#health insurance struggles

[health-insurance-struggles]

Medical Binder

You need a three ring binder. And sheet protectors. And tabs. “Why?”

‘Cause you need a medical binder.

What is a medical binder? A place that you store your medical information paperwork. All of it.

Why should I have this? Documentation. Insurance and medical care are all about documentation. If it’s not in writing, it didn’t happen and doesn’t exist. Why can’t you do it electronically? Because the internet can be compromised. No one can hack a piece of paper from a thousand miles away. Having a copy of your medical records means you have easy access to talk to a new doctor and get them up to speed.

For my fellow chronic illness people, this is what keeps you from going batsh*t insane if you see a new doctor or need to go to the hospital.

What should go in it?

Medical Records: This is a copy of whatever records you have from whatever appointments/visits you go to. Have a check-up? Get a printed copy. Have lab work run? Get a printed copy of records. ER visit? Printed copy. Surgery? Printed copy. Vaccine? Printed copy. I recommend having documentation going back at least five years. Include lists of any medications you’ve taken, along with start/stop dates. This is ideally a catch-all of everything you would want to tell a brand new doctor so they can immediately pick up where your last doctor left off. If you have chronic illnesses, this is where you want to include a history of it. Diagnosis, medications and treatments that have worked and not worked, and all symptoms/progressions you’ve noticed.

Medical Bills: Did you pay a bill? Print a copy of the receipt? Did you get a bill? Save it and then add the receipt after you pay it. Collections notice? Financial Hardship paperwork? Payment plan agreements? Print and add here.

Insurance Paperwork A copy of your ID card, a copy of your summary plan document, and any copies of your claims. Print it and save it.

Misc. Anything else related to your healthcare/bills that you could need. If you think in five years there is the remote possibility you could need this specific piece of paper, print it and save it.

These documents are important to have. If you're in an accident and you have everything on hand (or can have someone bring you everything), you're already ten steps ahead. Otherwise, your new doctor has to have you sign a HIPAA form for every single doctor you've ever seen so they can send your records to be reviewed blah blah blah. The main point is that process is time consuming and frustrating. Save everyone (and yourself) the headache.

[health-insurance-struggles]

As an aside, if a doctor refuses to run tests or take it seriously, always ask them to document in your chart that they refused to investigate. Then ask for a copy of the chart.

If something ever happens and that doctor didn't do anything, congratulations! You have a record and you can easily file a complaint with whoever you want. If it's bad enough, you can file a lawsuit.

Documentation is key. If the doctor refuses to listen, make sure they write down that they refused and give you a copy.

Doctors tend to be a lot more willing to listen when you want a copy of their notes.

The biggest male privilege I have so far encountered is going to the doctor.

I lived as a woman for 35 years. I have a lifetime of chronic health issues including chronic pain, chronic fatigue, respiratory issues, and neurodivergence (autistic + ADHD). There's so much wrong with my body and brain that I have never dared to make a single list of it to show a doctor because I was so sure I would be sent directly to a psychologist specializing in hypochondria (sorry, "anxiety") without getting a single test done.

And I was right. Anytime I ever tried to bring up even one of my health issues, every doctor's initial reaction was, at best, to look at me with doubt. A raised eyebrow. A seemingly casual, offhand question about whether I'd ever been diagnosed with an anxiety disorder. Even female doctors!

We're not talking about super rare symptoms here either. Joint pain. Chronic joint pain since I was about 19 years old. Back pain. Trouble breathing. Allergy-like reactions to things that aren't typically allergens. Headaches. Brain fog. Severe insomnia. Sensitivity to cold and heat.

There's a lot more going on than that, but those were the things I thought I might be able to at least get some acknowledgement of. Some tests, at least. But 90% of the time I was told to go home, rest, take a few days off work, take some benzos (which they'd throw at me without hesitation), just chill out a bit, you'll be fine. Anxiety can cause all kinds of odd symptoms.

Anyone female-presenting reading this is surely nodding along. Yup, that's just how doctors are.

Except...

I started transitioning about 2.5 years ago. At this point I have a beard, male pattern baldness, a deep voice, and a flat chest. All of my doctors know that I'm trans because I still haven't managed to get all the paperwork legally changed, but when they look at me, even if they knew me as female at first, they see a man.

I knew men didn't face the same hurdles when it came to health care, but I had no idea it was this different.

The last time I saw my GP (a man, fairly young, 30s or so), I mentioned chronic pain, and he was concerned to see that it wasn't represented in my file. Previous doctors hadn't even bothered to write it down. He pushed his next appointment back to spend nearly an hour with me going through my entire body while I described every type of chronic pain I had, how long I'd had it, what causes I was aware of. He asked me if I had any theories as to why I had so much pain and looked at me with concerned expectation, hoping I might have a starting point for him. He immediately drew up referrals for pain specialists (a profession I didn't even know existed till that moment) and physical therapy. He said depending on how it goes, he may need to help me get on some degree of disability assistance from the government, since I obviously shouldn't be trying to work full-time under these circumstances.

Never a glimmer of doubt in his eye. Never did he so much as mention the word "anxiety".

There's also my psychiatrist. He diagnosed me with ADHD last year (meeting me as a man from the start, though he knew I was trans). He never doubted my symptoms or medical history. He also took my pain and sleep issues seriously from the start and has been trying to help me find medications to help both those things while I go through the long process of seeing other specialists. I've had bad reactions to almost everything I've tried, because that's what always happens. Sometimes it seems like I'm allergic to the whole world.

And then, just a few days ago, the most shocking thing happened. I'd been wondering for a while if I might have a mast cell condition like MCAS, having read a lot of informative posts by @thebibliosphere which sounded a little too relatable. Another friend suggested it might explain some of my problems, so I decided to mention it to the psychiatrist, fully prepared to laugh it off. Yeah, a friend thinks I might have it, I'm not convinced though.

His response? That's an interesting theory. It would be difficult to test for especially in this country, but that's no reason not to try treatments and see if they are helpful. He adjusted his medication recommendations immediately based on this suggestion. He's researching an elimination diet to diagnose my food sensitivities.

I casually mentioned MCAS, something routinely dismissed by doctors with female patients, and he instantly took the possibility seriously.

That's it. I've reached peak male privilege. There is nothing else that could happen that could be more insane than that.

I literally keep having to hold myself back from apologizing or hedging or trying to frame my theories as someone else's idea lest I be dismissed as a hypochondriac. I told the doctor I'd like to make a big list of every health issue I have, diagnosed and undiagnosed, every theory I've been given or come up with myself, and every medication I've tried and my reactions to it - something I've never done because I knew for a fact no doctor would take me seriously if they saw such a list all at once. He said it was a good idea and could be very helpful.

Female-presenting people are of course not going to be surprised by any of this, but in my experience, male-presenting people often are. When you've never had a doctor scoff at you, laugh at you, literally say "I won't consider that possibility until you've been cleared by a psychologist" for the most mundane of health problems, it might be hard to imagine just how demoralizing it is. How scary it becomes going to the doctor. How you can internalize the idea that you're just imagining things, making a big deal out of nothing.

Now that I'm visibly a man, all of my doctors are suddenly very concerned about the fact that I've been simply living like this for nearly four decades with no help. And I know how many women will have to go their whole lives never getting that help simply because of sexism in the medical field.

If you know a doctor, show them this story. Even if they are female. Even if they consider themselves leftists and feminists and allies. Ask them to really, truly, deep down, consider whether they really treat their male and female patients the same. Suggest that the next time they hear a valid complaint from a male patient, imagine they were a woman and consider whether you'd take it seriously. The next time they hear a frivolous-sounding complaint from a female patient, imagine they were a man and consider whether it would sound more credible.

It's hard to unlearn these biases. But it simply has to be done. I've lived both sides of this issue. And every doctor insists they treat their male and female patients the same. But some of the doctors astonished that I didn't get better care in the past are the same doctors who dismissed me before.

I'm glad I'm getting the care I need, even if it is several decades late. And I'm angry that it took so long. And I'm furious that most female-presenting people will never have this chance.

[fellthemarvelous]

Deny. Defend. Depose.

It is clear to those of us that live in America, the only people we truly have on our side are ourselves. The ruling class has made it clear we don't matter to them.

Luigi Mangione was arrested and happened to have every single piece of evidence on him that law enforcement was looking for, including the parts for the ghost gun, inside his backpack (that he also got rid of in Central Park containing the Monopoly money???). Either he was trying to get caught or that evidence was planted. And when he was being forcefully pushed into the jail, he hollered back to the press about "injustice" and "being an insult to the intelligence of American citizens and our lived experiences."

The people have now turned against corporate America and the CEOs and billionaires are fucking terrified. Nothing the news stations are saying to us are changing our minds. The American people have finally united over this issue and there is no going back for us. Whoever did kill Brian Thompson (and theories abound on the game The Adjuster is playing because no one plays Monopoly alone) exposed the very real divide that exists between every day citizens and the extremely wealthy. Things were easier for them to control when they were able to divide us, but now that we are aware of how uncertain our future is in America and seeing just how little we matter to the people who take our money, we have realized that we have more in common with each other than the people who control every aspect of our lives. We are waking up.

There isn't one person in this country who hasn't been a victim to the predatory scam that is private health insurance. Medical debt is the leading cause of bankruptcy in America, and many of us are one ambulance ride or hospital stay away from homelessness. We all know people who have died because the insurance company denied them the treatment they needed or waited until it was too late for an approval of a medical claim to matter anymore.

Recently, I decided to be tested for autism and ADHD. Not life-threatening or anything, but my life is still in shambles and I want to know if I'm going untreated for something else. Before being tested though, I was informed that the insurance company (Aetna) has said that they were going to cover the full cost of the testing I was having (which was six hours of testing by the way). She even made sure several times that they were, in fact, going to cover it in full and they said yes.

The same day that Brian Thompson, CEO of another horrible healthcare company, was murdered in broad daylight, I received a call from that doctor's office with the woman telling me that Aetna was now telling her they never agreed to cover my testing and that they are going to bill me for $1600 (where the hell am I supposed to get that?) and she is fighting them, but considering our lives don't matter to the people who tell us what healthcare we are and are not allowed to receive, I don't think they will feel compelled to change their minds because they are bloodsucking parasites who only care about lining their pockets while I don't even have $6 lying around, let alone $1600!!

Corporate America leeches off our taxes. They take and take and take and we see nothing in return. They raise prices on insurance coverage and then deny us the very coverage that we pay for. They poison our food, price gouge our poisoned food, and then force us to pay for the treatment we get when the food makes us sick. Corporate America profits off of our hard work, our taxes, our health, our lives, our deaths.

I don't know if this will reach a larger audience or not, but I wanted to talk about it on Tumblr because this platform seems to be a crossroads for every type of creative soul. I initially brought up this idea on TikTok earlier, but I want to see if it can get traction in other places as well since I have fewer than 3,000 followers on TikTok (and I have seen a small few express interest in my idea in the hours since I posted the video.)

We're busy being lectured by politicians and the news media because while they are clutching their pearls at what happened to Brian Thompson, the rest of us do not give one single flying fuck about what happened to him. As CEO of a for-profit health insurance company, he signed off on denied claims and death for those of us who struggle to make it from one day to the next. The sicker you are, the poorer you are, the more they force you to struggle and pay. The love to deny coverage because regardless of whether we live or die, they already have the money we are forced to pay them.

I don't condone murder at all, but I also don't care that he was murdered because he was guilty of murdering so many more people in this country through legal means because it's profitable. The CEOs are scared and there are wanted posters with their names and faces popping up in places. Every CEO of every healthcare company is guilty of murdering Americans and they continue to go unpunished for it because "it's just business".

So (if you've read this far) all of this previous rambling is to say that I keep thinking about how I want to make an impression. I want to continue upsetting the billionaires and the CEOs because corporate America is full of murderers who are legally allowed to decide whether we live or die based on which outcome will give them more money.

I have thought about the idea of creating a wall/constructing a wall somewhere as an art piece or something (making a statement) that will somehow honor the memory of people who died because insurance denied them care.

I know I definitely want it to say something along the lines of "In memory of those murdered by for-profit healthcare systems in corporate America". Something blatant. Loud. Something they are forced to look at every single day. Somehow. The wall could have images of those who are gone, or names of the person who died with the name of the insurance company responsible for their death underneath. Just something to make it clear that we see them for what they are. Something to avenge those who were sacrificed so billionaires and CEOS and shareholders could brag about record profits. Something that shows the whole world that American citizens are waking up to who the real monsters are.

The Adjuster (whoever he is or is not) has fanned the flames of revolution in America. He managed to unite us in a way I can't even recall before. It's not over. We know what happened to Brian Thompson was just the beginning, and corporate America only just now realized how much we actually hate them. A single shooter has sparked an awakening in America that is starting to snowball into something much bigger.

So if there is anyone out there who might be interested in collaborating on something like this, please let me know. I know we are all tired and demoralized and we have no money. I want to make a statement though, and I love doing that through art or writing. Collaborating with other people who have been through this same shit will also probably help us unite even more.

This is a watershed moment in American history.

In the words of Kanan Jarrus, Jedi Knight,

"There is a future for us. One where we're all free. But it's up to us to make it happen."

[chrliekclly]

How did you get your job on sunny? I really wanna go into the entertainment industry.

iv told th story b4 but i got onto th show bcuz i just happened to b n th right place @ th right time

was working on smthn completely different nd drunk on th camera truck during one of our wrap days me, the DIT, nd the loader wer talking abt fave tv shows nd when i said tht always sunny was mine th loaders just like "oh lol funny im the 1st AC on that. i can get u some days if u want" ???

so i...did some days...then i did a season...and now im core crew i guess

[thewretchedsketcher]

It's true, we shouldn't tolerate violence. Allowing people to suffer and die for the sake of profits is unacceptable and should never be tolerated.

[cal-is-a-cryptid]

Something that makes me happy #4:

I’m alive at the same time as Hayao Miyazaki.

[bittsandpieces]

you good?

idk how you could've possibly known but I'm actually wicked upset rn about like five different things (none of which I can do anything about)

[mxwhore]

mutuals we are struggling

[bambiraptorx]

Your body horror baby story gives me such mixed feelings because on one hand it’s so wholesome in how much Donnie is so dedicated to his little monster baby and loves them so much. Then on the other hand half the family doesn’t like Bea which I understand is a trauma response but that’s Donnie’s baby that’s so heartbreaking. Beas name for Raph being “Scared” and Mikey being “Angry” absolutely shattered me. Honestly does Donnie have any resentment towards how his family views his kid. Like I hope they’re in therapy working on that trauma because Bea is a literal baby and doesn’t deserve that suspension on her. Hell, most of her horror creature behaviors could just as easily come from Donnie.

I also want to be very clear I don’t want to come off as angry at you or hating on your story. It’s genuinely incredible and the fact I’m so emotionally invested is a testament to how well written it is. I just adore Bea and would fight god for her

Honestly yeah, it's a very complicated family dynamic. None of the family members that are uncomfortable around her want to hurt or get rid of her (partly because they know Donnie and Draxum have had mechanisms in place since the beginning to deal with a situation where that might be necessary) but that doesn't exactly go a long way in creating positive interactions.

It's also hard because, especially when she's younger, Beatrice doesn't quite understand that they don't like her. They can understand that Mikey is angry and Raph is scared, but they don't really get what's causing that. It's similar with Casey Jr being scary, because while he's not really allowed to spend much time around her, he's the one constantly looking for signs that Bea is going to reveal what he thinks of as her true Krang nature. He's the one expecting them to become a threat, and Beatrice can pick up on that.

Donnie... understands why his family sees Beatrice the way they do. He does have some trouble remembering what actually happened during the invasion, but he knows enough to be aware of just how bad it was. He knows that Raph is scared of Beatrice because of his latent fears of being used by the Krang again. He knows that Mikey uses his anger as a defense against the self blame he holds for letting Donnie go into the Technodrome in the first place. And he gets it. That doesn't stop him from wishing it was different. It doesn't stop arguments from cropping up here and there about how Beatrice gets treated.

The family does start working on therapy eventually, but it's kind of piecemeal, not everyone at once. Leo's actually the first to start, and him openly admitting he has a therapist is sort of the push his family needs to look into it themselves. It certainly doesn't fix everything, but it helps them to process stuff a bit more.

I'm glad you like this au so much! It's been super fun sharing it!

[elliottkay]

In the last month, we’ve filed health insurance claims twice—for our cats. It’s thousands of dollars. The cats are with two different companies.

Both of them paid out. One step, no questions. They paid everything.

Because if pet insurers didn't do their job, people could and would stop buying policies.

[kg-clark-inthedark]

Trying to finish writing my week 4 dhkinktober smutfic while everything is on fire at work and I’m hopelessly anxious and depressed is… challenging lmao

[health-insurance-struggles]

Your claim got denied. Now what?

Don’t panic.

Most of the time, you can get your claim adjusted to approve.

First and foremost, find out why it was denied. Did your provider send in a duplicate? Was it an exclusion on your policy? If you know why it happened, you can figure out how to fix it (or at least make sure it doesn’t happen again).

Below are a few common reasons a claim is denied:

It’s an exclusion, aka not covered on your insurance policy. You can try to fight it by asking your doctor to send an appeal to show that the service was medically necessary, or even if your insurance company will make an exception. Either way, don’t depend on either of these things working on the back end. If you're not sure it's covered, ask BEFORE you do it.

It’s a duplicate. Your provider sent in two copies of the same claim. Your insurance isn’t going to pay it twice, so they denied the second one. No big deal; you can ignore it.

There wasn’t a prior authorization. Insurance companies usually want to make sure that whatever service you’re having is actually necessary. If your provider doesn’t get the procedure authorized before hand, your insurance company will probably deny it. This isn’t the end of the world! Most companies allow the doctor to get a retro authorization by reviewing the medical records from your procedure.

If it’s not any of these or you don’t see a reason the claim was denied, call your insurance. Don’t submit an online question because the answers that come from those almost always suck. Call and speak to a human person and ask them to look into it further. Find out what you can do or what your insurance’s policy on denials is.

Once you know what the denial is for (and if you can do something about it), your next step is almost always calling your provider. Most of the time, they’re aware of the denial before you and are already behind the scenes to get it resolved. They don’t usually need your help, but ask if you can help somehow.

And now...wait. The worst part. If there’s an appeal being filed, your insurance company has to process it. If there’s a medical records review, it has to be completed before they’ll adjust a claim.

Four times out of five, they’ll pay your claim if the provider appeals.

Finally, sometimes, it’s a mistake! Sometimes, your claim should’ve been paid and a human somewhere along the line messed up. That’s okay! Ask the claim to be reviewed. Follow-up a week later, and a week after that. It can take time, yes, but it’s better to push for a couple of weeks than to pay hundreds of dollars you shouldn’t have.

[tears-that-heal]

Dear Lord Help Me! 🦷🍭😖

Well….I got to finally see a dentist for the first time in almost 2 yrs. Many of you probably know what’s coming next. Yes, my teeth need some serious TLC.

What’s most frustrating is that I wish I could’ve prevented this from happening, but in the same time, since I moved to another state, finding the appropriate insurance has been a major challenge. Along with finances and etc. *sigh* Anyways, progress has been made and now I can receive decent dental help. Now for the real health report, I need to have 3 procedures to remove 2 wisdom teeth, repair broken filling and a possible root canal. 😫 Along with taking prescribed antibiotics for my gum infection, too.

Yes, my teeth are a mess! 😭

Since seeing the dentist, I’ve been staying in bed for the most part. The meds are really helping with the pain, but I’ve been also having to manage my stress and anxiety too. *sigh* Been fighting against a lot of past reacquiring insecurities like “feeling like a burden” to my family. Feeling somewhat helpless to my situation. Feeling like a baby that I can’t just push through the pain. 🥺 I can easily be too hard on myself, but I also know the great value of caring for myself; physically and mentally.

It’s more than okay to make the time to rest. It’s actually a very good lifestyle practice. Our bodies aren’t made to function 24/7, then more highly possible malfunctions will occur. I’ll, of course, make it top priority to make routine dentist visits after all this is set and done. I refuse to go through something like this with my teeth again…..but I have to get through it first. The Lord is still with me as He always is. I just need to once again trust in Him through this trial. ❤️

(images & gifs from pinterest)

[satanicspinosaurus]

Massage has a lot of medical benefits and absolutely should be covered as part of care. One specific benefit is going in after beating your head against the wall for the last 24 hours trying to get your shoulder to stop forming a c-curve and the provider being flummoxed as well. Hits differently when a professional is like, "Why is this so tight????"

[sagabrielle]

"tortured poets" RIGHT. world-renowed struggling artist, taylor swift.

[druggeddraccus]

you know what’s actually ridiculous

i cannot put my parents on my health insurance as dependents—it’s not necessary now—they have their own because they are able to work but 20-30yrs from now? they kept me on their health insurance until i was 25. why can’t i do the same for them?

and why would it be insanely difficult to find the loop holes to be able to do this for them? it’s all just really frustrating. it’s depressing for me to research this further so what i do know about this is very limited right now. and i don’t wish to debate/discuss anything just here to rant.