As someone living in Canada, I feel the exact same way. I dislocated my right kneecap twice when I was a teen, and my parents had to pay a measly $90CAD for the ambulance rides. That's it. EDIT: I recieved both fentanyl and morphine both times, as well as multiple xrays.
@@kureijisatsujinsha there are a few common ways to dislocate a kneecap. Both of mine were due to direct impact with the ground, which caused my patella to dislocate laterally. One common way to dislocate a kneecap is actually by standing up from a sitting position and rotating the body; most dislocations of this kind are not traumatic (EDIT: traumatic in regards to an impact being applied to the patella). Another way is to slip, usually on ice, without the patella being impacted by anything.
As a American citizen, please allow us American refugees sanctuary. The only way this healthcare system will ever change is by something like a revolution in my country. Too many members of federal government are making too much money from pharmaceutical companies and other sources for the sole purpose of keeping the system as it is, and that's just the culture in America and it will not ever change, not without blood being shed. I wish, I truly wish I was exaggerating but if you are American, have a reasonable head on your shoulders, and you know your history then you know these companies run our country and our life and death means nothing to them as long as they keep making the money they do to keep lobbying and getting people and policies elected and put into effect. American refugees will become common place soon if not already. Edit : Several idiots got upset I said this and are pretending like I said to throw your hands up in the air and just roll over and die, which was never said. I said to expect American refugees to become common in the future and I meant it. If you don't have the capacity to look a little down the road ahead of us as a country then that's okay, but don't think just because you can't means others can not and think before you reply with your panties in a bunch. I've already had to report 2+ people who've been sending me death threats which just supports my post. For the love of god people stop getting so emotional. It's a RUclips comment that has a lot of truth to it. Maybe don't act like animals? All the best.
I developed a radiculopathy in my left arm from what turned out to be a cervical disc protrusion. My doctor ordered a MRI. The insurance company insisted that I get plain x-rays first even though I would still need the MRI regardless of what the x-rays showed. Just a waste of money and my time for an unnecessary test.
Yuuuuuup, my favorite was when my oldest was in the NICU, got an infection in the line in her foot. Then needed a surgery to remove infected tissue and reconstruct the underlying foot structure so she could walk and avoid amputation. Blue cross blue shield called it cosmetic and non essential to her treatment. Apparently an infant who's life barely has started having two feet is cosmetic and non essential. Her non essential cosmetic foot surgery cost us $21k and that was after the surgeon getting irritated and just donating his time and several nurses also volunteering to help. They really pulled all the strings they could yo make it happen. It took us 5 years to pay that off and we are still paying on our deductible from her birth. She's 7 now and recently round housed her father while they were playing. It was a beautiful thing to see. Blue cross blue shield is probably one of the most evil organizations on the planet. They are like dealing with a bond villan.
Blue cross blue shield told my wife on 6 different occasions that the surgeon she was going to see was in network. She gets the surgery and we hear nothing and figure “great all is well”. 1 year later we are told the surgeon left the network before they had finished filing all their paperwork so now the surgery was retroactively out of network and we would have to pay the $45,000 it cost. We caught that tooth and nail for 3 years going back and forth with the surgeon and insurance. Finally we had them on the phone in a conference call with lawyers present and asked the insurance company “was this surgery in network at the time and therefore covered?” “Yes” “and you, doctor, we’re in the network at the time of the surgery and failed to submit the paperwork?” “Yes” “So then how does this fall to the patient as their responsibility?” And that silence was so satisfying. We finally got them to admit it won’t be paid by us, but BCBS did call 6 months later asking if we would “just pay $50 from the bill” which we refused. Didn’t want to open that can of worms again.
Medical biller here. Insurance companies have literally made my mental health worse over the past year. And the bigger they get, the less accountability they have. It’s soul sucking watching how they operate.
I'm chronically ill and the amount of fuss I have to deal with them is devastating. I was off medicine for half a month until yesterday and denied mental health services because I'm not mentally ill enough when I was just in the ER with a plan to game end myself. I'm a bit better, but I hate them so much.
Capitalism is absolutely the problem, and would be the problem no matter what. Exploitation and greed is ingrained in capitalism, as it rewards those who are greedy and exploit others. It punishes altruism and community building. This is because the only thing driving a capitalist system is profit. The ability to make a profit is the only thing that will get you ahead in a capitalist system, and you cannot make a profit without exploiting the value someone else produces.
It took 2 years, 2 specialist, 1 very angry pediatrician, and my daughter almost dying for insurance to approve a tonsillectomy and adenoidectomy. A common surgery that took less than an hour and my daughter went from being gravely sick every two weeks to almost never getting sick. She tells me now that she can't even remember how it feels to be sick. It's really sad!
Strange because Isn't the tonsils & the adenoid glands help protect the body from viruses and bacteria. Removing it must be last resort. Because now you don't have the frontline protection against outside organisms, threats .
That's horrible. I just got mine removed last week and insurance procedure done in like 4 days prior to surgery. I was expecting more hassle due to my age, 40. Malaysia is where I am by the way.
As someone who has a degenerative disease, i winced at “prior authorization”. LOOOvvVvEE getting the letter from my insurance about how vital treatments are “unnecessary”.
It’s not even just private. I was on Medicaid in college. Medicaid denied paying an ambulance they deemed “medically unnecessary” because I was conscious during the ride. That’s it, I was conscious. They argued I could have easily called a cab.
@@amely-i.sp. they are the SOLE reason American health expenses are so high. They caused things to be where they're at today almost exclusively by wanting cheaper prices because they're insurance, which caused a normal person's price to be higher, and insurance price to be normal. Then snowball
Simply google search the list of specialist who get banged up for going unnecessary procedures on patients for financial gain which cause major issues for the patient?
@@tpac7801 That one depends on the doctor. For medical insurance, they *always* want the cheapest option so that they pay less. This could range from medicine that's less effective with worse side effects to a completely irrelevant medical scan that is cheaper and can't even diagnose the problem.
My former boss was a doctor and he would constantly fight with the insurance companies to get their patients what they needed. Frequent calls, emails, letters, complaints. He would even help his patients to choose (when they were basically forced to pick an insurance) the most favorable insurance option for their particular needs. He was also a pro-patient’s rights activist. Since he was young, he voluntarily chose to work in a poor area to be able to actually help people. He died in 2015. He really loved his job and his patients.
So I’m going to be that guy in the comments that’s all about conspiracy’s… the insurance companies saw him as a threat to there way of making money so they killed him and made it look like natural or and accident. Is this true 99% no but people will believe in that one percent chance that it is
Let me guess, we can't sue our medical insurer's for malpractice when they make an unqualified medical decision on our behalf against a doctor's orders.
You can’t. You agreed on their terms and conditions without reading the hundreds of pages. If we actually read terms and conditions, I think we would reject most of them:(
A doctor I used to work for got on the phone with a new patient's insurance to demand they authorize surgery to repair his ACL because they wanted him to do physical therapy first. " Who TF is this? Uh huh, and your credentials? Uh huh, so not a surgeon or a doctor? Okay. So, you're telling me that you want to subject a 16yr-old to having a limp for the rest of his life because you want him to go through 6-8 weeks of PT that will just make his injury worse? I have room in my OR for him tomorrow and he needs surgery so unless you authorize this, I will make sure to assist them in whatever way I can to help them sue your ass for permanent I jury for refusing to authorize this surgery." The teenager went to surgery the next day. "Health insurance" in America is a scam.
Just to add, workers realllllllllly don’t get in trouble for saying bullshit, regardless if it’s apart of the rules or no. It’s sooooo slim that the company or workers face penalties so ...it’s fucked
Ummm, actually, doing PT, aka "pre-hab" before an ACL surgery is a great idea, and will help prevent this "magical" limp.... However, I don't think that line of thinking was in the B.S. formula actuaries created when designing their for-profit models for "health" insurance....so, in that sense, I agree with some of your criticism.
He had to be talking with another physician or a person who has the denial in front of them FROM A MEDICAL DR. BTW...these decisions are based on guidelines that DOCTORS have implemented. The industry goes by these and doesnt just say 'no' because they FEEL like it. 🙄....i hate this kind of misinformation getting people riled up
Insurance initially denied a surgical procedure to correct a birth defect I had because it was a, quote, "cosmetic procedure"...I felt so downhearted after preparing for the procedure for years, but thankfully I had an AWESOME doctor who personally fought for the insurance company to cover it!
it's so sad that doctors' time is wasted convincing insurance companies to pay for treatment. Time that could be used to save or improve other people's lives! And I'm sure doctors would be happier spending more time doing what they trained to do and less filling in paperwork and arguing with insurance bureaucrats.
@@Macbobob imagine studying for years and then having to fight insurance to make your patients life better. imagine all this frustration that you deal with when you see that you can do nothing to help this particular patient only because system doesn't work well.
I'm trying to imagine what it's like to work for an insurance company and having to deny people healthcare just for grabbing money. I can't. I can't imagine doing that.
@@Macbobob This is very discouraging and frustrating to hear because I want to become a doctor in the future. There is a lot of time and money invested in school to become a doctor, and having an insurance company denies a medical procedure is just so mess up.
As someone who handles prior authorization all day every day, this is so scarily accurate. Insurance companies have wayyyyyyy to much control over people health and wellness. Doctors can't order generic tests or procedures without having to fight tooth and nail to get it approved. Insurance companies are only getting more strick on their guidelines, this will only get worse.
I used to process prior authorizations through medicare. Sometimes the questions didn't examine context. If someone is in a SNF & the controlled med is under lock and key, the patient is noncompos mentis, they don't need to be counseled about the addictiveness of the med🤦🏼♀️ The process is very dichromatic and leads to stupid decisions.
I was indirectly involved in the Prior Authorization stuff when I worked for a division of United Health. I'm not a doc, but within our division, every decision about what type of care could be authorized, or not, was handled by a licensed physician. However, the idea about "so the person authorizing care is at least as qualified as the person directly carrying for the patient" didn't seem to be true. The doctors at our division may or may not have had the qualifications to make difficult patient-care decisions in each case they were handling
As a non American, I feel like every couple of weeks I learn about some new batshit crazy thing about the American healthcare system. You guys have it real rough out there.
Well it used to not be sooo terrible because health insurance wasn’t as insanely expensive as it is today thanks to the “everyone is required to have health insurance” law and you used to be able to get in to see your doctor relatively quickly. Now you’ll wait 2-3 weeks to get in to see your doctor so by the time you see your doctor you’re either better but suffered through all that time to get better rather than getting better quickly, or you get worse and worse and require even stronger medicine and take even longer to get better.
@@sandysimpson4785 except, no… “We” didn’t vote for it. A shit head president decided for us that this was a good idea and his cronies followed him and voted it to be a law. Now the American people pay even more than we used to for the same or even worse coverage then we had before, and the people that didn’t have insurance who got treatment anyway and just didn’t pay now get treatment with their new free insurance…. And just don’t pay the reduced treatment bill which is then passed along to the rest of us anyway.
The end “practicing medicine” reminds me of Kronk: “Oh, right. The poison. The poison for Kuzco, the poison chosen especially to kill Kuzco, Kuzco's poison. That poison?” 😂😂
I knew the cadence in his voice sounded like a line from something lol It was there in my brain but I couldn't figure out why it was so familiar. Thank you 😂
Really wish this argument could be used to defeat the way health care works in America. How anyone can act like health insurance companies should have this much power is beyond me.
They wouldn't give a shit. As long as the corporations (insurance company) keep putting money into their pockets they'll let them do whatever they want
This is just so awful that it’s true. Having the insurance company, whose whole existence is dedicated to making profit for shareholders, deciding if your life preserving treatment is necessary. Doctors should be treating patients as they were trained to do, not trying to negotiate a surgery or medication with an insurance company.
1) Yes, absolutely true. 2) It has gotten to this ridiculously beaurcratic point because not EVERY Dr. is scrupulous... This is SUPPOSED to negate Fraud, unskilled ( tho still "practicing ") personell, and absolutely UNNEEDED, unnecessary , and dangerous procedures. HOW-EV-AR , what these "auditors" adhere to, ultimately, is $$$, bottom line, and as was pointed out, the MOST juicy paycheck possible to "The Shareholders" ... They are also the third invisible man in the exam room with you & the doc, and are now dictating what drugs the docs are "allowed" to prescribe, in what quantities, and even ultimately determining what social/ political policies will be in the future. Humbug!!!
@@sharonwolfe5210 it really blows my mind that a nation (which is all you people living in said nation) take up with that sh*t. Vote! Get it on the agenda! Don’t accept no for an answer! Universal healthcare is no place for capitalism.
@@dasophie1 voting does nothing when every option wants to do the same thing its getting to the point where were gonna actually need to use our 2nd amendment instead of talking about it like its our only personality trait
@@gabrielleguitarist5043 help me out here; you’re referring to an add on, from 1791, to the bill of rights that protects the rights of citizens to ‘bear arms’. How is thát gonna help? You wanna shoot your way out of this? Really… help me out here. Explain yourself
@@spoopyd.8910 I found it on google forever ago. Can't remember where or what I searched to find it though. Don't think I even still have the image saved
It pains me to know this is true, BCBS (Blue Cross Blue Shield) was the insurance I had when I ruptured my spinal disc between my L4 and L5 dones. They wanted me to go to physical therapy after already getting 2 spinal steroid injections, not being able to bend toward my feet more than 15 degrees, could barely go to the bathroom by myself, couldn't sit in a chair more than 5 minutes, and couldn't sleep very well. Mind you, I was 20 at this time. Finally I found a doctor who did an X-ray and a MRI with and without contrast and I finally found out after almost a year of suffering that it wasn't just a "pinched nerve" I went into surgery less than 2 weeks later. The total of my "elective surgery" was $42,350 and the surgery lasted less than an hour. That surgeon is my hero, because by the end of it I was thinking of suicide because how bad the pain was. The American Healthcare System is a TRASH HEAP!
BCBS is a complete asshole of an insurance company (even for insurance company standards) which I have been dealing with too. Three months of excruciating pain and also slow death by sleep apnea, my Dr's put in for prior auths and they just never ever get back to them. Only one, for my EGD, they approved. All others, just sit on their desk indefinitely. I think they learned if they deny that way, patients and Dr's won't have a grievance or appeal process.
@@techguydilan wow that really sucks, hopefully someday soon we can fix the American Healthcare System, because we shouldn't have to fight like he'll to get medical help
did you appeal the decision of medical neccesity? you prob could have recouped the mri and surgery if testing should clinical rational end surgery alleviated your pain. theirs lots of ways to regain that money back thru insurance by simply mailing in a form
I got hurt on the job. The work comp thought it was all in my head. Despite sending me to multiple psych doctors. That disagreed with them. They screwed around for over 10 yrs. I had an attorney. I ended up getting a new attorney. But bc they didn't and wouldn't accept that I had CRPS. I didn't get treatment so now I live every day in severe debilitating pain. My CRPS is from my toes to my shoulder blades. I wouldn't wish this disease on my worst enemy. I have other diagnosis as well. The pain I deal with everyday is compared to having an amputation without pain meds or anesthesia.
Welcome to the US. My OB/GYN got on the phone and yelled at some pencil pusher at my insurance company for denying my medication that I had been on for years and attempting to PRESCRIBE SOMETHING ELSE in its place. My doctor was beyond mad.
That's a good doctor. Most just give up...mine did, then I had to educate his staff on how to properly fill out the insurance authorization paperwork so that it was accepted. Nothing like having to learn their job so I can teach it to them and pay for the privilege.
As a pharmacist, it’s irritating when the insurance requires PA and sad when you are the one to convey the news to the patient why their medication is not ready and won’t be until the next few days…
Yep. And if it's urgently needed medication, like heart medication or blood pressure medicine, your patient ends up in the ER again while waiting to find out if their insurance thinks they REALLY need that medication afterall. Ask me how I know that one 😬
I love when they won't cover it. The meds that the insurance would have paid $12 for you now have to pay out of pocket and it's no longer $12 but $510. You really have to love this system.
@@kuceracm that's actually how my pharmacist got them to authorize it every single time. "No, we won't cover the medication that costs $400." "Oh so you would rather pay several thousands for them when they end up in the hospital because they can't afford this medication that would have been $10." At most it would take 2 days to be authorized. Mostly because it happened at the end of the day.
Few days lol that's cute.. Mine take a couple weeks to a month or more for just the process of the doctor filling out the paper work and insurance approving it.
This is the system that led to me spending a year bedridden with pain because apparently there’s no way a 19 year old needs major spine surgery without having been in an accident so clearly I decided that spending a year in bed away from all of my friends was better than finishing the first semester of my first year in college that I had already paid for. 🙃
@@bidmcms3 don’t be a dick; this is hella common. Another example of paternalism: I was denied dx for endometriosis for fourteen years to save my uterus in case a man wanted to use it later. I popped out a kid and they’re taking my uterus now. Not removing leftover endo that’s causing my pain from my first surgery, just removing the fetal incubator bc it won’t stop bleeding. Ya know, since I was left to just die until I met the status quo so the tissue grew like cancer. Nothing for suffering, just the complaint of anemia and hemorrhaging. Oh and the average wait to dx endometriosis is 7 years bc no one believes uterus owners deserve pain-free lives. Research has been cited in Nancy’s nook and dr vidali of NYC’s findings for if you want to cite my sources. Good luck, took me years and I’m still reading.
@SpazNeedsAResetButton ABSOLUTE FACTS!! I wish I could be this concise and articulate in regards to my endo experience 😢 but please, KNOW, that I COMPLETELY understand because I am living it as well. Thank you, for saying this, how you said it. I hope you wouldn't mind if I use your wording to explain to others because it is so eloquent and succinct🙏
@@bidmcms3 my depression had nothing to do with it. Before I had any scans done, I could point to exactly where the pain originated. And when the scans were done, it showed a herniated disk exactly where I pointed. I don’t know how the disk got herniated but the pain was not my depression. And once I got the surgery, the pain was gone. I had post-op pains for the standard amount of time but that surgery gave me my life back. The fact I didn’t know how I herniated the disk shouldn’t have mattered. The pain and debilitation it caused me should have been all that matters. But that wasn’t the case and I suffered for a year that I didn’t have to because of that.
@@bidmcms3 Depression is fucking hell, but so if a kidney infection going on 3 weeks to the point of your kidney shutting down. And the doctors telling your mom you could have died. Get your head out of your ass, not every single pain is "depression" fucking Boomer.
I learned the definition of “practicing medicine” when I was about 8 or 9 and I knew the name of some bone a med student couldn’t name on the spot. I love med students but I was a precocious kid who wanted to impress her doctors as much as the med student did.
This is why I absolutely despise insurance. You pay them a crap ton of money in case they need to cover something expensive, and then when they do they fight to deny it. Absolute crooks.
As an American with a debilitating neurological condition (I fall asleep randomly and lose control of my body multiple times a day), I recently was denied a medication that I was already taking for months that was working great when I switched insurances. Prior authorization people said I needed to try a few other medications first. Didn’t give me a reason other than it was “general policy”. So happy that general policy is to deny my doctors request, ignore my medical history, disregard my disability, and encourage me to put foreign stimulants in my body. 👏
My mom's insurance likes to "mix things up" with prescription coverage so some of her medications can go from covered to suddenly not. Our healthcare system is beyond frustratingly ridiculous.
i have the same neurological condition, type 2! get denied my meds by insurance a few times a year and have gone into withdrawal bc they have started to randomly deny it right before it gets refilled. My sweet doctor always wants to beat my insurance with a rake for it but he knows to just fast track a prior authorization as many times as it takes now. Complete bs
This happened to me but after a lot of poking my nose where it shouldn't belong, I found out my doctor's office was filling out the paperwork wrong. I should have been reported as a continuation patient for the medication and they were reporting it as if I was just being prescribed that med for the first time. The doctors office staff had no clue that there was a difference or how much it mattered.
I absolutely love how average people are finally starting to see the issues that have plagued the US healthcare system for years. It's not the physicians, it's the corporations that used the government to control the physicians. Every medical professional I've spoken with would gladly take a paycut to get rid of these downright abusive systems that harm everyone.
Starting to see? We live in some fucking nightmare where my entire childhood every adult has agreed our Healthcare system is fucked up and yet I'm now 24 and it's like the conversation is JUST coming out.
It’s insurance in general. Insurance brings nothing to the table. Capitalism works where there’s room for stuff to be innovated. You’re an apple seller? One way to make greater profit is by making better apple growing procedures. Insurances only way to innovate is to find new ways to take more money than they give. That’s why it’s one of the few things that really needs to be government owned/run to actually benefit the general public.
It sucks but on the flip side many doctors and hospitals abuse the system and charge for non essential or incorrect treatment. Doctors want to make money and bill just as much as insurances want to save money
I literally had a doctor say to me once that "doctors don't really get to decide whats best for their patience the insurance company does" and it is true unless the patient can pay out of pocket.
I have said this for years in fact, whenever I’ve encountered it with my insurance company, denying some thing I asked to speak with the Doctor Who made the medical evaluation without seeing the patient. When they say there wasn’t a doctor involved, they ask for the nurse practitioner that made that decision, when they say there was no nurse practitioner involved. They ask who is practicing medicine without a license and can I please get their name and phone number. They usually hang up on me at that point.
A year after moving, I found out my former dentist cracked one of my teeth grinding on it, and that I needed a root canal. My new dentist told me that a root canal isn't covered by my insurance because chewing is now considered cosmetic. 🤨🙄🤦 Yeah, chewing is now on the same level of necessity as calf implants, except you don't rub your calves together to break up the food you eat to survive. Right.
I was waiting in my gynecologist's office and overheard the nurse telling the doc that a procedure was denied for another patient. He rhetorically asked her why they would refuse it for a 75 year old woman who was having profuse vaginal bleeding. He was furious and got on the phone. I never knew what happened but I hope the insurance company approved the proper diagnostic tests. And I hope it wasn't cancer.
Sounds like vaginal and pelvic prolapse causing tearing or possibly even infection that's resulted in vaginal bleeding. It's really common in my area because gynecologists are so damn expensive, take so few insurance plans (and if you're poor and in Medicaid, you only get to see one if you are pregnant or your GP did a pap and found cancer) that women end up suffering for decades. I was basically told last year my options were a medication that had caused blood clots, one that made me a barely in control rage monster, or bleed to death because they wouldn't perform a D and C on a woman who hadn't had any children yet "for fear of a a future lawsuit, especially a future husband lawsuit" if something should go wrong. A procedure done regularly in the past without complications, and now they apparently can't manage it without doing damage so extreme it causes either sterilization or inability to carry to term. And it's my fault for not having kids when I couldn't financially or emotionally care for them, that they were refusing the most effective treatment to stop a massive uterine hemorrhage. I took the Hulk Smash hormonal treatment, nearly lost my job (because passing out repeatedly at work and running to the bathroom to change post-partum level pads hadn't already caused enough strain, lets have a nasty resident who calls me an "inconvenient interruption" to her seeing her poor young mothers tell me side effects don't matter), but survived. Had to argue with multiple doctors to get back on treatment that prevented that nightmare years earlier when a family medicine doctor saw how off my hormone levels were and the risk of complications that created. Can't even see him now because of insurance drama. They really do just want all poor sick people to just die quickly and quietly and "stop being a drain on the system" as one person once accused me of being after suffering a seizure from a severe concussion missed by the ER doctor from a car accident.
@@chloe_alien in my opinion, mine isnt that bad as I'm still here without having had a seizure, but I was told I was faking it when I checked myself into the psych ward for suicidal planning and paranoid delusions. I still suffer, and the treatment I received that has put me in debt was being completely alone for 3 days, aside from having a nurse silently bringing me food. Almost slammed my head into the floor. And I did slam it against all the walls hoping to knock myself out due to building stress that had no outlet and no end in sight. Now I have brain damage and no way to get justice for being left alone for three days in my paranoid, and delusional state. I thought the President personally was trying to make me kill myself so he could have a good laugh. I someyime wonder if the paranoia was more on the nose then I will ever let myself believe.
They're being paid not to. And those that are good enough to not accept the bribes/lobbying, get replaced by making other candidates more affable to their goals more relevant in politics.
@@brandonn6099 I’m not sure how this works. If you truly believe it is worse in places with more affordable healthcare systems, can you explain in more detail? I genuinely want to know where you are coming from on this
@@Oscar4President Death panels. The Brits call it "rationing" healthcare. The government decides whether you live or die. Every government with free healthcare does it. You can't just magically fix every ailment because the government is paying for it.
So grateful you made this one with the concept of insurance companies essentially practicing medicine denying reimbursement for the treatment recommended by the doctor.
Years ago I was head butted by one of my cattle while feeding them. I had a tear in my eyelid on my right eye so much so that whenever I closed my eyes I could see daylight. Went to the ER and they couldn't stitch it closed so they simply glued the hole closed. 2 months later I get a bill of over $21,000. My insurance had denied payment due to the procedure not having prior authorization. After taking just under 3 weeks of making phone calls I finally got through to a human being that had the authority to override the decision. All it took was me asking them "So I guess I should have sewn up the hole in my eyelid by myself out in the pasture then. Is that what you are trying to tell me?" The bill was taken care the next day. I just love the bureaucracy.
I hope you're okay mate. We don't have system like this in india. We do have private doctors who charge alot but we also have quite alot cheap healthcare (government and many smal private doctors) I can't think how hard it must be for Americans with such an expensive healthcare. I mean most of your doctors are indians, indian doctors back home will charge 1/4 1/5 of what they'll charge (or rather their hospital management charge) before they move to America. Anyway I hope you're fine and healthy.
Wow!! $21000 for slapping on some skin glue that costs under $20 at most pharmacy stores. And then not covering emergency treatment under the bs of prior authorization... I guess your insurance company needs to speak to your cattle able getting permission to head butt people prior to taking actions
I had “gross gynecomastia” to the extent that i would have qualified for a free breast reduction if i was a female. (More than 250g of tissue per breast, or at least 500g in total) However because my sex is male and i was just unfortunate enough to have female breasts (i can not even begin to tell you how much grief it caused me) they denied the reduction mammaplast, forcing me to have to live with d cup breasts for another 4 years before i could finally afford to pay for the surgery, however there were surgical complications, i had a hematoma and was bleading out when i got home from surgery. The had to go back into surgery to cauterize that. The insurance also refused to pay for that and to this day im still paying it off. Keep in mind i was in network the entire time, i have a long history of mental problems, half of which stemmed from a massive lack of confidence in my body. And i had multiple suicide attempts on my record because of it. It didnt matter to them. Unfortunately I could not afford a lawyer to help me fight their decision, it would have been easily 20 hours of arguing or just over 6k-10k in lawyer fees...
@@HarlemSexyBlaqkat just keep fingers crossed that insurance will pay for at least part of the cost to get counseling. But even when they do agree that the sessions are covered, the copays & deductibles can make counseling very hard to pay for too. I needed counseling & I was dirt poor, disabled, just divorced after being an at-home mom for a decade, and waiting for my disability claim to be approved by Social Security. I went to my church leaders for help with paying for counseling since I couldn’t. Our national healthcare system keeps us sick. We are customers, not patients. There is NO REASON WHY IT HAS TO BE THIS HARD!!!
My insurance company didn't like the fact that I was in the hospital for 3 days and CALLED MY ROOM to ask how everything was doing and why I was in the hospital. I had a baby. Severe complications made me have a C-section. Person was extremely apologetic when I told them my child and I almost died a couple days prior and I was being kept for observation.
Yes, some insurances have bright moments. Aetna called a family member receiving care for an ongoing condition to let them know their policy would cover some in home help if needed.
Wow. I got a call from my insurance company because I had an undiagnosed chronic illness and they wanted to offer me a nurse navigator. I read between the lines and interpreted that as "you are costing us too much money so we want to stick our nose into what's going on here." Turns out, I just had a bunch of really lousy doctors. I had pernicious anemia which is easy to treat.
As a pharm tech, I felt this. I always hate giving people the news that their insurance won’t pay for their medications. Some patients have to pay thousands of dollars for their stuff, or some just say they can’t get it at all. Which is so concerning, because half the time they are life saving or important quality of life drugs. We try to find coupon cards for them whenever we can, but we can only do so much sometimes
Man... life in the USA has to be stressful. Me, I managed to get my asthma medication for like $5 when it is usually around $50 for a package of three. Simply because I had reached a payment limit over the year. Making the rest of my medication way cheaper. If it went high enough, I wouldn't have to pay anything at all. I live in Sweden, BTW. And while taxes is a huge part of it, it isn't the whole story.
Gotta love that ridiculous markup on medicine so the insurance companies don't get mad that they're paying more than the people they're supposed to pay for
Y'all want to know the worst part? Health insurance artificially marks up the sticker price to flex their "negotiated" rates. I buy my perscription for $10 a bottle, and without insurance it's $150 a bottle, but I never made my deductible, and insurance doesn't pay a dime. They literally just raise the price for poor people for no fucking reason except to flex "how much cheaper it is when you buy through us!" Almost all of these drug companies have "assistance" programs too that will just sell it at the normal cost too, you don't even have to meet any requirements just go through the hoops to ask them in the right way. The base price for most drugs is over 10x what it is immediately across the boarder into Canada. They pay way less for healthcare and have much better outcomes than us.
I find that so insane, that a person can end up in the situation of needing a critical medication but having the money, so the system literally says "go die about it 🤷"
Sometimes coupons from the drug companies are worthless especially if you are on Medicare. They won’t let you use the coupon because Medicare helps pay some of the cost. Which is stupid because the medicine is still waaaay too expensive.
@@pedrosso0It is *unethical*. The only reason it isn’t criminal is because it’s still legal. It’s absolutely an unethical system, though. If insurance is a capitalist manifestation of collective health care management, then it relies on competition and supply/demand to remain cost-effective. The problem here is that “demand” is not determined by a patient’s desires; there are few, if any, affordable alternatives; and it is much more costly to maintain. A single healthcare system cuts down significantly on administrative and record-keeping costs because all records can be housed in a central repository. No prior authorizations means freeing up time for doctors to see more patients/provide more care. Further, the system would only need to run at-cost: no profit necessary. These companies profit off of denying care. When people decide to forgo care because it is too expensive, they profit, too. It is unethical, and in a just world it would absolutely be criminal. A single-payer system would be great, but what we need right now is a very cheap public option to force insurance companies out of the market entirely.
@@TechnoSpicewouldn’t the medical industry benefit from more approvals to do work? That’s like saying contractors make more money by turning down projects. Sounds more like insurance is the one with the money and power
@@josiahbaumgartner7643 Sure the MEDICAL industry would benefit, but Insurance isnt the medical industry and they hate literally everyone for no reason other than "This is money i get for free to not spend on the one thing we are supposed to spend it on. Also, Insurance shouldnt have been a thing in the first place but you know, again, fucking money
What kills me is that even after a prior authorization has been approved for a type of prescription for a patient, the doctor has explained why the patient needs that drug and what other cheaper drugs the doctor has tried for this condition, 6 months later, insurance company can and usually do make the doctor repeat the same paper work for prior authorization all over again. You may have to go weeks to a full month or more suffering without your medicine for prior authorization to get completed.
Been there with that Belbucca crap that is for “around the clock pain”. Not only is it super expensive, authorizations are needed like every other month, and it doesn’t even work. So I stopped that after a month or two of trying it.
The insurance companies & doctors have to play by & follow the RULES set by the Government bureaucrats at MEDICARE or they loose their ability to get reimbursed by MEDICARE. They are also subject to big fines & or jail time for NOT following the MEDICARE rules & formulations when it comes to Medicare & Medicaid patients. Since it is harder to maintain & operate within 2 separate systems with the same price schemes almost all doctors, Insurance carriers, & HMOs follow the MEDICARE RULES & pricing for all their patients. Some still offer "cash" discounts, especially if it is for something Medicare (or your Health Insurance which has to follow MEDICARE policies) does not allow for.
I've dealt with this a lot from the administrative side. Their excuse is always, we aren't saying he can't have it, we're just saying we're not paying for it.
As a pharmacy technician, I’ve never thought prior auths should be a thing. They can hold up a prescription for days if the doc isn’t on top of handling the request we send and I don’t think the insurance company should have a part in deciding which meds a patient should get or not (besides maybe deciding brand vs generic bc of obvious price differences)
@@hereallydohatesandtho8304 While I do agree that many pharmaceutical companies practice predatory and scam-like practices with many of their medications (don’t get me started on medicine commercials 🙄), I do believe that keeping a patient alive for as long as possible is in their best interest. “Die for profit” is an oxymoron
@@lisacallan5462 That’s a different argument altogether. Insurance companies and pharmaceutical companies are separate entities. I, personally, hate private insurance companies for a litany of reasons.
We actually are currently on billing and insurance chapter for my pharmacy tech class and it is a bunch of bs how insurance companies work and get to decide who gets what
EXACTLY! I can’t stand insurance companies micro managing our health. It’s BS! I would explain how both my diabetic sons have to jump thru hoops to get their insulin and diabetic supplies because the insurance company thinks they know better then their drs but I don’t want to get angry this early in the morning 🙄🤦♀️🤬
I am so sorry that your family has to suffer through this. Tragically, this will never improve until more people understand what you have experienced, which is that healthcare has become "too big to care"-- patients are revenue streams rather than human beings. Most doctors along with people like you desperately want to see fundamental changes, but cannot figure out a way to get the message across to enough people to be able to effect the changes we know are needed.
@@username912912it’s called lobbying and both Democrats and Republicans have failed the American public, they need to make these things actual republic votes instead of having a democratic candidate to speak for the majority which is barely the majority in most places
@username912912 less Healthcare but insurance companies. Like the vid says they're basically practicing medicine without a license in making these calls. It's so dumb. Hell I've had to take so many meds just to get to the one I could've and should've started at first if it wasn't for insurance companies pulling bs. Same for surgeries if it weren't for them 😢
My dad is so weak because insurance denied his medicine. They said it’s too expensive and he’s not sick enough to get it. So he missed a week’s worth and today we found him on the floor. He was so cold and couldn’t get up. I hope there’s someone to investigate these insurance companies and give them fines.
To keep it real unfortunately you need to pony up the costs and or go to jurisdiction where you can afford it. Otherwise you’ll continue to get screwed over as you watch your parent suffer. I’m really sorry man. Our health care in the US is fucked
Reminds me of a time in college when my fiancée got taken off of vyvanse and put on adderall after her father’s work changed insurance providers and they didn’t want to pay for vyvanse twice a day. Grades tanked, she had physical outbursts, super angry with mood swings, had to increase anxiety medication, etc. all because an insurance company decided her medicine she had been on for the past 4 years was too expensive.
I spent years of my life listening to terrible hold music and filling out hundreds of prior auth forms on behalf of providers when I was an outpatient/acute psych nurse. Watching patients decomp because their instance company changed what medications they covered or wouldn't continue something that they had been stabilized in while inpatient was one of the worst parts of those jobs. Anytime someone tells me our system is superior to nationalized healthcare I launch into a 30+ minute diatribe. Sadly, Medicare for all won't fix it either. Medicare part D, the part that covers medications, are frequently managed by four profit insurance companies that require prior auths for basically everything. It's the worst.
Thanks for that last part. Want to see change in the system, but it seriously needs to be started from the ground up, but ACTUAL healthcare professionals. Not just people voted into office.
When we say Medicare for all, it includes fixes to that system too. If everyone is in the same boat, you bet for damn sure there will be fixes. If we sink, we all sink!
Yes, this is my fear. Everyone wants socialized medicine, but I don't forsee it solving the problem since the same system would still be used to manage the care. I don't see it being fixed in my lifetime and that terrifies me for my disabled daughter.
Although i admire your honor and commitment to make America a better place, i don't think a prosecutor could do much unless you're a federal prosecutor. The health insurance companies line the pockets of politicians and that's what you have to stop for this to end.
A really fantastic grace of this, is that so many doctors I've had over the years were more than willing to extend helpfulness, when predatory insurance issues ever arose. Just a few months ago I had my medication coverage denied in letter-form, stating there was no medical proof that my medication treated my diagnosis.... the same diagnosis my medication is commercially stated to be used for. I was in such a panicked state, I wouldn't ever have the ability to pay an extra $200 a month for something i need to function, and I could NOT imagine going back to rawdogging my symptoms 😭😭 My doctor met with me immediately, she called it total horseshit. Literally just ended up just half-ing the pill dose, and writing a prescription for twice that amount. The insurance company accepted it. Their entire business model is based on fear and intimidation based on completely inaccurate information, knowing that they're preying on people who wouldn't be able to take it to court.... because they're already dealing with so many medical issues.
right, i know of doctors who are really good at writing their prescriptions/treatments in a way that insurance companies will accept. it's crazy the lengths they have to go to in order for patients to not be financially crippled by A THING THEY NEED TO BE HEALTHY AND LIVE because of the way insurance companies work.
My medication is $21,000 per dose and can only be ordered via specialty pharamacy. The specialty pharmacy is owned by my insurance. Everytime I try to order my medication they give me the DUMBEST reasons for denying it, and every time it takes a solid 3-4 hours to get it. My favorite was the time I had to spend 5 hours explaining to 8 different people that it made 0 sense that they (the specialty pharamacy owned by my insurance company) didnt have my insurance information, and therefore they should not need 3 weeks to request and process said information. Its not even a medication for some rare or debilitating condition or anything, I just have psoriasis :(
Finally someone says what I’ve been saying for years! Even got the prior authorization because I asked why they were practicing medicine without a medical license. Brass tax denial meant they knew more than the actual doctor and I wanted to know who gave them that authority. Immediate approval and asked to never call again.
So ALL doctors need to be asking the insurance companies this question - or the docs will help the patients sue them for practising without a license. This really needs to be a CLASS ACTION!!!!
As someone who just graduated and can't really afford insurance at the moment, the thought of somehow getting injured and not being able to cover it is terrifying. Health insurance just raises prices for medical treatment and hurts everyone who just simply can't afford it. It's a huge scam that never should've been allowed to start with.
If *heaven forbid* you do get injured or end up with a serious illness, the hospital usually gives deep discounts to those who are self-pay. They’ll also work with you to set up a payment plan that’s affordable for you. Hospitals love being able to work with a patient to get the treatment they need (and also pay their staff). If, in the future, you do have a large debt owed to insurance or a medical facility, just keep paying at least $15 at a time. As long as you’re making payments, they can’t send it to collections.
Lauren: that's not true. Self payers are required to pre-pay full market rate price. I was asked to put down $32K few years ago. Whereas insurance gets heavily discounted rates
You would probably qualify for a very low cost policy. There are insurance agents who will do the legwork,to find you a policy. They get paid by the insurance company so it costs you nothing. You should get coverage ..even if it’s just catastrophic care, you don’t want to risk that. I hate that it’s this way. And it’s not a new phenomenon.
I don't know where you are but in California in a situation like that you could try to apply for emergency MediCal right from the hospital; they have staff who will help you. If you meet the financial qualifications they could cover everything or almost everything. Check with social services from your state to see if you have that option.
Back in the early 90’s, I had gallstones. Surgeon said the gallbladder needed to come out. The insurance company wanted me to carve out 90 minutes to discuss why I needed this surgery. The first thought that ran through my head was that I convinced the surgeon that this was my quick weight loss plan - divest myself of organs I don’t really need. I decided to behave myself, though… The nurse calls. First question: why do you think I need my gall bladder removed. I stifled my sarcasm, even bypassed the obvious - my doctor said so - and responded “because I have gallstones.” She replied that gallstones always required the removal of the gallbladder and the call ended. Less than 90 seconds. Really? REALLY?
@@MrsMBash22 I was younger then. The filter is less selective with age. Although, in grad school, My ex sprained his ankle. The insurance company denied his claim. It appeared that the X-rays weren’t requested by an MD. It happened late in the evening, so apparently either the ER doc or the radiology tech confused the date. I called them and they argued with me! So, in a voice dripping with sarcasm (and sarcasm IS my second language), I asked, “So you’re saying that he wandered into the radiology dept of a major hospital and asked for an X-ray, and they said, “Sure, hop on up, we’ll take care of you”? No paperwork or questions asked?” They paid the bill. I often wonder how we’re all still alive with insurance companies driving the bus.
@Lauren I wonder that too. Then I get sad because I KNOW there are people who arent around anymore, either because they couldn't pay so they didn't get care, or because the insurance company practiced medicine without a license or even knowing the first thing about a patient and overrode what the Dr ordered.
@@lauren9667 i got billed for getting blood work without a referral once! How the hell would I get my bloodwork done without a referral? Just walk in there and poke myself? 🤦🏻♀️ they will do anything to squeeze money out of people and make you pay for their mistakes.
This is so sad. I see it everyday in outpatient facilities and hospitals. I was always the deliverer of bad news when the authorizations weren't approved. Many of these patients had cancer.
Sadly has a cancer patient I think it's because it costs so much to treat us and keep us alive....depending on stage is how they (insurance) values our lives. I am stage 4 metastatic and have had my insurance say some stupid crap. My favorite was that I had to see my GP that they assigned to get a referral to see a oncologist. I was diagnosed after going to ER the wait to see that GP was 8 plus months. I said to heck with that and started calling oncologists and cancer clinics on my own. Found one 75 miles away that took my insurance and is a great clinic. I am lucky.
An example of what I face as a pharmacist. I was processing a prescription for a product that has 2 medications, one of which is 250mg. The insurance paid a fraction of the cost. When I called they said it is reference based pricing. This means that they pay the amount of a comparable product. I asked and was told it was compared with a product that was the same as the 250mg but actually they paid the price of that ingredient at 50mg. Hardly comparable. I managed to get around them by processing the 2 ingredients separately. Not always able to do that
Yes, this situation happened to me. Even my doctor testified 5 times that I need the test but still they denied the request. According to them "Lack of clinical proof". It is devastating.
I love how this M.D avidly points out how criminal privatized insurance really is. I’m 28 with full PPO coverage and had three trips to the hospital last year and I’m still thousands of dollars in debt . America ladies and gentlemen
Its not just privatized insurance that does this. For this reason i never make a Drs appt on a Thur or Fri bc every month i have to get a PA for the same med written by the same Dr. I got tired of bothering him after hours. I have a good Dr.
@@JerMal that’s exactly what ended up happening and I only chose PPO because I was uneducated when I selected my plan and was given the notion that you pay a bit more but in the long run if anything where to happen my coverage would allow me to have a wider selection of providers and out of pocket would be less. I was given the idea that HMO in my area would be very limiting. Thank you for kindly sharing this information, for a second when I got notified about your reply I thought you were going to call me an idiot. My point still stands though, this shouldn’t even be a problem people have to deal with a first world country, hell anyone for that matter. Quality health coverage is a necessity not a privilege.
I appreciate you talking about this subject! As a pharm tech I constantly have to explain this to patients and then they accuse either us or the doctor of “not doing their job” when in reality the insurance companies are the real villains
cool then charge 20k for a single injection and bypass the insurance company, let me know how the patient feels about that. Or maybe understand that without insurance policies and guidelines they would go out of business.
@@daemonsw77 Guidelines aren't going to provide a solution for everything, edge cases should allow the hospital to go along with planned procedure given sufficient explanation that it's the best, if not only, solution
@@jagodaduda2976 sufficient explanation to who and comparable to what? you mean with current standard practices or gasp guidelines. Do you not realize insurance companies base medic necessity off standard practice guidelines developed by independent doctors and proven case history? why should insurance companies pay 10x more for a drug when guidelines state another drug at a fraction of the cost will work, especially when the hospital stands to make the most out of the situation by buying certain medicines in bulk cheaper and charging for the single dose price. its not the doctors or insurance companies its actually the facilities and their corporate identities who are the villains, unless of course we need top notch emergency or healthcare at a facility that has the best equipment and services then you love them. its all relative no matter who you try and point fingers at
@@daemonsw77 damn hearing profit in the same sentence with healthcare really over complicates medicine. I'm glad I work in the UK. Sure I get paid a fraction of what they get in the US but I at least can prescribe the likely best treatment for my patients. The only issue is the time patients have to wait to see us.
@@deathberryjam907 Nah. The actual "American health care system" Government insurance is just as bad if not worse. Because at that point you have your GOVERNMENT telling you that they dont think you need that care.
Doctor here. So incredibly true. Dealing with insurance companies is the worst part of the job. Not only do they practice medicine as is mentioned, they'll deny something because of a missing punctuation mark. One time it was denied because I used "PTSD" instead of writing it all out.
I’m 25 and a 2x cancer survivor, I’m blessed to have good health insurance, and I’m active in a lot of young adult cancer support groups, and it’s honestly so devastating the amount of times I’ve had friend become critically and/or terminally ill solely based upon issues with insurance companies not wanting to cover screenings requested by the patient.
I did dialysis for about 5 years before I got my kidney last september and the amount of times i couldnt take x medicine but could take x medicine that cost 6x the amount of the first one because it was denied.. Its insane
As a European i just cannot grasp my head around this. Makes me feel blessed that I got all kinds of treatments without any delay. In my country if you have insurance the doctor is allowed to give you any kind of treatment that needs to be done to benefit your health or save your life (unless it's crazy expensive like $1M).
@@misshoneynevercame4832 i am really curious which dream country you are living in ^^ seriouly i am. Because as a molecular biologist with parts in pathology i dont know any country you are talking about. I am Swiss, born in Austria, lived in Switzerland, Austria, Germany, Netherlands, Sweden, Norway, Italy and America. A half year long in Liechtenstein as well 😛
And when the insurance company authorizes treatment there is still not any promise to actually pay for the service. Essentially, they have just said that your claim is not rejected. Yet.
:( This actually brings back traumatic memories when I got injured at my work literally due to no fault of my own, but my employer’s negligence. And had to go through workers compensation. It was an actual living nightmare. The system is so broken and terrifying
U.S health system is terrible though. I broke my ankle 3 weeks ago at work and was sent to a hospital got xrays, triage , my medicine and all i payed for was an air cast wgich was only 150$ and workers comp will cover like 75% of my time off . I cant imagine being told no for something i need by insurance .
I work in a kitchen and 99% of kitchen injuries are the result of stupid and slow people doing insanely idiotic things, like running through the kitchen with a sharp knife for example. Stupid people get injured and it drives up costs for everyone else!
@A R that’s wrong. It‘s because at least half of your country screams „communism!“ everytime someone tries to change your antisocial structures. But „big pharma“ is always a good target for blaming lol.
Yep just went through this with my six month old baby girl!! I went to the pharmacy after going in to a sick visit and did not realize that she needed prior authorization for albuterol for her nebulizer she had RSV needless to say the pediatricians office was closed and they said she definitely wouldn’t get the medicine that night. Surprise surprise I couldn’t pay for it out of pocket because I didn’t have the money to buy it it was over $200, she got worse in the night and she ended up in the hospital needing oxygen and in the end got albuterol in the hospital so her insurance ended up paying 100+ times more than they would have if they just approved the damn medicine and my poor baby ended up in the hospital because she didn’t get the outpatient medication she needed!!
This is simply not true. Everybody follows a major independent guideline developed by an army of doctors. Cost is NEVER the issue. But getting a Masectomy to treat you kidney stones is.
Yup. I no longer work in "health care" because it is not health care in the US. It's a litigious based health care model that is not remotely evidence based, and trying to have conversations with people about it (because trauma doesn't lead to informed conversations) is about impossible. I refuse to work with insurance companies, like since 1997. Pregnant people should not go into this kind of debt for the worst maternity care of any industrial nation. The US has a higher maternal and neonate morbidity rate than all the industrial nations, and almost 70 "emerging nations", but fear drives the decision making process so it's not going to change until people decide women and children are human beings, not cost extractive business models...
4 years ago I had a MSSA infection, which grew an abscess on my spleen and infarced half of it. I spent 2 months admitted because soonercare was giving the team looking over me a hard time. My hospitalist, Dr. Richards got so upset he came into my room (and I've cussed with him before this point and he's knows it's okay) cussing about how much they're fighting so I could get home health care and be at home. The even more insane part about it is the 6 weeks I spent in a hospital room DWARFED the cost of just sending me home with a PICC line and IV. The point this guys making is very valid. Just like police and even emergency operators are being required to have more training, there should definitely be more education required of the insurance company.
The insurance companies don't want more training. The refusals and denials are the point. They just want to wear people down so they stop fighting for coverage. Also, I hope you are feeling better now 🙏
and just imagine... we could have universal healthcare like every real country and then the insurance agents could train for new jobs that actually contribute to society rather than making everything worse.
There are doctors that choose a different model. There's a family Doctor I know who doesn't accept any insurance, you pay an annual subscription fee to him for his services and he's on call to you. Text, call, video chat, he'll do house calls and he works and has a relationship with one of the local hospitals and gets you deals on lab work and other things. Unfortunately I don't live in the same state and I've been looking for a doctor who operates like him ever since.
This is 100% true. I had came down with acute inflation that inhibited my ability to walk and all insurance approved was blood tests for the first year. After a year of dealing with extreme pain, loss of mobility and huge life changing affects at the age of 23, the insurance never paid the money for scans to help me feel better. Only figured out what was going on through tons of self research to determine I have an auto immune disease. Insurance is a heartless business.
I came expecting a pretty funny video and halfway through it turned into a nigtmare realization. This needs to be shared a lot. This is not just a video. This is very powerful information.
No bull. In Mexico, a neighbour of mine had cancer and went through multiple surgeries and rounds of chemo. Not only did he not pay a single cent for the entirety of his treatment and all of his meds, but he also got full paid medical leave for an entire year that didn't count against his retirement. The company he worked for? Coca-cola. This company could do the same for any worker in the USA, but only did so in Mexico because they have laws that require companies to treat their workers fairly.
@@JorgeRodriguez-ue9rr Americans actually sneak INTO Mexico to get healthcare. Healthcare tourism is common because Mexico somehow has a better system.
@@sidd7926 that's not true. Initially he got into making meth to fund his chemo. Then it became a way for him to fund his children's education. It then morphed into him seeing how high he could go, and he built an empire. In other words, his actions ended up being fueled by spite and greed, and a show to others of how capable he was.
It really isn’t.. obviously there are worse countries with even worse medical practices out there, however i agree the medical system is ridiculous and needs reform. I think law enforcement will reform first and the medical system will be soon to follow
The best part about insurance is that simply having it is financially devastating if you are chronically ill. $900 a month comes out of my husband's paychecks to cover premiums cuz I'm so sick and that's if we don't seek medical care at all. On top of that we have to pay for every appointment, test, and procedure.
I'm Swedish, living in Sweden. I have chronic illness and have several medicines on prescription. I pay less out of pocket for appointments AND medicines IN A WHOLE YEAR, than you pay for insurance per month! Granted, we pay a lot of taxes here, but that also means having that very heavily subsidized medical care and prescriptions (no matter if you're on disability benefits, or the CEO of IKEA), all kids get free (cooked) lunch at school on every school day, daycare is subsidized so that it's available to every family and not just the rich. And that's just a few examples of the many many things that are funded by our taxes. I don't have children, or even like children (they can easily cause sensory overload for me) but I'm more than happy to make sure they get a proper, nutritious lunch at school (which for some kids can be their one proper meal in a day if the family is struggling financially) by paying my taxes. It takes a village...
@@ReyOfLight we wanted to move to Sweden and I was gearing up to go on a research visa, but I can only manage part time work anymore. Disabled people are only allowed to immigrate to Sweden (and most other countries) if they are doing it on a highly skilled worker visa like the research visa. So we are stuck here.
I'd love to see a class action suit against every insurance company for this. If a doctor orders it, the insurance company should simply sign the check.
@@purpleXpotionnobody says the doctor OR the patient should decide the price of the cough syrup. But if the doctor says the patient needs it for his HEALTH, then the HEALTH insurance should cover it. If it turns out to cost an unrealistic amount of money, let the insurance company take it up with the manufacturer of the cough syrup. Not with the patient or the doctor.
@@felix3138 And then patients get the following response from insurance: _”Please allow 4-6 years for us to negotiate the legitimacy of cost relating to your request for cough syrup medication. Alternately, please feel free to criminalize yourself buying opiates off the street.”_ 😆
Yeah except for all those old school, and maybe less than trustworthy doctors ordering expensive and unfound tests just to line their pockets. 1 bad apple ruins the bunch, and that's why the system is what it is now. Somewhere along the line, 1 shitty doctor was ordering experimental treatments for something unnecessary and insurance was just paying it.
Girl I dated was on disability. They would just randomly willy nilly tell her doc "nah we don't wanna pay for that one. Do the other one." Which would be on file as very ineffective for her issues. US insurance is messed up
I just had a patient with basal cell carcinoma (skin cancer) on his back that physician ordered PET scan for in August - insurance refused even after appeal so pt never got. Instead he showed up to hospital in October in uncontrolled pain. He was packed with cancer throughout his spine, liver and lung- just went on in-patient hospice. Healthcare is beyond frustrating and heart breaking
I didn't know basal could metastasize that way. I've had 3 on my face. Surgeon said don't ignore lesions on the head because it's a short trip to the brain and those are the ones that kill. He never mentioned anything about basal elsewhere on the body. Now, melanoma is known to spread and kill quickly.
I take topamax and emgality as migraine preventatives. For 2 years my insurance denied covering emgality. The first year they said they wouldn’t cover it because I didn’t try other specific classes of meds first, starting with beta blockers. My neuro responded saying shes not going to prescribe beta blockers because I have moderate (sometimes severe) asthma. The second year - after I had been taking emgality for a year thanks for Eli Lilly’s coupon covering all but $1.50 a month - they denied it saying according to my records I didn’t have enough migraines. Because the medication they wouldn’t cover was working. They did finally cover it and now I have a new insurance that didn’t even question coverage.
I'm also a chronic migraine sufferer and the fact that I saw "topamax" and was able to predict the direction your comment was going is... upsetting. I used to have migraines with side numbness that resembled a stroke and was treated like a drug seeker. I take amovig and had a similarly difficult time getting it
@mrE365 every insurance plan is different. It’s important that you reach out to the plans themselves and discuss which has the best benefits that suits your needs. This person’s situation is totally different, she was prescribed a very expensive newer drug on the market. Age related denials are from plan to plan but also easily solvable by your healthcare provider.
@@seanathanbeanathan I have chronic migraines but refuse to get treatment. I have bad arthritis and its already hard getting pain meds for that so I just can't bother with my migraines. With both my migraines and arthritis I tend to just try to sleep it off and usually just get sick in the process. Its great /s
I have a lot of feelings but shoving them aside, I just wanted to thank you for making a skit that explains the absurdity of it all in such a concise way. You’re awesome and your skits help keep me sane!
The best part is that in dr.’s offices, the staff (medical assistants, nurses etc.) are the ones in charge of processing PA’s, so if you go to a poorly run office, those PA’s pile up until they find the time to look into it.
Tell me about it! My dad had a stress test and other test back in October. His chest is been hurting last few days so he went to doctor. Turns out be had a mild heart attack before the stress test sometime and it's now December and it just came to light when they looked at report . Well doc says he needs a stint but insurance says his artery isn't blocked enough yet ,it needs to be like 10 percent more before they will cover it. 😒
Yup I'm a nurse at a doctor's office. We have a large patient population with 5 doctors but 4 medical assistants and 2 nurses but not everyone works everyday so we are constantly short staffed. so in addition to rooming patients refilling scripts triaging patients answering medication or procedure questions prior Authorizations are not a priority. I mean covid hit us hard to the point of having 60 plus calls and 30 plus emails to deal with on a daily basis. We cannot get to everything and struggling.
@@starfireonvf thank you! Office nurse here too. It’s not that we don’t want to do the PA’s there is just more than we can handle but everyone thinks their needs are the most important and have 0 patience.
I may live in an "undeveloped" country, but knowing that I can get a life-saving surgery without being charged for it if I need to makes me proud. Americans should fight for public healthcare
There is very little chance we can change this. Half the country is gaslit to believe this is *the best* way to have medical innovations. The truth is that politicians will never change the system because of the millions of dollars they personally are paid by insurance lobbyist. To remove lobbying, we need a majority of politicians to agree and act against their own financial betterment. We are a nation where the mega-corporations actually run the country and call the shots by buying politicians to do their bidding, and no hope of that changing.
Same. Im from a developing country and my insurance pays almost everything including doctor appointment and surgeries. Other than some meds, the rest is basically free!
THIS!!! As someone who has a chronic condition, on top of other diagnoses, I'm absolutely sick (ha) of all the hoops I have to jump through as a patient. I can only imagine how it is for the doctors.
I am sorry you have to suffer through our broken system. I hope you find good physician advocates that can help you fight. As you know, there are plenty of (most likely burned out) doctors who are not good advocates either because they don't understand the complexities of what the healthcare system places on patients, or feel like it isn't their responsibility to work late days every day to fight a battle that we know we'll probably lose anyhow. At any given time, we have hundreds of people that we are fighting for one thing or another. At a certain point, just to maintain our sanity, we have to create some boundaries or burnout is all but assured. I like to believe that I still fight very hard, but each year it becomes more hopeless...
As a medical biller, i felt this on another level. I am the middle man between the doctor and insurance companies. Its is the saddest feeling when i cant get the patients approved. Btw, Electives and non surgical is the hardest to get approval for.
I have been amazed over the years to see how many necessary procedures are termed "elective" too, things that are not cosmetic or optional in any way. The things they do with words.
Thanks to your videos, I now know what prior authorizations are! When I got my medication the other day, and the pharmacist told me that I would need a prior authorization to get it, I knew to go “AUUUUUGGGHHHHH”
Prior authorization: doctor: " You need this medicine" doctor to pharmacy: "He needs this medicine" Pharmacy to insurance: "His doctor says he needs this medicine" Insurance to doctor: "Does he need this? Let's just ask the doctor"
I work for an insurance company. For my company (and it IS a company) it's not "let's just ask the doctor", it's "let's ask /our/ doctor/nurse whose only relationship with the patient is whatever documents their provider has sent us and who has never met the patient."
@@BjornNatan no, they're still qualified. When it's medication, especially certain kinds, they're reviewed by a nurse/doctor to make sure that the doctor prescribing it, isn't doing so just because the patient wants it, and that they actually need it. There are patients who somehow get doctors that just give them what they want, including prescribing meds and diagnosing either incorrectly or at a higher level than they actually are. Some doctors are not as afraid of malpractice as they should be.
@@BjornNatan not unqualified in the sense that they didn't go to medical school. They just don't necessarily have a personal relationship with the patients seeking a PA. Sometimes that's a good thing because do people go to whatever doctor will prescribe them something. But it's also often not a good thing because doctors know their patients best.
Yep had this issue happen with a parent multiple times. Mainly with the main meds they have to take because of their transplant. I’ve had to tell them you want them to go back to where they were without the transplant. Then they go quiet no issues once you get at them for being ignorant.
Most teachers also don't really know how to read the law either. It's quite the paradox but if you think about it, Slave owners shouldn't have made their own laws. That'd be a massive conflict of interest
@@VicSellsPeace teaching is a public service. Their existence is only to help. there is no benefit for the teachers. Slave owners only profit themselves. So yes it's a huge conflict of interest. Same as if you let business men make all the policies. Us the consumers suffer from it because they're only going to introduce policies where they get most of the profit. And sometimes to the disadvantage of the consumers
This is so horrifying to hear. I had a brief stint at an insurance agency dealing with these types of letters and for us there was a doctor for every department (DME, dental, etc…) and they mostly approved everything and if they denied it was just bc they were asking for more paperwork. I assumed it worked that way across the board. The fact it doesn’t is super alarming.
Sadly they'll deny things simply because of stable vitals at X time after medicine has been administered for pain control and claim it is no longer emergent because "well their vitals are stable" b!tch I'm not leaving this person in extreme pain while I wait for auth from you! What even are you?! - a real life senario from September.
What agency did you work for? I work in dental. We pretty much tell the patient what you will pay or not pay. You all tell us upfront what is covered. We have to tell people everyday they will need to pay or pull a tooth that we have ways to save. We are giving dentures to 17 year olds because insurance won't cover root canals, crowns, or implants. Insurance companies dictate patient care way before a PA is needed.
@@brittany7573 I must have bitchin dental insurance then because I have been begging for dentures for YEARS and they (the dentists) won't do it! They just pull it, root canal it or fill it and 6 months down the road I'm back again. I have a family history of bad teeth, and several health problems that exacerbate this issue. I have 5 set to be removed soon 🙄 I just want them all out and to be DONE! I'm 33 btw
@@mistyarcher802 I understand your frustration. If you have an underlying health issue, full mouth extractions might be a good route. But normally we discouraged removal of healthy or save able teeth. Your jaw bone has one purpose, to support teeth. If the bone doesn't have teeth, the body will absorb the bone. That is why older people without teeth look like their jaws and face are all squished together. This becomes a problem because you won't have a ridge as you age. The ridge is what keeps the dentures in your mouth. You are so young. I wish you didn't need dentures
I’ve had this happen multiple times. It’s the main reason I’m still dealing with a facial spasm issue because they denied a CAT Scan ordered by the Neurologist. Thanks guys! This is fabulous to deal with X not embarrassing or life altering at all. 🤬
THIS NEEDS TO GO AS FAR AND AS VIRAL AS WE CAN GET IT! That’s how I feel. As soon as he said, “and that will eventually just cause MORE MENTAL HEALTH ISSUES..” We need everyone to hear this fr!
Train hard kid! We need more people. Grow your passion. Meet more of us in the medical field. It's a hard job but not once have I woken up on a Monday and thought to myself "oh god..."
as someone who is not gonna be a medical professional but would still need a lot of healthcare, damn i'm glad to not be living in the usa. also, best of luck to you!
Glad we don't have this capitalist system in France, we have a system that comes from the "CNR" or National Council of the Resistance (Conseil National de la Résistance) where there is national health care managed by the state put in place by the commies and lefties who were numerous in the Résistance (as the big bosses and the right had collaborated with the nazies they got shot or had to shut up) off course over the last 70 years the right and the ultra-rich have been chipping away at it to privatise it so the insurances (private compagnies) get theirs hands on our health care money
Yep almost got denied a chemo med, it was recommended my doctor prescribe another med or change the dose, for stage 4 lymphoma. Survived that to now live with an immune deficiency which requires infusions of antibodies to keep me close to healthy and out of the hospital or off constant antibiotics. Now I and my Drs get to regularly argue with my insurance. I even had a 6 week delay of treatment this year, good times.
Money. Those who make the decisions get big donations, and spread misinformation. For example, when Obamacare was initially being crafted, it was toned down because insurance company messaging made it seem scary for there to be a public option and talked about "death panels" but we already have death panels, they're also known as insurance companies.
So, just to understand, what's the issue with those infamous "death panels" that politicians want voters to believe exist in all countries with socialized health care? That they would not produce a profit for a private company? I mean, if they existed, which they don't, in what would they differ from the current US system, besides that?
I think that people there are basically brainwashed from a young age to think that the US is the best country in the world, and that any change that could resemble socialism in any way is a step towards communism. I lived in the US for a year, and I saw this attitude in many smart, well educated and kind people. The school system is in my opinion not doing a good job of teaching the pupils about other countries, cooperation between different countries, or critical thinking in general. I think that this is one of the major reasons why Americans are reluctant to vote for someone who wants to change the healtcare system. Also what has been stated about the power of the organisations currently profiting on the American healthcare system..
People are so afraid of becoming ill that they've convinced themselves it's a moral failing and is somehow our fault for needing healthcare. It's ableism all the way down.
So effed true! As a certified medical assistant for 20 years, I can say I probably spent 5 of those compiling evidence for prior auths. Now as a disabled "professional patient" I have to wait on the other side for approvals. 😭
Insurance companies in nursing homes can say how long a Patient can have physical and or occupational therapies. The usual cut off is if the Patient can walk 50 feet they can go home regardless if they can or can’t bathe and or dress themselves. It used to be the therapist had the say as to how long a patient needed therapy. Sometimes even the administrator gets in on the decision regardless of what the therapist say.
Oh god don’t even get me started on PA’s. Having to explain it to patients on the pharmacy end is the best and worst thing ever. Best because you send it in and it’s out of your hands, worst because 90% of the general public doesn’t know what it is and wants to argue with us half the time
I'm currently trying to get my doctor's office to send an authorization to my insurance company to get a shingles vaccine. They denied me because I'm under the age of 50... even though I'm immunosuppressed.... and literally recovered from shingles months ago and am at risk of getting it again... Well, i guess it's up to them if they don't want to cover the vaccine, but would rather cover the valtrex prescription each time or a possible hospital admission if another shingles episode comes back worse or in a place that's vision threatening.
I’m sorry to hear this, I know that the US HCS is messed up, but to deny you a vaccine that is both lifesaving and preventative disgusts me - it’s tragic that this country’s healthcare system is so fragmented, confusing and expensive for no reason other than insurance companies privatizing medical access to those they deem worthy. Patients, doctors, and hospital admins all suffer under the thumb of big pharma and insurance agencies. Livelihoods are destroyed and lives are lost prematurely because of hubris and greed - it’s tragic. Best luck 🍀 to you, your loved one’s and good vibes headed your way. Stay safe out there! 👍
I work for a PBM. When prior authorizations get rejected like this you can always submit a benefit appeal. Usually prior authorizations will only be approved if you meet certain criteria while a benefit appeal will look at the whole situation. Hope that helps
Hey Dr. G, I don’t know if you will see my comment. As an aspiring doctor, I really appreciate how you create videos not only about the life as a medical student but including the issue with the health insurance, which can be very complex and frustrating process to understand. Thank you for spreading the awareness about this issue and explaining in a way that it is very easy to understand.
Spot on. I am a social worker and work as a Care Manager. Be nice to all the secretaries and RN’s in clinics, because they often do all the ground work for the “Prior Auth’s”, even when it’s a medication that is prescribed monthly. Ridiculous system and great video.
I now understand a little more clearly why Bob choked and threw his boss through several walls.
"well let's hope that he's covered
Am unhappy bob unhappy
Bob is my spirit aminal
When you're a kid you laugh, as an adult you understand
@@Lee_Key_Bum who is this Bob that you guys are talking about?
As a UK doctor, this scenario is beyond the realm of my darkest nightmares
As someone living in Canada, I feel the exact same way. I dislocated my right kneecap twice when I was a teen, and my parents had to pay a measly $90CAD for the ambulance rides. That's it.
EDIT: I recieved both fentanyl and morphine both times, as well as multiple xrays.
@@drake5560 How exactly do you dislocate a kneecap? It’s something that wouldn’t come to my mind when someone says “dislocation”
@@kureijisatsujinsha there are a few common ways to dislocate a kneecap. Both of mine were due to direct impact with the ground, which caused my patella to dislocate laterally.
One common way to dislocate a kneecap is actually by standing up from a sitting position and rotating the body; most dislocations of this kind are not traumatic (EDIT: traumatic in regards to an impact being applied to the patella). Another way is to slip, usually on ice, without the patella being impacted by anything.
As a American citizen, please allow us American refugees sanctuary. The only way this healthcare system will ever change is by something like a revolution in my country. Too many members of federal government are making too much money from pharmaceutical companies and other sources for the sole purpose of keeping the system as it is, and that's just the culture in America and it will not ever change, not without blood being shed. I wish, I truly wish I was exaggerating but if you are American, have a reasonable head on your shoulders, and you know your history then you know these companies run our country and our life and death means nothing to them as long as they keep making the money they do to keep lobbying and getting people and policies elected and put into effect. American refugees will become common place soon if not already.
Edit : Several idiots got upset I said this and are pretending like I said to throw your hands up in the air and just roll over and die, which was never said. I said to expect American refugees to become common in the future and I meant it. If you don't have the capacity to look a little down the road ahead of us as a country then that's okay, but don't think just because you can't means others can not and think before you reply with your panties in a bunch. I've already had to report 2+ people who've been sending me death threats which just supports my post. For the love of god people stop getting so emotional. It's a RUclips comment that has a lot of truth to it. Maybe don't act like animals? All the best.
I developed a radiculopathy in my left arm from what turned out to be a cervical disc protrusion. My doctor ordered a MRI. The insurance company insisted that I get plain x-rays first even though I would still need the MRI regardless of what the x-rays showed. Just a waste of money and my time for an unnecessary test.
Yuuuuuup, my favorite was when my oldest was in the NICU, got an infection in the line in her foot. Then needed a surgery to remove infected tissue and reconstruct the underlying foot structure so she could walk and avoid amputation. Blue cross blue shield called it cosmetic and non essential to her treatment. Apparently an infant who's life barely has started having two feet is cosmetic and non essential.
Her non essential cosmetic foot surgery cost us $21k and that was after the surgeon getting irritated and just donating his time and several nurses also volunteering to help. They really pulled all the strings they could yo make it happen. It took us 5 years to pay that off and we are still paying on our deductible from her birth.
She's 7 now and recently round housed her father while they were playing. It was a beautiful thing to see. Blue cross blue shield is probably one of the most evil organizations on the planet. They are like dealing with a bond villan.
BCBS is actually one of the better private insurances. Chew on that one for a minute...
@@RandomTXDude210 exactly
Good on her for round housing her father.
Blue cross blue shield told my wife on 6 different occasions that the surgeon she was going to see was in network. She gets the surgery and we hear nothing and figure “great all is well”. 1 year later we are told the surgeon left the network before they had finished filing all their paperwork so now the surgery was retroactively out of network and we would have to pay the $45,000 it cost. We caught that tooth and nail for 3 years going back and forth with the surgeon and insurance. Finally we had them on the phone in a conference call with lawyers present and asked the insurance company “was this surgery in network at the time and therefore covered?” “Yes” “and you, doctor, we’re in the network at the time of the surgery and failed to submit the paperwork?” “Yes” “So then how does this fall to the patient as their responsibility?” And that silence was so satisfying. We finally got them to admit it won’t be paid by us, but BCBS did call 6 months later asking if we would “just pay $50 from the bill” which we refused. Didn’t want to open that can of worms again.
@@RandomTXDude210 yuuup.
Medical biller here. Insurance companies have literally made my mental health worse over the past year. And the bigger they get, the less accountability they have. It’s soul sucking watching how they operate.
I'm chronically ill and the amount of fuss I have to deal with them is devastating. I was off medicine for half a month until yesterday and denied mental health services because I'm not mentally ill enough when I was just in the ER with a plan to game end myself. I'm a bit better, but I hate them so much.
@@_sleepyaisha_ I hope you're doing better now. I'm sorry you're having a hard time right now. I've been there. ♡♡♡
Capitalism 😊
@@ElectricAlien577 capitalism isn't the problem, it's the way people use it
Capitalism is absolutely the problem, and would be the problem no matter what. Exploitation and greed is ingrained in capitalism, as it rewards those who are greedy and exploit others. It punishes altruism and community building. This is because the only thing driving a capitalist system is profit. The ability to make a profit is the only thing that will get you ahead in a capitalist system, and you cannot make a profit without exploiting the value someone else produces.
It took 2 years, 2 specialist, 1 very angry pediatrician, and my daughter almost dying for insurance to approve a tonsillectomy and adenoidectomy. A common surgery that took less than an hour and my daughter went from being gravely sick every two weeks to almost never getting sick. She tells me now that she can't even remember how it feels to be sick. It's really sad!
What's sad is you bringing a child to this world when your unfit to care for it 🖕
Strange because Isn't the tonsils & the adenoid glands help protect the body from viruses and bacteria. Removing it must be last resort. Because now you don't have the frontline protection against outside organisms, threats .
And what lead to this? What lead to insurance companies having this kind of power? After all of we can't diagnose the problem how can we fix it?
That's horrible. I just got mine removed last week and insurance procedure done in like 4 days prior to surgery. I was expecting more hassle due to my age, 40. Malaysia is where I am by the way.
@@foreverything9794
I'm actually interested in Malaysia and Indonesia as a potential expat of America.
As someone who has a degenerative disease, i winced at “prior authorization”. LOOOvvVvEE getting the letter from my insurance about how vital treatments are “unnecessary”.
It’s not even just private. I was on Medicaid in college. Medicaid denied paying an ambulance they deemed “medically unnecessary” because I was conscious during the ride. That’s it, I was conscious. They argued I could have easily called a cab.
@@alize0623 . . . I am.. REALLY... starting to wanna go killing insurance companies' idiotic CEOs
Thanks to all the crooks out there defrauding insurance companies we get to suffer.
@@amely-i.sp. they are the SOLE reason American health expenses are so high. They caused things to be where they're at today almost exclusively by wanting cheaper prices because they're insurance, which caused a normal person's price to be higher, and insurance price to be normal. Then snowball
Fight them in court and you will get millions in return.
Doctors: Practice medicine
Insurance Companies: cause malpractice lawsuits, then try to cover them up.
Simply google search the list of specialist who get banged up for going unnecessary procedures on patients for financial gain which cause major issues for the patient?
@@tpac7801 You are saying that you trust the insurance companies over a doctor. You sweet summer child.
@@username912912it can be argued that the user was born when they were still burning lead for fuel
@@tpac7801 not all doctors are bad but all insurance companies will try to make your life as miserable as possible
I'll take my chances on the doctor
@@tpac7801 That one depends on the doctor. For medical insurance, they *always* want the cheapest option so that they pay less. This could range from medicine that's less effective with worse side effects to a completely irrelevant medical scan that is cheaper and can't even diagnose the problem.
My former boss was a doctor and he would constantly fight with the insurance companies to get their patients what they needed. Frequent calls, emails, letters, complaints. He would even help his patients to choose (when they were basically forced to pick an insurance) the most favorable insurance option for their particular needs. He was also a pro-patient’s rights activist. Since he was young, he voluntarily chose to work in a poor area to be able to actually help people. He died in 2015. He really loved his job and his patients.
What a loss for his patients
What an amazing guy.....
Wow! Love seeing a doc that's there for the calling!
So I’m going to be that guy in the comments that’s all about conspiracy’s…
the insurance companies saw him as a threat to there way of making money so they killed him and made it look like natural or and accident.
Is this true 99% no but people will believe in that one percent chance that it is
And the world is a slightly better place because of the impact he had on people's lives and a slightly worse place now that he's gone.
Let me guess, we can't sue our medical insurer's for malpractice when they make an unqualified medical decision on our behalf against a doctor's orders.
That was great. Thank you for that thought.
They can probably sue us for lost business if we die from the result of the decision though.
Nope! It just means the insurance company saves money. To them that's all that matters.
You can’t. You agreed on their terms and conditions without reading the hundreds of pages.
If we actually read terms and conditions, I think we would reject most of them:(
@@natalyaakselaleksander4502 and then the IRS fines the bejeezus outta you for not having health insurance 🤷♂️
A doctor I used to work for got on the phone with a new patient's insurance to demand they authorize surgery to repair his ACL because they wanted him to do physical therapy first. " Who TF is this? Uh huh, and your credentials? Uh huh, so not a surgeon or a doctor? Okay. So, you're telling me that you want to subject a 16yr-old to having a limp for the rest of his life because you want him to go through 6-8 weeks of PT that will just make his injury worse? I have room in my OR for him tomorrow and he needs surgery so unless you authorize this, I will make sure to assist them in whatever way I can to help them sue your ass for permanent I jury for refusing to authorize this surgery."
The teenager went to surgery the next day.
"Health insurance" in America is a scam.
Is that good doctor still practicing?
Just to add, workers realllllllllly don’t get in trouble for saying bullshit, regardless if it’s apart of the rules or no. It’s sooooo slim that the company or workers face penalties so ...it’s fucked
This is how every doctor needs to advocate for their patients.
Ummm, actually, doing PT, aka "pre-hab" before an ACL surgery is a great idea, and will help prevent this "magical" limp.... However, I don't think that line of thinking was in the B.S. formula actuaries created when designing their for-profit models for "health" insurance....so, in that sense, I agree with some of your criticism.
He had to be talking with another physician or a person who has the denial in front of them FROM A MEDICAL DR. BTW...these decisions are based on guidelines that DOCTORS have implemented. The industry goes by these and doesnt just say 'no' because they FEEL like it. 🙄....i hate this kind of misinformation getting people riled up
Insurance initially denied a surgical procedure to correct a birth defect I had because it was a, quote, "cosmetic procedure"...I felt so downhearted after preparing for the procedure for years, but thankfully I had an AWESOME doctor who personally fought for the insurance company to cover it!
it's so sad that doctors' time is wasted convincing insurance companies to pay for treatment. Time that could be used to save or improve other people's lives! And I'm sure doctors would be happier spending more time doing what they trained to do and less filling in paperwork and arguing with insurance bureaucrats.
@@Macbobob imagine studying for years and then having to fight insurance to make your patients life better. imagine all this frustration that you deal with when you see that you can do nothing to help this particular patient only because system doesn't work well.
I'm trying to imagine what it's like to work for an insurance company and having to deny people healthcare just for grabbing money. I can't. I can't imagine doing that.
@@Macbobob This is very discouraging and frustrating to hear because I want to become a doctor in the future. There is a lot of time and money invested in school to become a doctor, and having an insurance company denies a medical procedure is just so mess up.
@@thepremedbear8597 move to Canada! Problem solved 🙂
As someone who handles prior authorization all day every day, this is so scarily accurate. Insurance companies have wayyyyyyy to much control over people health and wellness. Doctors can't order generic tests or procedures without having to fight tooth and nail to get it approved. Insurance companies are only getting more strick on their guidelines, this will only get worse.
I'm actually applying to a prior authorization job and know nothing about it, and advice?
I used to process prior authorizations through medicare. Sometimes the questions didn't examine context. If someone is in a SNF & the controlled med is under lock and key, the patient is noncompos mentis, they don't need to be counseled about the addictiveness of the med🤦🏼♀️ The process is very dichromatic and leads to stupid decisions.
Any reviews for prior authorizations should be done by a third party and not the insurance company who has a built in conflict of interest to deny.
@@caesarq7513 true!
I was indirectly involved in the Prior Authorization stuff when I worked for a division of United Health.
I'm not a doc, but within our division, every decision about what type of care could be authorized, or not, was handled by a licensed physician. However, the idea about "so the person authorizing care is at least as qualified as the person directly carrying for the patient" didn't seem to be true. The doctors at our division may or may not have had the qualifications to make difficult patient-care decisions in each case they were handling
As a non American, I feel like every couple of weeks I learn about some new batshit crazy thing about the American healthcare system. You guys have it real rough out there.
Same
They vote for it....soooo... 🤷♀️🤷♀️🤷♀️🤷♀️🤷♀️🤷♀️
Well it used to not be sooo terrible because health insurance wasn’t as insanely expensive as it is today thanks to the “everyone is required to have health insurance” law and you used to be able to get in to see your doctor relatively quickly. Now you’ll wait 2-3 weeks to get in to see your doctor so by the time you see your doctor you’re either better but suffered through all that time to get better rather than getting better quickly, or you get worse and worse and require even stronger medicine and take even longer to get better.
@@sandysimpson4785 except, no… “We” didn’t vote for it. A shit head president decided for us that this was a good idea and his cronies followed him and voted it to be a law. Now the American people pay even more than we used to for the same or even worse coverage then we had before, and the people that didn’t have insurance who got treatment anyway and just didn’t pay now get treatment with their new free insurance…. And just don’t pay the reduced treatment bill which is then passed along to the rest of us anyway.
AMERICA IS SOOOOO N-O-T THE GREATEST COUNTRY ON EARTH 😐
The end “practicing medicine” reminds me of Kronk: “Oh, right. The poison. The poison for Kuzco, the poison chosen especially to kill Kuzco, Kuzco's poison. That poison?” 😂😂
I read it in his voice lol
To a T lol
I knew the cadence in his voice sounded like a line from something lol It was there in my brain but I couldn't figure out why it was so familiar. Thank you 😂
Lol 🤣 now I gotta look that up 😂
Came here to say this
Really wish this argument could be used to defeat the way health care works in America. How anyone can act like health insurance companies should have this much power is beyond me.
Its called lobbying and you can thank Regan for it
It's called fraud prevention.🤔🤫🤭
@@jeremysanchez8329 What kind of fraud does this prevent?
@@tth-2507 Medicare fraud for one but there are others
@@tth-2507 also believe it or not some people try to put in a high cost insurance claim to get out of work or to sue for more money
Someone play this on a loop in Congress until they get it!
They wouldn't give a shit. As long as the corporations (insurance company) keep putting money into their pockets they'll let them do whatever they want
SCARY SCENERIO😮😢
😢😢😢 SCARY-SCARY
@@bluestriker256 As long as Citizen's United is still on the books, we're not going anywhere.
They get it they know it they enabled it they get paid by it
This is just so awful that it’s true. Having the insurance company, whose whole existence is dedicated to making profit for shareholders, deciding if your life preserving treatment is necessary. Doctors should be treating patients as they were trained to do, not trying to negotiate a surgery or medication with an insurance company.
My former primary physician went out on her own and charges monthly and decides what tests are needed as she was tired of this happening.
1)
Yes, absolutely true.
2)
It has gotten to this ridiculously beaurcratic point because not EVERY Dr. is scrupulous...
This is SUPPOSED to negate Fraud, unskilled ( tho still "practicing ") personell, and absolutely UNNEEDED, unnecessary , and dangerous procedures.
HOW-EV-AR , what these "auditors" adhere to, ultimately, is $$$, bottom line, and as was pointed out, the MOST juicy paycheck possible to "The Shareholders" ...
They are also the third invisible man in the exam room with you & the doc, and are now dictating what drugs the docs are "allowed" to prescribe, in what quantities, and even ultimately determining what social/ political policies will be in the future.
Humbug!!!
@@sharonwolfe5210 it really blows my mind that a nation (which is all you people living in said nation) take up with that sh*t. Vote! Get it on the agenda! Don’t accept no for an answer! Universal healthcare is no place for capitalism.
@@dasophie1 voting does nothing when every option wants to do the same thing its getting to the point where were gonna actually need to use our 2nd amendment instead of talking about it like its our only personality trait
@@gabrielleguitarist5043 help me out here; you’re referring to an add on, from 1791, to the bill of rights that protects the rights of citizens to ‘bear arms’. How is thát gonna help? You wanna shoot your way out of this? Really… help me out here. Explain yourself
I love the depression slowly settling in as he realizes his life is a lie
That’s the bit
@@TSRUclipsr and he loves it. Chill out
This might be weird, but ya got sauce for that pfp?
@@spoopyd.8910 I found it on google forever ago. Can't remember where or what I searched to find it though. Don't think I even still have the image saved
@@maskedrecruit4571 damn that sucks. The artstyle seems so fucking familiar
It pains me to know this is true, BCBS (Blue Cross Blue Shield) was the insurance I had when I ruptured my spinal disc between my L4 and L5 dones. They wanted me to go to physical therapy after already getting 2 spinal steroid injections, not being able to bend toward my feet more than 15 degrees, could barely go to the bathroom by myself, couldn't sit in a chair more than 5 minutes, and couldn't sleep very well. Mind you, I was 20 at this time. Finally I found a doctor who did an X-ray and a MRI with and without contrast and I finally found out after almost a year of suffering that it wasn't just a "pinched nerve" I went into surgery less than 2 weeks later. The total of my "elective surgery" was $42,350 and the surgery lasted less than an hour. That surgeon is my hero, because by the end of it I was thinking of suicide because how bad the pain was. The American Healthcare System is a TRASH HEAP!
BCBS is a complete asshole of an insurance company (even for insurance company standards) which I have been dealing with too. Three months of excruciating pain and also slow death by sleep apnea, my Dr's put in for prior auths and they just never ever get back to them. Only one, for my EGD, they approved. All others, just sit on their desk indefinitely. I think they learned if they deny that way, patients and Dr's won't have a grievance or appeal process.
@@techguydilan wow that really sucks, hopefully someday soon we can fix the American Healthcare System, because we shouldn't have to fight like he'll to get medical help
I understand. I had BCBS and was suffering from endometriosis for years and in order to get the surgery, I would've had to come out of pocket $10k.
did you appeal the decision of medical neccesity? you prob could have recouped the mri and surgery if testing should clinical rational end surgery alleviated your pain. theirs lots of ways to regain that money back thru insurance by simply mailing in a form
I got hurt on the job. The work comp thought it was all in my head. Despite sending me to multiple psych doctors. That disagreed with them. They screwed around for over 10 yrs. I had an attorney. I ended up getting a new attorney. But bc they didn't and wouldn't accept that I had CRPS. I didn't get treatment so now I live every day in severe debilitating pain. My CRPS is from my toes to my shoulder blades. I wouldn't wish this disease on my worst enemy. I have other diagnosis as well. The pain I deal with everyday is compared to having an amputation without pain meds or anesthesia.
Welcome to the US.
My OB/GYN got on the phone and yelled at some pencil pusher at my insurance company for denying my medication that I had been on for years and attempting to PRESCRIBE SOMETHING ELSE in its place. My doctor was beyond mad.
That's a good doctor. Most just give up...mine did, then I had to educate his staff on how to properly fill out the insurance authorization paperwork so that it was accepted. Nothing like having to learn their job so I can teach it to them and pay for the privilege.
As a pharmacist, it’s irritating when the insurance requires PA and sad when you are the one to convey the news to the patient why their medication is not ready and won’t be until the next few days…
Yep. And if it's urgently needed medication, like heart medication or blood pressure medicine, your patient ends up in the ER again while waiting to find out if their insurance thinks they REALLY need that medication afterall. Ask me how I know that one 😬
I love when they won't cover it. The meds that the insurance would have paid $12 for you now have to pay out of pocket and it's no longer $12 but $510. You really have to love this system.
@@kuceracm that's actually how my pharmacist got them to authorize it every single time.
"No, we won't cover the medication that costs $400."
"Oh so you would rather pay several thousands for them when they end up in the hospital because they can't afford this medication that would have been $10."
At most it would take 2 days to be authorized. Mostly because it happened at the end of the day.
Same. Glad I'm working in cannabis now. No insurance, no prior authorization, no chasing doctors 🙌
Few days lol that's cute.. Mine take a couple weeks to a month or more for just the process of the doctor filling out the paper work and insurance approving it.
This is the system that led to me spending a year bedridden with pain because apparently there’s no way a 19 year old needs major spine surgery without having been in an accident so clearly I decided that spending a year in bed away from all of my friends was better than finishing the first semester of my first year in college that I had already paid for. 🙃
Depression can be brutal
@@bidmcms3 don’t be a dick; this is hella common.
Another example of paternalism:
I was denied dx for endometriosis for fourteen years to save my uterus in case a man wanted to use it later.
I popped out a kid and they’re taking my uterus now. Not removing leftover endo that’s causing my pain from my first surgery, just removing the fetal incubator bc it won’t stop bleeding. Ya know, since I was left to just die until I met the status quo so the tissue grew like cancer.
Nothing for suffering, just the complaint of anemia and hemorrhaging.
Oh and the average wait to dx endometriosis is 7 years bc no one believes uterus owners deserve pain-free lives. Research has been cited in Nancy’s nook and dr vidali of NYC’s findings for if you want to cite my sources. Good luck, took me years and I’m still reading.
@SpazNeedsAResetButton ABSOLUTE FACTS!! I wish I could be this concise and articulate in regards to my endo experience 😢 but please, KNOW, that I COMPLETELY understand because I am living it as well.
Thank you, for saying this, how you said it. I hope you wouldn't mind if I use your wording to explain to others because it is so eloquent and succinct🙏
@@bidmcms3 my depression had nothing to do with it. Before I had any scans done, I could point to exactly where the pain originated. And when the scans were done, it showed a herniated disk exactly where I pointed. I don’t know how the disk got herniated but the pain was not my depression. And once I got the surgery, the pain was gone. I had post-op pains for the standard amount of time but that surgery gave me my life back. The fact I didn’t know how I herniated the disk shouldn’t have mattered. The pain and debilitation it caused me should have been all that matters. But that wasn’t the case and I suffered for a year that I didn’t have to because of that.
@@bidmcms3 Depression is fucking hell, but so if a kidney infection going on 3 weeks to the point of your kidney shutting down. And the doctors telling your mom you could have died. Get your head out of your ass, not every single pain is "depression" fucking Boomer.
"Practicing medicine..." You could really tell how the realization dawned on him and how it devastated him 💀
…without the hassles of having to attend med school or acquire any of the related debts.
Probably the best word to describe the American health care system.
I learned the definition of “practicing medicine” when I was about 8 or 9 and I knew the name of some bone a med student couldn’t name on the spot. I love med students but I was a precocious kid who wanted to impress her doctors as much as the med student did.
This is why I absolutely despise insurance. You pay them a crap ton of money in case they need to cover something expensive, and then when they do they fight to deny it. Absolute crooks.
As an American with a debilitating neurological condition (I fall asleep randomly and lose control of my body multiple times a day), I recently was denied a medication that I was already taking for months that was working great when I switched insurances. Prior authorization people said I needed to try a few other medications first. Didn’t give me a reason other than it was “general policy”. So happy that general policy is to deny my doctors request, ignore my medical history, disregard my disability, and encourage me to put foreign stimulants in my body. 👏
Sorry you have to go through this 😢
My mom's insurance likes to "mix things up" with prescription coverage so some of her medications can go from covered to suddenly not. Our healthcare system is beyond frustratingly ridiculous.
i have the same neurological condition, type 2! get denied my meds by insurance a few times a year and have gone into withdrawal bc they have started to randomly deny it right before it gets refilled.
My sweet doctor always wants to beat my insurance with a rake for it but he knows to just fast track a prior authorization as many times as it takes now. Complete bs
I think that's absence seizure
This happened to me but after a lot of poking my nose where it shouldn't belong, I found out my doctor's office was filling out the paperwork wrong. I should have been reported as a continuation patient for the medication and they were reporting it as if I was just being prescribed that med for the first time. The doctors office staff had no clue that there was a difference or how much it mattered.
I absolutely love how average people are finally starting to see the issues that have plagued the US healthcare system for years. It's not the physicians, it's the corporations that used the government to control the physicians. Every medical professional I've spoken with would gladly take a paycut to get rid of these downright abusive systems that harm everyone.
Starting to see? We live in some fucking nightmare where my entire childhood every adult has agreed our Healthcare system is fucked up and yet I'm now 24 and it's like the conversation is JUST coming out.
@@OsiDio gotta wait for the old farts that make these decisions die out.
@@OsiDio yeah but I bet still a lot of people you encounter will bash handouts or rally against socialism..
It’s insurance in general. Insurance brings nothing to the table. Capitalism works where there’s room for stuff to be innovated. You’re an apple seller? One way to make greater profit is by making better apple growing procedures. Insurances only way to innovate is to find new ways to take more money than they give. That’s why it’s one of the few things that really needs to be government owned/run to actually benefit the general public.
It sucks but on the flip side many doctors and hospitals abuse the system and charge for non essential or incorrect treatment. Doctors want to make money and bill just as much as insurances want to save money
I literally had a doctor say to me once that "doctors don't really get to decide whats best for their patience the insurance company does" and it is true unless the patient can pay out of pocket.
This is 100% accurate. I tell this to my patients all the time. We have to change how medicine is paid for in the US.
*patients
I have said this for years in fact, whenever I’ve encountered it with my insurance company, denying some thing I asked to speak with the Doctor Who made the medical evaluation without seeing the patient. When they say there wasn’t a doctor involved, they ask for the nurse practitioner that made that decision, when they say there was no nurse practitioner involved. They ask who is practicing medicine without a license and can I please get their name and phone number. They usually hang up on me at that point.
Do you get the help that you need tho?
A year after moving, I found out my former dentist cracked one of my teeth grinding on it, and that I needed a root canal.
My new dentist told me that a root canal isn't covered by my insurance because chewing is now considered cosmetic.
🤨🙄🤦
Yeah, chewing is now on the same level of necessity as calf implants, except you don't rub your calves together to break up the food you eat to survive.
Right.
Ah yes because chewing is so pleasing to the eye. “Cosmetic” my ass.
WTF it’s not even your fault, but the dentist’s! I wish there was a way the medical system can undo this fuckup
What the actual Fu.....
Sorry, dude. 😢
Hooray for American Healthcare. Ranked 46th in life expectancy but rank 1 for most expensive Healthcare
Daily reminder that treatment in India/Eastern Europe is usually perfectly safe and of good quality and extremely cheap (even for Americans)
I was waiting in my gynecologist's office and overheard the nurse telling the doc that a procedure was denied for another patient. He rhetorically asked her why they would refuse it for a 75 year old woman who was having profuse vaginal bleeding. He was furious and got on the phone. I never knew what happened but I hope the insurance company approved the proper diagnostic tests. And I hope it wasn't cancer.
Sounds like vaginal and pelvic prolapse causing tearing or possibly even infection that's resulted in vaginal bleeding. It's really common in my area because gynecologists are so damn expensive, take so few insurance plans (and if you're poor and in Medicaid, you only get to see one if you are pregnant or your GP did a pap and found cancer) that women end up suffering for decades.
I was basically told last year my options were a medication that had caused blood clots, one that made me a barely in control rage monster, or bleed to death because they wouldn't perform a D and C on a woman who hadn't had any children yet "for fear of a a future lawsuit, especially a future husband lawsuit" if something should go wrong. A procedure done regularly in the past without complications, and now they apparently can't manage it without doing damage so extreme it causes either sterilization or inability to carry to term. And it's my fault for not having kids when I couldn't financially or emotionally care for them, that they were refusing the most effective treatment to stop a massive uterine hemorrhage. I took the Hulk Smash hormonal treatment, nearly lost my job (because passing out repeatedly at work and running to the bathroom to change post-partum level pads hadn't already caused enough strain, lets have a nasty resident who calls me an "inconvenient interruption" to her seeing her poor young mothers tell me side effects don't matter), but survived. Had to argue with multiple doctors to get back on treatment that prevented that nightmare years earlier when a family medicine doctor saw how off my hormone levels were and the risk of complications that created. Can't even see him now because of insurance drama. They really do just want all poor sick people to just die quickly and quietly and "stop being a drain on the system" as one person once accused me of being after suffering a seizure from a severe concussion missed by the ER doctor from a car accident.
@@KatieCottingham nailed it. We need to decrease the surplus population of psychopathic BILLIONAIRES!
@@KatieCottingham sorry, what in the actual fuck?! You had a SEIZURE and were accused of being a burden? I’m so done
Oh that sounds like endometrial cancer.
@@chloe_alien in my opinion, mine isnt that bad as I'm still here without having had a seizure, but I was told I was faking it when I checked myself into the psych ward for suicidal planning and paranoid delusions.
I still suffer, and the treatment I received that has put me in debt was being completely alone for 3 days, aside from having a nurse silently bringing me food.
Almost slammed my head into the floor. And I did slam it against all the walls hoping to knock myself out due to building stress that had no outlet and no end in sight.
Now I have brain damage and no way to get justice for being left alone for three days in my paranoid, and delusional state. I thought the President personally was trying to make me kill myself so he could have a good laugh. I someyime wonder if the paranoia was more on the nose then I will ever let myself believe.
The decommodification of healthcare is one of the most important actions our government could make, but chooses not to.
They're being paid not to. And those that are good enough to not accept the bribes/lobbying, get replaced by making other candidates more affable to their goals more relevant in politics.
This happens because healthcare is not a commodity
And it happens MORE in countries that have "free" healthcare
@@brandonn6099 I’m not sure how this works. If you truly believe it is worse in places with more affordable healthcare systems, can you explain in more detail? I genuinely want to know where you are coming from on this
@@Oscar4President Death panels. The Brits call it "rationing" healthcare. The government decides whether you live or die. Every government with free healthcare does it.
You can't just magically fix every ailment because the government is paying for it.
As a retired PA, I think this guy is brilliant and making absolutely important editorial medical points. Thank you and keep up the excellent work.
So grateful you made this one with the concept of insurance companies essentially practicing medicine denying reimbursement for the treatment recommended by the doctor.
I don't know anyone in the medical field that does not feel this way about it.
I agree with you. I'm happy he made this video. 💯
Let's get the lawyers on this. I wanna see how long until I can own one of these companies.
Years ago I was head butted by one of my cattle while feeding them. I had a tear in my eyelid on my right eye so much so that whenever I closed my eyes I could see daylight. Went to the ER and they couldn't stitch it closed so they simply glued the hole closed. 2 months later I get a bill of over $21,000. My insurance had denied payment due to the procedure not having prior authorization. After taking just under 3 weeks of making phone calls I finally got through to a human being that had the authority to override the decision. All it took was me asking them "So I guess I should have sewn up the hole in my eyelid by myself out in the pasture then. Is that what you are trying to tell me?" The bill was taken care the next day. I just love the bureaucracy.
I hope you're okay mate. We don't have system like this in india. We do have private doctors who charge alot but we also have quite alot cheap healthcare (government and many smal private doctors) I can't think how hard it must be for Americans with such an expensive healthcare. I mean most of your doctors are indians, indian doctors back home will charge 1/4 1/5 of what they'll charge (or rather their hospital management charge) before they move to America.
Anyway I hope you're fine and healthy.
Wow!! $21000 for slapping on some skin glue that costs under $20 at most pharmacy stores. And then not covering emergency treatment under the bs of prior authorization... I guess your insurance company needs to speak to your cattle able getting permission to head butt people prior to taking actions
I wish I never went through the exact same eye injury....IT HURT LIKE sh¡t
@@ggburnitup4055 this is my nightmare how the fuck do you sleep with an injury like that?
@@hardwirecars on the left side of my face....
I had “gross gynecomastia” to the extent that i would have qualified for a free breast reduction if i was a female. (More than 250g of tissue per breast, or at least 500g in total)
However because my sex is male and i was just unfortunate enough to have female breasts (i can not even begin to tell you how much grief it caused me) they denied the reduction mammaplast, forcing me to have to live with d cup breasts for another 4 years before i could finally afford to pay for the surgery, however there were surgical complications, i had a hematoma and was bleading out when i got home from surgery. The had to go back into surgery to cauterize that. The insurance also refused to pay for that and to this day im still paying it off.
Keep in mind i was in network the entire time, i have a long history of mental problems, half of which stemmed from a massive lack of confidence in my body. And i had multiple suicide attempts on my record because of it. It didnt matter to them.
Unfortunately I could not afford a lawyer to help me fight their decision, it would have been easily 20 hours of arguing or just over 6k-10k in lawyer fees...
im sorry that's horrible, the world does not make sense. make a go fund me page
All the while still paying for your health insurance.
Damn shame I hope you are at least able to get counseling?
@@HarlemSexyBlaqkat just keep fingers crossed that insurance will pay for at least part of the cost to get counseling. But even when they do agree that the sessions are covered, the copays & deductibles can make counseling very hard to pay for too.
I needed counseling & I was dirt poor, disabled, just divorced after being an at-home mom for a decade, and waiting for my disability claim to be approved by Social Security. I went to my church leaders for help with paying for counseling since I couldn’t.
Our national healthcare system keeps us sick. We are customers, not patients. There is NO REASON WHY IT HAS TO BE THIS HARD!!!
@@KatySueWho why sell the cure when you can sell symptom relief. Like you said, we are just their walking bags of money.
My insurance company didn't like the fact that I was in the hospital for 3 days and CALLED MY ROOM to ask how everything was doing and why I was in the hospital. I had a baby. Severe complications made me have a C-section. Person was extremely apologetic when I told them my child and I almost died a couple days prior and I was being kept for observation.
Holy...that's a new one on me! That's HORRIBLE!😡
Yes, some insurances have bright moments. Aetna called a family member receiving care for an ongoing condition to let them know their policy would cover some in home help if needed.
Wow. I got a call from my insurance company because I had an undiagnosed chronic illness and they wanted to offer me a nurse navigator. I read between the lines and interpreted that as "you are costing us too much money so we want to stick our nose into what's going on here." Turns out, I just had a bunch of really lousy doctors. I had pernicious anemia which is easy to treat.
As a pharm tech, I felt this. I always hate giving people the news that their insurance won’t pay for their medications. Some patients have to pay thousands of dollars for their stuff, or some just say they can’t get it at all. Which is so concerning, because half the time they are life saving or important quality of life drugs. We try to find coupon cards for them whenever we can, but we can only do so much sometimes
Man... life in the USA has to be stressful. Me, I managed to get my asthma medication for like $5 when it is usually around $50 for a package of three. Simply because I had reached a payment limit over the year. Making the rest of my medication way cheaper. If it went high enough, I wouldn't have to pay anything at all.
I live in Sweden, BTW. And while taxes is a huge part of it, it isn't the whole story.
Gotta love that ridiculous markup on medicine so the insurance companies don't get mad that they're paying more than the people they're supposed to pay for
Y'all want to know the worst part? Health insurance artificially marks up the sticker price to flex their "negotiated" rates. I buy my perscription for $10 a bottle, and without insurance it's $150 a bottle, but I never made my deductible, and insurance doesn't pay a dime. They literally just raise the price for poor people for no fucking reason except to flex "how much cheaper it is when you buy through us!" Almost all of these drug companies have "assistance" programs too that will just sell it at the normal cost too, you don't even have to meet any requirements just go through the hoops to ask them in the right way.
The base price for most drugs is over 10x what it is immediately across the boarder into Canada. They pay way less for healthcare and have much better outcomes than us.
I find that so insane, that a person can end up in the situation of needing a critical medication but having the money, so the system literally says "go die about it 🤷"
Sometimes coupons from the drug companies are worthless especially if you are on Medicare. They won’t let you use the coupon because Medicare helps pay some of the cost. Which is stupid because the medicine is still waaaay too expensive.
what really gets me is that we know this yet it continues to happen. its criminal.
Money is speech and the medical industry has the loudest voices.
If it is criminal, sue them
@@pedrosso0It is *unethical*. The only reason it isn’t criminal is because it’s still legal. It’s absolutely an unethical system, though. If insurance is a capitalist manifestation of collective health care management, then it relies on competition and supply/demand to remain cost-effective. The problem here is that “demand” is not determined by a patient’s desires; there are few, if any, affordable alternatives; and it is much more costly to maintain.
A single healthcare system cuts down significantly on administrative and record-keeping costs because all records can be housed in a central repository. No prior authorizations means freeing up time for doctors to see more patients/provide more care.
Further, the system would only need to run at-cost: no profit necessary.
These companies profit off of denying care. When people decide to forgo care because it is too expensive, they profit, too.
It is unethical, and in a just world it would absolutely be criminal. A single-payer system would be great, but what we need right now is a very cheap public option to force insurance companies out of the market entirely.
@@TechnoSpicewouldn’t the medical industry benefit from more approvals to do work? That’s like saying contractors make more money by turning down projects. Sounds more like insurance is the one with the money and power
@@josiahbaumgartner7643 Sure the MEDICAL industry would benefit, but Insurance isnt the medical industry and they hate literally everyone for no reason other than "This is money i get for free to not spend on the one thing we are supposed to spend it on. Also, Insurance shouldnt have been a thing in the first place but you know, again, fucking money
What kills me is that even after a prior authorization has been approved for a type of prescription for a patient, the doctor has explained why the patient needs that drug and what other cheaper drugs the doctor has tried for this condition, 6 months later, insurance company can and usually do make the doctor repeat the same paper work for prior authorization all over again. You may have to go weeks to a full month or more suffering without your medicine for prior authorization to get completed.
I go thru this every month, for the same prescription written by the same Dr. - Its total B.S.
Been there with that Belbucca crap that is for “around the clock pain”. Not only is it super expensive, authorizations are needed like every other month, and it doesn’t even work. So I stopped that after a month or two of trying it.
They use numbers and stats to play with medicine. Normalize individualized health care.
In Canada it’s the government that authorizes treatments and they can deny you major surgeries
The insurance companies & doctors have to play by & follow the RULES set by the Government bureaucrats at MEDICARE or they loose their ability to get reimbursed by MEDICARE. They are also subject to big fines & or jail time for NOT following the MEDICARE rules & formulations when it comes to Medicare & Medicaid patients. Since it is harder to maintain & operate within 2 separate systems with the same price schemes almost all doctors, Insurance carriers, & HMOs follow the MEDICARE RULES & pricing for all their patients.
Some still offer "cash" discounts, especially if it is for something Medicare (or your Health Insurance which has to follow MEDICARE policies) does not allow for.
I've dealt with this a lot from the administrative side. Their excuse is always, we aren't saying he can't have it, we're just saying we're not paying for it.
As a pharmacy technician, I’ve never thought prior auths should be a thing. They can hold up a prescription for days if the doc isn’t on top of handling the request we send and I don’t think the insurance company should have a part in deciding which meds a patient should get or not (besides maybe deciding brand vs generic bc of obvious price differences)
I also don’t like that pharmaceutical companies purposely trying to keep patients on a med for as long as possible until they die for profit.
@@hereallydohatesandtho8304 While I do agree that many pharmaceutical companies practice predatory and scam-like practices with many of their medications (don’t get me started on medicine commercials 🙄), I do believe that keeping a patient alive for as long as possible is in their best interest. “Die for profit” is an oxymoron
@@Elquequ3 not if the patient costs more to keep alive to the insurance company 🤷
@@lisacallan5462 That’s a different argument altogether. Insurance companies and pharmaceutical companies are separate entities. I, personally, hate private insurance companies for a litany of reasons.
We actually are currently on billing and insurance chapter for my pharmacy tech class and it is a bunch of bs how insurance companies work and get to decide who gets what
EXACTLY! I can’t stand insurance companies micro managing our health. It’s BS! I would explain how both my diabetic sons have to jump thru hoops to get their insulin and diabetic supplies because the insurance company thinks they know better then their drs but I don’t want to get angry this early in the morning 🙄🤦♀️🤬
I am so sorry that your family has to suffer through this. Tragically, this will never improve until more people understand what you have experienced, which is that healthcare has become "too big to care"-- patients are revenue streams rather than human beings. Most doctors along with people like you desperately want to see fundamental changes, but cannot figure out a way to get the message across to enough people to be able to effect the changes we know are needed.
@@username912912it’s called lobbying and both Democrats and Republicans have failed the American public, they need to make these things actual republic votes instead of having a democratic candidate to speak for the majority which is barely the majority in most places
@username912912 less Healthcare but insurance companies. Like the vid says they're basically practicing medicine without a license in making these calls. It's so dumb. Hell I've had to take so many meds just to get to the one I could've and should've started at first if it wasn't for insurance companies pulling bs. Same for surgeries if it weren't for them 😢
My dad is so weak because insurance denied his medicine. They said it’s too expensive and he’s not sick enough to get it. So he missed a week’s worth and today we found him on the floor. He was so cold and couldn’t get up. I hope there’s someone to investigate these insurance companies and give them fines.
You need to speak up then so the people will notice
To keep it real unfortunately you need to pony up the costs and or go to jurisdiction where you can afford it. Otherwise you’ll continue to get screwed over as you watch your parent suffer. I’m really sorry man. Our health care in the US is fucked
Fines are just the cost of doing business. People need to start advocating for jail time.
@@A_Box yeah, such things should be criminal offenses.
@@A_Box or putting the insurance company out of business since they are clearly a SCAM!!!
Reminds me of a time in college when my fiancée got taken off of vyvanse and put on adderall after her father’s work changed insurance providers and they didn’t want to pay for vyvanse twice a day. Grades tanked, she had physical outbursts, super angry with mood swings, had to increase anxiety medication, etc. all because an insurance company decided her medicine she had been on for the past 4 years was too expensive.
I spent years of my life listening to terrible hold music and filling out hundreds of prior auth forms on behalf of providers when I was an outpatient/acute psych nurse. Watching patients decomp because their instance company changed what medications they covered or wouldn't continue something that they had been stabilized in while inpatient was one of the worst parts of those jobs. Anytime someone tells me our system is superior to nationalized healthcare I launch into a 30+ minute diatribe.
Sadly, Medicare for all won't fix it either. Medicare part D, the part that covers medications, are frequently managed by four profit insurance companies that require prior auths for basically everything. It's the worst.
Thanks for that last part. Want to see change in the system, but it seriously needs to be started from the ground up, but ACTUAL healthcare professionals. Not just people voted into office.
When we say Medicare for all, it includes fixes to that system too. If everyone is in the same boat, you bet for damn sure there will be fixes. If we sink, we all sink!
New plan then: Medicare for all PLUS we feed all the executives of insurance companies to starving sharks. That fixes the medicare part D problem
You have no idea what you are talking about.
Yes, this is my fear. Everyone wants socialized medicine, but I don't forsee it solving the problem since the same system would still be used to manage the care. I don't see it being fixed in my lifetime and that terrifies me for my disabled daughter.
As a prosecutor, I sooooo wish someone would let me go after those people…. 🤞🤞( IWishIWishIWish…)
If you see my reply, can you help someone in Massachusetts?
While you're at it help me too please
Have a Ortho in NYC that disables any patient that smokes cigarettes
List is at 10 or more
Although i admire your honor and commitment to make America a better place, i don't think a prosecutor could do much unless you're a federal prosecutor. The health insurance companies line the pockets of politicians and that's what you have to stop for this to end.
@@yecrof4873 bump
The people deciding that are the same people who own the insurance companies
A really fantastic grace of this, is that so many doctors I've had over the years were more than willing to extend helpfulness, when predatory insurance issues ever arose.
Just a few months ago I had my medication coverage denied in letter-form, stating there was no medical proof that my medication treated my diagnosis.... the same diagnosis my medication is commercially stated to be used for. I was in such a panicked state, I wouldn't ever have the ability to pay an extra $200 a month for something i need to function, and I could NOT imagine going back to rawdogging my symptoms 😭😭
My doctor met with me immediately, she called it total horseshit. Literally just ended up just half-ing the pill dose, and writing a prescription for twice that amount. The insurance company accepted it. Their entire business model is based on fear and intimidation based on completely inaccurate information, knowing that they're preying on people who wouldn't be able to take it to court.... because they're already dealing with so many medical issues.
right, i know of doctors who are really good at writing their prescriptions/treatments in a way that insurance companies will accept. it's crazy the lengths they have to go to in order for patients to not be financially crippled by A THING THEY NEED TO BE HEALTHY AND LIVE because of the way insurance companies work.
My medication is $21,000 per dose and can only be ordered via specialty pharamacy. The specialty pharmacy is owned by my insurance. Everytime I try to order my medication they give me the DUMBEST reasons for denying it, and every time it takes a solid 3-4 hours to get it. My favorite was the time I had to spend 5 hours explaining to 8 different people that it made 0 sense that they (the specialty pharamacy owned by my insurance company) didnt have my insurance information, and therefore they should not need 3 weeks to request and process said information. Its not even a medication for some rare or debilitating condition or anything, I just have psoriasis :(
Finally someone says what I’ve been saying for years! Even got the prior authorization because I asked why they were practicing medicine without a medical license. Brass tax denial meant they knew more than the actual doctor and I wanted to know who gave them that authority. Immediate approval and asked to never call again.
Whats is Brass tax?
So ALL doctors need to be asking the insurance companies this question - or the docs will help the patients sue them for practising without a license.
This really needs to be a CLASS ACTION!!!!
@@elijahhernandez906 assuming brass tacks. As in a hard line.
Dude you are seriously doing a huge service to society with this video. Thank you for taking xtra time from your day to do this!
As someone who just graduated and can't really afford insurance at the moment, the thought of somehow getting injured and not being able to cover it is terrifying. Health insurance just raises prices for medical treatment and hurts everyone who just simply can't afford it. It's a huge scam that never should've been allowed to start with.
If *heaven forbid* you do get injured or end up with a serious illness, the hospital usually gives deep discounts to those who are self-pay. They’ll also work with you to set up a payment plan that’s affordable for you. Hospitals love being able to work with a patient to get the treatment they need (and also pay their staff). If, in the future, you do have a large debt owed to insurance or a medical facility, just keep paying at least $15 at a time. As long as you’re making payments, they can’t send it to collections.
Lauren: that's not true. Self payers are required to pre-pay full market rate price. I was asked to put down $32K few years ago. Whereas insurance gets heavily discounted rates
@@laurenfuerst8802 none of that is true. This is the kind of goofy feel-good misinformation that Republicans spread to keep the money printer running.
You would probably qualify for a very low cost policy. There are insurance agents who will do the legwork,to find you a policy. They get paid by the insurance company so it costs you nothing. You should get coverage ..even if it’s just catastrophic care, you don’t want to risk that. I hate that it’s this way. And it’s not a new phenomenon.
I don't know where you are but in California in a situation like that you could try to apply for emergency MediCal right from the hospital; they have staff who will help you. If you meet the financial qualifications they could cover everything or almost everything. Check with social services from your state to see if you have that option.
Back in the early 90’s, I had gallstones. Surgeon said the gallbladder needed to come out. The insurance company wanted me to carve out 90 minutes to discuss why I needed this surgery. The first thought that ran through my head was that I convinced the surgeon that this was my quick weight loss plan - divest myself of organs I don’t really need. I decided to behave myself, though… The nurse calls. First question: why do you think I need my gall bladder removed. I stifled my sarcasm, even bypassed the obvious - my doctor said so - and responded “because I have gallstones.” She replied that gallstones always required the removal of the gallbladder and the call ended. Less than 90 seconds. Really? REALLY?
Serious question. How did you resist the sarcastic response? Mine always slip out without my brain engaging first!!
@@MrsMBash22 I was younger then. The filter is less selective with age.
Although, in grad school, My ex sprained his ankle. The insurance company denied his claim. It appeared that the X-rays weren’t requested by an MD. It happened late in the evening, so apparently either the ER doc or the radiology tech confused the date. I called them and they argued with me! So, in a voice dripping with sarcasm (and sarcasm IS my second language), I asked, “So you’re saying that he wandered into the radiology dept of a major hospital and asked for an X-ray, and they said, “Sure, hop on up, we’ll take care of you”? No paperwork or questions asked?” They paid the bill.
I often wonder how we’re all still alive with insurance companies driving the bus.
“Quick weight loss program via organ removal!!” 🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣
@Lauren I wonder that too. Then I get sad because I KNOW there are people who arent around anymore, either because they couldn't pay so they didn't get care, or because the insurance company practiced medicine without a license or even knowing the first thing about a patient and overrode what the Dr ordered.
@@lauren9667 i got billed for getting blood work without a referral once! How the hell would I get my bloodwork done without a referral? Just walk in there and poke myself? 🤦🏻♀️ they will do anything to squeeze money out of people and make you pay for their mistakes.
My ex-husband died waiting for heart medication to be approved. This was the VA, another gatekeeper. Our son was devastated.
This is so sad. I see it everyday in outpatient facilities and hospitals. I was always the deliverer of bad news when the authorizations weren't approved. Many of these patients had cancer.
Sadly has a cancer patient I think it's because it costs so much to treat us and keep us alive....depending on stage is how they (insurance) values our lives. I am stage 4 metastatic and have had my insurance say some stupid crap. My favorite was that I had to see my GP that they assigned to get a referral to see a oncologist. I was diagnosed after going to ER the wait to see that GP was 8 plus months. I said to heck with that and started calling oncologists and cancer clinics on my own. Found one 75 miles away that took my insurance and is a great clinic. I am lucky.
An example of what I face as a pharmacist. I was processing a prescription for a product that has 2 medications, one of which is 250mg. The insurance paid a fraction of the cost. When I called they said it is reference based pricing. This means that they pay the amount of a comparable product. I asked and was told it was compared with a product that was the same as the 250mg but actually they paid the price of that ingredient at 50mg. Hardly comparable. I managed to get around them by processing the 2 ingredients separately. Not always able to do that
I think I remember Valsartan/HCTZ was like that for a hot minute a while back. It’s ridiculous!
@@stephw6046 yup. and frustrating.
So much of our time is wasted just to make these parasitic multibillion insurance companies do their fuc king jobs!!
@@stephw6046 My mom is on valsartan and her insurance is always denying refill requests.
Yes, this situation happened to me. Even my doctor testified 5 times that I need the test but still they denied the request. According to them "Lack of clinical proof". It is devastating.
It's wild that you can lay it all out like this, and we still haven't fixed the system.
I love how this M.D avidly points out how criminal privatized insurance really is. I’m 28 with full PPO coverage and had three trips to the hospital last year and I’m still thousands of dollars in debt . America ladies and gentlemen
Freedumb and lieberty
The country is not wrong, it's the people running it!
I don't have a problem with privatized insurance - what I have a problem with is insurance companies practicing medicine.
Its not just privatized insurance that does this. For this reason i never make a Drs appt on a Thur or Fri bc every month i have to get a PA for the same med written by the same Dr. I got tired of bothering him after hours. I have a good Dr.
@@JerMal that’s exactly what ended up happening and I only chose PPO because I was uneducated when I selected my plan and was given the notion that you pay a bit more but in the long run if anything where to happen my coverage would allow me to have a wider selection of providers and out of pocket would be less. I was given the idea that HMO in my area would be very limiting. Thank you for kindly sharing this information, for a second when I got notified about your reply I thought you were going to call me an idiot.
My point still stands though, this shouldn’t even be a problem people have to deal with a first world country, hell anyone for that matter. Quality health coverage is a necessity not a privilege.
I appreciate you talking about this subject! As a pharm tech I constantly have to explain this to patients and then they accuse either us or the doctor of “not doing their job” when in reality the insurance companies are the real villains
cool then charge 20k for a single injection and bypass the insurance company, let me know how the patient feels about that. Or maybe understand that without insurance policies and guidelines they would go out of business.
@@daemonsw77 Or perhaps you get universal healthcare and it is no longer a worry. Like every other civilized country.
@@daemonsw77 Guidelines aren't going to provide a solution for everything, edge cases should allow the hospital to go along with planned procedure given sufficient explanation that it's the best, if not only, solution
@@jagodaduda2976 sufficient explanation to who and comparable to what? you mean with current standard practices or gasp guidelines. Do you not realize insurance companies base medic necessity off standard practice guidelines developed by independent doctors and proven case history? why should insurance companies pay 10x more for a drug when guidelines state another drug at a fraction of the cost will work, especially when the hospital stands to make the most out of the situation by buying certain medicines in bulk cheaper and charging for the single dose price. its not the doctors or insurance companies its actually the facilities and their corporate identities who are the villains, unless of course we need top notch emergency or healthcare at a facility that has the best equipment and services then you love them. its all relative no matter who you try and point fingers at
@@daemonsw77 damn hearing profit in the same sentence with healthcare really over complicates medicine. I'm glad I work in the UK. Sure I get paid a fraction of what they get in the US but I at least can prescribe the likely best treatment for my patients. The only issue is the time patients have to wait to see us.
The good thing about the americain healt care system is that it allowed us to see Breaking Bad
Might as well call it the American Health Cult System, seems more fitting. Lmao
@@deathberryjam907 Haha good one
The only good people thing
@@deathberryjam907 Nah. The actual "American health care system" Government insurance is just as bad if not worse. Because at that point you have your GOVERNMENT telling you that they dont think you need that care.
@@ashleybrown5883 that's got be the dumbest thing relating to health care I have ever heard
Doctor here. So incredibly true. Dealing with insurance companies is the worst part of the job. Not only do they practice medicine as is mentioned, they'll deny something because of a missing punctuation mark. One time it was denied because I used "PTSD" instead of writing it all out.
I’m 25 and a 2x cancer survivor, I’m blessed to have good health insurance, and I’m active in a lot of young adult cancer support groups, and it’s honestly so devastating the amount of times I’ve had friend become critically and/or terminally ill solely based upon issues with insurance companies not wanting to cover screenings requested by the patient.
I did dialysis for about 5 years before I got my kidney last september and the amount of times i couldnt take x medicine but could take x medicine that cost 6x the amount of the first one because it was denied.. Its insane
As a European i just cannot grasp my head around this. Makes me feel blessed that I got all kinds of treatments without any delay.
In my country if you have insurance the doctor is allowed to give you any kind of treatment that needs to be done to benefit your health or save your life (unless it's crazy expensive like $1M).
@@misshoneynevercame4832 i am really curious which dream country you are living in ^^ seriouly i am. Because as a molecular biologist with parts in pathology i dont know any country you are talking about. I am Swiss, born in Austria, lived in Switzerland, Austria, Germany, Netherlands, Sweden, Norway, Italy and America. A half year long in Liechtenstein as well 😛
Why don’t you guys just get national healthcare? Like the rest of the worldv
@@danieldavis5465 idk, why don’t you phone up Joe and see if he can have it done by this afternoon?
And when the insurance company authorizes treatment there is still not any promise to actually pay for the service. Essentially, they have just said that your claim is not rejected. Yet.
Lol. Exactly
:(
This actually brings back traumatic memories when I got injured at my work literally due to no fault of my own, but my employer’s negligence. And had to go through workers compensation. It was an actual living nightmare.
The system is so broken and terrifying
U.S health system is terrible though. I broke my ankle 3 weeks ago at work and was sent to a hospital got xrays, triage , my medicine and all i payed for was an air cast wgich was only 150$ and workers comp will cover like 75% of my time off . I cant imagine being told no for something i need by insurance .
A lawyer will help with comp
I work in a kitchen and 99% of kitchen injuries are the result of stupid and slow people doing insanely idiotic things, like running through the kitchen with a sharp knife for example. Stupid people get injured and it drives up costs for everyone else!
@@robertcutts3929 Oh man I’m sorry to hear about your work injury. I hope you have a speedy healthy recovery.
@A R that’s wrong. It‘s because at least half of your country screams „communism!“ everytime someone tries to change your antisocial structures. But „big pharma“ is always a good target for blaming lol.
Yep just went through this with my six month old baby girl!! I went to the pharmacy after going in to a sick visit and did not realize that she needed prior authorization for albuterol for her nebulizer she had RSV needless to say the pediatricians office was closed and they said she definitely wouldn’t get the medicine that night. Surprise surprise I couldn’t pay for it out of pocket because I didn’t have the money to buy it it was over $200, she got worse in the night and she ended up in the hospital needing oxygen and in the end got albuterol in the hospital so her insurance ended up paying 100+ times more than they would have if they just approved the damn medicine and my poor baby ended up in the hospital because she didn’t get the outpatient medication she needed!!
yep. These insurance scammers are DEFINITELY practising medicine without a license.
The insurance company saying “Not medically necessary” means this is going to cost you a lot of money.
This is simply not true. Everybody follows a major independent guideline developed by an army of doctors. Cost is NEVER the issue. But getting a Masectomy to treat you kidney stones is.
Yup. I no longer work in "health care" because it is not health care in the US.
It's a litigious based health care model that is not remotely evidence based, and trying to have conversations with people about it (because trauma doesn't lead to informed conversations) is about impossible.
I refuse to work with insurance companies, like since 1997. Pregnant people should not go into this kind of debt for the worst maternity care of any industrial nation.
The US has a higher maternal and neonate morbidity rate than all the industrial nations, and almost 70 "emerging nations", but fear drives the decision making process so it's not going to change until people decide women and children are human beings, not cost extractive business models...
there is a special place in hell for insurance companies
They go to satans bedchambers wearing a lighter-fluid tshirt
Capitalism is the main problem become a communist
If hell exists, I wish it were so.
@@ujjalshill6442 to many, pots, Stalins, Maos, lenins and minhs to my liking.
@@Internetguy_L337_90D there has never been a communist country and those people were not communist
4 years ago I had a MSSA infection, which grew an abscess on my spleen and infarced half of it. I spent 2 months admitted because soonercare was giving the team looking over me a hard time. My hospitalist, Dr. Richards got so upset he came into my room (and I've cussed with him before this point and he's knows it's okay) cussing about how much they're fighting so I could get home health care and be at home.
The even more insane part about it is the 6 weeks I spent in a hospital room DWARFED the cost of just sending me home with a PICC line and IV. The point this guys making is very valid. Just like police and even emergency operators are being required to have more training, there should definitely be more education required of the insurance company.
The insurance companies don't want more training. The refusals and denials are the point. They just want to wear people down so they stop fighting for coverage.
Also, I hope you are feeling better now 🙏
and just imagine... we could have universal healthcare like every real country and then the insurance agents could train for new jobs that actually contribute to society rather than making everything worse.
So glad I found out about this shit before going into Med School, there is no way I could stand working for insurance like this.
There are doctors that choose a different model. There's a family Doctor I know who doesn't accept any insurance, you pay an annual subscription fee to him for his services and he's on call to you. Text, call, video chat, he'll do house calls and he works and has a relationship with one of the local hospitals and gets you deals on lab work and other things. Unfortunately I don't live in the same state and I've been looking for a doctor who operates like him ever since.
This is 100% true. I had came down with acute inflation that inhibited my ability to walk and all insurance approved was blood tests for the first year. After a year of dealing with extreme pain, loss of mobility and huge life changing affects at the age of 23, the insurance never paid the money for scans to help me feel better. Only figured out what was going on through tons of self research to determine I have an auto immune disease. Insurance is a heartless business.
I came expecting a pretty funny video and halfway through it turned into a nigtmare realization. This needs to be shared a lot. This is not just a video. This is very powerful information.
The US is the only country in which Breaking Bad could take place.
No bull. In Mexico, a neighbour of mine had cancer and went through multiple surgeries and rounds of chemo. Not only did he not pay a single cent for the entirety of his treatment and all of his meds, but he also got full paid medical leave for an entire year that didn't count against his retirement. The company he worked for? Coca-cola. This company could do the same for any worker in the USA, but only did so in Mexico because they have laws that require companies to treat their workers fairly.
@@JorgeRodriguez-ue9rr Americans actually sneak INTO Mexico to get healthcare. Healthcare tourism is common because Mexico somehow has a better system.
Not really Walter did what he did because he wanted to live the rest of his life best ad possible
@@sidd7926 that's not true. Initially he got into making meth to fund his chemo. Then it became a way for him to fund his children's education. It then morphed into him seeing how high he could go, and he built an empire. In other words, his actions ended up being fueled by spite and greed, and a show to others of how capable he was.
It really isn’t.. obviously there are worse countries with even worse medical practices out there, however i agree the medical system is ridiculous and needs reform. I think law enforcement will reform first and the medical system will be soon to follow
The best part about insurance is that simply having it is financially devastating if you are chronically ill. $900 a month comes out of my husband's paychecks to cover premiums cuz I'm so sick and that's if we don't seek medical care at all. On top of that we have to pay for every appointment, test, and procedure.
Makes me want to cry. Roof over your head and food or insurance.
I'm Swedish, living in Sweden. I have chronic illness and have several medicines on prescription. I pay less out of pocket for appointments AND medicines IN A WHOLE YEAR, than you pay for insurance per month!
Granted, we pay a lot of taxes here, but that also means having that very heavily subsidized medical care and prescriptions (no matter if you're on disability benefits, or the CEO of IKEA), all kids get free (cooked) lunch at school on every school day, daycare is subsidized so that it's available to every family and not just the rich. And that's just a few examples of the many many things that are funded by our taxes. I don't have children, or even like children (they can easily cause sensory overload for me) but I'm more than happy to make sure they get a proper, nutritious lunch at school (which for some kids can be their one proper meal in a day if the family is struggling financially) by paying my taxes. It takes a village...
@@ReyOfLight we wanted to move to Sweden and I was gearing up to go on a research visa, but I can only manage part time work anymore. Disabled people are only allowed to immigrate to Sweden (and most other countries) if they are doing it on a highly skilled worker visa like the research visa. So we are stuck here.
@@wsue1038 and you get fined if you don't have insurance! 🥲
As a medical assistant, I feel this. I used to be on the phone for so long trying to get medication approved for patients.
You are the hero in the current US medical system.
I'd love to see a class action suit against every insurance company for this. If a doctor orders it, the insurance company should simply sign the check.
Hahahhahahaa
Yea.. cause no patient or doctor would be corrupt enough to bill insurance 500k for a 4oz bottle of cough syrup. 😂
@@purpleXpotionnobody says the doctor OR the patient should decide the price of the cough syrup. But if the doctor says the patient needs it for his HEALTH, then the HEALTH insurance should cover it. If it turns out to cost an unrealistic amount of money, let the insurance company take it up with the manufacturer of the cough syrup. Not with the patient or the doctor.
@@felix3138 And then patients get the following response from insurance:
_”Please allow 4-6 years for us to negotiate the legitimacy of cost relating to your request for cough syrup medication. Alternately, please feel free to criminalize yourself buying opiates off the street.”_ 😆
Yeah except for all those old school, and maybe less than trustworthy doctors ordering expensive and unfound tests just to line their pockets.
1 bad apple ruins the bunch, and that's why the system is what it is now.
Somewhere along the line, 1 shitty doctor was ordering experimental treatments for something unnecessary and insurance was just paying it.
Girl I dated was on disability. They would just randomly willy nilly tell her doc "nah we don't wanna pay for that one. Do the other one." Which would be on file as very ineffective for her issues. US insurance is messed up
I just had a patient with basal cell carcinoma (skin cancer) on his back that physician ordered PET scan for in August - insurance refused even after appeal so pt never got.
Instead he showed up to hospital in October in uncontrolled pain. He was packed with cancer throughout his spine, liver and lung- just went on in-patient hospice.
Healthcare is beyond frustrating and heart breaking
That's horrible. He could've been saved.
I didn't know basal could metastasize that way. I've had 3 on my face. Surgeon said don't ignore lesions on the head because it's a short trip to the brain and those are the ones that kill. He never mentioned anything about basal elsewhere on the body. Now, melanoma is known to spread and kill quickly.
I take topamax and emgality as migraine preventatives. For 2 years my insurance denied covering emgality. The first year they said they wouldn’t cover it because I didn’t try other specific classes of meds first, starting with beta blockers. My neuro responded saying shes not going to prescribe beta blockers because I have moderate (sometimes severe) asthma. The second year - after I had been taking emgality for a year thanks for Eli Lilly’s coupon covering all but $1.50 a month - they denied it saying according to my records I didn’t have enough migraines. Because the medication they wouldn’t cover was working. They did finally cover it and now I have a new insurance that didn’t even question coverage.
I'm also a chronic migraine sufferer and the fact that I saw "topamax" and was able to predict the direction your comment was going is... upsetting.
I used to have migraines with side numbness that resembled a stroke and was treated like a drug seeker.
I take amovig and had a similarly difficult time getting it
@@seanathanbeanathan it’s so great 😐
@mrE365 every insurance plan is different. It’s important that you reach out to the plans themselves and discuss which has the best benefits that suits your needs. This person’s situation is totally different, she was prescribed a very expensive newer drug on the market. Age related denials are from plan to plan but also easily solvable by your healthcare provider.
@@seanathanbeanathan I have chronic migraines but refuse to get treatment. I have bad arthritis and its already hard getting pain meds for that so I just can't bother with my migraines. With both my migraines and arthritis I tend to just try to sleep it off and usually just get sick in the process. Its great /s
@mrE365 total healthcare. The literal worst. I have blue care now
I have a lot of feelings but shoving them aside, I just wanted to thank you for making a skit that explains the absurdity of it all in such a concise way. You’re awesome and your skits help keep me sane!
The best part is that in dr.’s offices, the staff (medical assistants, nurses etc.) are the ones in charge of processing PA’s, so if you go to a poorly run office, those PA’s pile up until they find the time to look into it.
Tell me about it! My dad had a stress test and other test back in October. His chest is been hurting last few days so he went to doctor. Turns out be had a mild heart attack before the stress test sometime and it's now December and it just came to light when they looked at report . Well doc says he needs a stint but insurance says his artery isn't blocked enough yet ,it needs to be like 10 percent more before they will cover it. 😒
Some offices do that, I’m glad where I worked we tried to get everything done that same day
Yup I'm a nurse at a doctor's office. We have a large patient population with 5 doctors but 4 medical assistants and 2 nurses but not everyone works everyday so we are constantly short staffed. so in addition to rooming patients refilling scripts triaging patients answering medication or procedure questions prior Authorizations are not a priority. I mean covid hit us hard to the point of having 60 plus calls and 30 plus emails to deal with on a daily basis. We cannot get to everything and struggling.
@@starfireonvf thank you! Office nurse here too. It’s not that we don’t want to do the PA’s there is just more than we can handle but everyone thinks their needs are the most important and have 0 patience.
Sounds like a staffing issue. Almost like ppl don't want to work for such a vile and corrupt system
I may live in an "undeveloped" country, but knowing that I can get a life-saving surgery without being charged for it if I need to makes me proud. Americans should fight for public healthcare
There is very little chance we can change this. Half the country is gaslit to believe this is *the best* way to have medical innovations. The truth is that politicians will never change the system because of the millions of dollars they personally are paid by insurance lobbyist. To remove lobbying, we need a majority of politicians to agree and act against their own financial betterment. We are a nation where the mega-corporations actually run the country and call the shots by buying politicians to do their bidding, and no hope of that changing.
Same. Im from a developing country and my insurance pays almost everything including doctor appointment and surgeries. Other than some meds, the rest is basically free!
This breaks my heart. So grateful to live in Australia.
Yeah, all that government authoritarianism really is worth It.
Thank God I'm about as far from there as one can be
@@mmalovr57 authoritarianism? Bitch where
@@spicysalad3013 really? open your eyes dipshit.
@@mmalovr57 Australia is rather well off from what I hear, other than horrible internet, fires, and racial tension.
THIS!!! As someone who has a chronic condition, on top of other diagnoses, I'm absolutely sick (ha) of all the hoops I have to jump through as a patient. I can only imagine how it is for the doctors.
I am sorry you have to suffer through our broken system. I hope you find good physician advocates that can help you fight. As you know, there are plenty of (most likely burned out) doctors who are not good advocates either because they don't understand the complexities of what the healthcare system places on patients, or feel like it isn't their responsibility to work late days every day to fight a battle that we know we'll probably lose anyhow. At any given time, we have hundreds of people that we are fighting for one thing or another. At a certain point, just to maintain our sanity, we have to create some boundaries or burnout is all but assured. I like to believe that I still fight very hard, but each year it becomes more hopeless...
As a medical biller, i felt this on another level. I am the middle man between the doctor and insurance companies. Its is the saddest feeling when i cant get the patients approved. Btw, Electives and non surgical is the hardest to get approval for.
I have been amazed over the years to see how many necessary procedures are termed "elective" too, things that are not cosmetic or optional in any way. The things they do with words.
Thanks to your videos, I now know what prior authorizations are! When I got my medication the other day, and the pharmacist told me that I would need a prior authorization to get it, I knew to go “AUUUUUGGGHHHHH”
Glad that prior to then you had not encountered that problem!
Prior authorization: doctor: " You need this medicine"
doctor to pharmacy: "He needs this medicine"
Pharmacy to insurance: "His doctor says he needs this medicine"
Insurance to doctor: "Does he need this? Let's just ask the doctor"
I work for an insurance company. For my company (and it IS a company) it's not "let's just ask the doctor", it's "let's ask /our/ doctor/nurse whose only relationship with the patient is whatever documents their provider has sent us and who has never met the patient."
@@LeeLeeMak Soooo an unqualified individual?
@@BjornNatan no, they're still qualified. When it's medication, especially certain kinds, they're reviewed by a nurse/doctor to make sure that the doctor prescribing it, isn't doing so just because the patient wants it, and that they actually need it. There are patients who somehow get doctors that just give them what they want, including prescribing meds and diagnosing either incorrectly or at a higher level than they actually are. Some doctors are not as afraid of malpractice as they should be.
@@BjornNatan not unqualified in the sense that they didn't go to medical school. They just don't necessarily have a personal relationship with the patients seeking a PA. Sometimes that's a good thing because do people go to whatever doctor will prescribe them something. But it's also often not a good thing because doctors know their patients best.
Yep had this issue happen with a parent multiple times. Mainly with the main meds they have to take because of their transplant. I’ve had to tell them you want them to go back to where they were without the transplant. Then they go quiet no issues once you get at them for being ignorant.
THIS IS TEACHING!! 99% of people making laws about teaching aren't teachers and have never spent time in a classroom since they left one.
Most teachers also don't really know how to read the law either. It's quite the paradox but if you think about it, Slave owners shouldn't have made their own laws. That'd be a massive conflict of interest
@@VicSellsPeace teaching is a public service. Their existence is only to help. there is no benefit for the teachers. Slave owners only profit themselves. So yes it's a huge conflict of interest. Same as if you let business men make all the policies. Us the consumers suffer from it because they're only going to introduce policies where they get most of the profit. And sometimes to the disadvantage of the consumers
@@azzahraa7943 Teaching is fundementally not a public good. It is a private activity transported to the public domain by any body of governemnt.
@@VicSellsPeace "a private activity transported to public domain"..... Thus making it a public good..
Assuming they were in one.. At this point, I'm convinced a high schooler probably can make better decisions than those idiots.
This is so horrifying to hear. I had a brief stint at an insurance agency dealing with these types of letters and for us there was a doctor for every department (DME, dental, etc…) and they mostly approved everything and if they denied it was just bc they were asking for more paperwork. I assumed it worked that way across the board. The fact it doesn’t is super alarming.
Sadly they'll deny things simply because of stable vitals at X time after medicine has been administered for pain control and claim it is no longer emergent because "well their vitals are stable" b!tch I'm not leaving this person in extreme pain while I wait for auth from you! What even are you?! - a real life senario from September.
What agency did you work for?
I work in dental. We pretty much tell the patient what you will pay or not pay. You all tell us upfront what is covered. We have to tell people everyday they will need to pay or pull a tooth that we have ways to save.
We are giving dentures to 17 year olds because insurance won't cover root canals, crowns, or implants.
Insurance companies dictate patient care way before a PA is needed.
@@brittany7573 I must have bitchin dental insurance then because I have been begging for dentures for YEARS and they (the dentists) won't do it! They just pull it, root canal it or fill it and 6 months down the road I'm back again. I have a family history of bad teeth, and several health problems that exacerbate this issue. I have 5 set to be removed soon 🙄 I just want them all out and to be DONE! I'm 33 btw
@@mistyarcher802 I understand your frustration. If you have an underlying health issue, full mouth extractions might be a good route.
But normally we discouraged removal of healthy or save able teeth. Your jaw bone has one purpose, to support teeth. If the bone doesn't have teeth, the body will absorb the bone. That is why older people without teeth look like their jaws and face are all squished together. This becomes a problem because you won't have a ridge as you age. The ridge is what keeps the dentures in your mouth.
You are so young. I wish you didn't need dentures
Sounds like how it should run! Medicaid/ Medicare is very stingy but private insurance should want to keep their clients.
I’ve had this happen multiple times. It’s the main reason I’m still dealing with a facial spasm issue because they denied a CAT Scan ordered by the Neurologist. Thanks guys! This is fabulous to deal with X not embarrassing or life altering at all. 🤬
THIS NEEDS TO GO AS FAR AND AS VIRAL AS WE CAN GET IT! That’s how I feel. As soon as he said, “and that will eventually just cause MORE MENTAL HEALTH ISSUES..” We need everyone to hear this fr!
But its wrong info. It should not be shared. Denials are only made by doctors.
@@makona2002 Search it up its true
As a teen who aims to become a doctor, damn I'm glad to be living in France
Train hard kid! We need more people. Grow your passion. Meet more of us in the medical field. It's a hard job but not once have I woken up on a Monday and thought to myself "oh god..."
French health system is great but we have to fight to keep it that way.
as someone who is not gonna be a medical professional but would still need a lot of healthcare, damn i'm glad to not be living in the usa. also, best of luck to you!
Glad we don't have this capitalist system in France, we have a system that comes from the "CNR" or National Council of the Resistance (Conseil National de la Résistance) where there is national health care managed by the state put in place by the commies and lefties who were numerous in the Résistance (as the big bosses and the right had collaborated with the nazies they got shot or had to shut up) off course over the last 70 years the right and the ultra-rich have been chipping away at it to privatise it so the insurances (private compagnies) get theirs hands on our health care money
Hell yeah !... Oh, wait... Ummm, courage, les prochaines années s'annoncent pas folles.
Yep almost got denied a chemo med, it was recommended my doctor prescribe another med or change the dose, for stage 4 lymphoma. Survived that to now live with an immune deficiency which requires infusions of antibodies to keep me close to healthy and out of the hospital or off constant antibiotics. Now I and my Drs get to regularly argue with my insurance. I even had a 6 week delay of treatment this year, good times.
I was diagnosed with Lupus at 14, and have some other health issues. I swear, prior authorizations are the story of my life!
Haven’t gotten my meds in nearly a month because apparently my insurance knows more then my doctor.
My age long question remains: *WHY DO AMERICANS PUT UP WITH THIS*
Money. Those who make the decisions get big donations, and spread misinformation. For example, when Obamacare was initially being crafted, it was toned down because insurance company messaging made it seem scary for there to be a public option and talked about "death panels" but we already have death panels, they're also known as insurance companies.
Capitalism is a hell of a drug.
So, just to understand, what's the issue with those infamous "death panels" that politicians want voters to believe exist in all countries with socialized health care? That they would not produce a profit for a private company? I mean, if they existed, which they don't, in what would they differ from the current US system, besides that?
I think that people there are basically brainwashed from a young age to think that the US is the best country in the world, and that any change that could resemble socialism in any way is a step towards communism. I lived in the US for a year, and I saw this attitude in many smart, well educated and kind people. The school system is in my opinion not doing a good job of teaching the pupils about other countries, cooperation between different countries, or critical thinking in general. I think that this is one of the major reasons why Americans are reluctant to vote for someone who wants to change the healtcare system.
Also what has been stated about the power of the organisations currently profiting on the American healthcare system..
People are so afraid of becoming ill that they've convinced themselves it's a moral failing and is somehow our fault for needing healthcare. It's ableism all the way down.
So effed true! As a certified medical assistant for 20 years, I can say I probably spent 5 of those compiling evidence for prior auths. Now as a disabled "professional patient" I have to wait on the other side for approvals. 😭
Insurance companies in nursing homes can say how long a Patient can have physical and or occupational therapies. The usual cut off is if the Patient can walk 50 feet they can go home regardless if they can or can’t bathe and or dress themselves. It used to be the therapist had the say as to how long a patient needed therapy. Sometimes even the administrator gets in on the decision regardless of what the therapist say.
Oh god don’t even get me started on PA’s. Having to explain it to patients on the pharmacy end is the best and worst thing ever. Best because you send it in and it’s out of your hands, worst because 90% of the general public doesn’t know what it is and wants to argue with us half the time
I'm currently trying to get my doctor's office to send an authorization to my insurance company to get a shingles vaccine. They denied me because I'm under the age of 50... even though I'm immunosuppressed.... and literally recovered from shingles months ago and am at risk of getting it again... Well, i guess it's up to them if they don't want to cover the vaccine, but would rather cover the valtrex prescription each time or a possible hospital admission if another shingles episode comes back worse or in a place that's vision threatening.
I’m sorry to hear this, I know that the US HCS is messed up, but to deny you a vaccine that is both lifesaving and preventative disgusts me - it’s tragic that this country’s healthcare system is so fragmented, confusing and expensive for no reason other than insurance companies privatizing medical access to those they deem worthy. Patients, doctors, and hospital admins all suffer under the thumb of big pharma and insurance agencies. Livelihoods are destroyed and lives are lost prematurely because of hubris and greed - it’s tragic. Best luck 🍀 to you, your loved one’s and good vibes headed your way. Stay safe out there! 👍
I work for a PBM. When prior authorizations get rejected like this you can always submit a benefit appeal. Usually prior authorizations will only be approved if you meet certain criteria while a benefit appeal will look at the whole situation.
Hope that helps
@@1985Mischief thank you for mentioning this. I didn’t know I could file a benefit appeal if they denied the prior authorization.
Hey Dr. G, I don’t know if you will see my comment. As an aspiring doctor, I really appreciate how you create videos not only about the life as a medical student but including the issue with the health insurance, which can be very complex and frustrating process to understand. Thank you for spreading the awareness about this issue and explaining in a way that it is very easy to understand.
I wish you all the best of luck, PreMed Bear. Go make the world better! 😊
Spot on.
I am a social worker and work as a Care Manager. Be nice to all the secretaries and RN’s in clinics, because they often do all the ground work for the “Prior Auth’s”, even when it’s a medication that is prescribed monthly.
Ridiculous system and great video.