cross-posted from: sh.itjust.works/post/9208209
I’ll spoil this for you, much of the time they didn’t even read the medical documentation sent to them, just denied whatever was asked for. And then hoped the patient would drop it and never even let their doctor know it was denied. Or if that fails and the doctor finds out it was denied they hope the busy doctor wouldn’t be able to figure out how to contact the company and the right number to do so, navigate phone trees and find archaic long series of ID numbers and case numbers and other information specific to that one company, then schedule a time range of hours, often in the evening at home, to be ready to answer a call at any moment from some “peer” (who’s not actually a peer, a doctor, or even in the same specialty) who also never read the medical documentation sent. They point out to the company the rationale meeting all their criteria is clearly met in the medical documentation. But the “peer” states their company has a new additional rule about that treatment and that wasn’t included in the initial documentation sent. The doctor points out it was, they claim they don’t have it though. This is followed by another denial. That additional documentation is sent in, no response for weeks (please allow up to 4 weeks for response). After finally getting a hold of someone, they state that they can’t accept this since there was already a denial and now must go through an official a hoping the doctor won’t know how to find out about their appeal process. If the doctor figures out how to do that then they write a letter again explaining the medical rationale for the treatment being denied including citing sources from the literature. But oh wait that appeal was denied, because this was a Medicare advantage plan or some crap and the appeals process is not applicable. But you may file an appeal with the state insurance authority.
Anyways, three months and much unpaid labor later, treatment finally approved. Which, if they had just read the original note sent, should have been approved in the first place. Not speaking from experience here or anything, lol.
DerisionConsulting@lemmy.ca 7 months ago
I’m glad this tool exists, but I am more glad that I don’t live in the USA.
dom@lemmy.ca 7 months ago
But this shit can come to other countries if they aren’t careful. Fight Healthcare privatization with everything you’ve got
Norgur@kbin.social 7 months ago
That's a message for the Brits then. As long as the USA are a almost daily reminder as to why completely private healthcare is a really bad idea, mist countries that have public healtcare will probably be very hesitant to even discuss shit like that.
Yet, ideas being obviously and utterly stupid hasn't stopped the Brits very often in the past, has it?
HubertManne@kbin.social 7 months ago
this stings but I totally get the sentiment. We are in our benefits selection process and I chatted that we should invite our eu counterparts so they can have a laff. You see what you do is you compare the price of the drug with what your insurnace offers versus a private discount card and then you factor in usage of the tax deductible account versus the value of it coming off your deductible. If you every want to know why americans seem angry so often think about that.
Anonymousllama@lemmy.world 7 months ago
Usually don’t like jumping on the US healthcare = bad bandwagon, but jeeze having these shithole insurance companies in the middle looks awful.
It’s as simple as a doctor giving you a script and the chemist dispensing it here, thank fuck the government takes care of the rest