this post was submitted on 08 Dec 2024
1577 points (98.6% liked)
Mildly Interesting
17559 readers
2 users here now
This is for strictly mildly interesting material. If it's too interesting, it doesn't belong. If it's not interesting, it doesn't belong.
This is obviously an objective criteria, so the mods are always right. Or maybe mildly right? Ahh.. what do we know?
Just post some stuff and don't spam.
founded 2 years ago
MODERATORS
you are viewing a single comment's thread
view the rest of the comments
view the rest of the comments
And your doctor will have to fight with the insurance company over the phone for an hour to do a pre-auth. When my doctor wants to perform something or give a certain treatment not covered, he assures me he will make this long and stressful call. I really wonder what they are discussing and what goes on in these conversations...
Agree I feel fortunate to have found a doctor(and their PA, and their staff) who feels like my own personal swat team to get my treatments. I am not wealthy and don't have gold plated coverage, I just found a winner.
It's so much paperwork and phone tag.
I was the feisty little gremlin that fought with the insurance at a cancer-focused plastic surgery clinic. I got really good at stacking up all of the info in the first submission so that they couldn't drag their heels on shit that was time-sensitive.
Preesh.
As an EMT I rode with too many people who were sobbing in the bus because they knew the financial hit that was coming when we got to the ER.
I'm in medical school now and looking at either emergency med or family med, and either way, I am going to be exceedingly careful about how I construct my notes, diagnoses, evaluations, and treatment plans to leave as few cracks as possible for the insurance companies to try to weasel their way into.
I would encourage you to CAREFULLY and WITH DETAIL listen to your senior tutors (senior grisled paramedics, charge nurses, etc). They have a very particular line to walk and you can blow the show if you don't learn the language.
It's performative...everyone in the equation wants the patient to get the best, but if you haul off and make it obvious, they may be screwed.
Not saying you'd do that, but it's a new world of...bullshit nuance.
Edit and if they ever give you a knowing look, and ask you to check the blinker fluid, or if the vending machine is stocked with saline, nod, and go "check". They want to talk to the patient with no witnesses, so they can coach them on how to fit a proper insurance code.
I am quite familiar with this nonsense from the patient side as well. As a physician, I think I will be well-placed to ensure that my patients are getting appropriate care while not giving the insurance company bullshit reasons to deny claims.
Good on you. I mean no assumption, only shared advice from some years in the trenches.
When I was a clinic assistant in a cancer-focused plastic surgery clinic, it was my job to fight with the insurance companies. I did prior authorizations for every surgery and they would do shit like approve the removal of a melanoma without requiring prior authorization, but performing the skin graft to repair the 10cm diameter hole required a prior authorization because the procedure code falls under the "Plastic Surgery" heading and they wanted to make sure you're not getting skin grafts for cosmetic reasons.
I've had doctors lead me to make certain statements so they can more readily justify a given treatment that they know I need.
It's a bit of a wink-and-a-nod situation.
It's even worse if you're part of an HMO, because the doctors are beholden to the business side, unlike independent doctors who don't have a management overhead telling them how many times a year they can prescribe a treatment, becuase they're doing it more frequently than other doctors in the system.
This demonstrates the major issue with socialized care, because it's also managed this way. I've been in both HMO and PPO systems - overall they both cost about the same despite HMOs acting like they cover more day-to-day stuff. It's just with PPO (independent doctors), I get care that's more tailored to me and my wishes, I don't get pushback from corporate, because there's no corporate involved. I may have to discuss with my doctor how to present things so my insurance won't push back, but at least the insurance company doesn't directly control my doctor's salary, bonus, etc.
All this crap started in the 80's as business management orgs started taking over healthcare organizations and consolidating them, and turning them into profit centers.