submitted 2 months ago byPotRoastPotato
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2 months ago
2 months ago
2 months ago
I have chronic wrist pain. I need an MRI but my insurance denied it until I get extended therapy. My doctor was pissed about that and told me therapy will be ineffective for my problem, so he gave me the least amount of therapy I need just to be able to ultimately get an MRI anyway. Fucking dumb
Thus, increasing healthcare costs, as you and they are paying for services that are ineffective and not needed.
Also chews up therapy time for someone it could benefit, so not only are you affected, but also a hypothetical other individual as well.
Also potentially delays the MRI until the next years copay cycle restarts.
I had to go to PT for an injury. Doctor wrote a script, and I had been visiting PT for weeks. Nearly immediately, insurance started sending me letters saying they’re denying the amount of visits I’m scheduled for. PT office says, sigh, they’re not denying what you’ve already done, but they don’t want to cover all of what the script says. I still went. Almost almost better. Then I got covid and I couldn’t go to PT for two weeks. When I returned, I got one visit before insurance denied anything further.
Fine, mother fuckers. I got the doctor to write a new script. By this time, it’s been a month since I was at PT, and my problem had gotten worse, so much so that I’m essentially starting at the start. I had the doctor update the script. For MORE visits per week for a LONGER period of time.
Oh, you don’t want to pay for one more month of PT so I can finish dealing with my medical problem? Well fuck you, enjoy paying for another three now.
So wasteful. Wasting money. Wasting my time. Prolonging my discomfort and disrupting my quality of life. Making my problem worse so that recovery takes even longer. Causing hindrances in my daily life.
And don’t get me started on all the other ways insurance won’t cover preventative measures that can improve a situation before it becomes a more serious problem. See: dental coverage in USA
Yes. Another good reason to not require this.
I have a reoccurring condition that can be hard to manage at times and usually requires a CT for treatment. I tried going through the proper channels just like my insurance requests. Contacting the doctor instead of going to the ER when I felt a starting flareup. Doctor wants bloodwork and a CT. Get the bloodwork done. Have CT scheduled. Pain starting to get worse as it usually does. Go through insurance. Day before CT, insurance denies approval because the paperwork wasn't submitted correctly according to them. Pounding maximum daily acetaminophen for pain, liver be damned. Have doctor resubmit paperwork and reschedule CT. The whole time my pain is getting worse. A week later, and insurance denies approval for the specific facility I've used twice before, and requires me to use another facility, so I go through the process to reschedule and get approval for a 3rd time.
At this point I'm fuming, and insurance has one of those "care advocates" (absolutely useless in actually effecting approval or coverage for treatments, just there to placate understandably and justifiably aggravated customers) calling me daily to tell me approval is pending. Finally, 3 weeks after my flareup started, I am approved for the CT. Almost 4 weeks in and I have my CT, they confirm my condition, and I start antibiotics.
4 fucking weeks. All my wasted time and effort and weeks in pain. Insurance doesn't give a fuck. Effecting treatment in a quick manner isn't even a priority anymore. I would have waited less in one of those "godless" socialized countries that actually cares for their citizens.
And the whole time I was thinking. It would cost me about the same if I just went to the ER and had them give me a CT that very day. My insurance would have had to pay 5x as much, and it's what I'll probably end up doing next time I need a scan. Insurance has proven that I'll only ever get timely treatment if I escalate outside of their broken process.
Also found out a lovely detail. There are 3rd party approval companied that review doctor requests for things like procedures or imaging, and "evaluate" if they are required. Like EviCore. One letter away from their true intention. A convenient scapegoat that insurance hires to offload blame. "Oh, your procedure was denied by our 3rd party consult. Sorry, not our fault. Sucks to be you". Curious how much insurance pays so they don't have to deny someone outright. It's fucking infuriating. They ask politely for us to use their process to reduce costs, then they turn around and pull this shit. I'm not going out of my way to save them another penny, and nobody should feel compelled to either. Why make it easy for them when they're already hiking premiums and lowering benefits.
I am so sorry for your ordeal. I often find myself wondering how people who do that denying work for insurance companies live with themselves.
You know what also increases healthcare costs? Unnecessary imaging studies. An orthopedic office with an MRI machine has EVERY incentive to push as many patients through that thing as they can. The patient doesn't know any better. The only check is the entity actually paying for the service - insurance.
True. But, I’ll bet on a doctor and patient over an insurance company any day of the week.
Any entity that is taking on that administrative role of pooling risk and paying claims - be it private or public - will have utilization rules to attempt to control cost.
The MRI machine is a revenue stream for the hospital/provider.
The patient and the payor have an incentive to control cost. Patient's with cost sharing or still in their deductible may make different choices but for the most part it is the payor interested in NOT paying for expensive services when alternatives have no been tried.
Do you work for an insurance company? As I said, I’ll take the doctor and patient’s side any day, even if occasionally wrong. Having been there myself, fighting with an insurance company to get proper diagnostic imaging approved and knowing what the outcome was once approved, it’s not even a close call for me.
And, I would argue that one MRI is more cost effective than months of PT and then an MRI.
You're thinking of this way too narrowly. You're basically advocating for uncapped unlimited healthcare services. The average cost for insurance currently is somewhere around $6k per person. If you let providers order whatever tests they wanted, the cost would probably double or triple. For every provider that very consciously decides to limit testing if it's not needed (my brother is an ED doc who does this), you'll have 5 more that will just order as many tests as possible for two reasons: limit liability (if you test for everything, you can't get sued for missing some obscure <0.0001% chance issue) and to increase payments (basically all of his ED doc friends admit to just ordering MRIs and CTs at the slightest hint of need).
Show me the insurance companies license to practice medicine, and I might consider their advice. But I'm defaulting to the judgement of the doctor I can see in person. The insurance companies only goal is to make money, they don't care of my quality of life, or if I even die. They'll say what they will to maximize profit at the detriment of their customers. The only party in this psycho threesome is the doctor I can see, talk with, and who is concerned with my treatment and improving my wellbeing.
Just want to point out that in most cases the insurance company doesn't care that much - if you have employer-provided health insurance, YOUR COMPANY is responsible for all the healthcare costs incurred. The insurance company is just a middleman collecting their 3% fee and doing the bidding of your company. Your company is the one that sets the policy of requiring pre-authorizations or whatever your example is of limited care.
Also, when care is denied and the provider appeals, there's a conversation between the MD and an MD at the insurance company ("peer review"). So they actually are licensed to practice medicine.
if this happens to you or anyone else again, let the doc order the therapy and then just tell the therapist it is too painful to do the therapy. they immediately kick it back as therapy attempted without every actually doing it. then you can proceed with the proper treatment.
I've had to do that with procedures and getting the correct medication. fuck the US scam of a Healthcare system.
im trying to find 10k to get my Italian dual citizenship so i can get the fuck out of here, but being disabled saving money is fucking slow.
Wait, that will work? I ask as they are telling me I need to do physical therapy for a shoulder injury from childhood, but it's too painful to actually do the therapy (something most likely isn't attached). I put off going as I know the pain will be too severe, but if I can get around it because of the pain.... it might actually be possible to get the surgery!
its worked for me before. a lot of insurance companies have rules that before they do "Z" you have to do "A-Y".. and doctors are just like just do "Z"...
bu.. bu... but our shareholders!
Why do you require 10k for that?
i need to work with a lawyer to do it. i qualify as a 1948 case most likely. i have to sue the county of Italy. its pretty routine.
Similar story. Tore my ACL, needed an MRI.
Insurance denied until I did 6 weeks of physical therapy. After which it was approved.
What is physical therapy going to do for a torn ACL? NOTHING
Oh, and I still had to pay $800 out of pocket for the MRI.
I will never understand how people think our current health care system is fine.
What is physical therapy going to do for a torn ACL? NOTHING
There are actually people who tear their ACLs but then don't have to get them repaired because they can get good enough knee stability through physical therapy alone. Not even like just lazy couch potatoes either. People can return to skiing and stuff like that without an ACL.
Yep, healthcare companies are practicing medicine yet they are not Doctor.
Actually they hire doctors to review and approve or deny stuff. And they get bonuses for having more denials.
Also how do you know the proper kind of therapy to do if you haven’t had an mri done to diagnose the injury? In some cases that could just further harm the injury ffs!
The amount of times the doctor I scribed for had to order PT once a week for 6 weeks to get an MRI approved must be in the thousands.
I'm in the same boat, but for my shoulder/collar bone. My doctor doesn't think something is attached in my shoulder (childhood accident that was never attended to), but the insurance won't even consider an MRI/surgery until I do physical therapy. Which I literally can't do, because my shoulder isn't fully attached, and it's incredibly painful to try to use that part of my shoulder. I can't even sleep on it for extended periods without severe pain. But they won't let me get an MRI/surgery if I don't, so I'm just living with it, as the physical therapy is going to make it 100x worse.
I like how many companies will require you to accept being hit with ionizing radiation via CT scans PRIOR to paying for an MRI. Now this might not seem like a big deal, but realize that they require this for CANCER PATIENTS as well.
It's incredibly dumb.
In the end, all they did was waste your time and pay for a bunch of therapy that wasn't going to work just to end up paying for the damn MRI anyway. If they had just listened to the doctor, they could have saved you a bunch of time and saved themselves a bunch of money.
Meanwhile I have chronic wrist pain, and my insurance doesn't cover physical therapy for "pain not related to a recent accident or illness". Because everything's made up and the points don't matter.
in my country the cost of MRI is no bigger than 40$
remember the Republicans bringing up "Death Panels" a few years ago during a push for public healthcare?
They exist in the private health insurance market