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This should be the law!
WorkReform | by /u/zzill6 | 114 comments | 2026-09-02T13:50:56+00:00 Central
Comments
| /u/GrandpaChainz The health insurance execs reporting this post from Popular can take a seat. Mods will not be removing. 👉 Join r/WorkReform if you're ready for MEDICARE FOR ALL |
| /u/hansn How about we just get rid of private health insurance. Their motives are not aligned with the patient's interests. |
| /u/Coyote__Jones Never forget that Blue Cross Blue Shield was going to establish a policy to limit the amount of time anesthesia would be covered during surgery per procedure. While they cancelled this policy, states that have moved to enact laws barring anesthesia limits. The only reason state legislature had time to work on passing such laws was because the policy was cancelled following Brian Thompson's death. We have an ass backwards system where the insurance companies can do whatever they want so long as there isn't a law preventing them, and the law has to react to what they're doing. |
| /u/OptimisticSkeleton The market is incapable of regulating itself. That's why we need regulations, because of situations exactly like what you just described. |
| /u/NargWielki But tell me, how can you properly regulate anything when the regulators themselves are in the pockets of the same companies that would be liable to such regulations? That is the number one major contradiction with the so called "democracy" that most countries abide by. The only democracy possible is a democracy made by the working force. |
| /u/OctaBit There is also Sortition or a Lottocracy. https://en.wikipedia.org/wiki/Sortition Similar to how jury selection works, this article describes elected officials pick in a similar way. An alternative that I heard was to have random citizens brought in, educated on a topic by experts and propose a law or action. The elected officials wouldnt be able to propose the laws, simply vote on them. It's still not immune to bribery (any system with people is going to be), but it's much harder to do when you don't know who will be writing the policy. |
| /u/LowlySlayer "we grab a random person, tell them what to think, and then have them draft a law. This will be much more challenging to rig." |
| /u/OctaBit We do the same exact thing with juries now. Edit: To expand on this, it could be as simple as two parties each bring in their own group to inform the batch of citizens are going to propose the law. They make their arguments, have their experts present facts, and you could even have some moderate the discussion, similar to a judge. The individual members of the group can then work together to propose and vote on policies, work with legal experts to refine language and in the end present something that could be actionable and understandable to the average American (especially since it came from the average American). Say what you will about the justice system, and I could say plenty, but a jury of peers is probably one of the best functioning pieces of it. It also catters much more towards the average then say, the electoral college. |
| /u/tcfinance I'm largely inclined to agree with your sentiment, but there's also all the crap you can read about how jury selection proceeds and how lawyers/litigators learn to manipulate the jury. That makes me a lot less confident. |
| /u/OctaBit That's completely valid, and to be honest unless we really clean up our current system I would be really suspicious of anyone trying to switch us to another one. Still there are plenty of manipulation in our current politics too. Hell, I feel like most campaign promises these days are just people trying to say anything and everything to get elected and then immediately sell their vote to the highest bidder. There's plenty of challenges, but I think we can devise solutions to these problems when we try. It's just getting them implemented once we come up with something workable, that's the real challenge. |
| /u/tcfinance I remember as a kid John Kerry getting decimated by "flip flopping" allegations by the right. If everyone held todays politics up to the microscope of the early 2000s, we might still have a functioning democracy. I'm not convinced devising solutions goes anywhere in a world where we're really considering if the 14th amendment holds, or a world where the supreme court is dominated by people who believe in "originalism" with a cornerstone of the text being fixed in its time, then believe that arms beyond those of the time are protected anyway. That pessimism aside, the only way to fix things is a collective return to sanity. That means angry loudmouths like myself toning it down and trying to move conversations toward evidence based decisions, and people in general taking the time to self reflect and bring the conversation toward outcomes and not who hates who more or which politician is better. We need a cultural change to fix things, and I'm afraid that's only going to come as a result of a generational trauma which is coming. Case in point - how exhausting it was to rewrite this paragraph so less of my own biases were clear. |
| /u/regoapps Put everyone including billionaires and politicians and law enforcement on the same healthcare plan. Make it so that it's illegal to pay out of pocket, and make the patient's identity anonymous to the single payer so that there's no bias when it comes to denials. Now it's in everyone's best interest to keep this healthcare plan good or else they'll also be stuck in the same bad healthcare plan. There'll be no favoritism. Nobody will get better or worse healthcare than others. Nobody will pay more or less than others for the same care. Then have it all funded by estate taxes after closing all loopholes (no leaving your money to a charity or a trust to avoid the estate tax). This will discourage people from hoarding all their money. If they don't spend it in their lifetime, then the money goes towards paying for the country's healthcare. The estate tax percentage will be determined by how much the nation's healthcare bill costs. This will discourage rich people from making the country unhealthy via pollution and what not. The more unhealthy people are, the higher the healthcare bill will be and the more will be taken from the estate taxes. |
| /u/no1singlemomghoster Put everyone including billionaires and politicians and law enforcement on the same healthcare plan[...] *Put everyone including billionaires and politicians and law enforcement on the same healthcare plan in the ocean |
| /u/Snobolski Nobody will get better or worse healthcare than others. You're assuming that all doctors and all facilities are equal. Even under your system, you won't attract good docs to work in small towns or bad neighborhoods. |
| /u/OptimisticSkeleton Yeah stable democracy is not an easy thing to build or maintain. It's more of a finicky Italian sports car requiring constant maintenance and upkeep than an impossible to kill old reliable truck that my fellow Americans like to treat it as. |
| /u/Reddits_Worst_Night There is no democracy. It's a lie and always has been |
| /u/RivenRise I'm with you it's hard to know how to go about this in a way that works. That's part of the reason Luigi did what he did, seemed to somewhat work in the sense that it got people talking about it... |
| /u/Twink_Ass_Bitch Any business in a free market is incentivized to make it not free. Markets without competition, customers who don't have knowledge on the technicalities of the product, no duty to be responsible for side effects (e.g. waste/garbage dumping) , etc. all benefit that business. Free markets can work to create great products and services, but they require referees to make sure everyone plays fair, because there is a monetary incentive to cheat. Companies should be forced to compete through product and service quality, not through who can wheel and deal the red tape or bribe the refs better. |
| /u/Eyeball1844 Which is why every capitalist country will eventually arrive at the same point. The incentives say that they will deregulate so they do. |
| /u/xdsm8 Healthcare ticks basically zero of the boxes necessary for an efficient, fair, free market, according to basic economics. You can't shop around for medical care. You don't have enough information about the service (lack of a medical degree and all that). You don't really know what you are getting (don't know the quality of a doctor until they screw up big time). You don't have the time to consider all options (might be actively dying or in agony). The price is also not stated to you |
| /u/thenikolaka The market is showing that the shareholders can't extract profit every time without causing great harm. They are ignoring the market. |
| /u/mewfour Technically, the death of a CEO is the market regulating itself. It adjusts for more money spent on security and such too, to enable higher prices, which drives other plots for CEO deaths for further market corrections etc |
| /u/FeijoadaAceitavel WRONG! The market is perfectly capable of regulating itself... Towards maximum profits. |
| /u/mathe_matical Blue cross blue shield arbitrarily decided to stop paying my psychiatrist years ago, leaving me to wean myself off of anti-depressants without help from a doctor. That was a rough and dangerous year for me. I am too scared to go back on the pills now because I don't want to face the risk of all the side effects I had from tapering off on my own. |
| /u/Coyote__Jones That should be a crime. It is cruel and unusual punishment to subject a person to this. My mom has an ostomy, and her insurance company randomly stopped covering the supplies that work best for her and so she's been paying out of pocket because the alternative they'll pay for just doesn't work. I was on the phone with them during the beginning of this issue and they acted like she had an attitude problem for not wanting the contents of her bowels to leak all over herself, her clothes, and to be smelled two blocks away. She's a cancer survivor, and with the right supplies she's able to travel and live a life, and keep her job. They'd have her housebound and functionally disabled before paying for the right supplies. |
| /u/Slinky_Malingki How would that even work? Like, a timer runs out and the doctor goes "that's all we have on anesthesia! Time to do the second half of your surgery while you're awake!" |
| /u/Coyote__Jones You still get the anesthesia but it's no longer covered by insurance. So basically, you might end up alive and well but bankrupt. |
| /u/PedanticBoutBaseball That, or, because its a top down change from an insurance carrier and anesthesia is necessary for many procedures, they're indirectly applying pressure for doctors to complete the procedures faster and save themselves even more money by trying to justify reimbursing them less because "well this procedure only takes x number of minutes now, so we're going to pay you pro-rata" fuck the risk to patient health, physician mental health and their malpractice premiums tho. |
| /u/DernTuckingFypos Had a situation where a doctor rushed my surgery. I had testicular cancer and was scheduled to have surgery to remove it. Right before the surgery was supposed to start, there was an emergency that came in and the surgeon that was performed my operation had to rush to the emergency right after, so was pretty quick with performing mine. Ended up in a huge amount of pain with a giant hematoma the size of a baseball, and he ended up severing a nerve so now half of my groin is completely numb with 0 feeling. |
| /u/Decantus Blue Cross Blue Shield C suite should be required to go through a major surgery without anesthesia and then give their opinion. |
| /u/Snobolski Just FYI, "Blue Cross Blue Shield" isn't one entity. It's different depending on where you are. Anthem isn't the same company as Highmark, for example. Some states BCBS plans are independent entities. BCBS is a set of brands and trademarks that members sign up to use by agreeing to participate in the association rules. |
| /u/Decantus Cool, 2 sets of C suites to subject this to. |
| /u/ZoomZoom_Driver My 75 yo 'representation' (federal senator) has taken over $5m from healthcare ceos and industry pacs. That $5 million to deny her constituents the same universal healthcare.that ALL OF CONGRESS receives. |
| /u/Geno0wl Never forget that Blue Cross Blue Shield was going to establish a policy to limit the amount of time anesthesia would be covered during surgery per procedure. My 63 YO FIL tore a tendon in his shoulder because he had a chip on his shoulder(avulsion fracture). His doctor plainly stated he needed to repair the chip while they repair the tendon, or the chances of it re-tearing would be very high. But the insurance(BCBS) refused to approve the bone repair because they said the X-rays were "inconclusive," and they wanted a better view to prove it was necessary. In order to acquiesce to the insurance company's demands, they had to do the tendon repair, then after completing that they had to "dig" further in down to expose the bone, take pictures of it, and then send those to the insurance company. Once they had those pictures they would approve the surgeon to finish the procedure(which they ultimately did). Think about that for a second. Not only did they mandate a 60+ aged person unnecessarily stay longer under anesthesia, but they made all of the doctors and nurses wait around doing nothing as well, wasting time and money. Not only that, but the effort to even get to the bone to get a clear picture was like 50% of the work required to fix it in the first place. When you account for all of that BS, the insurance company probably spent more money than if they had just approved the obviously needed fix in the first place. These companies are insane. |
| /u/sweetonionbun FUCK blue cross/blue shield. They are a bunch of dinks. |
| /u/CzarTanoff I just got a letter from blue cross that they approved my upcoming c-section (how generous!), and that they have approved a whole three days for me to stay in the hospital! If you've ever had a c-section, you know that you don't even begin really walking until the second day at the earliest. |
| /u/CommanderofCheeks My wife worked for blue cross and literally had to quit after working there for a few months. She said it was soul sucking and couldn't take telling people no for what they needed for no reason. She had one lady who got her treatment denied and she told my wife "so I'm just supposed to die" or something along those lines and my wife was speechless. She has since changed career paths. |
| /u/thekrone As long as "for-profit" health insurance exists, yes absolutely. They are always going to do whatever they can to limit their costs, which means denying as many claims as possible. That means people suffer and/or die so that executives and shareholders can make some cash. It's just not sustainable. We need to move to a public option, or at the very least, make it illegal for anything health related to be "for-profit". |
| /u/stevez_86 And for profit in a marketplace with monopolies because the company's sponsor the benefit for their employees. And all the expenses are pre-tax. They are self funded plans. The companies pay for the treatment at the contracted rates. You the consumer is left to pay the rest. Still pretax, but not a benefit if the expense that is not taxable is more than your income or a substantial part of it. Because it inevitably eats up your disposable income. They need to cap the tax advantage for corporations sponsoring employer group healthcare. Then they will work to keep healthcare costs down. Strange that it is such a burden on the economy but the corporations that pay for it (pre-tax) don't lift a finger to stop the cost increases. It is basically a monopoly. Looking at ERISA, the law package that governs those benefits, the whole point of it has been lost. It doesn't help draw talent. The plans don't even hardly cover the most prescient of health concerns like diabetes drugs in full. Its because they like the way it is. And if they like it they don't want it to change. Fuck with their taxes then. That is a sure fire way of inspiring them to do something. But offer something actually useful in place of it. Another financial product that draws talent and encourages upward mobility. They could even offer it as a pilot program to covered spouses that don't use the company benefits. Let them use the product to see how much it saves the company on their tax liability. Usually the first people they look at to lay off are people that don't use the company benefits. Because they aren't helping the company that way financially, compared to those that do buy their insurance from the company. That is why they charge a fee sometimes to cover a spouse when they are eligible on their own. |
| /u/Big-Active3139 Or... Hear me out... https://i.redd.it/otz1kj0we4nh1.gif |
| /u/CelandineRedux I've always wanted to pillory these motherfuckers until they break down sobbing, apologize for their avarice, and promise to make restitution; that would be so incredibly satisfying. |
| /u/NargWielki Well, we can learn a thing or two from the French. |
| /u/Winter_Persimmon_110 We need to acknowledge the fact that we need activism outside of pay-to-win elections in order to get it, when the mainstream of both viable political parties are accepting campaign contributions from private healthcare companies. The people dying from lack of healthcare in our country are suffering from the same problem of people dying from homelessness-related complications. Our country is ruled by the wealthy and that is the root issue we need to solve. We can't push through legislation that impoverishes a major industry in a political system where that industry can defend itself effectively with campaign contributions. The people who are in power need to all be replaced with people who act in the interest of the working class. |
| /u/BolotaJT My insurance is now requiring a huge amount of papers and justifications to authorize a simple vitamin D and B12 blood work. God protect me if I need surgery. |
| /u/hansn I just had to make an appointment. The provider made a big deal of "confirm we're in network with your insurance." I called my insurance, they said that it depends on how the provider handles billing and they couldn't guarantee they were in network. As if I'm supposed to know how the provider talks with the insurance company. |
| /u/BolotaJT Omg! That's insane! "Sure, let's schedule a moment so we can discuss this matter". |
| /u/ariolander Its times like this I appreciate being in an HMO, They have an entire network for everything and since everything is in network they coordinate care, billing, etc. and I don't have to worry about it. The worst part about being a PPO is when my Primary Care recommended I needed to see a specialist I had to go to my PPO provider's website, lookup a directory of doctors like its the goddamn Yellow Pages, then individually Google each doctors name to look at reviews, their education history, all their basic info from external sources. Like bro, I have a hard time deciding what to eat for dinner when I am too lazy to cook and can lookup random places on Yelp, yet I am supposed to research dozens of in network doctors and figure out for myself which is the right one for me? Fuck that, I will let my HMO coordinate everything, assign me someone, and I can request a change it if I want someone else. |
| /u/ActualCartoonist3 Well you can do that with a PPO too - just pick the first doctor on the list and pretend you got assigned them. At least you have options with a PPO that you don't with an HMO. |
| /u/nalaloveslumpy That means they're not fully in network and the practice has some services they're in network for and others that aren't. It's short hand for "no", but they legally can't tell you no since there are a few things they do cover. Probably lab work. |
| /u/hokie48 They just have a bunch of AI systems that get good AI rewards for delaying or denying anything and flood the system with BS. The AI is never built to get a reward for getting the patient better. |
| /u/fckfckf If we have the right to life, health insurance denials should be unconstitutional. We should have health insurance that includes teeth and vision. |
| /u/jjflores91 https://preview.redd.it/fzzpvy9v75nh1.jpeg?width=1164&fo rmat=pjpg&auto=webp&s=98bb6193752ca3847cb68bd5b18d2d6d66 f3710c |
| /u/Qwirk It's been fully documented that private health insurance costs American taxpayers more money than public. Completely on board with this. |
| /u/VgArmin HOA Act of 1970. Most people in congress grew up with nonprofit healthcare. |
| /u/Beard_o_Bees Are you maybe thinking of the HMO Act of 1973? This was signature legislation pushed by the Nixon administration - which broke the seal on allowing insurance companies to begin their predatory 'for profit' practices - which have become the steaming pile of misery and greed that passes 'healthcare' in the US today. There's a whole lot of truth to what you say, though. Many of the old farts in congress have never had to struggle financially to get any sort of care (let alone good care). Even more disturbing are the politicians that know full well what their constituents are experiencing, and don't give a rats ass except to 'talk the talk' around election day. Evil motherfuckers. Edit: For those that are interested in how the turd started rolling downhill - https://en.wikipedia.org/wiki/Health_Maintenance_Organiz ation_Act_of_1973 |
| /u/VgArmin I was 🤏 this close. Goes to show always proofread before hitting send. Yes, this is exactly what I meant HOA Act. Geez.... |
| /u/Beard_o_Bees I have a little anecdote that's been on my mind since it happened recently. I went to pick up a couple of prescriptions about 1 week early, since I was going on vacation. Naturally, the pharmacy tech said 'it's too soon', to which I replied 'yup, check the doctors notes', which he did. 'Ok, I see that, but your insurance wont cover the early fill, you'll have to pay full price out of pocket', to which I responded 'I get that, go ahead and do it'. These 2 meds usually run about $45.00 (+/- $5.00, because fuck me, that's why) - and I was expecting the worst when it was time to pay. 'That'll be $25 (and change)'. Uhhhh..... really? Yes. It was more expensive to pay for the meds using my 'good' insurance than to buy the drugs at retail price. What the actual fuck? Like.. i'm starting to think they don't really care about my well-being so much as how much extra they can squeeze me for. I get that in the scope of things related to the current state of America's healthcare machine that this is small potatoes - but it illustrated the core problem in my mind, so I thought i'd share. |
| /u/hansn The joy of insurance also being a pharmacy benefits manager. They can make you pay more for a drug than they do by calling it your copay and pocket the difference. |
| /u/onlyfakeproblems There needs to be checks and balances going both ways. Healthcare providers have an incentive to bill for more than necessary. Insurers have an incentive to reduce cost or deny coverage. If they have a disagreement, it shouldn't be the patient getting stuck with life altering bills. Patients should also maybe have some responsibility for lifestyle/preventative care, but that's a very slippery slope. |
| /u/PuzzleheadedWeb9876 Good luck convincing 100-200 million extremely stupid Americans. |
| /u/AnnaMotopoeia For-profit healthcare in general should be illegal. |
| /u/chinacatsf Ding ding ding... because these for profit hospitals and health care systems left unchecked would also go buck wild racking up charges to increase profit. The whole system needs to fucking go |
| /u/Easteuroblondie It's an odd system too. I swear one time I was in line at the pharmacy. Guy in front of me was getting meds, and they said it would be like 400. He said he can't afford it, and was trying to figure out options. The pharmacists comes, punches some stuff in, and gets it down to like 120. What'd they do? I didn't quite hear the full exchange but I gathered that essentially, that was the out of pocket price with some coupon. Somehow, billing it through insurance was, inexplicably, substantially more than not having insurance. So we pay to pay more. That was probably jot a common situation but I was just like...how? How is that a thing. |
| /u/AlphaNoodlz We can literally vote to nationalize the health insurance industry if enough of us actually show up to vote |
| /u/aworldwithoutshrimp We would need to scrap the entire model, including the superstructure. Under Medicaid, community health plans also deny services for economic reasons and force the poor to appeal to state health boards. |
| /u/Darkmagosan That's my situation right now. I have thyroid hormone resistance. This is quite rare at 1:20-40K and basically means I need enough free thyroid hormones to kill three people outright and severely sicken a fourth. 'Normal' for me is lethally low, as thyroxine levels that are too low eventually can be fatal as the lack of thyroxine damages every system in the body with special focus on the heart and CNS. I also have the full triad of APS-II with secondary thyroid failure, aka no TSH. It will forever be undetectable. Thyroid hormones and TSH exist in a negative feedback loop--one is high, the other is usually low. Usually. Secondary thyroid failure is rare and happens less than one percent of the time, and will throw the labs if the doctor doesn't know what they're looking at. Treatment for RTH and/or secondary failure is straightforward--dose with levothyroxine and/or liothyronine until the symptoms are gone and the resistance is overridden, damn the lab gauges. 75-85% of cases are due to a beta receptor mutation. The other 15-25% of RTH cases have either an alpha receptor mutation, which has symptoms like developmental delays and intellectual disability, or transport errors. Alpha and beta receptors can be tested for. The only transport issue we are able to currently test for is MCT-8, which is sex linked and also includes developmental delays. My endocrinologist KNOWS I don't have this as I'm female. The other cases have unknown origin, so they're idiopathic with unknown etiology--and this is well documented in the literature starting in the 1970s. So basically because of this, UHC is harassing my endocrinologist and saying I'm overreplaced. They say I can't have RTH because I don't have the mutated receptors, which is patently false. I was able to find and read the literature from places like NIH and the NHS as a layman, so there's no excuse for them not to know this. They don't want to pay for the amounts of Cytomel (liothyronine) I need because they don't believe I need it, yet they're not specialists dealing in rare diseases. I'm still carrying around 50 pounds of fluid when my dry weight should be around 100 lbs at 5'4. Because this isn't straight water, it's a mix of glucosaminoglycans and hyaluronic acid trapping water in tissues, it causes global and non-pitting edema--and non-pitting edema is ONLY caused by two things: lymphedema, where the lymph nodes can't drain properly, and this will be localized to the area with the damaged nodes (like after cancer surgery, and myxedema. Myxedema only occurs in hypothyroidism and will be global, with pronounced ascites and swelling of hands, feet, and face along with eyebrow and eyelash loss with swollen eyelids and ptosis. This is Queen Anne's sign and is a textbook hallmark of hypothyroidism. Because of this swelling, I can't have IVIG for GAD65 driven demyelination in core control areas of my brain (titer was 500x normal at first labs, now is likely 600-700x normal), cannot have muscle and skin biopsies my neurologist wants to look for AI neuropathy, and cannot have my cataracts repaired--all because UHC's bean counters can't think outside their algorithm. And as a newly minted type 1 diabetic (LADA), they don't want to give me insulin yet because my a1c hasn't stayed above 7. Best practices for t1d/LADA now is to start insulin as soon as the a1c stays above 6.5% to protect remaining beta cell function, but UHC is saying no because I'm apparently not in DKA yet so nothing's wrong? Bullshit. Likewise, they want to charge me eighty bucks for a Solu-Cortef emergency injection kit for Addison's because I haven't had an adrenal crisis despite having this for nearly 20 years. No, you dumbass cretins at UHC, the injection kit will keep me OUT of the ICU should I kick into Addisonian crisis. Penny wise and pound foolish are the orders of the day here. An hour in the ICU is a hell of a lot more expensive than a vial of steroids and a needle. I had to squeal to AZ's Medicaid department. I've had to talk to them before about other things so here's hoping they can clear the logjam and smack UHC upside the head to get their shit together. This is ridiculous--these medications are not expensive, treatment is simple, but all they see is 'well maybe this woman should die because she's an outlier and we don't want to actually think.' It's not like I'm asking for anything like cosmetic surgery or expensive elective surgeries--UHC bean counters are denying meds that are literally less than 100 for a 90 day supply because my lab titers are out of range. I dream of the day these CEOs are busted for practicing medicine without a license and racketeering under RICO laws. People are dying every day from simple shit like this and it's totally unacceptable. |
| /u/Jiminy_Cricket12 Their motives are not aligned with the patient's interests. worse than that. their motives are OPPOSITE the patient's interests. |
| /u/MudWallHoller Plus we save money as a country with universal healthcare and not by a little. |
| /u/Dear_Blood_8872 Exactly, there is a direct conflict of interests here, one is to treat a patient medically, the other is to maximize profits but not using premiums paid to deliver treatment. |
| /u/HotBrownFun Medicare advantage plans are garbage too. They cost the feds about 40% than a normal medical patient. Lots of money going into the insurance industry that way Lots of ways for them to scam bilk the government too One way is risk adjustment fraud which has been well documented. Probably too dry for me to explain properly in a sound bite. Basically insurance has incentive to not take sick patients because it would cost them money, so they give them risk adjustment so sicker patients give the insurer more money So the insurers game this by making patients look sicker than they are. An entire third party industry does this for insurers. |
| /u/jjflores91 https://preview.redd.it/gsbhxmpq75nh1.png?width=1620&for mat=png&auto=webp&s=0052ef7059f57be648a71e6102b349c2b579 5657 |
| /u/IntnsRed What we really need is to implement FDR's "4 Freedoms" concept, that would create a gov't requirement for health care. The US is the only advanced, industrial democracy without national health care. We rely on the outdated "private" system and wonder why we have the most expensive health care in the world! |
| /u/FourthLife Do you think Medicare and Medicaid will pay for anything doctors want to do? |
| /u/Rionin26 Medicare does if its not part b...which irony of it is tje private insurance part of medicare. Ive never heard of medicaid denials. |
| /u/unrealflaw Perhaps we should stop calling it a recommendation. |
| /u/reisalvador We don't call it a reccomendation. It's called a prescription. |
| /u/Winter_Value_7632 recommendation ❎ reccomendation ❎ prescription ✅ |
| /u/falcrist2 Why are both ❎ and ✅ light green with white writing? They're surprisingly difficult to read. |
| /u/Winter_Value_7632 that's how the emojis are ☹️ |
| /u/falcrist2 I know. I'm just whining about it. There's ❌ and ✔️ I guess... but ❎ should be red and ✅ should have a black check. |
| /u/One_Olive_8933 The insurance company owns the board of physicians... like a death panel of sorts. |
| /u/PsyOpBunnyHop Yeah, this is the problem with that whole premise. Even an independent body of people intended to do good can be corrupted. It doesn't have to be the corruption of the people present. It can just be the eventual insertion of the already corrupted, one by one. This is what happened in politics and nearly every other body of people in control of anything profitable or exploitable. As long as we are permitted ways to exploit one another, we are doomed as a whole. |
| /u/Freakishly_Tall It's especially fun when a nationally or internationally renowned expert in the disease has their order denied by an insurance company, as happens all the time, then has to argue with some FMG podiatrist or similar "peer expert" to get it reversed, who incorrectly cites a paper or textbook chapter the physician coauthored, requiring hours of paperwork and phone calls back-and-forth. None of which is billable. Step One in fixing any of this would be making the appeals process billable to the ins co when they're overturned. All of which takes time away from other patients who need help. But, of course, the insurance denial isn't "practicing medicine" because they aren't stopping you, no, see, you're free to pay for it yourself. Bonus: That way they don't need licenses in your state, either. |
| /u/EamonBrennan IIRC the ratio is something like 1.4 insurance adjusters to 1 doctor. Doctors see dozens of patients. Insurance adjusters only have to review a fraction of the claims, and can mostly just rubber stamp a "denied" to any they want to. |
| /u/CatsPlusTats It's because words have multiple meanings and one of the definitions of practice means to be professionally engaged in. |
| /u/someoldbagofbones Doctor's orders, board member's decision. |
| /u/i_am_a_real_boy__ Use of the word "practice" has nothing to do with liability. |
| /u/Winter_Persimmon_110 "Power concedes nothing without a demand." - Frederick Douglas |
| /u/Admirable-Setting261 "Now you're taking away my rights" - someone in America, probably |
| /u/Debatebly I came here specifically for that word. Why is not referred to as "prescribed"? |
| /u/Justis29 My insurance just denied an MRI I had. Been dealing with back pain that's gotten worse over the last year. I've had X-rays 3x, 3 different rounds of physical therapy, steroids and stronger than OTC anti-inflammatories. The MRI found a bulging disc that has been causing all of my issues. X-Rays don't pick up soft tissue like that. It diagnosed the problem. Insurance: 'HUR DUR YOU HAD LOWER BACK PAIN AND MRI ISN'T FOR THAT EVEN THOUGH YOUR DOCTOR GAVE US A DETAILED HISTORY OF YOUR ISSUES GET FUCKED' signed a disgraced proctologist that shills for the insurance company. Hoping my doc can talk to them and change their mind. I'm not paying for something that was needed to help diagnose the actual issue. |
| /u/Katsu_39 Couple years ago insurance denied an MRI for full body. They denied it twice. After my doctor going back and forth with them, they reluctantly approved. Turns out i had and still have several tunors on my spine. |
| /u/kenwill90 Would be awesome if doctors and their staffs could focus on patient care instead of going back and forth with insurance companies. I bet our "doctor shortage" would get fixed instantly. |
| /u/metheus-13 I saw a post saying exactly that recently. That the USA has a "doctor-hour" shortage, but that's only b/c all the doctors are spending so much time playing telephone with insurance companies instead of spending time on patients. |
| /u/ChiknBreast Trust me we despise the system as much as patients do. Its unsufferable. And broken by design. Purposefully wasting everyone's time with prior authorizations, denials, and constant runaround. |
| /u/hokie48 What is super shitty is that the MRI is diagnosis tool. Like with soft tissue every thing else is making a educational guess. They don't want to pay for the MRI because that might mean a surgery that will cost even more than the MRI. They are not denying the MRI because of the MRI they really denying because might mean surgery. |
| /u/SaveyourMercy Eight years ago, my sister was having all kinds of problems. Her doctor was concerned there could be a tumor on her pituitary gland in her head and referred her to get the scans to see. After 3 different insurance changes and tons of begging, she's still being denied because she's "too young and healthy" to have a brain tumor. She's sick and can't hold a job and is struggling in so many aspects with her health but they still refuse her. I fear she'll never get an answer at this rate. |
| /u/MysticScribbles At this rate it might be cheaper and faster to do the scans and procedures out of country. |
| /u/SaveyourMercy Honestly I've been telling her to go to Mexico on a week her daughter is at her dads and get them done but it's just hard to swing when funds are this tight but I THINK she's trying to save. She also has the added hard cost of legally fighting her ex husband for full custody which is a whole other can of worms unrelated to this but does end up being a huge financial drain. |
| /u/montybo2 A lot of my job is getting MRI and CT preapproved for patients. I've been doing it about 9 or so years now. Every year a new hurdle popped up, every year something about it got more difficult.... then 2026 happened. I dont know what it is but 2026 started and everything got drastically worse. Denials left and right with weird new rules and regulations for how to overturn them, if post denial options are even allowed. Insurances that used to be easy to work with now split and merged with other plans and payers and have whole new guidelines and processes. The veil has dropped almost completely. Insurance isnt a healthcare field or even healthcare adjacent, it's death panels and I tell my providers that. Everything is worse, worse than most people know. |
| /u/PlopPlopPlunk then 2026 happened. I dont know what it is but 2026 started and everything got drastically worse. There was this really big federal change that happened in 2025, idk if you saw it, some orange guy got elected, and then all of these horrible project 2025 policy decisions were made that came into effect in FY26... Probably that. Every professional I know across numerous industries from medical, science, law, finance, military, etc all say their job and how things are done is now drastically worse one year to the next. |
| /u/prrosey I know people leaving medicine and law to run for local elections because they can't operate in their respective fields the way they want to or the way they believed they would be able to until policy is changed. The Grand Old Party and their Conservative Dem cohorts have halted American progress. People ain't happy. So much so they will abandon their careers to participate in politics for the mere off chance they can make some tangible difference. |
| /u/tdasnowman then 2026 happened. I dont know what it is but 2026 started and everything got drastically worse Trumps Big Beautiful Bill happened and there is still three more years of changes coming. 2026 was the easy year. |
| /u/wafflesthewonderhurs well.. that's concerning. i'm sure it has nothing to do with all of the other ways that the worst possible parts of society have decided that there will be no punishment for doing terrible things to the populace at large in america. seriously though thank you for your service, legitimately. when you think about it, any other opposing force whose sole purpose was to kill tens of thousands of americans would be opposed by the military, so it only seems fair to use that phrase. |
| /u/CrustyToeLover I mean it's pretty obvious why, when you look at who's in charge. |
| /u/whyamionthispanel You can often ask for an ombudsman or a specialist in your area. From experience, they can help. Man, I hate these people. They make your life hell just so you can get what you need to live. (Not so) fun story: I'm diabetic, and in my 20's my doctor recommended and wrote me a prescription for a certain type of insulin pump when it was an accepted form of treatment. (That is to say, it wasn't a brand new or novel treatment or anything.) Longer story shorter: My insurance initially denied the claim and I had to fight through a labyrinth of bureaucrats before I got to an ombudsman who spoke to me dismissively saying I should've asked for his support right away. Nonetheless, he got the claim approved almost immediately, and all was well after, but they stole 10 hours of my life or more on the phone. The point is they make your life miserable and the process difficult to navigate because they presume you'll give up before they have to pay. It should absolutely be criminal. Now, any time I ask for a specialist or on ombudsman now, it certainly makes the process go a lot more smoothly. |
| /u/Justis29 I'm going the route they gave me in the letter first. Thank you for laying out the steps that you took. Thankfully I live in a state whose dept of commerce makes filing complaints easy as well. |
| /u/NPVinny Was this lower back and did it have any butt/thigh pain or leg/foot numbing with it? I have a suspicion I might have a bulging disc as well. |
| /u/DIABL057 My wife and I both have bulging disc in same spot L5 S1. Mine right side. Hers left. Hers much worse than mine. Both of them hit nerve roots that travel down the buttocks and corresponding leg. So pain in glute, down corresponding leg into calf. Yes, it can cause tingling or worse if it is compressing nerves bad enough from my understanding. My wife had what is called drop foot. The nerves would be getting compressed so much that her left foot would become completely numb as she was trying to walk causing her to trip over her own foot and fall. In my experience the pain is always worse at night when I'm trying to sleep. It is an never-ending constant pain. The only question is how severe the pain is at any moment. The thing I never hear people talk about when it comes to chronic pain is the mental fatigue it causes. Her nerve compression was bad enough that she couldn't walk without a limp. She couldn't sleep without inevitably crying from pain and frustration of not being able to sleep from pain. She could hardly function. Luckily we had good insurance and found through an MRI that she had a bulging and broken disc and then she had a discectomy and is now almost completely free of pain other than minor aches during certain movements and weather related aches. Sorry for the long rant. TLDR. Not a doctor but yes those pains could very much so be caused by a bulging disc. Look up the cauda equina nerve root. So named because it looks like a horse tail. |
| /u/hillbilly_bears I had an L5-S1 bulged disc similar to your wife's. I didn't get drop foot but I did have a limp. Every step I took had to be carefully planned because it was excruciating to walk even just across my living room; those 15-20 steps could take between 5-10 minutes alone. God forbid I forget something in the other room. Before this, I thought I had back pain. Nope, never. It was aches. A bulging disc with sciatica is some of the worst pain I've ever experienced and I wish it on no one. I ended up getting a nerve block shot in my spine to heal. |
| /u/I_Learned_Once As much as it pisses me off that innocent people have to go through this bullshit every day, it equally pisses me off that we are burning out our good doctors by forcing them to fight this hydra every single day of their lives. I do hope your doctor can go to bat for you, but I'm worried that every swing he takes gets him one step closer to mental and emotional fatigue. Imagine you had to argue this crap with insurance every day when you know you're right and you know they're evil but you just can't win because they're the corp. |
| /u/CrustyToeLover Insurance denied my fiancé's CT on her head since she has chronic migraines and her mom died from multiple aneurysm, because "it wasnt deemed medically necessary" and "all steps haven't been done first". What do they want, for her to have open brain surgery before a scan? |
| /u/TomCruising4D Mine just denied a medication. They approved two separate prescriptions for the name brand medication, that add up to the same exact dosage my doctor tried to initially prescribe. The name brand doesn't make this exact dosage. Cool. Lucky enough to be able to afford it. Still stupid as fuck. |
| /u/Justis29 Very stupid. It's wild, really. The same insurance of mine will let me pay 25 bucks for GLP1 and eat 1300 bucks of cost monthly, but won't shell out MRI money. (Hooray diabetes I guess) |