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
24 comments:
Same. It started late last year after our company switched coverage.
The medical industrial complex is devoted to stripping every last bit of money from Americans. Any "healthcare" is simply a "side effect".
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.
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?
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...
So far, no. I'm on Medicare with a supplemental policy.
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?
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/
Obama destroyed private insurance, just like he created the student loan fiasco. Transformative indeed.
Medical insurance is like all insurance. It takes the cost from a small percentage of people and spreads that cost over a large group of subscribers. The problem with medical insurance is twofold. The number of old decrepit people who use health care at a massive rate is growing while the number of young productive workers paying IN to the system is dropping. It's simple math and it's a formula that CANNOT continue. Either we must find a way to increase the number of people paying in to the system who DON'T use much healthcare OR we must eliminate large numbers of people who use the system at a greater cost than what they pay in to it. It's basic math. We see the same problems with auto insurance. Fewer and fewer people buying insurance and more and more people driving "uninsured". The costs created by the uninsured must be borne by those who DO purchase insurance. And thus the cost of auto insurance has skyrocketed. Same phenomenon. Same basic cause.
Haven't been to the doctor in years. Will finally be applying for social security since soon to be 67, albeit very reluctantly, because I don't want Medicare. I despise the government and 'health care' system and the 'insurance' system and everyone's belief that they're entitled to live forever.
This is why we belong to a health-care sharing ministry, not insurance. The monthly fee, which goes directly to pay part of another member's medical bills, doesn't change from month to month unless voted on by the membership. We can use any doctor, hospital or lab we choose. Since we're retired we have Medicare part A, so any hospital stays are covered, for the most part. Couldn't afford part B. Samaritan Ministries is a life-saver. The body of Christ "bearing one another's burdens".
Just fought with Medicare to cover 4 simple blood tests and won. It would have been cheaper for them to pay the 265 instead of going thru 2 appeals but it was the principle of the thing that lead me to pursue it. Shakespeare said first we kill the lawyers. I think he would be rewriting that line today
-Randale6-
I become more and more convinced of the benefits of medical tourism each and every day. Even with flight costs (to Mexico) and hotel prices factored in...the spics are still cheaper. As a bonus your gringo dollars afford you access to their premium, rich people hospitals.
I haven't seen those issues, but I find it more and more difficult to find out which facility and which doctor accepts which insurance and what the charges will be.
Jonathan
It's always the other guy's fault. CYA and spread the blame - with all focused on milking the payer (you and me). Funny how all these companies reduce costs yet the price keeps going up.
My wife’s employer changed insurers this year. It’s been a pain in the backside because they keep sending notices as her medication refills come due that they aren’t authorized. So then the doctor has to fill out forms that, yes she has tried these other alternatives but they weren’t as effective as this med she’s been on for the last 5 years. There was also an issue for her regarding her secondary insurance (my employer covers a family plan) where they wouldn’t cover anything, which took an afternoon of calling and another business day for the IT guys to fix.
The industry as a whole is a scam.... but I'd digress.
My wife had to find a new doctor this year - employer changed management companies, old doctor wasn't on the list.
Goes to new doctor for intake appointment, gets medical history form. My wife is AT the new doctors solely to get a prescription refill for some migraine medicine she's taken for the last 5 years. On the medical history form it asks "have you ever suffered from..." and lists 25+ maladies. My wife checks the box that says "headaches" because she is at the doctor seeking medication to deal with her migraine headaches.
Office visit goes smoothly and normally, refill for script issued. Wife goes to pharmacy to get refill - insurance denied coverage, you pay $150 cash or no pills. Wife calls insurance company, repeatedly, before getting an answer: Medical history form said "Headaches", so you can take tylenol or motrin instead of this prescription you've been taking for the last 5 years for said headaches.
No recourse, decision made, doesn't matter what your doctor says.
Most people don't grok it yet, they're too stupid. You and your doctor are NOT the people in charge of your health care. You are NOT making the decisions. Your insurance company makes those decisions, you choose to put up with it, or not.
I'll give you another example that's even MORE outrageous! I don't have health insurance, I'm a cash-customer. I snore. Went to a sleep-center for their free consult. We can do this, that, or the other thing to fix your snoring. OK, sign me up - here's my government issued ID. Oh, you have a CDL license? We can only sell you this one model CPAP machine. No no, I'm a cash customer, I don't have insurance restrictions... Nope, federal fucking government says if you have a CDL, the only prescribed anti-snoring product that you can buy from a medical professional is a 30-year old model CPAP machine.
... and you think as a consumer you're going to be able to exert influence on the insurance industry?
That IS one of the goals - make the population totally dependent on the state.
My husband and I have been on Medicare for several years, and not had any problems so far. Everything is covered to something like 80 or 90%. I do not have any serious health issues. My husband’s treatments were covered when he needed it.
Only thing I’ve noticed lately, is almost every visit I’m seen by a Nurse Practitioner. Doctors are booked a couple or 3 weeks out. Specialists like dermatology may be 2 months unless considered ‘emergency’.
Martha
Free Luigi.
My wife and I are on Medicare, and aside from a 10% increase in Medigap (via Blue Cross) coverage, we haven't had any problems.
I had torn the meniscus in my knee in Jan '24, and when I finally broke down and saw a doc, myriad other issues cropped up. 4 CT scans later, only two for the knee, and several other diagnostic tests, but it was all covered. The eventual knee surgery (6 months to the day after the injury, and 5 after I first saw the doc) was covered, though it was in my interest to rent a hotel room in town for a few days.
The other knee is making complaints, and for other reasons, I'm switching my first-line doc (the old one pushed the not-vax clotshot way too much, then went radio silent when mainstream media started to publish adverse information. He didn't take the transfer well, but it looks like TPTB gave him a Gibbs-slap. Hmm.
We have Samaritan, which is a christian health sharing organization. Doesn’t take care of basic stuff or routine visits, but covers big stuff really well. It’s like self pay, where it’s you and the doctor making the decisions without worrying about insurance interfering and having to wonder what they may cover or what they may make you do.
Instead of raising rates, have doctors tell us which government mandated rules forced them to raise prices? Cut those first.
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