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We got the call saying my hubs cancer surgery would be 83K dollars and what kind of payment plan would we like? There is ONE hospital within 150 miles that does the surgery, "out of network". As if we WANT to travel out of state, pay for hotels, food, we're broke and broken old people. Waiver needed

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I just was denied by my doctor, and when I went to urgent care as a back up they denied me too.

Coming to a greedy CEO near you:

I mean... I posted several accounts from verified physicians today. Insights: insurance companies want to make money and they do that by denying care.

UHC dental approved a core build up and crown. After the work was done they denied my claim because I didn’t have documentation that there was a cavity or flaw in the existing crown that would necessitate a new crown. They say I own them $1,900. I had never had a crown on that tooth.

Pre-authorizations are cruel, dangerous, unethical, and sometimes murderous. Practicing medicine without a license is illegal in every state and paying shill doctors to do the immoral bidding of their MBAs does not qualify. Don't get me started. Oops. Too late.

I worked for a predatory insurance company for 23 years. I can give you a lot of insight.

Done

I have a pending approval since April on what should be covered with an already completed deductible because a DME company can't seem to submit paperwork correctly and the insurance company won't accept what they did send.

I love that you’re doing this! It can’t continue.

That is good news. They may have to argue back and forth. It seems the insurance companies hope that the provider and the patient will eventually give up and the cost is left to the patient. Be persistent. You or your HR may have to intervene to get some reimbursement.

Anonymous option may be helpful in getting people to open up to you???? Too much backlash by big pharma is a killer as we all know.

I bet!

bsky.app/profile/brya...

Umm, people with private health insurance do not get the same access to mental health care as this who is on state medical insurance. The claims are less likely to be approved over 72 hours, which is no time to help someone in a mental health crisis or just to help someone in general find care.

Are you interested in insurance denials were eventually approved? I had brain surgery 2.5 yrs ago (just realized almost to the day). All in thanks to my amazing surgeon fighting for approval. Reading all the insurance denial stories is heart breaking and I feel guilty. I want ppl to have hope.

Don't just share your insight on BS. Share it with someone who is elected and in office. They are the ones who actually decide. It only takes a few minutes and best of all..doesn't cost any money. We don't need money in politics. We just need people to participate. www.nationalfinancialplan.com

Yes I worked for United for many years and insurance is much much more complicated than just paying premiums and getting anything you want. There many odd requests and unusual requests that need to be worked through. I was a strong pt advocate by choice and degree RN CCM and quit quickly.

2/2 When all goes well everything is approved. Some things are just not covered and all you need to do is google "UHC policy on.....then put in procedure name" try it.

They request clinical from providers and that clinical is then forwarded to a physician for review for medical necessity. The good physicians request a doctor to doctor discussion b4 a denial is made. 1/2

That’s so true! I’ve had State Farm for 45 years! They have never denied a claim I’ve filed. Prompt and fair. They always ask me if I’m okay 🤷🏻‍♀️. Crazy………….

Claim refusal is also rare in medical insurance, insisting that you go to PT before getting an MRI is NOT refusal.

Plans often require that the PCP refer the patient to the specialist or for a procedure and a claim can be denied simply because the patient skips this step. Some forms of treatment get denied simply because there is a less expensive option the insurance company prefers.

The crazy thing is even if it’s medically necessary they still will say it’s not so that they don’t have to pay. That’s been my situation three different times.

When I was fighting for my life in February 2022, I read a statistic that said an American dies every 12 minutes because they don’t have access to medication and 70% of those people that are insured.

Breach of contract

I’m a 64 y.o. Cancer survivor and just receive notice from my insurance company that they are denying coverage for a flu shot my doctor urged me to get.

Physicals are supposed to be covered 100% .

Every form of insurance destroys. I once had to explain to a customer why his beautiful one owner car that he had lovingly maintained for 30 years was being taken by the company for a fender bender. Seems the cost of repair (like $75 in 1979) was higher than blue book on that car.

Hey Americans! We're right here in Canada with the example! We've been telling you for years! Wake up!

Exactly. The whole scam about how preventive surgery becomes diagnostic is the biggest moneymaker for insurance companies. It's ridiculous.

It’s total BS. Paper pushers shouldn’t be telling us what we can and can’t have treated.

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Thank you @propublica.org for doing these stories 💙

Agree that assessment of denial should include comparison of types of plans; always have been in indemnity plans (non-network) and never had issues with denials.

I tried to get an advantage plan that would cover monthly infusions of my rheumatoid medication & none of them would cover it. I currently inject it myself but after so many yrs, the meds start to fail & infusions are the last resort.

I always advise everyone to avoid buying any insurance off a tv ad. It’s costs nothing to use an agent. My late dad was an independent agent and taught me that.

It’s not just insurance companies, but medical equipment companies take advantage of the elderly. I know this because I sit with my elderly mother while she talks to them about her prescription socks that prevent blood clots.

www.change.org/p/declaratio...

I have denied the private insurance companies monthly pay. Instead, i put money into a high yield investment every month. This money is to be used for medical bills only. It takes self-discipline, but it is doable.

When your Dr's office calls your ins.co AmWorst, you know you have problems. My suggestion NEVER use AmBetter as your insurer. If an Insurance company sponsors a #NASCAR race, maybe they're "making" too much money. Ask yourself why. 😡

How about my 35 yo needs a psychiatrist because she sleeps all day and doesn’t shower walks like a shuffle, delayed speech. She has a psychologist There are no available appointments or psychiatrists taking patients in the Kaiser network in Washington

I have to take a prescription medication, per my doctor. For the rest of my life. If insurance would pay for it, it would be $11/month, with a manufacturer’s coupon. Without insurance, it is $1200/month!! Insurance refuses to pay for it. From Canada, it is $396/month.

Oh, I love Chris Hedges. Following you.

the arrogance , mf was born on third base and thinks he hit a triple

You know if this clown can be the Ceo of not 1, but 4 fcking companies and run a quasi governmental org , all while gallivanting the globe addled with ketamine, then lets face it CEO isnt that fcking hard.

the greed of middle management "PRICELESS"

I'm not saying I condone killing CEOs, especially health insurance CEOs... ...but I understand it.

Medicare Advantage which is private insurance & a scam

I wrestled hard with getting my dad's 44 treatments paid. Took over 9 months of back n forth between svc provider and ins. co. I kept records with names and dates. It was extremely challenging effort. If I hadn't been involved my 82 yo parents would have faced $$$k in debt.

I'm sharing this whenever I can...because it could quite literally save someone's life.

That’s awful , the guys who invented insulin wanted it to be free ‘ it was a gift to the world ‘

Same here in France for lifelong conditions like diabetes

It feels that way sometimes

I remember having to tell people who had been on CGM for years that Medicare wasn’t going to cover it and their secondary was going to follow Medicare guidelines. It was awful. They broke down in tears a lot.

Thank you

📌 UMR denied the Entyvio my GI recommended for my UC. Now I’m waiting (2 months) to hear if they’ll pay for the rattlesnake bite incident, including ambulance, 12 vials of the insanely expensive anti venom, 24+ hrs of required ICU time, etc. ***They did send an ominous letter, so I’m concerned***

Hey Einstein, you're talking to the wrong crowd. Go tell MAGA that.

Yep

And average Americans who are in favor of a national healthcare system are still voting for Republicans who are vehemently against public health care time and time again. We are not an enlightened country.

It’s not just the politicians. A lot of dumb people bought into the death panels and “you’re gonna have to change your Drs” bs when the ACA was passed. And there are people who don’t want “their tax $$” paying for other people ie minorities. America is a truly selfish country.

Of course it does. Fox *news* based their whole business on it

Look no further than Jesus Entrepreneurs. They are the weird mob who love guns and hate science.

When approximately 36% of the country turn off right wing propaganda and stop voting for Republicans and licking the boots of the wealthy. So probably never.

Millions of Americans agree

But all they have 2 do is see what other countries have and do. Lots of people on Social Media talk about the virtues of their countries' Universal Health Care. I have about Australia's system. I think average American isn't interested in any other country, especially if people point out it's better

This. ⬆️

Like a favorite pair of jeans that suddenly don't fit, health insurance often seems perfect - until you actually need it. Let's unravel this mystery together, one denial at a time.

Check well care.

I have to say that I admire all your investigative reports. You are an example of honest and professional journalism which unfortunately, it’s hard to find now days.

Thank you for your hard work.

ProPublica, I can’t thank you enough. You guys are simply the BEST. 🫡

Study idea. Rich spoiled ivy leaguer maniac shoots family man in the back on NY street. Find out if the maniac was justified in murder. Yeah. That’s the plan.

I hope you interview Brianna Boston!!!!

My insight is that health is too important to this country to be left in the hands of capitalists. Billions in corporate profits mean billions paid by people not getting that worth in coverage. Those are dollars not spent in the economy. The sick and bankrupt cost, they don't contribute.

From what ive been told, its because they aren't saying you can't get said treatment or medication, they just wont pay,knowing people cant afford it. They can make requirements, but dont need to tell us the requirements beforehand 😑 its so stupid

If a law firm had all the data in one location maybe they would be more likely to start class action

The insurance companies write the contracts and have years of experience at limiting expenses. I am betting this won't work. We can thank Luigi for getting the conversation started.

I'm glad you get what you need. Making you guys jump through hoops is foul. Be well & happy Holidays 🤘

It's almost comical that not two days after this CEO incident the cardiologist office called me saying my insurance denied my PET Scan/Chemical Stress Test that was in two days and appointment was made 3 months prior. My Heart isn't something to worry about I suppose.

If ProPublica bows down to the convicted felon-in-chief like the other MSM outlets, I'll never read another article again.

Red or white

Health care for all.

someone is ripping you off somewhere!

So, by retailers making contracts with these discount programs, they still make the money that would otherwise be paid out by insurance companies by marking up acquisition costs. Nothing really changes.

My guess would be that GoodRX has a contract with pharma companies to partially cover the cost of meds, or they’re running a program where your first few coupons are free to access but then a membership fee is required Plus all of the website ads and client clicks drive revenue

We're not really privileged with a whole lot of information of the under workings of programs like these. It still took some research for me. Even then, this is still just a best guess with how these discounts work with the experience I have.

So, paying $13.95 from a $400 medication is a little bit of an exaggeration, but GoodRx does take the cost down to a "manageable" copay. That cost is still well above the acquisition cost of the medication. So a profit is still made. GoodRx gets a share, and a fraction of that goes to the retailer.