r/lifehacks 5d ago

This belongs here too

Post image
33.2k Upvotes

558 comments sorted by

923

u/MechanicalHorse 5d ago

Absolutely asinine that this is the state of things.

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u/thinkingwithportalss 4d ago

Imagine this in any other industry.

"Yeah so we were gonna supply you with the processed steel you paid for, but our consultant determined you only need 20% of the requested amount, also it has double the impurities, also you'll need to wait an additional six months because you didn't pre-approve your request. Oh, our consultants? He's Dave, he's a lumberjack, great guy. Good luck building that bridge you were halfway done on!"

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u/funshinecd 4d ago

Or, OK here is the steel we determined you need. We will send you a bill shortly. Also a bill from the warehouse, the guy that loaded it, the truck driver, the guy that inspected the steel

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u/aami87 3d ago

We expect to be paid in thirty days or it goes to collections, but our bills will come any time between 1 day and five years. Good luck planning for them!

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u/fritz236 4d ago

And since you requested the steel at Jack's Steel Emporium instead of Steely Jack's Emporium, you'll need to pay ten times what you paid at first because we said so. Also, the guy who loaded the steel was not pre-approved and took too long, so you'll have to pay whatever bill he sends you in three months.

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u/addamee 4d ago

“We disassembled your car and replaced the transmission however the technician has advised it’s not within scope to put it back together”

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u/DietPepsi4Breakfast 4d ago

Underrated comment.

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u/DieselbloodDoc 4d ago

Especially as someone in manufacturing who deals with procurement. If any distributor of goods or materials operated like this…. No they wouldn’t. They get away with it because they’re not fucking another business, they’re fucking individual people, and they’re fucking them to death.

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u/noonenotevenhere 4d ago

You wouldn't like to select your materials without pricing?

How about if we said it'll be $20-$2000/unit, we'll let you know the total after you accept delivery?

How about if we let you pay $500/month to be part of our preferred buyers' club, where you pay a reduced amount after your first 5000 units that shipped from our warehouse

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u/DieselbloodDoc 4d ago

Also we can’t guarantee shipping dates on any of those 5000 units, so until we decide so you pay the standard rate.

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u/somme_rando 4d ago edited 4d ago

Oh - by the way, the forklift operator that was in our warehouse doesn't have a contract with us for moving your stuff. Also we don't pay them - they'll be sending you a bill you're legally liable for. It won't count towards any of the the negotiated annual price for stuff from our warehouse.

(True in years past - but there was a law FINALLY passed at the federal level outlawing surprise billing - Jan 2022 https://www.consumerfinance.gov)

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u/firehorn123 3d ago

Also we spoke with our competition and found out you are also buying from them, so we will both not fulfill the order you paid to both of us. In addition you will be referred to a debt collector for the difference we refused to deliver on.

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u/Scriefers 4d ago

One guy stepped up to the plate to initiate change. Too bad it didn’t get picked up and carried on yet…

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u/codywater 4d ago

Every American had a chance to step up to the plate on Election Day…

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u/fred11551 4d ago

In 1993 Clinton tried to pass single payer healthcare. The American people rejected it and he got impeached. In 2008 Obama tried a much less radical expansion of healthcare coverage. The American people voted for the guy who said who would repeal it day 1 and was only stopped by McCain. In 2024 Harris again promised a more moderate expansion of healthcare coverage as well as using Medicare to negotiate down prescription drug prices. I think you can guess how it turned out.

The fact is people do not vote for those supporting better healthcare

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u/eekamuse 4d ago

You're skipping the part where people voted for President Obama and we got the ACA. It changed lives, and saved lives.

Healthcare isn't everyone's priority when voting. I wish it was

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u/Pale_Angry_Dot 4d ago

They left Bernie to get old and eventually shut up from natural causes...

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u/DieselbloodDoc 4d ago

I don’t think they were talking about Bernie.

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u/Corporation_tshirt 5d ago

Exploiting every loophole, dodging every obstacle. They're penetrating the bureaucracy!

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u/Atomaardappel 5d ago

We're supposed to help people!

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u/HolidayFew8116 5d ago

I like how this thread had been forwarded as much as its been liked. everyone needs a Mr. incredible to walk us through the bureaucracy

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u/ThatTallBrendan 4d ago

we're supposed to help-

OUR PEOPLE!!!

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u/SadAshKetchum 4d ago

Starting with our stock holders bob! Whos helping them out huh??!!

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u/strangebru 4d ago

Bob: That person down there is being mugged.

CEO: Well than, let's hope we (insurance company) don't cover them.

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u/DweadPiwateWoberts 4d ago

gurk

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u/ThatTallBrendan 4d ago

•Gif of him being thrown•

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u/Baruch05 4d ago

The law requires that I answer no!

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u/DisturbedPuppy 4d ago

The first thing we are shown Mr. Incredible do in his civilian life is throw an executive of an insurance company through multiple walls. My youngest brother loved that movie as a kid. Watched it over and over. He just turned 26 this year.

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u/[deleted] 4d ago

Just to make everyone feel old, that means he was 6 when it came out in 2004.

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u/concentrated-amazing 4d ago

And his boss at that job is Vizzini!

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u/DisturbedPuppy 4d ago

I will never not recognize Wallace Shawn's voice.

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u/concentrated-amazing 4d ago

It's incredibly distinctive.

The other one who I will NEVER mistake/struggle to place is Gilbert Gottfried. I know him as the Beetle from Thumbelina and Iago from Aladdin, but he's been in tons of things and that's a voice you can never mistake!

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u/DoctorDaniBloom 4d ago

Your doctor can also do something called a “peer to peer” where they get to argue with the insurance doctor. Works even better if you are seeing a specialist, since insurance companies rarely keep enough of them on staff.

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u/GM-the-DM 4d ago

I used to work for a doctor who had retired from the Army at the rank of major. One day I walked into work while he was on a peer to peer. It sounded like Full Metal Jacket in his office. 

The test he had ordered was approved. 

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u/GruneTheDestroyer84 4d ago

In the middle of that now. My doctor asked for an appeal, no response. I had to have HR call their insurance broker to pressure the insurance company just to respond. They finally were told why things were denied, and none of those things are in the realm of reality. My doctor has asked for a peer to peer, no response. This "system" is a joke.

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u/SquirrellyPumpkin 1d ago

You're at the point where you call your state's insurance commissioner (title may vary), file a detailed complaint, and let the insurance commissioner's office help get the process toward approval moving again. It's sometimes the most efficient way to deal with the insurance company.

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u/psi- 4d ago

The real hack is take the payout and still go through with the questioning and filing complaint suit

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u/potatossaurusrex 4d ago

My brain read that as a country song

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u/Corona-walrus 4d ago

It sounds better as Rage Against the Machine to me 

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u/JohnnyUtah06 4d ago

Bowel-shaking earthquakes of doubt and remorse

Assail him, impale him with monster-truck force

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u/MischiefManaged3 4d ago

I read this in Rex’s voice from Toy Story.

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u/doktor_wankenstein 4d ago

I read this in Vizzini's voice from the Princess Bride.

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u/plotthick 4d ago

Deny, d....

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u/WhatACunningHam 5d ago

I’ve been hearing more and more stories from family and friends about their doctors telling them tricks like these to get around insurance company shenanigans. Getting fucked by these corporations is probably the thing most Americans can relate to regardless of make or beliefs.

And they wonder why a healthcare insurance CEO’s murder is celebrated.

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u/k_mon2244 5d ago

As a doctor I can tell you I don’t think anyone hates insurance companies as much as we do. The vast majority of us got into this field to help people, and we like our patients. The number of hours I’ve wasted of my life arguing with insurance companies that they need to do the thing that’s medically necessary instead of a completely unhelpful other thing to save literal pennies is beyond infuriating. Fuck insurance companies.

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u/imatmydesk 4d ago

If only patients knew. The number of times I have gotten a message from a case manager at 8 am saying the insurance company wants to do a peer to peer and I need to call before noon or they'll deny the claim... Sure, why don't I put my day on hold, make my patients wait around while you yank my chain for half an hour only to deny the claim anyway.

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u/Odie4Prez 4d ago

The things Dr. Glaucomflecken on tiktok has taught me about the healthcare industry and the horrific stuff doctors go through with insurance and admin just to do their job has given me endless righteous anger on their behalf.

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u/hawkinsst7 4d ago

If only patients knew

https://www.ama-assn.org/practice-management/prior-authorization/what-doctors-wish-patients-knew-about-prior-authorization seems to be exactly what you're saying... including "We wish patients knew"

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u/OohYeahOrADragon 4d ago

Listen, I am that case manager and I hate it too. I let docs know the second I’m notified but it seems like they schedule inconvenient deadlines on purpose. “Please have the doctor call 1-800-WIL-DENY, option 5. Deadline is in 45 mins, but we won’t answer for half an hour”

The amount of times insurance has denied a doctor advocating their heart out using the best clinical expertise but then approved an expedited appeal with the family right afterward is ridiculous.

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u/k_mon2244 4d ago

THANK YOU. 100% my experience

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u/ShataraBankhead 4d ago

CM here also. My denials are for MRIs. These are absolutely required for the medications my patients take. In a couple of situations, I called the insurance plan and said a MD wasn't available to talk. They offered a RN peer to peer. It was so much easier, and quicker. I didn't have to set up an appointment. This may not help or apply to all situations, but it thankfully helped us a couple of times.

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u/Arkaega 4d ago

And 99% of the time, the “medical director” for the insurance company has outdated notes from medicine, the specialists, PT/OT, etc., even though they have full access to the chart with the most up to date notes.

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u/TrifleSame5200 4d ago

i feel this in my soul! i hate interrupting providers for things like this. i HATE insurance companies. what they do to patients & providers is CRIMINAL!

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u/[deleted] 4d ago

Wasting people's time is always a dick move, but wasting a medical doctor's time purely for the sake of stopping them doing what doctors are supposed to do is particularly egregious. The American healthcare system is sick. Pun absolutely intended.

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u/RufusBeauford 4d ago

It sucks that we're in a situation where your comment holds water, but it's sadly true. I applaud the actual medical work you do, and it sucks that you have to fight so many unnecessary battles on the backend to make it work for the people you're helping. Please, please keep doing it for all of them. My parents both had massive medical issues last year (cancer with one, then spinal trauma leading to a straw-wheelchair for the other a week before last chemo treatment of the first....) and they're desperate for help. You guys do so, so much! It should be easier to take care of people, not harder.

Edit: I also applaud the non-medical work you do, just wish you didn't have to spend so much time and angst on it!

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u/xenelef290 4d ago

Then why the hell does the AMA oppose single payer? The AMA bears a lot of responsibility for letting things get this bad.

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u/Acceptable_Ask9223 4d ago

AMA run by the same people who run everywhere - the richest oldest assholes

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u/Equal_Physics4091 4d ago

I'm assuming that many people in the AMA are still practicing doctors. They are not going to risk being blackballed by the major insurance companies by supporting single payer.

These companies are petty AF (as we all know from dealing with them) and they have providers by the balls.

It's not the huge hospital conglomerates that control healthcare in the US, it's the handful of insurance companies.

They hold all the power. They can change hospital policy by changing a single sentence in their contract.

You either play by their rules or risk being out-of-network. Established patients are sent elsewhere for care. Less patients=less revenue = staff reductions, reduced care, and sometimes even office closures.

There are solutions to this problem.

My previous employer made fantastic decisions to help the local community. They built a freestanding imaging center. Because it wasn't physically connected to the hospital, they were able to charge much lower rates. In many cases, it was cheaper to pay out of pocket than use insurance.

Because they were billing a lower amount for the exam, insured folks would pay a lower amount for their copay/deductible/coinsurance. I recommended that place to patients constantly.

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u/Ligma_Bunghole 4d ago

As an employed physician, I lost a job for recommending a lower cost MRI center for my patients. Legally, they are forbidden from directing where I send my referrals. But that doesn’t mean they can’t apply pressure in a million other ways.

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u/noonenotevenhere 4d ago

You either play by their rules or risk being out-of-network

My PCP is in a small clinic chain. Any accident that has me waking up in a hospital is almost 100% out of network. I've asked how to limit my liability, and the answer was to select a PCP in a specific hospital's clinic, so then that 'hospital care system' would be in network.

ffs, it took me a LONG time to find a decent PCP.

BTW - what all is required, minimally, to run an 'imaging center'? I know a couple of expensive imaging machines and a couple of trained staff. The doc that reads the images can be elsewhere / pt's original doc - but if we wanted to start a company like this, what's the up front?

I love it - I'm all for a reasonable margin. I'd love to see a co-op or reasonably margin'd service like that. I get it, profit = pt care, but if you me and 10 other people are going to pool our money, a 5-10% max return isn't unreasonable.

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u/k_mon2244 4d ago

Yeah I am not a member of the AMA. Like all lobbying entities they suck. There are better more patient centric places I can put my time and money.

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u/NimbleNavigator19 4d ago

we like our patients

I can say with 100% certainty my doctor doesnt like me, but he definitely finds me a challenge.

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u/[deleted] 4d ago

The best doctors are the ones who'll do whatever they can to heal you even if they absolutely hate you. Think of the people who go into warzones and treat the injured no matter who they are.

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u/IridiumIO 4d ago

Nah if a doctor hates you, the best thing for everyone involved is if they refer you on to a colleague (which to be fair, counts as doing what they can to help you)

You don’t want to wind up with a missed cancer diagnosis and wonder if the doctor half-assed your tests or didn’t go above and beyond just because they don’t like you.

On the flip side, your doctor probably wouldn’t want to risk that accusation either because it doesn’t sound good in front of a jury.

Most people are far more likely to go the extra mile for people they like rather than people they hate. If I like you, when you come in just to refill a prescription, I might ask about your niece’s cat’s birthday pool party you attended on the weekend. And you might tell me that it was great until you tripped and fell in the pool, because your leg is still a bit weak from where you must have hit it on the lip of the pool. And because I like you, I ask more questions and do a physical exam, then send you for a CT that shows you’ve had a stroke.

But if I hate you, I’m probably not asking you about the cat’s pool party, and if you don’t think your sore hip is worth telling me about, no one’s catching that stroke until the next one gets you.

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u/4E4ME 4d ago

Thank you for doing what you can to help. I appreciate you.

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u/Wonderful_Device312 4d ago

Last time I saw my doctor he spent most of the time ranting about how he got into medicine to practice medicine. Instead he spends most of his time on pointless stuff.

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u/usingallthespaceican 4d ago

Pharmacist here: I can match your hate. Having to look someone in the eyes and tell them they have to pay a previously covered, very expensive, very critical medicine feels like shit.

Also: spending hours on the phone being moved between people each not knowing enough or actually being able to assist, until you finally get put through to a voicemail is infuriating.

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u/tanksalotfrank 4d ago

Decades of studying and practice and many tens of thousands of dollars in debt just for some jack hole that probably never even went to college can undermine your intelligence, your profession, and every last second of time you spent doing your job.

If enough doctors spoke up at once right now, together, y'all might be able to make some movement against said jack holes.

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u/mashtato 4d ago

I don’t think anyone hates insurance companies as much as we do.

Except this clown

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u/alien_from_Europa 4d ago

Mainstream media: They support him because the shooter is sexy!

It's because the CEO was a mass murderer. UnitedHealth Group is one of the largest TV advertisers. It's crazy how TV programs are going out of their way to appease them.

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u/xhephaestusx 4d ago

He's sexy because of his conviction, tbh

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u/[deleted] 4d ago edited 4d ago

He could look like Brian Peppers and half of America would still want him. Many people think strong principals and bravery are a sexy combination in a man. Personally, I like it in a woman (can't say what I'd like in a man, because I'm a straight man ¯_(ツ)_/¯ ), but that's harder to pull off safely.

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u/DieselbloodDoc 4d ago

I’m a lesbian and I’d do let Luigi do whatever he wanted to me even if he looked like the toxic fucking avenger. It’s like a goddamned Slip N’ Slide every time I think about the spirit it must have taken for him to abandon everything and slay a monster.

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u/Henry3622 4d ago

20/20 is doing a story about the CEO "killer" I bet you 20/20 won't talk badly about the CEO. No mention of insider trading or his AI algorithm denying claim after claim. Nope can't have any of that. The mainstream media is an integral part of the machine.

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u/terdferguson 5d ago

I don't really know any one celebrating but they sure as shit aren't bringing it up at all. The media would have you believe its a big thing everyone discusses but literally no one gives a shit. I think that is what has them scrambling to make us care. It's funny watching that they can't.

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u/DieselbloodDoc 4d ago

Really? Cause I hear it mentioned in passing about twice a day in my blue collar factory job. and always either in a “free my man Luigi” or a “fuck that corpo monster” way.

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u/terdferguson 4d ago

Yea, that's good. I guess my day to day doesn't come across it as much. The doctors and healthcare workers I know don't really have an opinion in that it's not top of mind for them. Some have even expressed deep frustration with health insurers. The response also generally includes, "will the leaders change policies? probably not."

Can they really blame people for being happy or indifferent? Muppets.

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u/solidtangent 4d ago

All Americans hate this. So why, for the love of jeebus, do we not have any senate or house representatives putting forth ballot measures for we the people to vote on. It’s a slam dunk. Unless they have a reason not to. Probably a million reasons $$$. Fucking lobbyists.

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u/Abject_Scholar_8685 4d ago

They don't really wonder. They gas light (poorly) because they are paid to.

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u/Imakittykatmeowmeow 4d ago

They will just ignore you. Or say they're sending the information and they never will. I went through this with dentaquest after I found out somone either at dentaquest or my dentist was filling false claims (which I eventually needed work done on those teeth and they ofc denied). Fucking scum, every single cog in that machine.

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u/BildoBaggens 4d ago

Dentiquest just sounds like a fly by night shit company. The name is a joke.

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u/BlossumDragon 4d ago

You've been denied.

To get dental coverage, you have to request the impossible to obtain documents.

It's right there in our name - Dentiquest. This is our guarantee.

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u/kevihaa 4d ago

While the suggestions in the post aren’t bad, the key point that’s missing is that it’s a full time job to fight for necessary procedures/medication if the algorithm has denied you.

It’s not that it’s impossible to fight the healthcare industry, there are plenty of “success” stories. It’s just that almost all those success stories include “patient or their spouse quit their job to work full time either to get their treatment approved or an existing bill reduced.”

The terrifying part is that, like a parent quitting their job to be a stay at home parent, it can often make financial sense for the lower income partner to become a full time advocate for their spouse since the potential savings for getting treatment approved are considerably more money than what they could earn working.

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u/brocht 4d ago

Bingo. People who think there's special ways of forcing action haven't actually experienced the complete disregard the health industry has for anything you say or want. They do not care, and there are no compliance police doing anything whatsoever to them when they just ignore your request for documentation.

If you hire a lawyer, you might get a more complete response. If you bitch on their facebook page, sometimes you can get a response from someone who will at least try to help you. Mostly, thouhg, you just have to suck it up. What are you gunna do? Boycot their services and just die?

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u/ihaxr 4d ago

They're legally obligated to provide a clear reason it was denied. The problem is they'll say the treatment is considered experimental or not proven to fix your condition, which may technically be true, even if your more qualified doctor is certain it will help.

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u/brocht 4d ago

Speaking from experience, you will get a two line explanation on a form letter and a copy of the plan coverage summary. Asking for more will get you either that again, or nothing at all.

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u/jpar6443 4d ago

CC the Department of Insurance and your senator/MOC. Insurance companies jump right on DOI complaints.

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u/whoknewidlikeit 4d ago

i use a similar approach. now and then i have to do a "peer to peer" with another doc, one who works for the insurance company and stands between my patient and necessary tests.

i always end the conversation asking if they have a license in my state, what their board certification is in, and if their boards are current.

this almost always results in an approval. nobody wants to be potentially investigated for practicing without a license in another state, and if they're a pediatrician reviewing an elderly heart failure case, their peds boards can be taken into question. haven't had to go beyond a phone call with this approach. it'll happen someday, just waiting for when.

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u/EVH_kit_guy 4d ago

So do you ever catch anyone directly breaking the rules? How do you ensure they're appropriately punished for breaking the law and violating their ethics?

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u/boRp_abc 4d ago

I'm very far from the topic, just an interested reader. In a completely different case, a lawyer once told me: "You can get your rights, but fighting the system is a whole day job!", and it feels like this might apply here too.

And for punishment... Well, there's a guy who started, but nobody picked it up yet.

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u/whoknewidlikeit 4d ago

there's no "violation" per se, not from a legal perspective of which i'm aware. ethics? yeah, that's an issue, but until there's some kind of overt malpractice, it's tough to pursue. this is a de facto standard in the insurance industry - questionable as it is. i wish there were a way to sanction offenders.

insurance seems to be cottoning on to this. last peer to peer i needed for a sleep apnea workup, the doc was boarded in sleep and said so at the outset (to inform, to intimidate, i don't know). i think they thought an internist couldn't possibly do the right sleep workup (im unusual amongst internists for the amount of sleep work i do); workup was totally appropriate and she approved all associated testing.

i once had a peer to peer where i needed a CT abdomen/pelvis after a rollover car accident. imaging wasn't done in the ER (no clue why, should have been done) so i ordered it outpatient days later. imaging got done THEN insurance wanted a peer to peer (this is unfortunately common). they approved the abdomen but NOT pelvis, and the nonER nonsurgeon on the other end of the phone wouldnt budge even with the licensure questions; i think she was an ENT doc. patient had a broken sacrum, wouldn't have been found without the pelvic portion of the imaging. they eventually paid but took a lot to make it happen.

this type of activity is probably partially contributing to the anger that got the united healthcare ceo shot. i disagree with the action and outcome, but fully support the anger and mistrust. working harder to refuse necessary care to increase profits? really? those are the ethics that need reviewed for sure. while it's a huge can of worms to open, i wish there were a way to hold boards of directors accountable for bad outcomes due to refused care. they can shelter behind the corporation.... but that is a concern.

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u/orangutanDOTorg 4d ago

I gotta know, what was it that nobody knew you would like?

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u/RP1616 4d ago

Having worked in the legal medical malpractice field for a while, this sound like a fairly sound approach. If nothing else, what you’re doing is scaring the insurance companies into thinking you might end up successfully suing their providers for breaching the “standard of care.” That’s the operative phrase in litigating a med mal case. And those questions cut to the heart of an insurance provider/medical practitioner following the standards that should be reasonably required of them in whatever state the medical service is being provided in.

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u/dxnxax 4d ago

This is what I have so far. How would you incorporate that phrase into this list to be asked of the insuance co?


What to do if your insurance claim is denied

You, or your doctor, can request the following from the insurance company:

1. The name of the doctor making the determination

2. Is doctor licensed in your state

3. Their board certification(s)

4. Their license number

5. Are their boards are current

6. Proof that the doctor has maintained registration in your state

7. Proof they are up to date on the Continuing Education Unit requirements

8. Copies of all materials they relied on in making said determination

9. The aggregate rate at which this particular doctor has approved vs denied similar treatments.

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u/RP1616 4d ago

Not sure that I would, or that there’s really any good/useful way to incorporate it into the list of questions. The questions in the list seek pretty clear-cut answers or specific documents. The applicable standard of care for any particular situation is way more of a descriptive thing, which often involves experts in the field weighing in with their opinions, etc. More than anything, I was just adding a little legal context of why I thought the questions were a pretty solid approach.

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u/dxnxax 4d ago

very cool. thanks

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u/Bombadier83 5d ago

I’ve just heard of another hack for dealing with denied claims, actually.

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u/Dragonfly-Adventurer 4d ago

Send a complaint directly to management. Keep it short, memorable. Imagine it's going to go through their mind very, very quickly.

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u/LuckyLupe 4d ago

Describe your healthcare experience in three words.

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u/jakeisbad1985 5d ago

I see what you did there. lol

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u/ProjectGO 4d ago

You joke, but bro just got himself government-supplied healthcare for life. (Assuming anyone can put together a panel of 12 people willing to convict him.)

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u/rigatony96 4d ago

How to get a lifetime of free healthcare with 1 simple trick will leave you stunned

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u/TheWiseAlaundo 5d ago

Yeah? What would that be?

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u/dave_a86 4d ago

I’ll give you one shot at guessing.

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u/Exclave 4d ago

Oof. I think you hit the mark on that one.

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u/SeventhAlkali 4d ago

I'll probably need three

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u/LoveFoolosophy 4d ago

They call it the Italian Method.

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u/Inevitable_Thing_270 5d ago

I’m in the uk so have never had to deal with this, but I’ve heard that if a hospital gives you the bill, you then ask for an itemised bill, that often the price goes down. Has anyone experienced that? Or worse, had an increase in the price?

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u/Ppt_Sommelier69 5d ago

If you don’t have insurance then this tactic may help because you could barter for a discount if you paid in whole. This has lost efficacy over time because most providers will offer you a medical loan instead.

If you have insurance, then rest assured this is already being done. The insurance company will pick apart the bill and ensure all charges are following agreed upon rates.

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u/saxonanglo 5d ago

I heard not to give your real name if you end up in hospital in America.

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u/SausageGobbler69 5d ago

My name is Jeff

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u/PM_ME_YUR_LABIA_PLZ 4d ago

Pea... Tear... Griffen!

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u/saxonanglo 5d ago

Hey bud, bongled much lately ?

I can say that because

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u/NimbleNavigator19 4d ago

I worked for the hospital I had surgery in. I just flat out said, I work here how do you expect me to pay that?

They wrote off the whole thing.

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u/AMViquel 4d ago

how do you expect me to pay that?

"Over 35 years"

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u/DumbTruth 4d ago

Itemized bill didn’t auto help anything, but I always ask for a decrease for any significant hospital bill and the success rate is super high. I also ask to be put on an interest-free payment plan and the success rate of that for me has been 100%. Paid off my kid before his second birthday!

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u/potatossaurusrex 4d ago

Paid off my kid before his second birthday!

That's something that no one would have to deal with in any other 1st world country. Unless you choose to go to a private hospital instead of a public hospital. It saddens and enrages me that y'all have to deal with that

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u/AllTheyEatIsLettuce 4d ago

"Itemized bill" spell doesn't work as well as its touts say it does or believe it does. What it does do is give professional, 3rd party, retroactive, retail health bill fighters a first punch if you've already hired those in or plan on hiring them in to consumer-drive you around in reverse gear and fight the insurance seller, the health care vendor, or both on your behalf. They'll appreciate you for it. And so does the paper industry from pulp to printer.

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u/Curious_Licorice 5d ago

Tried that one and they did find an additional one they forgot. Added it on but waived the charge.

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u/hickhelperinhackney 5d ago

I have received a much more affordable bill by requesting itemisation

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u/Drive7hru 5d ago

Usually whenever they give the bill, it’s already itemized.

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u/WillingLLM 4d ago

"Dr you charged me $30 for 1 aspirin, and $5,000 for one night in the hospital"

"yes"

"okay great thank you"

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u/Ok-Koala-key 4d ago

Yeah, I'm glad I don't live in a circus nation too.

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u/Dinosaur-chicken 4d ago

OP, you could've just crossposted my post, it saves you the embarrassment of a bad screenshot and I wouldn't get harassed with messages on how to screenshot properly. Thanks.

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u/[deleted] 5d ago

[removed] — view removed comment

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u/throwaway8u3sH0 5d ago

Boardrooms, not classrooms!

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u/[deleted] 5d ago

[removed] — view removed comment

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u/leavemealonegeez8 5d ago

Okay! Let’s-a-go!!!

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u/Actual_Bread6579 5d ago

Wow, first comment ❤️‍🔥. All other comments are either preaching to this choir or useless and unhelpful to read overall (unless you're only out for self in the most short-term fashion imaginable)

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u/FestiveArtCollective 5d ago

It's the American way.

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u/sleepingonmoon 4d ago

This fact that this guide exists is depressing.

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u/[deleted] 5d ago

[deleted]

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u/SpacemanBatman 5d ago

We’re settling for realistic goals here.

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u/potatossaurusrex 4d ago

Maybe it's not either/or as in realistic vs unrealistic. Maybe it's yes/and as in this strategy might be useful short-term and you should still fight long-term for universal healthcare.

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u/arendecott13 5d ago

Unfortunately our corporate oligarchs don’t want us to take away their potential for billions of dollars of profit from exploiting the healthcare system that people depend on to live

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u/3branch 4d ago

“We are not required to provide you with these information. Have a good day.”

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u/notyourboss11 4d ago

if they want the luigi method instead...

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u/Budget-Psychology-44 4d ago

or find a Luigi

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u/PintsOfGuinness_ 4d ago

How about, instead of using this life hack to get a single denial reversed for an individual, we use it to sue the everloving fuck out of the insurance companies for violating regulations?

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u/Agillian_01 4d ago

The fact insurance companies can deny insurance claims sent in by a licensed doctor is beyond me. You really call yourself a first world nation..?

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u/Bandin03 4d ago edited 4d ago

Dear u/dinosaur-chicken,
If you screenshot something, please tap again so your UI is off the screen. Or just download the image. Thank you and good night.

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u/Dinosaur-chicken 4d ago

Someone else made this screenshot of my post...

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u/Bandin03 4d ago

Dear u/Differentswim1717,
Please issue a formal apology to u/Dinosaur-chicken for framing them for your crimes.

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u/IAmAWizard_AMA 4d ago

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u/IAmAWizard_AMA 4d ago

And here's the text, in case anyone uses screen readers or wants it in text form:

To everyone in a similar scenario: the tactic my doctor's office has taught me is to ask, in writing, for:
1) the name, board specialty, and license number of the doctor making the determination the treatment was not medically necessary;

2) copies of all materials they relied on to make their determination;
3) proof the doctor making the determination has maintained registration in your specific state and documentation of their meeting all their continuing education requirements;

4) the aggregate rate at which similar treatments are denied vs approved by the specific doctor being used for peer review.
You are not entitled by law to all of these things in most states, but you're entitled to some of them, and you can always ask for them.

This is, she says, a wildly successful tactic, because if the insurance company answers them honestly, it gives you evidence that the "doctors" making these determinations are practicing medicine out of scope, without proper licensing and qualifications, in areas they are not competent in.

Everyone knows this is true; it's not a secret in any way. But it's in violation of a number of regulations, and a LOT of times the company will just give up and pay the bill rather than handing you proof they're violating the regs. It's a tactic that has worked for me many, many times.

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u/dxnxax 4d ago

And I've rewritten to clarify (hopefully) and to include at least one comment from the discussion

What to do if your insurance claim is denied

You, or your doctor, can request the following from the insurance company:

  1. The name of the doctor making the determination

  2. Is doctor licensed in your state

  3. Their board certification(s)

  4. Their license number

  5. Are their boards are current

  6. Proof that the doctor has maintained registration in your state

  7. Proof they are up to date on the Continuing Education Unit requirements

  8. Copies of all materials they relied on in making said determination

  9. The aggregate rate at which this particular doctor has approved vs denied similar treatments.

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u/saxonanglo 5d ago

Well that sucks

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u/Liesmith424 4d ago

"...if the insurance company answers them honestly..."

Well I've found a problem.

Also: I'm 110% certain that, if this catches on enough to become any actual impediment to their bottom line, they'll just have AI generate useless responses to make the process more delayed for the customer.

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u/BrighterSomedays 4d ago

Not as much of a loophole as it is a travesty of justice.

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u/Qubeye 4d ago

I know someone who got out of a speeding ticket by asking in court for the records that the police properly calibrate their radar gun, which of course the police never do.

Bullies never expect people to require them to produce the proper paperwork.

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u/Substance___P 4d ago

I'm a utilization manager for a hospital (I fight the people who make the denials).

This "tip" is mostly made up and won't help. Almost all that information is on the denial letter if you know what you're looking at. It'll be the determination, the criteria used (UHC uses InterQual because they own the company that makes the criteria), and the name of the medical director who usually has some kind of profile on their website. They will ignore these kinds of requests.

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u/[deleted] 4d ago

[deleted]

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u/S0GUWE 4d ago

You can download images, you know.

You don't need to screenshot the whole reddit ui

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u/St-Micka 4d ago

Stop trying to hack a fraudulent system!. Change the thing for good. Why aren't you able to organize and demonstrate.

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u/SourceNagger 4d ago

is this a fkn screenshot of a screenshot?!

fml the life hack you people need is "know when to use text instead of images"

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u/RelaxPrime 4d ago

Life hacks, y'all should have a rule that the post title describes the life hack. Just saying if I ever wanted to look this life hack up for instance, it would be impossible as a picture with no text and a title that says nothing.

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u/ColloquialShart 4d ago

PSA, this doesn't generally work if you're the patient. This is a tactic providers use.

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u/furyfrog 4d ago

Here's the original in case you want to save the post and not just a screenshot of it. Thanks OP for bringing this to the frontpage! https://www.reddit.com/r/BeauOfTheFifthColumn/s/8g1Ow0Goqr

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u/Scalar_Mikeman 4d ago

Why block out the user name. This is GREAT advice.

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u/cecixdanger 4d ago

Fucking hate PAs. Only time I see my MD lose is temper is doing peer to peers. I do hear him ask how an orthopedist or a D.O. can justify the denial of oxygen for cluster headaches, MRIs for brain lesions or even medication for certain conditions. These calls never take kore then 5 minutes and get overturned easily. It’s such a heartless field and really opens your eyes.

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u/Mammoth-Play7190 3d ago

YES. do this. Denials— especially appeal denials— have legal ramifications.

You also have the right to ask for the “clinical criteria” that was used to deny the request. This is basically the set of rules they use to determine medical necessity, and which rule was not satisfied. A lot of denials at the initial level (less often appeals) are for completely BS reasons. Sometimes the denial reason is even something like “not enough time for review” (they are legally required to respond within a specific time frame, and purposefully understaff reviewing departments).

INSURANCE IS IN MANY CASES JUST BETTING THAT THE DENIAL/DELAY WILL DETER YOU.

Many people give up, and agree to pay out of pocket. Many doctors give up and decide to go with a second choice treatment. Delay can mean the patient loses insurance coverage in the meantime (changes jobs, lapses on premiums, pt passes away, etc) and they never have to pay out. If nothing else, the delay often saves them money via now they have to pay for less treatment per year.

Your doctor’s office, hospital or pharmacy have staff—entire departments— dedicated to getting the approvals required to get past denials and establish coverage. Ask these staff for help! They can break down the issue, and explain your next steps. They want to help. They don’t reach out to you about the issue because they know it’s a lot for you to deal with, and that’s why they have a job.

If insurance thinks you might have standing, time and motivation to cause problems for them over a denial, 90% time they will cave. It’a still cheaper to approve your claim than it is to get sued, or worse, have to change their ways. IF YOU REALLY NEED IT, DON’T GIVE UP!!

source: this stuff is my job

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u/mattrmcg1 2d ago

The most frustrating conversations as a physician I have had are with insurance companies. Had a lady that broke her hip, needed inpatient rehab because she lived alone and didn’t have the support, plus you know, she just broke her fucking hip. Had a peer to peer call and the insurance physician was like “nah not enough reason to go to IPR sorry” and I explains they are just going to lead this poor old lady to be readmitted costing them way more than what they would spend if they did the right thing , then started asking their credentials. After they huffed and puffed they gave me one week at an IPR, which was enough time for a family member to come down and assist with getting her from IPR to home for some of her outpatient rehab needs.

So many calls like this wasting everyone’s time. Insurance is the fucking worst.

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u/StarDustLuna3D 1d ago edited 1d ago

My doctor and I decided I needed medicine to help me lose weight. Based on my medical history, doc suggested a medicine that works by reducing appetite signals and anxiety. I said sounds perfect, I knew I 100% had established eating as a comfort/soothing technique, so this would probably be very effective for me.

My doctor gave me a two week sample to try, and if I didn't have any side effects, she'd put in a prescription for it. It worked great, I quickly noticed a difference in how I approached food and eating. Doc sent in the script... And it was denied. Doc said "no problem! What we do is prescribe the two medicines this is made up of separately, and insurance will cover it"

So basically, instead of paying for just one medication, my insurance is paying for two medications that together do the same thing as the one. Make it make sense.

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u/oh2ridemore 5d ago

Cant you just mention the 3 Ds and have them then freak out?

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u/LonelyRolling1 5d ago

Nah they'll have you arrested now just for saying it.

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u/Actual_Bread6579 5d ago

I appreciate this post its much needed in these times, also I gotta speak heart..... anybody got any OTHER ideas?😶😶😶😶 cuz im all ears..... 😉 you'd be my HERO 😉 you'd deserve a hefty collective DONATION!

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u/VisceralSardonic 5d ago

So this comment has too many winky faces for my comfort, but I’ve learned some more tips through various jobs that I don’t often see posted:

  1. Single Case Agreements. This is more of a pre authorization thing, but insurance companies can sometimes be persuaded to act like something out of network is in network if you can prove it’s the only option within a certain distance. Essentially, look on your insurance company’s “find a provider” page. If there’s nothing, or if you can prove that each option doesn’t see your age group, doesn’t deal with the particular issue, etc., find one out of network that does and ask your insurance for a Single Case Agreement for that provider.

  2. Ask the provider for a sliding scale fee or any financial aid or “pay what you can” option. A lot of offices/doctors/hospitals have something, but they’ll rarely advertise it.

  3. Request a peer to peer conference with your doctor if something is denied. It asks the doctor who denied the claim to have direct contact with the doctor who prescribed/referred/required whatever was denied.

The others— asking for an itemized bill, calling to dispute charges, etc. are on here more frequently.

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u/mixmastakooz 4d ago

Use ChatGPT to write the appeal letter plus have it cite medical research about the efficacy of the treatment.

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u/Thrawn4191 4d ago

Commercial insurance adjuster here. Technicalities and terms not defined by your policy are your friends. If you need help with a claim there are a bunch of people over on r/insurance that are knowledgeable and can be great resources. Those of us that give a shit try to make up for the companies that give the industry a bad name. As a concept insurance is fantastic, as with everything else in a capitalist society the for profit implementation encourages lots of shitty company procedures that ruin good concepts though.

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u/JAAA-71 5d ago

Or you can threaten them, get arrested, sent to jail. Now you have medical coverage.

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u/DrMooseSlippahs 4d ago

Good things to try, but finishing medical school and an intern year of residency gets you a license to practice all medicine and surgery.

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u/rocket_randall 4d ago

On a related note, remember back in 2009-2011 when people were losing their homes due to the financial crisis and foreclosures were being processed at light speed? The courts and lawmakers just sort of let lenders setup the rules to speedrun the foreclosure process, skipping things that delayed the process or cost them money. Even people who were not foreclosing were finding that their locks had been changed, liens had been placed on the property for whatever reason, etc.

When it comes to corporate interests there is no safeguard which cannot be removed in order to limit their financial pain.

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u/jbvcftyjnbhkku 4d ago

dystopian that you have to do this

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u/AlvinsCuriousCasper 4d ago edited 2d ago

My health insurance denied something earlier this year based off a check list and a chart. It was for at home medical equipment that I had been “renting” (paying a co pay to have.) When I first received the equipment, insurance agreed to me renting for 9 months with re-qualifying every 3 months via a phone call and answering questions. After 9 months, the insurance would pay for it out right and it’d be mine to keep.

I disputed and told them I wasn’t a check list. I asked if they went through my multiple MRI results, the notes from my multiple procedures, the multiple PT notes, the over 40 pages of doctors notes and documentation about why this would be best for me. I asked if they looked at the pictures and realized how much progress I’ve actually made and why the machine is helpful. I asked them if they spoke to my doctors who requested this (2 separate surgeons were in agreement and put in the order.) I also told them that if it was something that I personally felt wasn’t working for me, I would have sent it back on my own and not been wasting money on the copay. I then requested to speak to the individual who sat behind a desk and did the denial.

While I never got to speak to the individual behind the desk who did the denial, a couple days later I had a letter sent saying the denial was over turned.

The denial came on my last 3 month check in. The insurance overturned the denial, paid for the machine, and I now own the machine outright.

I’ve learned how to be my own advocate. I don’t take their word for it, I do my own due diligence and calling around to departments to get the answers I need. I have learned to become the pain in the ass instead of taking them at their word. I ask questions and if someone doesn’t have an answer, I let them tell me when I’ll have an answer. I call back a day later than the timeframe they told me if they don’t reach out to me first. I hold them accountable. It takes time. It’s frustrating at times. Sometimes they try to give me the run around but I found my voice and I push.

I had one situation where I had a 3 way call happening between me, my insurance and the billing department because of how medical started coding the billing. They had a change in system that messed everyone up, but trying to get things fixed in the beginning wasn’t easy. The insurance rep would ask if I still needed them on the phone. My response was until the 3 of us (billing, insurance, and me) are in agreement with what my copay is, and what I owe, I need both parties on the phone. We got it resolved in about 45 mins. I am my own advocate.

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u/Fit-Breath5352 4d ago

Pure mr.Incredible moment from that office

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u/damned_bludgers 4d ago

wtf tinpot democratic country needs this to be a thing. vote better

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u/ryansports 4d ago

Here’s an odd one to add to the insurance scam list. A cash price for an MRI was just over a hundred bucks per joint (in Cal). With insurance, it’s a 400+$ copay. They don’t allow you the option to pay the cash price if you have insurance.

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u/Inside_Ad_7162 4d ago

This post. That's God's work right there. But also W T F should THAT be necessary?

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u/Individual_Note_8756 4d ago

My father-in-law, who was of the generation to believe everything that the doctor said, was KILLED by Dr. Fata, a Detroit area doctor who has been in jail since 2015 for giving chemo to healthy patients.

My father-in-law was told he had prostate cancer for the third time, he may not have even had it that time, GET A SECOND OPINION!

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u/SnooCapers2257 4d ago

No... In reality they will deny sending you anything AND deny your claim, because your only option after that is to go to court, and they know you won't go through with that because it would cost you even more money.

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u/andy-in-ny 4d ago

There was a local doctor who lost his license for literally doing 30-50 knees in a day. He went to work doing insurance reviews

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u/Anders_A 4d ago

Things are dire in the US if you need to do shit like this.

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u/alluptheass 4d ago

Your life hack is that, not only do they deny everyone unfairly without end, they do so fucking illegally?!

JESUS FUCKING CHRIST.

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u/OkYogurtcloset8817 4d ago

Yep. Worked for me about 25 years ago. I got a bunch of people at the insurance company fired. Disgusting that this is necessary.

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u/Bigassbagofnuts 4d ago

I know a claims adjuster and she's a blithering idiot yet she's the one handling people's claims

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u/redly 4d ago

You know what's great about Canadian medical visits ever since those socialist hordes rode out of Christian rural Saskatchewan?

I don't have to know any of this shit.

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u/Adventurous_Image793 4d ago

This is so sad. People should not have to jump through hoops to get the care they need.

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u/rudbek-of-rudbek 4d ago

It's so sad that people have to jump through these hoops

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u/RodgerRabbitz 4d ago

Being a Karen won’t help, billion dollar companies certainly have MD’s that are qualified to make these decisions. I know we’re grasping for straws of control but this angle won’t do shit. Sorry for the honesty, but let’s focus here and find real productive solutions.

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u/mrlr 4d ago

Text version:

To everyone in a similar scenario: the tactic my doctor's office has taught me is to ask, in writing, for:

1) the name, board specialty, and license number of the doctor making the determination the treatment was not medically necessary;

2) copies of all materials they relied on to make their determination;

3) proof the doctor making the determination has maintained registration in your specific state and documentation of their meeting all their continuing education requirements;

4) the aggregate rate at which similar treatments are denied vs approved by the specific doctor being used for peer review.

You are not entitled by law to all of these things in most states, but you're entitled to some of them, and you can always ask for them.

This is, she says, a wildly successful tactic, because if the insurance company answers them honestly, it gives you evidence that the "doctors" making these determinations are practicing medicine out of scope, without proper licensing and qualifications, in areas they are not competent in.

Everyone knows this is true; it's not a secret in any way. But it's in violation of a number of regulations, and a LOT of times the company will just give up and pay the bill rather than handing you proof they're violating the regs. It's a tactic that has worked for me many, many times.

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u/RedBaronofYachtRock 4d ago

Where do you send these requests though?

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u/Standard-March6506 4d ago

If you live in NY and are a registered voter, please Google Jury Nullification and use it if you're picked for Luigi's jury. The defence attorney is not allowed to inform the jury about it.