#american health insurance sucks

[timewasjustadream]

I hate the US health insurance system, particularly Aetna. They are the worst.

For the past 3-4 weeks, I've had sudden, new symptoms in lower back that I haven't felt since I had back surgery 5 years ago. Tingling in the feet. Sciatica. Pain near the spine. Back muscles feeling like they are working harder than they should. Can only sit on the edge of a seat because sitting normally hurts.

I saw my doctor. Got a steroid pack to try to pull down the inflammation. I'm seeing a physical therapist for a leg muscle pull and they are concerned about the sudden change in my back given my history. They wanted me to see a spine specialist. I should note that I can't go back to my surgeon because he doesn't practice anymore.

I contacted a new spine center. They won't see me without an MRI because of my surgical history. I went back to my primary care doctor, who ordered the MRI. I got it scheduled for about a week later. I checked the patient portal last night (appointment is tomorrow) and the appointment is gone.

Turns out, Aetna denied the MRI so the radiology place canceled my appointment without telling me. I'm still scheduled to see the spine doc on Tuesday (6 days from now).

So I got the MRI rescheduled to today and I paid $867 out of pocket to have an MRI that my insurance should have covered if I had suffered for 2 more weeks and gone back to my doctor after.

Yep. Aetna requires 6 weeks of "treatment" and a follow up visit to my primary care before they will pay for an MRI. Mind you, had they covered it, I would have paid $100 and they would have paid $400. $400!! And they would have paid 6 weeks of PT (probably going to happen anyway) and the follow up visit to my doc.

I called Aetna and asked about the denial. They told me the above but also told me the other MRI policies. 15 days for pre-authorization, which I didn't successfully get past. If the doctor marks it as "urgent", they can do the pre-authorization in 72 hours.

How do they define "urgent" you may ask.

To Aetna, "urgent" = can wait 3 days = "imminent loss of life, imminent loss of limb, or condition will worsen"

3 days if you might not be alive soon?! 3 days if you might lose an arm?! 3 fucking days! AND that's if the doctor marks it as urgent and they may still need to call Aetna and talk with someone to actually get it taken seriously.

I hate Aetna.

[secsysweetcadaver]

[yellobb]

American “healthcare” can go fuck itself please and thank you

[reno-the-himbo-turk]

American healthcare at its fucking finest pt 1

So due to where I live being a red state being ran by assholes I started my Trans Journey properly roughly 4ish months ago. Now thanks to the fact I work 3rd shift I really can't be out and about during the day and my off days are weird. I really only have one solid day for appointments as the nearest trans care is over 30+ minutes away without rush hour traffic which is when I get off work assuming I am not forced/asked to stay late For those of you who live outside of America depending on where you are at in America there are multiple hospitals/doctors offices in your area and some of them are ran by different groups. Where I am at we have SSM, BJC/WASH-U, and MERCY are the big three. Now I do most of my medical stuff with BJC 95% of it for at least the last 15 or so years. Now this matters as BJC will share records with any BJC/WASH-U doctor no questions asked and will gladly refer you to another doctor if needed from BJC normally in pretty much the blink of an eye. Now they will not be able to access or share records with SSM/MERCY normally unless you go through a lot of paperwork and hoop jumping and if said doctor works at several facilities you can tell them I need paperwork sent to Blank place and more often than not they will mail/fax it to the wrong building (at least on my experiences) which then requires more waiting time (days in my cases) in addition to hoping they can basically look it up and be like "ohh it got sent to X place instead of Y place" Then going from there. Now why this is relevant. The doctor I see for transitioning is a specialist that with my insurance I pay a $75 copay to see. They deal with Endocrinology and issues of that nature. When I started seeing the doctor months ago I was able to get appointments for Thursdays which is the one day I am truly free to safely drive 30+ minutes to visit a doctor. My doctor for T no longer has Thursday appointments. They have 3 different facilities with different doctors I could in theory see, but after going through the hassle of telling them I need to change doctors for that reason, getting my doctor to approve it and then waiting on any number of other doctors to approve a patient switch I get told none of them have Thursday appointments. Instead I am told I have to do Zoom appointments on days that don't work for me which is an issue because I will have lab work that would need to be done and they still make you do in person visits every so often which if they only have non-Thursday days won't work. I also do not have a clean, safe, and private filming area for Zoom meetings because I do not live alone and cannot afford too when rent where i'm at is easily 1200-2000 a month and they would like you to make 2-3x that.

[an-absolute-trainwreck]

im fighting against my eczema and im losing

[dont-read-this-im-dead]

I have a pretty high pain tolerance. Like, I stub my toe, you'll hear me "swear" and complain loudly about it for several minutes, but I'm mostly just ranting. If you hear me complain on an hourly basis, it's not bad, and you learn to just ignore me.

But then there's PAIN. Pain which doesn't go away over time, often gets worse the longer I wait to tell someone about it. The pain that makes you curl up into a ball and cry for days on end, but instead, you put on a smile and go right into work like nothing is wrong. I will push it away for days, weeks, even months before I admit it hurts, just so I don't sound like a cry baby to everyone else.

I literally woke up screaming from pain at 4 am this morning. Tears running down my cheeks, I can't even curl into a ball because it HURTS something FIERCE. I've recovered from surgeries that didn't hurt as much as this. I've had actual holes drilled into my HEAD that didn't hurt HALF as much as my knees do now.

That's when I realized this kind of pain is not normal, and I really need to see a doctor.

So wish me luck. Idk how I'm gonna get there, because I'm in NO condition to drive, but I'll find a way.

[raspberryconverse]

*sigh* TFW you have too much anxiety to contact your spouse's insurance to find out how they handle out of network providers (do we need to hit the deductible first?) and so you probably have to reschedule your appointment to talk to a psychiatrist to help you figure out how to treat your anxiety.

This really sucks because I definitely have $300, but my spouse is paying so much to keep me on their insurance for this month I'm without my own coverage that it's so fucking stupid that I'd have to pay $300.

I made it so far and got this appointment only to have it be a fucking nightmare before it even happens. And you wonder why I didn't want to do this.

[lavinia-de-mortalium]

Took myself to Emergency on Monday for extremely high blood pressure (we're talking 210/160) because my regular doctor was too booked to see me for the next 6 months. 2.5 hours, 2 EKG's, a blood draw, and some monitoring, and the doctor on shift said, "Yep, you have extremely high blood pressure. We can't do much but provide a low dose of lisinopril for 30 days. Try and get into your doctors.

~Welcome to the American Health Care System~

[radiosummons]

POV: You're forced to study over 400 pages worth of health and medical insurance, as well as 200 additional pages of standard federal and state law practices and regulations in a 1 and 1/2 week time span in order to pass a licensing exam. And if you fail the exam, you'll be out $300 and have to start all over and pay an additional $300 to try again.

[justinspoliticalcorner]

Andrew Perez at Rolling Stone:

EARLIER THIS WEEK, two Democratic senators announced they have requested a criminal investigation into Supreme Court Justice Clarence Thomas — regarding, in part, a loan for a luxury RV provided by a longtime executive at UnitedHealth Group, one of America’s largest health insurers. Thomas apparently recused himself in at least two cases involving UnitedHealth when the loan was active, according to a Rolling Stone review. Yet, he separately chose to participate in another health insurance case and authored the court’s unanimous opinion in 2004. The ruling broadly benefited the industry — shielding employer-sponsored health insurers from damages if they refuse to cover certain services and patients are harmed. Thomas’ advice to patients facing such denials? Pull out your checkbook.

While UnitedHealth was not a party to the case, the company belonged to two trade associations that filed a brief urging the Supreme Court to side with the insurers.  “As we saw so starkly this term, Supreme Court decisions can have sweeping collateral implications: If the court rules in favor of one insurance giant, for instance, it tends to be a boon for all the other insurance giants, too,” says Alex Aronson, executive director at the judicial reform group Court Accountability. “That was the case here, and it’s a perfect example of why justices shouldn’t accept gifts — especially secret ones — from industry titans whose interests are implicated, whether directly or indirectly, by their rulings.” The public had no way of knowing about Thomas’ RV loan at the time of the decision: The loan was only exposed by The New York Times last year. Senate Democrats investigating Thomas believe that much or all of the loan, for a $267,230 motor coach, was ultimately forgiven. Sens. Sheldon Whitehouse (D-R.I.) and Ron Wyden (D-Ore.) recently requested the Justice Department investigate whether Thomas reported the forgiven portion of the loan on his tax filings, after he failed to disclose it in ethics forms.

Meanwhile, Thomas’ health insurance opinion has had wide-ranging, long-lasting ramifications, according to Mark DeBofsky, an employee benefits lawyer and former law professor.  “It hasn’t been rectified. The repercussions continue,” DeBofsky tells Rolling Stone. “People who are in dire need of specific medical care, and [their] insurance company turns around and says, ‘That care is not medically necessary,’ and there’s an adverse outcome as a result of the denial of the treatment, or hospitalization, or service — there’s no recompense for what could have been an unnecessary death or serious injury.” Since last year, the Supreme Court has faced an unprecedented ethics crisis, with much of the focus aimed squarely at Thomas. ProPublica reported that Thomas received and failed to disclose two decades worth of luxury gifts from a conservative billionaire, Harlan Crow, who allegedly provided free private jet and superyacht trips to Thomas and his wife; bought a house from Thomas and allowed the justice’s elderly mother to live there for free; and paid for at least two years of boarding school tuition for Thomas’ grandnephew.

[...] Federal law requires Supreme Court justices to recuse themselves in any case where their “impartiality might reasonably be questioned.” The justices decide for themselves when such a move is necessary — and when they do withdraw from a case, they rarely say why. Thomas does not appear to have explained his decision to withdraw from the two matters that directly involved UnitedHealth. Thomas did not take similar steps in Aetna Health Inc. v. Davila, a case that broadly affected the health insurance industry. He instead authored the court’s opinion, which expanded insurers’ favorite tool for limiting liability: ERISA. Congress passed the Employee Retirement Income Security Act, commonly known as ERISA, in 1974 to protect employee benefits. The law is relatively vague when it comes to “welfare benefits,” and contains a broad preemption clause. The courts have filled in the blanks — including in the Aetna Health case — with distressing results for patients. Half of Americans have employer-sponsored health insurance coverage; nearly all of these plans are governed by ERISA.

Rolling Stone exposes how SCOTUS Justice Clarence Thomas received a $267K RV from a health insurance executive.

[dr-jingles]

Art is hard when Life is Happening but we persist- That's to say I've had a Big Life event happen recently, and a series other things to keep the punches coming. Some context below [ CW death, pet death, uh tooth issues ?]. I want to get back into drawing a bit more regularly- to get back some normalcy in my life. I might start up streaming again, or I might just start posting more whatever doodles here to help keep me on track. But thanks to everyone who has stuck around, and for all the love you've given me and especially my silly little characters.

On July 20th my father passed away. I still don't really know how to cope with it- or process it. I can't rightly put to words how important he was to me, just like the rest of my family. He was always supportive in his own way- encouraging of my art- and was the one who introduced me to the wonders of video games and MUCH more. Then August 3rd, two weeks later, our family dog passed away. I know it will get easier with time, but it's still hard. It all sucks a lot. I've got great friends and a good support system to help me through it, and I'm so thankful for that. So then of course I have to get some dental work done [root canal babeyyy] which was not cheap even with insurance [love that American health care system] and it will need a crown sooner rather than later just to add the cherry on top of this Sundae. I swear it better start going up from here cos I'm starting to run out of pegs to get knocked down from. [ I will be alright, just using a bit of some good ol humor to help cope].

[celestie0]

hey!! currently reading ihm and as someone who is in nursing school and has terrible health insurance, reader tearing up about medical debt made me tear up as well. american health insurance can be so frustrating and disappointing, and you did a wonderful job writing that out.

anyways, i just finished pt2 and i really am loving the series so far, and cannot wait for the moment when reader and gojo realize their feelings for each other!!! hope you’re having an amazing day!!!💐🤍

hiii darling omg yes it really sucks how health insurance strife is an issue so many americans deal with! i had horrendous health insurance at both the hospitals i used to work at and even rn i can't afford anything lol i had to stop going to therapy bc it's just outrageously expensive compared to my old insurance. and that's, like...minimal. there are people out there who are actually drowning in debt bc they have chronic conditions that need continuous management or had an accident that they are healing from. the whole "buy at an unknown price now, then pay it later" in our healthcare system is NUTS and like idk i know that ihm reader is just fictional but even when i write for her and try to channel those feelings, it's like, because i KNOW that there are people that actually go through that and are going through it rn, it's just heartbreaking.

anywhosdfhkjlsdhfk i went on a rant but i'm so happy you're enjoying the series so far!! and yes still a long way to go for the feelingsss but i'm excited to get there :) you have an amazing day too and good luck with your studies!!

[ashleywool]

health update/diatribe/infodump BUT THERE'S A CAT VIDEO AT THE END

Dearest reader: This should be a simple health update, but instead, it's an obnoxiously detailed info-dump written by the kind of person who knows more than most people about American health insurance but is still surprised at how it continues to find new and innovative ways to suck. If this is not the type of thing your brain or nervous system wants to wrap itself around, I don't blame you one bit, but if it is, I hope you'll at least walk away having learned something or being at least mildly entertained. If not, feel free to

SCROLL TO THE END FOR A HTDIO-ADJACENT CAT VIDEO!

When last we left our third-or-fourth-favorite mildly niche-famous T-list Broadway person, she was finally on the brink of getting a brain and pituitary MRI. This was supposed to happen on Friday.

But I wasn't allowed to get the MRI on Friday because Cigna's pre-authorization was still pending and there was nothing my doctor could do to escalate its urgency, nor could they withdraw the order. They couldn't do anything at all until the third-party organization that approves the pre-authorizations signed off on its medical necessity.

Look, I get it. This is an expensive and labor-intensive procedure, so they have to be thorough. I mean, sure, my doctor said it was medically necessary, and sure, they sent the additional clinical information to confirm its medically necessity, and sure, every order at every stage was marked as urgently medically necessary, and it was sent for processing on Monday, but how can they REALLY be sure it's medically necessary until my case is also reviewed by doctors who have NEVER seen me, and don't work weekends or holidays, and will get around to reviewing it at their own leisure? The folks at the radiology clinic rescheduled me in their next available spot and maintained that they'd contact me as soon as possible to fill any upcoming cancellation spots.

A ridiculous mildly annoying setback was that their next available appointment wasn't until July 26. They couldn't attempt to book me at any of the other dozens of clinics affiliated with this hospital network, because the pre-authorization is site-specific, which is like buying someone a gift card from the Starbucks on my block only to find out that they won't honor it at the Starbucks two blocks down perfectly reasonable, because I'm sure every site has differences that can't be perceived from a patient perspective.

Oh, and the existence of a pending pre-authorization prevented them from doing the MRI that day even if I'd had $8K in cash to pay out of pocket for the procedure. Which is perfectly reasonable, because why shouldn't American healthcare policy punish rich people too? I'm sure it's many flavors of unethical for one doctor to do something without the approval of another doctor even though the doctor whose approval it hangs on has NEVER SEEN ME.

One fellow in particular--I'll call him Quincy--gave me some insider info on how to prepare for the types of advocacy he's had to do in the past with this particular pre-authorization team, and which numbers to call and questions to ask. He isn't technically supposed to know this stuff and also isn't technically supposed to share it, but says he does it all the time anyway--hence why I'm keeping him anonymous. Quincy isn't his real name, but Quincy is a real one, and I took in his information like a medieval warrior selecting the choicest armor to prepare for battle the informed and fully compliant patient I strive to be.

Anyway, a few persistent phone calls later, a Cigna rep informed me that the middlemen would approve the pre-authorization for the MRI on the condition that I get the procedure done at a standalone radiology facility instead of a hospital-affiliated facility. Which is like buying someone a gift card that could only be honored at Starbucks kiosks located inside Target stores, but not at a standalone Starbucks or anywhere else in Target perfectly reasonable, I know the insurance companies don't wanna have to spend hospital prices any more than I do. So I spent a great deal of time yesterday looking up non-hospital-affiliated radiology clinics that were in-network.

I made an appointment with one clinic for Thursday. But I also made an appointment request at a different clinic for Monday morning, just in case they could see me sooner--because I knew this clinic didn't accept Medicare or Medicaid, and were therefore exempt from the requirement of third-party pre-authorization. (Pro-tip: even if you do have Medicare or Medicaid, always try to bypass pre-authorization for diagnostic procedures, especially if you have a particularly high in-network deductible--it's entirely possible that paying out of pocket for a service at an out-of-network provider could cost less than the amount you'd have to pay towards your deductible at at in-network facility. American math.)

THIS MORNING, I woke up at 8am to a phone call from the latter clinic, saying that if I sent them the doctor's prescription, they could pre-authorize the procedure and see me tomorrow. So that's what I did...and then I got an email saying that they couldn't accept a prescription for an MRI with and without contrast because they don't have contrast at that facility. Which is like finally securing a coveted reservation at an elite steakhouse only to find out they don't season their steak or even have steak sauce perfectly reasonable, because not everyone needs contrast, but I do, so that place was out.

But as far as I've been told, Thursday's appointment should go off without a hitch as long as I call EviCore (the pre-authorization middlemen) tomorrow morning to tell them all about the not-hospital that will be giving me a not-hospital-priced MRI, so that they can grant the pre-authorization at long last.

Perhaps if I plead my case and bat my eyes at them real cute-like through the phone, they'll give me some other reason why it's actually not medically necessary for me to know definitively whether or not I have a literal brain tumor I can get seen even sooner than Thursday.

FUNNY STORY THOUGH...

A couple weeks ago I was talking to a friend from church who was going through a lot of the same stuff as I was, and I was like "idk, maybe get your cortisol checked?" and lo and behold, he messaged me back a few days ago saying that he'd found a new doctor and asked him to do just that, and WITHIN A DAY his doctor ordered ALL the labs I'd fought for (serum blood cortisol, low-dose dexamethasone suppression test, 24-hour urine, saliva, etc.) AND an MRI for suspected Cushing's.

And he completed ALL OF THAT within a week.

Although he did have to suffer for quite a while before I floated the possibility of Cushing's, just like my friend Alan had to suffer for years before his own endocrinologists floated the possibility of Cushing's. Still, they both got that MRI the second it WAS floated, without a fight, and I'm genuinely happy for them.

But I can't help wondering how much quicker and easier this whole process would have been for me if I were a man. Or if I was neurotypical. Or if I still had a choice about whether or not to disclose being autistic. But mostly if I were a man.

THIS IS THE END! HERE IS THE HTDIO-ADJACENT CAT VIDEO YOU WERE PROMISED!

I'm fostering my friends' exquisite tuxedo princessfloof for a few weeks. Chevy and Tex are being very accommodating foster siblings, but she's much younger and is used to being the only pet, so naturally it took her a while to acclimate.

But there was one thing she took to immediately: the How to Dance in Ohio fidget spinner.

[reno-the-himbo-turk]

American healthcare at its fucking finest pt 2.

After explaining that zoom won't be a long term fix and the fact that I live 30-40 minutes away from the doctors office so going after work isn't an option as I would be driving into Rush hour traffic and have no idea how long it takes me to get there, plus I don't leave work on time often. The scheduling person no joke tells me "that I could just burn my vacation days and take vacation days or swap shifts with a coworker" or "that I could just go to work and request to switch my days off, or call in ill." Now the issue with both of these statements is swapping shifts whilst allowed isn't overly common at my job, I have a chronic condition that doesn't leave much sick time.

Swapping my days isn't feasible as the company went through a restructuring thing while back. If I request to change my days off though that means I'd be working with horrible manager more often and that I would no longer be guaranteed a full 40 hours as I agreed to this set of off days and signed a piece of paper saying if I keep these days off I will get 40 hours guaranteed as it was their big push to cut peoples hours if they tried getting premium days off (So weekends like Friday, Saturday, Sunday) as a weekly day off. They let you have one but not both. Most people want their days off to be back to back. If I am not Full time I loose my medical insurance.

Come the end of my call with Scheduling I am told that "I wasn't her problem and If I was inflexible then I needed to seek treatment at another set of doctors and hospitals" at this point 95% of all my medical care for my adult life is through them.

When I wrote my doctor back via the online patient portal and explained all of this and asked her what do I do/how do i keep getting medical care the nurse fucking writes me back and just tells me "Sorry we can't see you on Thursdays."

[shiraishi--kanade]

Wait so you have universal health care and also have huge medical bills??? I'm genuinely confused

Anon, you're probably American and you know what, I'm as confused about how American healthcare works and how therefore you guys imagine universal healthcare works as you are, so I'm not going to hold it against you.

But here's how it works in my country:

1. I have a heart disease. I go to a cardiologist in my city. My cardiologist takes one good look at me and says: "I'm sorry, we have nothing to help you here"- (because they lack the medical equipment, educated staff, or, in more cases than not, both). -"Here's reception contact for our state cardiology clinic, please go there."

2. So I go to the state clinic (that is located a fair distance away). They take a closer look at me, and they would treat about 60% cases that come to them, but then will also say "here's your meds and diagnosis but we don't have the equipment or staff to be 100% sure this is what's wrong. Have you considered..."

And then they refer me to a private hospital. Or a private clinic. Regardless, a private doctor, who charges their patients like everyone else does, and that pay goes up in thousands and tens of thousands for diagnostic processing or monitoring alone. And that's where I actually get my treatment. And my bills. Because regardless if you have universal healthcare or not, healthcare industry exists and will continue to exist.

State-funded healthcare (which we call free but it's not actually free, it's just paid for you by the state) will never be able to compete with the private healthcare industry because 1) the state doesn't receive any profit, and in fact only loses money on providing healthcare, 2) the state therefore does only the bare minimum to keep up with the demand, and usually doesn't necessitate enough funding to provide new technology and equipment or training, if any, 3) the medical staff, who have no equipment or training or pay, says "screw this, I'm out" and goes into the private field, where they actually have a shot at having a decent pay and working conditions.

Therefore the universal healthcare institution grows only weaker.

Is it fucked up? Yeah. Does it bring unnecessary suffering to anyone? Also yeah. But if you're any level of smart in this situation you'd just skip the first two steps and immediately go and pay to get treated properly instead of risk wasting PTO, gas and possibly your pre-existing condition flaring up to go through the routine.

And this is also why medical insurance is starting to get traction in my country with universal healthcare, because universal healthcare doesn't mean that you can get all the medical services free of charge but rather that there are options provided for you. No-one ever said these options have to not suck, especially for someone with a chronic condition. Fun!

Still better than the USA though I will admit to that.

[raspberryconverse]

Good god, do I hate the American healthcare system.

TL;DR: Even with employer sponsored health insurance (either my own or my spouse's), there is no good option for me to see the providers I want to see and have all of them covered.

I've been working as a contractor (not an independent contractor, but contracted to the company by my employer). They had been working for years to get my team converted to be their actual employees and last year they brought over my boss. They finally got everything squared away to bring the rest of the team over in 2 weeks. This will leave me with a gap in healthcare coverage, but because I'm married and having a "major life event," my spouse can add me to their insurance for the month I'm not covered.

This gives my spouse the opportunity to switch from the HMO to the PPO (which is what we decided would be best for them during open enrollment last year, but they went ahead and signed up for the HMO anyway and are having major regrets) and I can either stay on their insurance or take the insurance my new employer offers 30 days after I start.

I had actually been ok with my health insurance from my current employer. First the first time in over a decade, my therapist takes my insurance (granted, the first several years I didn't even have insurance and the first couple years at my job she didn't take my insurance either, but they switched to a different company that she now takes). I really liked the primary care doctor I saw and would like to continue to see her, but she's not covered on my spouse's HMO plan. She'd be covered on the PPO plan (which is basically the same as what I have with my current employer), but we'd have to pay a higher premium and hit our deductible. She'd probably be covered on my new employer's insurance too, but I haven't checked.

That PMHNP that I contacted does take my new employer's insurance, but not my spouse's insurance. My therapist did promise we'd work something out, but I have no idea what the PMHNP will charge out of pocket, so IDK if it'd be better to take my new employer's insurance or stay on my spouse's. And honestly, the jump from "employee only" to "employee + spouse," both in premiums and deductible, is huge, thus us having separate coverage with the same insurance company right now.

It's a big headache and I hate it and it makes me want to move to Canada or somewhere else with socialized medicine.

Literally the only thing that is good about being converted to an actual employee is the $13k pay bump. I had no idea my employer was making that much money to contract me and am kinda pissed they were so stingy with raises the past 6 years. I got a 3% raise after a year and a 9% raise last year to sort of make up for the previous 3 years. This pay bump is about 17% more than my current salary, but this insurance bullshit is a nightmare.