We pay all of this money to maintain health insurance for what?
So they can haggle with our health. It’s a business to them and has nothing to do with what is best for the patient.
My son was diagnosed with a rare genetic disorder called glute1. Immediately we sprang into action to get the only treatment available and known, which going under ketosis and remaining on a strict keto diet. They begin every patient with a keto formula tailored to the patients keto ratio.
He is non verbal and very delayed cognitively so we were worried he would not take the treatment well.
The doctor suggested getting a gastric tube placed in case he did not want to drink the formula and we agreed that was the best route, just in case.
Great news! He loves the formula and drinks it by mouth. I asked when we could remove the g-tube, because it can cause problems later on if it stays in for a year or more.
Insurance doesn’t cover the cost of the keto formula unless the patient has a g-tube. Wow, ok. How much is the formula out of pocket?
Only $1600-$1700 dollars a month.
So I’ll say it again, health insurance has no right or health care knowledge to make a decision on whether or not a patient needs coverage of a certain medicine.
If we want to continue with insurance, then insurance should cover the cost of any test, procedure or medicine that is prescribed by THE DOCTOR!! PERIOD!
I work in healthcare and completely agree. They need to get out of making decisions about people’s health. They aren’t trained, they’re not physicians, and this isn’t their role.
Yes! Insurance companies are very closely tied with government over-regulation. Doctors/nurses/etc have to fight with insurance companies to prove that patients need things like physical therapy, continuous glucose monitors, and even insulin coverage! If a Dr. orders it, it should be covered (at least partially depending on their insurance plan). Also the Kaiser Permanente system, and other large hospital systems, is a disaster!!! Drs can only spend minutes with patients and they fall through the cracks with their care not being covered or even completely reviewed with them.
I completely agree! I am a Marine Corps veteran and am currently undergoing spinal injuries treatment and it is such a complicated process because the insurance company has strict policies to keep people from getting the necessary care. The insurance is afraid of “sticker shock” so they mandate or require that all these small things or already tried (and failed) methods be tried multiple times before the actual big procedures are paid for.
The doctors said from day one said that I need spinal reconstructive surgery yet the insurance doesn’t want to pay because the price tag is too high. Yet they will spend 5 times what it costs for the major surgery, “trying” things. This only makes my life worse and delaying what actually needs to get done. They are NOT doctors and need to let the doctors make the decisions.
In my opinion, Hospitals should be SELF INSURED, by the people in the community. People pay HUGE premiums for health care coverage, that the insurance company ultimately denies payment, THEN the patient ends up paying the bill anyway. IF people sent their premium payments to their LOCAL Hospitals, and they were INSURED via THAT fund, Hospital charges would go down, Salaries and Services Fees would go down and be FAIR. People could have the option to make tax deductible donations, Estates could “WILL” funds to the account. A BOARD, of LOCAL ELECTED RESIDENTS, NOT Physicians or staff, of at least 25 people, set policy, prices, standards, The PEOPLE have a say in costs, and management. WHY, because health care costs in California are so EXPENSIVE, should rural America chip in to cover those costs. KEEP IT LOCAL. I am NOT in favor of Social Medicine, I AM in favor of a well run FAIR system. THINK about how much in a “Community or County” gets sent to a huge insurance company in Chicago or New York every month. THAT could be going to a Trust Account to cover that facilities costs. SELF INSURED, would make Insurance companies be more competitive as well. SCREW HEALTH CARE the Monopoly. *** I must add - ELECTIVE Procedures, Modifications, Alterations, ELECTIVE / Convenience Abortions, AND SEX Change procedures are covered by THE PATIENT ONLY. RULES THAT ARE NOT DEBATABLE / BENDABLE.
On a similar note to my previous post here. I was on BOTH sides of this issue. My first daughter was born when I did not have insurance. The Hospital Bill was more than I could handle. Somewhere someone passed away, and created a fund for those who could not afford care. I went through 4 months of review and assessment, paying $10.00 each month, THEN the 5th month I got a notice – PAID IN FULL – Via that fund… GOD BLESS THAT WOMAN – THEN my 2nd daughter born, in different hospital; I HAD INSURANCE with a Maternity Rider. Bankers Life & Casualty DENIED payment for her birth because she was NOT in the hospital due to sickness or injury. I appealed - I LOST. I was liable for the ENTIRE BILL. So I LIVED both sides of things I think could be solved if hospitals were self insured.
100% I went through months of not being able to work because i had to jump through so many hoops the have a hysterectomy done. Im 46 and have had my tubes tied for 21 years, 2 c-sections and had endometriosis and so much scar tissue built up, it was attaching organs to my abdominal wall. So much pain. I had to live on credit cards that are now maxed out and im trying so hard to pay them down but its not working. The amount of out of work time could have been greatly reduced if they had just done the hysterectomy in the first place. Im drowning and cant swim to the surface, all the while taking care of my mom.
Insurance companies shouldnt have any say in whether or not a medication is needed by a patient! They are NOT my doctor, they shpuldnt get to make those decisions!
Christa
Please see my contribution: Increase the Number of Private Practice Physicians, Restore Provider Autonomy, Decrease Regs. I outline a plan to accomplish what you are asking.
If a doctor prescribes a medication, intervention or procedure, insurance should be forced to cover it. No more conditions, no more PAs. Let doctors practice medicine: insurance companies are no longer insurance but “managed care”. You get to pick from limited options, not receive the care prescribed. Insurance companies need to stop practicing medicine without a medical license!
I used to work in the medical field in different rolls, as well as having to deal with my own unexplained infertility struggles that have come with surgery and tests and medications and losses involving hospital admissions none of which have been cheap even with so called “good” insurance. So I’ve seen behind the curtain and experienced the other side in my opinion these insurance companies denial of treatments/coverage of needed care are all but practicing medicine without a license. In any other situation that’s criminal. We need a medical, pharmaceutical, and insurance industry that works together for the people they care for with honesty and transparency.
My insurance initially refused to cover nausea meds for me when I was diagnosed with hyperemesis gravidarum (unrelenting nausea/vomitting) during my first pregnancy. They told my doctor I was “25 weeks and shouldn’t be nauseous anymore.” I almost lost my son due to severe dehydration and malnutrition. My doctor forced them to cover it but it took weeks. It was ridiculous.
Agreed! My doctor has ordered me test that were definitely needed and my insurance denied them and I had to appeal….still have not heard back from the insurance company at all. So in the mean time I have gotten worse and need more test but my doctor was really needing that test that was denied to rule out some things.
My daughter was really sick and went to the emergency room and they Admitted her into the hospital for dehydration and high kidney levels. She was in there for 5 days and My insurance refused to pay the medical bill for that hospital stay because they felt that it wasn’t necessary for her to be admitted into the hospital. Like I am paying for medical insurance, so the insurance should be paying any part of the bill that they get they do not have the right to decide whether or not they feel that the medical treatment they received is deemed necessary or not
I second this.
As a healthcare professional, it’s absolutely disgusting to fight with insurance companies about whether or not a drug can be covered or not, and for how much.
Is your flow chart so firm that you need a doctor override that could take months?!?! People need medication, and specialty medicine in particular along with blood thinners is WILDLY expensive. Does it work?! I don’t know, because people never seem to be getting better, but people NEED it, so it’s time for big pharma to stop playing games.
By the way, coupons from pharmaceutical companies are not nearly enough.
100% agree! If a doctor prescribes the medication that is best for us- insurance should never be able to deny payment!
Claire- I empathize with your concerns. Please see my post “ Increase the number of Private Practice Physicians, Increase Provider Autonomy , Decrease Regs”. Some of your issues could be remedied by my post and possible further regulations.
Agreed. My insurance denied my MRI because they claimed it “wasn’t medically necessary”. So I guess I’ll have to wait to see if the lesions on my brain have gotten bigger or if there’s more 
I had to drive out of state to find a doctor who was even covered through my insurance:rofl:
Yes 100% agree! I’m so tired of people having to fight with insurance companies just so they can get the treatment their doctors want. Insurance companies are not doctors, nor do they know you or the whole medical story. They should not be able to just stay no because they think other treatment is better. Doctors should be able to practice medicine and not have to fight for to get the necessary care for their patients. This is very true for women, while some insurance easily cover surgical treatment for gender dysphoria they make women who need a breast reduction and or lifts after having children jump through hoops because insurance deems it cosmetic even after multiple doctors state it is medically necessary to fix medical issues. In many cases insurances make women diet and lose weight first, go to a “proper” bra fitting, or try other options first before approving the surgery. And once the surgery is approved it is only covered is so much tissue is removed. I’m tired of someone who isn’t a medical professional sitting behind a computer making decisions that override the doctor.
Insurance companies need to stop determining what a procedure should cost. Or doctors must accept what insurance will pay.