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the madness that is US “healthcare” never ceases to amaze me.
Know what happens when a doctor recommends me a treatment? I get that treatment.
I don’t have to hope an insurance company will “approve” of me getting that treatment. I don’t have to worry about paying for it.
Anyone still defending this system needs psychological help. Which would be denied by the insurance company. And cost 10000s out of pocket
It gets better. So many times Dr's will have to start with treatments they know won't work because otherwise insurance will just decline it all together.
Anyone still defending this system needs psychological help. Which would be denied by the insurance company. And cost 10000s out of pocket
Approximately half the country supports it because it hurts people they don't like, and they're about to elect a literal dictator. Please send help
What country do you live in?
LPT: If your doctor firmly believes that you require X treatment/medication/etc. Have them use the specific term "medically necessary". If your insurer kicks it back with that phrasing attached, contact them. Ask for the medical license number of the doctor who indicated that it was not medically necessary. Push for this information (they won't have it) and continue the line of "Someone on your end is making a medical decision against my doctors orders. I require their credentials so I can confirm they are a) qualified to make medical decisions, and b) have a higher education that my doctor possesses."
I'll be interested if someone actually tried this
I speak from experience. Blue Cross has not argued or denied any of our doctors' requests since the second time I used that method.
Had a specialist tell my wife she needed a shoulder replacement. Insurance wanted her to do physical therapy. I was livid. "I want the license number of the doctor on your end who is deciding that physical therapy is going to some how magically fix torn rotator cuff tendons. Telling our medical specialist that physical therapy is required is a medical decision that contradicts their diagnosis that it needs replaced. If we follow your recommendation and it fails, I need the name and license number of who to go after for making that decision. Shielding this professional, and I use that term loosely, indicates that you're willing to assume all the liability when "physical therapy" causes more pain and damage."
Did they ever give you a license number, or did they just cave?
Said they'd have to "look into it". Called back 20 minutes later to inform that they decided to approve the procedure.
This reads like a summary of a chapter in a dystopian novel
It reads like sovereign citizen advice.
Ffs, is this truly where we are at? Fuck me...
Nurses usually make these calls, as I understand.
Why are we letting the insurance companies make decisions like doctors in the first place again again?
This is a good step in the right direction, but I'd like to see it applied to commercial plans as well. Prior authorization is everything they're saying it is and worse.
It’s the difference between single-payer systems run by the government and private, for-profit commercial plans. I’m happy to see this carried out on an executive level since an actual law regulating private insurance would be a shit storm in congress. Remove the profit motive from insurers and the shift quickly moves towards real-world evidence and health outcomes rather than profit margins.
Were all fighting over the most miniscule things in the grand scheme. We should all be demanding the most effective and efficient single payer program the world has ever seen.
You're right, we should be cutting out the bloated middleman entirely.
It's true, but perfection is still the enemy of progress.
So I see you had diabetes last year. Was the insulin we gave you last year enough to cure it, or do still have it? Either way, we need to make sure you aren't selling it to bodybuilders, so go see a doctor to confirm it hasn't been cured.
You joke, but I'm literally fighting this fight right now.
Prescription: Your doctor thinks you need a medication
Prior Authorization: Your insurance doesn't want pay for the medication and wants your doctor to affirm that he wrote a prescription
How about a similar rule that puts the provider on the hook for getting authorization for what they do?
Like I know the system is fucked, but I don't want my doctor having me go somewhere to find out I get a $500 bill. Make them get authorization and if it fails tell me the cost before the appointment gets made.
If I have to spit in a tube again to get a $500 bill, I'll call and threaten Natera again till they drop the bill. Bastards.
That would slow medical care down dramatically.
But why? This should be automated based on my coverage plan.
Because it's not an automated process to get a procedure authorized.
Make it automated.
They already do for big services. Thats why its called a preauthorization. It just doesn't work well in emergencies and they dont do it for shit like routine blood draws. Ive had them tell me I could get a CT now and hope they approve it or take my chances. There is still incentive for the provider to fight the battle because patients getting big bills often don't pay them at all (it helps if you tell them though, they are busy and not necessarily keyed into every patients bill status).