necessary. No, prescription alone does not count. Yes, it can come from the same Dr. who prescribed it.

And yes, I have to do it yearly to “ensure it’s still medically necessary” because my ADHD could magically go away one day, apparently

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- spaghettiwestern@sh.itjust.works ⁨8⁩ ⁨months⁩ ago
  It’s beyond belief, but insurance companies do the same thing to amputees.
  
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  - gamermanh@lemmy.dbzer0.com ⁨8⁩ ⁨months⁩ ago
    Oh I know, I had a family member make the joke about suddenly regrowing a limb
    
    It’s disgusting and absolutely should result in anyone who’s ever approved that being put against the wall for their pure evil
    
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  - s_s@lemm.ee ⁨8⁩ ⁨months⁩ ago
    Any hassle they can create to manufacture a reason to deny coverage
    
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- uis@lemm.ee ⁨8⁩ ⁨months⁩ ago
  Wow. This is similar to what disabled people have to deal with in Russia. Like arm will grow back.
  
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  - PM_Your_Nudes_Please@lemmy.world ⁨8⁩ ⁨months⁩ ago
    Oh don’t worry, disabled vets deal with it all the time in America too. Oh, that leg you lost during your deployment? Gotta prove it’s still missing, and that you’re still disabled every year.
    
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- AlecSadler@sh.itjust.works ⁨8⁩ ⁨months⁩ ago
  I have to do it quarterly for some reason. Annually would be…better, but still stupid. My doctor even thinks it’s dumb, so he usually just asks me all the rote questions…
  
  …no he doesn’t, he usually goes blahblahblah you’ve been doing this for 10+ years we know the routine. Unfortunately I still have to make an appointment, have an appointment, pay the deductible for said appointment, just to get 3mos of a medication that, thus far, I have a medical need for.
  
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- nul9o9@lemmy.world ⁨8⁩ ⁨months⁩ ago
  Same with my MS. It’s frustrating to know that if they fuck around and feah their feet one year, i could be getting further brain damage without my meds l.
  
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- Sam_Bass@lemmy.world ⁨8⁩ ⁨months⁩ ago
  It means they have to compare your request to a list of allowances that change annually at the whim of Corporate
  
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jordanlund@lemmy.world ⁨8⁩ ⁨months⁩ ago
I tore an achilles tendon last year. Doc wanted me in physical therapy, but PT wouldn’t take me because they needed an MRI showing the position and size of the tear.

PT was very clear. Tendons don’t show up on xrays.

Doctor was very clear. Tendons don’t show up on xrays.

Podiatrist was very clear. Tendons don’t show up on xrays.

Aetna: “You didn’t do an xray first, MRI denied.”

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- repungnant_canary@lemmy.world ⁨8⁩ ⁨months⁩ ago
  They try to spend less so aggressively that they end up actually spending more
  
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  - jordanlund@lemmy.world ⁨8⁩ ⁨months⁩ ago
    Fought them for a month, meanwhile I’m in pain, limping with a busted tendon.
    
    Finally we just gave in and did the xray, which - surprise! - showed nothing! Then they approved the MRI.
    
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  - aesthelete@lemmy.world ⁨8⁩ ⁨months⁩ ago
    Corporations are all about stepping over dollars to pick up pennies.
    
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terminhell@lemmy.dbzer0.com ⁨8⁩ ⁨months⁩ ago
Image

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- Boozilla@lemmy.world ⁨8⁩ ⁨months⁩ ago
  What you really need on top of that insurance is supplemental insurance! That way you can pay two insurance companies and they can both say no!
  
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- Klanky@sopuli.xyz ⁨8⁩ ⁨months⁩ ago
  Haha exactly! I mean, I know this is how it works, it just feels like it’s gotten way worse in the last few years.
  
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toiletobserver@lemm.ee ⁨8⁩ ⁨months⁩ ago
Vote for a single payer system (Medicare for all) if you want out

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- Hildegarde@lemmy.world ⁨8⁩ ⁨months⁩ ago
  How? Who do I vote for to make that happen?
  
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  - uis@lemm.ee ⁨8⁩ ⁨months⁩ ago
    Doesn’t USA have referendums?
    
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neidu2@feddit.nl ⁨8⁩ ⁨months⁩ ago
One of the biggest advantages I see from living under single payer health care is that I don’t have to put in extra clerical work like you describe. Sure, the insurance company should be able to pick up a phone, but In my opinion, the responsibility should rest on the hospital - they are the ones demanding a payout.

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- assembly@lemmy.world ⁨8⁩ ⁨months⁩ ago
  I worked in healthcare tech for a long time and I would say that healthcare facilities should focus on delivering healthcare. We had so much administrative overhead from dealing with this insurance bullshit that it drove up costs to staff a ton of people to deal with insurance bullshit and thus increased costs. If we had single payer it would be a single process that couldn’t possibly be more convoluted than what we have now. Sending shit to insurance clearing houses with exact ordering of diagnosis matching procedures so that they don’t get kicked back. The hospital doesn’t want you dealing with this shit either they just want the money that the insurance provider said it would pay for your treatment. It’s 90% insurance bullshit all the way down.
  
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- Lith@lemmy.sdf.org ⁨8⁩ ⁨months⁩ ago
  Just to offer another perspective, this covers just how difficult the burden of administrative tasks already is for physicians: www.ncbi.nlm.nih.gov/pmc/articles/PMC8522557/
  
  Not all physicians work for a hospital, so I don’t think they all have much access to large departments that can take up the slack for them. It’s difficult to ask them to chase our insurance for us when the paperwork they already do is driving them insane and taking them away from their patients.
  
  The solution, as you said, is single payer. The overwhelming administrative overhead is a symptom of a very broken system. Nobody directly rendering or receiving care is benefiting from how things currently are in the United States.
  
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  - Klanky@sopuli.xyz ⁨8⁩ ⁨months⁩ ago
    I do feel sorry for the admin staff that have to deal with it, and my ire is 90% directed at insurwnce. However, when they can’t even read the back of the insurance card to follow the instructions to properly file a claim, it just gets tiring.
    
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- Klanky@sopuli.xyz ⁨8⁩ ⁨months⁩ ago
  I completely agree about it being the providers responsibility. The problem is, they don’t want to do anything to resolve the issue either. Other times, it doesn’t even involve the provider, they did everything right but for some byzantine reason it didn’t go through the insurance system correctly and you have to call them and tell them to process it the same way they have processed every other exact same bill from the exact same provider.
  
  Just wanted to vent. I should clarify I live in the US (as if that wasn’t clear from my post LOL!)
  
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  - neidu2@feddit.nl ⁨8⁩ ⁨months⁩ ago
    
    they don’t want to do anything to resolve the issue either. In any other line of work, that’s an excellent way of forfeiting any right to getting paid.
    
    In the jobs I’ve had where I’ve had to bill someone, I’m having a hard time imagining that I could expect to get paid if I just sent a bill to someone who didn’t owe me.
    
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- captainlezbian@lemmy.world ⁨8⁩ ⁨months⁩ ago
  I disagree. The hospital is employed to provide medicine. I pay a medical insurance company to pay for my medicine. If a doctor says I need medicine the insurance company should respond and pay because why else am I paying them.
  
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afraid_of_zombies@lemmy.world ⁨8⁩ ⁨months⁩ ago
I don’t know if I should say this but I will.

The last time it was an issue for my kids I conferenced called the insurance and the doctor’s office. I then laid into the insurance adjuster saying things that were truly revolting with as much profanity as I could cram into it.

Haven’t had an issue since. Turns out the system only works if they think you are unstable enough to make it work.

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Gigan@lemmy.world ⁨8⁩ ⁨months⁩ ago
I wish I could Thanos-snap the entire health insurance industry out of existence. It’s a giant, bloated, bureaucratic middle-man that makes the whole process more expensive, time-consuming, and complicated.

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- Willie@kbin.social ⁨8⁩ ⁨months⁩ ago
  I'd assume we'd see insurance invest money into making offers to providers. They'd refer the patient to a health insurance company instead of negotiating, and in exchange they'd get a large one time payout for a successful referral. This would please investors in the providers, because they'd see short term gains, and it'd please the insurance company because patients would be forced to have insurance again. Everyone (with money) wins!
  
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rufus@discuss.tchncs.de ⁨8⁩ ⁨months⁩ ago
It is unique to the way healthcare works in the USA. I don’t know why, the conplete system looks broken. I can only tell you we pay less for healthcare here in Europe and we don’t have to call unless it’s really complicated and a rare situation.

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- Boozilla@lemmy.world ⁨8⁩ ⁨months⁩ ago
  Several decades ago in the USA, healthcare was affordable to working class people. It wasn’t cheap, but it was at least affordable to middle class people. It certainly wasn’t great even back then, because in my view healthcare is a basic human right. And poor people (especially minorities) had limited or no access. But even then, it was still better than the shit show we have today.
  
  Anyway, what happened was some large corporations like IBM and others started offering an executive perk they called “major medical”. This was to help pay for expensive, unexpected medical expenses. It was a nice perk for the country club set. But like anything with money attached to it, some people got together and said, “Gentlemen, how can we weaponize this and take ALL the money?”
  
  So, over time, it became the “standard practice” to tie your health insurance to your employer. This introduced a ton of friction into the system and created an entire ecosystem of rent-seekers who add no value to the patients or providers but charge a fee just because they exist.
  
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  - rufus@discuss.tchncs.de ⁨8⁩ ⁨months⁩ ago
    Hmmh. I recently learned about that. Seems to be roughly 1980 when things started going sideways and nowadays it’s really bad…
    
    Life_expectancy_vs_healthcare_spending
    
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- lurch@sh.itjust.works ⁨8⁩ ⁨months⁩ ago
  Yeah, I’m in EU and I have never ever contacted my health insurance since the day I chose it. They just send me new insurance cards every couple of years and once they sent a letter that said they have an app that lets me get doctors appointments more easy etc.
  
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  - AA5B@lemmy.world ⁨8⁩ ⁨months⁩ ago
    Hah, I had an app that lets me get appointments and prescription renewals …. The app would send an effing fax to the doctors office where it would sit in a pile until I called to ask the same thing
    
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dhork@lemmy.world ⁨8⁩ ⁨months⁩ ago
I agree with you. I am fortunate enough to have insurance now which covers the things I need without much of a hassle. But at my last job, they had an insurance provider who was very fond of losing paperwork, making up bullshit, and not really delivering on what it was supposed to do.

I recall complaining about this to a co-worker, who was incredulous that I would be so lazy. You see, he had a whole system of who to call and where to file what paper to get the results he wanted… sometimes. But I was amazed at how much effort he put in to work around a system that was totally artificial, inserted between patients and doctors for no other reason than to skim money. And he was proud of it! He was convinced that putting in all this effort showed that the system was working as intended. (I should add that he is the stereotypical “small government” conservative, or at least was until Donald Trump convinced him that the best use of Government was to be a tool to beat up Liberals and Immigrants with.)

It’s like these people are convinced that if something doesn’t require a huge amount of effort, it must be worthless. Meanwhile, their boss’s boss’s boss merits their large salary and stock compensation specifically because they are enough of a psychopath to make monumental decisions on as little data as possible. I am starting to feel bad for most ordinary people who vote for conservatives. Not only are they getting garlic, but they prefer it that way!

I think Obama care has gone about as fast as we can go in reforming Healthcare while half the country is so masochistic.

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- Boozilla@lemmy.world ⁨8⁩ ⁨months⁩ ago
  It’s sad how effective punching down on patients and workers is. They always use the bullshit Protestant work ethic thing to call folks lazy when we complain about the systemic abuses. And it’s a crime how the corporate bloodsuckers that pay little or no taxes want to frame the working class guy who needs reasonable accommodations and services as a “parasite”.
  
  Unfortunately a big chunk of the voters fall for this song and dance year after year. Like your friend.
  
  It’s all a “culture wars” diversionary tactic to keep us fighting each other instead of demanding systemic changes as a unified class of non-billionaires vs the elites.
  
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- snooggums@midwest.social ⁨8⁩ ⁨months⁩ ago
  Bet that coworker lived doing the artificially confusing and overly complicated taxes too!
  
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ArtVandelay@lemmy.world ⁨8⁩ ⁨months⁩ ago
The amount of inefficiencies in the healthcare system is staggering. Like, you almost wouldn’t believe it kind of staggering. I can’t go into much detail without doxing myself, but it’s bad.

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Boozilla@lemmy.world ⁨8⁩ ⁨months⁩ ago
Healthcare practices vary in how much they are willing to run interference for you on insurance. Most of them will at least try “pretty hard” to help with the claims because it’s good for their income stream to do so. However, sometimes you’ll find yourself using a provider who can’t be bothered with staffing up and/or supervising it to make sure it gets done. In my (limited, anecdotal) experience, this seems to happen more often with specialists or niche providers.

Or sometimes it’s your insurance plan. It might have so many byzantine rules and/or shitty admins that it’s just too much work for even a crackerjack provider staff to deal with it. So they end up kicking it back to you and saying “good luck”. If this happens enough, the practice may stop accepting that plan in the future.

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Th4tGuyII@kbin.social ⁨8⁩ ⁨months⁩ ago
Because if they pay out, they make less money, far cheaper to get you to give up trying - which is what a lot of people will do because it's designed to be an exhausting system.

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jdf038@mander.xyz ⁨8⁩ ⁨months⁩ ago
Same with HSA cards. I quit paying into mine because they wanted proof I got work done after using at a dentist.

Yeah, because dentists usually sell fun things. Fuckin morons

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- kuraitengai@programming.dev ⁨8⁩ ⁨months⁩ ago
  I never had an issue with my HSA card. Paid into one from 2016-2020 when I had a state job. Then switched off a high deductible to a standard plan with an FSA. Left the state job in August 2021 to go private. finally burned through the last of the HSA money in June 2023. Switched jobs back to the state last August and started paying into the FSA. They hassled me over every charge that wasn’t a copay. Go go the eye doctor. Prove it. Buy contacts. Prove it. Go to a chiropractor. Prove it. They deactivated my FSA card over $1.60 that the insurance said was over the standard amount.
  
  Sorry, I pay into the account for medical purposes. I go to a doctor and you pay it. You have no business knowing WHAT the doctor did to me. They were demanding stuff as documentation from my wife that was a blatant privacy violation.
  
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  - jdf038@mander.xyz ⁨8⁩ ⁨months⁩ ago
    Similar issue with me! In our case both were HSAs and my employer changed companies. The first was awesome (and super helpful considering it was pre tax) and the second was horrible.
    
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Jaysyn@kbin.social ⁨8⁩ ⁨months⁩ ago
It so you give up.

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- OpenStars@startrek.website ⁨8⁩ ⁨months⁩ ago
  And if you happen to die in the meantime, well then in that case you cannot sue :-P.
  
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psmgx@lemmy.world ⁨8⁩ ⁨months⁩ ago

The amount of emotional energy we have to spend untangling this stuff leaves us drained.

That’s the point. Take a look at the Fortune 500 and Global 500, and notice how many of them are US healthcare companies. No company gets that big doing all the work themselves…

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realitista@lemm.ee ⁨8⁩ ⁨months⁩ ago
Living in Europe with single payer health care, this sounds crazy. I just go to the doctor, leave, pick up my drugs, etc. It’s all handled by the insurance except maybe a few bucks on some drugs. Worst case I have to show my insurance card but that rarely even happens.

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- IamAnonymous@lemmy.world ⁨8⁩ ⁨months⁩ ago
  It is crazy because OPs case is not very common, at least in my experience. The hospital sends the bills to the insurance and later I get a bill for what I owe. I don’t need to make any calls.
  
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  - yessikg@lemmy.blahaj.zone ⁨8⁩ ⁨months⁩ ago
    Oh no, it’s very common, especially with large bills
    
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Sam_Bass@lemmy.world ⁨8⁩ ⁨months⁩ ago
Poor souls are weighed down by the egregious amounts of money they have to take in and hand out. Leaves little time to do much else

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snooggums@midwest.social ⁨8⁩ ⁨months⁩ ago
It is shadiness, because the odds are that you wil make a mistake and they will hold it against you. The whole private insurance setup exists to find ways to delay and poasibly deny coverage.

That is also why you pick what you will be covered for before the year starts, as if you can predict which major medical issues you will have in the upcoming year. Better pick a bunch of stuff that isn’t likely, and they can deny when you didn’t pick the obscure one!

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BritishDuffer@lemmy.world ⁨8⁩ ⁨months⁩ ago
If you fail to run the gauntlet, or give up in frustration, the insurance company doesn’t have to pay. They could absolutely make this process easier, but the incompetence works in their favor.

I’ve lived in single payer countries as well as in the US, and the incompetence is the same everywhere. In my experience the big difference is in universal healthcare countries the rules are very strictly defined and there’s very little scope for exceptions, so either you qualify or you don’t. The other issue is that even if you qualify there’s often a multi-month waiting list for treatment.

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ikidd@lemmy.world ⁨8⁩ ⁨months⁩ ago
It’s the first time they’ve ever done a claim. Take it easy on them.

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Pulptastic@midwest.social ⁨8⁩ ⁨months⁩ ago
This happened to me today. Dreading the hold times tomorrow.

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DontTreadOnBigfoot@lemmy.world ⁨8⁩ ⁨months⁩ ago
Sounds to me like your insurance company sucks.

In the decade I’ve had my current insurance, I don’t think I’ve ever had to call them.

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- snooggums@midwest.social ⁨8⁩ ⁨months⁩ ago
  My insurance requires me to take personal action a couple times a year to say I stilll need to take the same medication I have taken for a decade, and that the other cheaper generics don’t work. They won’t take this answer from the doctor’s office and won’t stop asking.
  
  They also don’t provide the pharmacist with a clear error that this is the reason they deny filling a prescription. I have a reminder now each year that I will be denied that month because of this bullshit and that I need to call.
  
  Also, I can’t call early.
  
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IamAnonymous@lemmy.world ⁨8⁩ ⁨months⁩ ago
Another post to feed America Bad and EU Good circlejerk on Lemmy.

Yes, the system is bad and we should have universal healthcare but I never had to call anyone to figure anything out in the past 15 years. The hospital sends me the bills after getting it through insurance. Not sure who your insurance provider is but this issue is not common.

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Blackmist@feddit.uk ⁨8⁩ ⁨months⁩ ago
Come on now. If you really had to do your insurance company’s job for them, you’d have to think of your own reason why they won’t pay up.

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