Health Insurance Physicians

Check out the article (link below) from ProPublica that inspired this video. The info about UHC “medical directors” is particularly abhorrent. There is so much we don’t know about the inner workings of health insurance companies. Investigative journalism like this helps shed a little light.

[DGlaucomflecken]

I’m not joking about the physician who stopped practicing in the 90s because he was scared of STDs. It’s all in this article. This person has been denying claims since 2010

[T]

As a transfusion medicine physician, I am personally a HUGE fan of blood money.

[laurafrenzel]

Non-medical field watchers think you are not kidding....😢

[CompletelyNormal]

I work in oncology. One of the oncologists I work with had a peer to peer where a pediatrician who had never worked in oncology in her life told the oncologist that the National Cancer Institute guidelines were actually wrong, and that the insurance company would not be paying for what standard medical practice considered to be the next appropriate drug.

Moral of the story: This video is not an exaggeration even slightly.

[aziouss]

I like how honest the insurance guy is.
If only real evil was like that :(

[adamwilliams]

I have UHC and my favorite denial so far was about my daughter. “Admission was not medically necessary because you stopped vomiting.” She spent 3 days in the hospital trying to get her condition back under control, she stopped vomiting because there was nothing left to vomit and medication to suppress her immune response…

[jasonmajernik]

I had a denial for a patient based on an interpretation of a physician statement that a patient was Her-2 (+1) negative. When I called about it, they stated that the patient must be Her-2 negative. I told them to put me on hold and google how to read FISH results on Her-2. Magically they did, and came back with: “Good news! The notes have been re-reviewed and now we’re approving the medication!”. True story.

[AmataTai]

I'm a pharmacy technician, and I utterly despise these insurance companies. Also the "we only cover this specific brand of insulin/diabetic supplies, so screw you"

[VorpalRabbit]

I really dislike UHC.

"This claim denied as not medically necessary per Medicare's guidelines."

But, uhh, the published medical policy on Medicare's website shows it's covered for this specific condition, here's the written guideline...

"I SAID NOT MEDICALLY NECESSARY. NEXT."

[joshuaguthrie]

I had surgery last Wednesday…. I was told it would be fine and covered. However, we got a message from the insurance company FOUR DAYS after the surgery when I had just gotten home from the hospital saying they’re denying my procedure. I don’t know why they changed their minds or why they told me after the procedure was done…here starts the appeals fight

[laurendukes]

As a former medical administration worker, 1 of my jobs was prior authorizations. The lengths these "health" insurance companies go through to NOT approve necessary medicines & procedures is gross. And the government accepts bribes not to change a thing.

[mohibawan]

I know you’re trying to raise awareness through comedy but every time I think about what these prices of human garbage are doing it make me want to actually through a revolution

[absolutetuber]

My BIGGEST pet-peeve is when my office staff hand me a note for a “peer-to-peer” for imaging I’ve ordered and I call and wait for 15 minutes on hold only to have a nurse pick up and question me about my medical decisions. Peer-to-peer my eye.

[Mia]

I know this was for UHC but I’m also looking at you, Aetna - thanks for making it so difficult to get the medication that keeps me alive. Oh and deciding that the appeal isn’t urgent, despite having been on this medication for years.

[koneyj]

As a Neurosurgery RN that handles my surgeon’s peer to peers and appeals, THANK YOU FOR NAILING THIS 100% 🤣🤣our latest peer to peer: a 17 year old patient’s scoliosis surgery was denied because “her spine wasn’t badly curved”… she had a Cobb angle of 52 degrees. We asked them what “badly curved” meant and they couldn’t answer 🤦🏼‍♀️

[wholeNwon]

Absolutely true. One evening I received a call from an insurance "doc" who told me that they were not going to cover a large portion of a pt.'s hospital costs incurred because of a delay in his definitive care. That delay was due to technical factors beyond my control. He was dependent on IV meds at the time. I explained the situation with great care but the insurance doc wouldn't budge. I finally said that I didn't really care what they chose to cover but asked that they inform the pt. who was a few ft. away listening to my end of the conversation. So I passed the phone to him. The doc. then said that they had made an error, had confused him with another pt. and all of his hospital care would be fully covered. He was a senior executive of one of the world's largest corporations. Never heard from that ins. co. again. I feel certain that, if that pt. had not been both wealthy and powerful, the outcome would have been very different.

[vanntooot]

I just finished a basic course in occupational safety and health and one of the lecturers (who was also a physician) talked about "Managed Health Care" which I only just learned was what HMO, PPO, and other privatized medical insurance models were officially called. It was an extremely uncomfortable 2 hours of him struggling to justify how having our patients pay exorbitant premiums and requiring prior authorization before being given access to a physician was a good thing

[dalegreer]

Years ago I got divorced and bought a United Healthcare policy for my daughter, $100/month with $2000 deductible (adjusted for inflation that's $160/month and $3200 deductible). When she was 17, she was trying to open one of those plastic packages that are so difficult to open, and the scissors slipped and cut her thumb tendon. I looked up hand surgeons in the United Healthcare recommended physicians guide, and picked one close by.
I paid the $2000 deductible, and then after the surgery, they of course declined to pay $894 for anesthesia, and then they said the doctor I had chosen from THEIR GUIDE was too expensive and they were only paying 50% instead of 80%, leaving me to pay another $4500. And they only paid for 6 physical therapy visits. Then I got laid off, and delayed payment. Eventually the clinic knocked $1500 off of the bill.
In total I paid UHC around $7200 for 6 years of premiums, paid around $4000 to the hand clinic, and UHC paid about $2000 to the hand clinic. And yet they claim health insurance companies only make 5% profit.

[AlwaysWright]

Pharmacist here - honestly, I'm a little surprised that some of these aren't worse than they actually are. Insurance companies do some really shady shit.

[christinehallet]

I came home from work one day to find my mother in tears because she got a denial letter on the injectable being used to treat her metastatic renal cancer. The same medicine that she had been using for months. This medicine cost $5000 a month. After I was able to calm her down a little bit, I got on the phone with her insurance company. The lady I spoke with was very nice, very helpful and VERY honest. After looking at my mother’s information, she said that the agent that was working with her claim was behind on their number of denials so they had to make up for it with another random denial!!