Back into this well.
A few years ago I was informed I needed a particular medical examination. I went and got it. The local hospital I went to was in-network, and they provided the service, though the doctor was telehealth from another state; essentially the hospital had sub-contracted that function to a different clinic.
After getting the necessary exams, I was recommended to get a medical device. Up until now, everything was fine. A few weeks later I got the device, and started using it. A few weeks after that, my insurance informed me that the device was not covered.
Digging into this matter, I discovered that while the initial exams and everything had been billed out from the local hospital (which presumably then forwarded money to the subcontracting clinic), the medical device I had been prescribed was sent directly from the subcontracting clinic and billed out, directly through them. As this subcontractor was in an entirely different state, this meant my insurance considered them “out of network.”. I fought this but nobody would budge, and worse, “No returns on used medical equipment.” So that was a fun several hundred dollars extra expense.
Later that year, I was asked to get a similar exam through this subcontractor. At this point I was wary, but since my out-of-pocket for the year was paid up, I asked to schedule it. I was told they couldn’t, as the technician they’d used locally to set up the prior exam had retired, and they hadn’t found a new one yet. This was in mid August; I told the staff that I would do the test, but we needed to do it before the end of the year.
They called me on January 3rd to schedule.
When I refused, on grounds that I was now on a new plan year, they made a fuss, and eventually discharged me from their care as “failing to follow doctor’s advice”. And I suppose that might be the case in technical terms, but I don’t have infinite money for these multi-thousand dollar tests, and I made my time restrictions clear.
I am doing much better on that front now, thankfully, but the sheer level of which the system fails, particularly with vertical integration of healthcare by equity firms, is appalling. A friend of mine works in a hospital, and he mentions that these days, that some insurance companies deny LITERALLY EVERY CLAIM, and demand documentation for the need. The denial is automatic, on the assumption that the caregiver will be unable to jump through the hoops…and furthermore, even if the caregiver doesn’t provide the information, simply the act of re-filing an appeal is enough to get it approved. They don’t even review the claim until the second time it’s sent in.
Madness. And that’s before we get into so-called “Pre existing conditions” which are used to enslave people, or the fact that businesses constantly bitch about how much providing health insurance costs…but also campaign against any universal healthcare in the US, because many jobs use the carrot of “health insurance” as a way to get people to do jobs or put up with situations they otherwise wouldn’t. They hate paying for it, but they don’t want to lose the lever.
-Arrow