Whistleblower Exposes Health Insurers' Most Evil Scheme

A health insurance whistleblower is exposing their most appalling practice. It’s called prior authorization — and it’s part of a money-making scheme based on denying and delaying patients care. But doctors are fighting to reform it.
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[nbeezhao]

I'm a nurse, and I met another nurse, who tried to convince me that taking care of the shareholders, was more important than taking care of the patient.

[cartoonjohn]

Healthcare in america is working exactly as designed. It just wasn't designed to help human beings.

[jessicaheuerlynch]

Imagine my surprise and great comfort during my first pregnancy when I received a letter from my insurance company notifying me that I’d been approved to GIVE BIRTH to my child. I hadn’t realized that it was optional at that point.

[cryschanel]

'Prior authorization' is what bankrupted me at age 25. I had an emergency cesarean, followed by a week stay in the hospital due to complications from the surgery. It wasn't pre-authorized to have this emergency while trying to push out a kid for 2 days.

Now, I'm 38 and can't get my adhd meds without getting a prior authorization every 3 months from my doctor. It's DISGUSTING. I have to take time off work, losing $$, to keep my meds - they need to make sure my adhd hasn't magically been cured.

[landerson]

US health insurance companies need to face criminal charges for practicing medicine without a license and also pay out to the people who have been harmed for the delay.

[richardlin]

Ignoring everything, it's crazy that NON-MEDICAL PROFESSIONALS are deciding whether treatment is necessary and often OVERRIDING MEDICAL PROFESSIONAL'S JUDGEMENT.

[HobbitBroad]

My grandfather was a paraplegic. He had been in a wheelchair for over 40 years. Like most appliances they wear out. It was time for him to get a new wheelchair. The insurance company denied his request for a new wheelchair. When my mother called to find out why they told her that he had been in wheelchair long enough and didn't need one anymore. I'm not actually sure what steps my mother took, but after she was done with the insurance company, not only did he have a new wheelchair they also provided him with a wheelchair accessible van.

[gracesunshine]

Went through the same thing last month was denied coverage for a one night hospital stay after a major surgery that ended late in the afternoon, tubes placed during surgery and hanging out, catheter, bloody urine, five incisions, fever, pain, in post sedation state. Payment was denied due to it “being not medically necessary.” The doctor has ordered a minimum of one night stay. Called Blue Cross and explained that what they are doing is denying payment of care hoping we would go away. The doctor that reviewed and denied the claim was listed on the back of the denial letter. I plan to write the medical board regarding the denial. What doctor would endorse that denial. Very stressful at a vulnerable time when you are already weak. The stress of it all could lead to death. Criminal greed. Insurers need to be held accountable and the doctors that are endorsing the denials held accountable too.

[Little_Lepus]

I like how it's totally legal to be denied coverage that you pay for. Can you imagine if we did that with something like groceries? Like, oh, you have to pay upfront, and then the store gets to decide what groceries you actually get to take home with you. Also, there's no way of knowing beforehand what groceries you'll be allowed to keep until you try to leave with them.

[Kobay]

My partner went to a doctor about a lump they had found. The doctor had them get a mammogram and testing which showed to be benign. Later we got a large bill for the mammogram even though the insurance site said the cost was fully covered. I called them to figure it out. Turns out that mammograms are only covered for regular screening, but because there was concern of an issue that wasnt covered. Insurance is a scam.

[mindyallen]

I have worked for a pharmacy that provides high-dollar medication. I was provided with the approval guidelines of every insurer in the Northwest. Dr would send me the patient notes and charts so I could handle getting the medication initially authorized and then maintained because authorizations are only good for a defined time. If I knew an insurer was looking for a specific word and it wasn't there, I let the doctor know. This helped the process, but it is a circus and we are all clowns. They don't want to pay for anything. And medical necessity is apparently subjective.

[amazinggrapes]

I don't want to live in this country anymore

[bluensx]

I’m a physician. I’ve been practicing since 1996. What has happened in the US over the past 15-20 years just disgusts me. What the insurance companies do is flat out fraud. Should be illegal. They look for the smallest loophole or tedious paperwork that a lot of people do not understand. This combined with nobody to speak to, and long hold times, drives people to just give up. I’m super surprised that more patients don’t go “postal” on insurance companies.

[maxcrss]

The root of all of this is the fact that we’ve allowed insurance companies to use individuals who DO NOT HAVE medical degrees to override the doctors making the decisions about operations.

[GeassStudioR]

This is one of many examples of how white collar crime CAN negatively impact people’s lives; even to the point of actual death. These companies need to be served actual justice through jail time and NOT easily payable fines.

[sunflower]

I signed up for a Medicare advantage program after double and in some Triple checking that all my doctors were covered and my medications were too. Turns out 4 of my doctors and multiple medications were not covered. Not only was I unable to go to the doctor it cost me thousands of dollars to pay for medication. To top it off I battled 9 months to get out of the program. They changed what I had to do 3 times to be unenrolled. Even then they claimed twice they did not get my unenrollment fax. I used two different fax machines. The third time I faxed I used a government agency that one finally went through. It turns into a year of nightmare, and endangered my life.

[erin]

I worked in a doctor's office where EVERY YEAR one of a pair of identical twin girls would get deleted from their parents' insurance policy because *clearly* two kids couldn't have the same birthday.

[thface]

I have worked at many insurance companies around the country. These outsourced denials let the sociopaths in the board room sleep well on their giant piles of our cash. Medicare for All, today!

[primal]

I don't work for healthcare but I work for a company that's contracted by a large healthcare conglomerate. They make every step incredibly complicated and often pointless to try to refuse more claims. Like one support ticket will have multiple departments working it. They'll go back and forth requesting pointless information stalling the process. Information they already have they demand of the member even when unrealistic for them to have it. If they don't "oh well... nothing we can do." They make sure the people calling have no involvement in the ticket process so that they can't help the member.

They're evil. 100%.

[WillAsplund]

Healthcare should not be a for-profit vertical. It should be regulated, controlled, and paid for by the government. Healthcare Insurance companies are the scourge of the earth.