Tuesday, July 22, 2025

How is your medical insurance treating you?

 

I'm sure you've seen headlines like these in recent weeks.


Insurers Request Huge Obamacare Rate Hikes, Many Over 20 Percent

Health Insurers Are Becoming Chronically Uninvestable


They indicate that across the health care industry, costs are becoming unaffordable not only for consumers, but for the insurance providers on whom they rely.

I've noticed a new trend this year.  Previously, I've never been denied a treatment or medication prescribed by a doctor.  This year, I've had four denials, two for medication and two for in-patient hospital treatment.  None were issued directly by my insurer;  they all came from some sort of specialist claims investigation agency employed by my insurer to assess whether the prescribed service(s) and/or medication(s) were "appropriate" or "met clinical guidelines".  This is presumably so that my insurer can claim, "Oh, we didn't deny your treatment - an outside agency did.  It's not our fault!"

I'm told that I'm far from alone in this quandary.  It looks as if anything other than the most basic of medical care is being far more heavily scrutinized, and may be denied.  This is of particular concern to me with some major surgeries pending.  What if they become unaffordable for me, thanks to penny-pinching insurers?

That made me wonder.  What's your experience in recent months, dear readers?  Are you finding it increasingly difficult to get the treatment and/or medication and/or medical services you need?  Are you being fobbed off with excuses?  Please let us know in Comments, so we can assess whether or not this is a common trend.

Thanks.

Peter


9 comments:

TWS said...

Same. It started late last year after our company switched coverage.

Anonymous said...

The medical industrial complex is devoted to stripping every last bit of money from Americans. Any "healthcare" is simply a "side effect".

Anonymous said...

We have a healthshare, so... prices went up last year. But it's basically catastrophic coverage, doesn't kick in until like $4k, and doesn't cover regular doc visits, medication, etc. It's for if somebody gets appendicitis, basically. The plus side is that it's cheap, they can't tell me what doc to see, and I don't have "surprise" medical billing.

Anonymous said...

Just saw a video on you tube yesterday. Clip of Senator Hawley grilling some experts on the problems of “vertical integration” in which medical insurers were buying up pharmacies and PCBs that negotiate prices between insurers and pharmacies, as well as buying up the doctors offices and hospitals in some areas, with the obvious result that patients lose and insurers benefit. And then the insurers that own every step in the process pretend that realistic price negotiations are still occurring between the different parts. Wonder if this is connected to what you see?

Peteforester said...

My mom had labwork done and received a notice that the labs weren't covered... AFTER THE FACT... My insurance company is jerking me around, changing my doctors due to "contract issues."

I know two people who are on MediCal (Medicaid for anyone not in California). One spent two weeks in ICU. Not a penny paid... by him... The doctor prescribes meds. He doesn't pay a penny out of pocket. The other person spent two weeks in detox at the local hospital, "free" to him. His wife just had a baby. Not a penny out of pocket.

It seems the answer here is to become a welfare bum and let "somebody" pay for it... This is the kind of thing that happens when illegal aliens and the dead are allowed to vote...

Jess said...

So far, no. I'm on Medicare with a supplemental policy.

Anonymous said...

The one meds that saves my life. The insurance decided to change the tier it's priced at my old 30 bucks for 90 days went to 1150 for the same 90 days. Now I use Cost Plus and get them for 189 for 90 days, but must have insurance for any anesthesia etc. What are we paying for?

Peter B said...

All the comments above are relevant. So is this:

https://www.reddit.com/r/Damnthatsinteresting/comments/vvhw38/growth_in_administrators_vs_doctors_in_the_us/

Anonymous said...

Obama destroyed private insurance, just like he created the student loan fiasco. Transformative indeed.