How do sick people survive the US healthcare system?

Amazon stega
May 14 98 Comments

I just spent hours wrangling with Premera and my doctor's office to get pre approval for a test I need done. Hours. Learning about CPT codes and other bullshit to persuade the insurer to listen to my doctor. Finally got it approved.

What bullshit.

I'm relatively healthy trying to deal with a particular condition that ended up requiring an expensive test. But what if I were sick? Can't imagine a sick person would have the energy to do battle with the insurance company like this. I guess I just wouldn't get the test or treatment and die?

I come from a country with public healthcare. Never experienced such unrelenting bullshit before in my life. Why does some non medical person at the insurance company feel they know better than my doctor about what tests I need done?

This is with Premera be Blue Cross, supposedly the best insurer. What happens to people with crap insurance?

The doctors are good. They are hamstrung by insurance company bureaucracy.

If you have never needed a procedure that required pre-approval please don't comment that you think care here is good. You've had colds and flu's and maybe a sprained ankle. Wait until you need a test that costs $4000 and see that fuckery happens.

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TOP 98 Comments
  • Oracle droned
    The ignorance spewing on this thread is amazing. The US healthcare system is light years ahead of all others because it’s NOT single-payer/gov’t run. You want long waits for care? You want lack of medical innovation that comes from the free market system? Then vote for Bolshevik Bernie the dumbass! Btw, I have UnitedHealthcare and have been very pleased. I agree that some insurers can suck (like Premera?), but the free market should squeeze them out or cause them to improve. Under gov’t run systems there is no incentive to improve. For God’s sake, just look at our VA system for a microcosm for failure that would occur on a grander scale.
    May 1415
    • Apple Hansel2
      We already have long waits for healthcare, dumbass. Trying getting an X-ray any day of the week for a non life threatening issue.
      May 14
    • Apple Hansel2
      Lemme guess, Oracle also believes in trickle down economics like he/she believes free market is god?
      May 14
    • Microsoft pJcW86
      But but but free market is supposed to make x-rays faster!!!! /Trumptard
      May 14
    • Veritas hsiwbvc
      got a same day xray just yesterday for some neck pain an hour after my dr requested one never personally experienced problems here
      May 14
    • Amazon stega
      OP
      Firaxis, when you need a procedure done in order to remain healthy and you have to spend a day on the phone dealing with a three way clusterfuck between the insurer, the clinic, and the faceless company the insurer outsourced approval decisions to, come back and tell me it's only a "lower level customer experience issue".

      In practice it determines whether you get the care you need or not. Fortunately I'm otherwise healthy and have the stamina and the wits to navigate this bullshit and get the treatment I need.

      But I can't imagine getting this done if, say, I had some life threatening condition that also impacted my alertness and mental state. I think I would give up and then die from lack of treatment.

      This is a fundamental problem with the system and goes to the very heart of the problems caused by private insurance.

      In my opinion once my doctor decides I need a test or procedure that should be all that's needed. No pencil pusher should be challenging my doctor's decision and making me run around like this. That is in fact how it works in most countries. Doctor+patient=decision.
      May 14
    • Apple Hansel2
      And I waited 8 hours for one.
      May 14
    • Veritas hsiwbvc
      Who is your provider?
      May 14
    • Amazon stega
      OP
      Premera / Blue Cross
      May 14
    • Facebook lolwutm8
      Universal healthcare should be the obvious conservative choice. Reduces business costs (so they can hire more full timers) and increases entrepreneurs. I personally know several very smart people who would have tried founding their own company if they weren't worried about how who was going to pay for their families healthcare.
      May 14
    • Auth0 / EngFiraxis
      Oh stega, cut the condescending nonsense. I'm from another country that has a much worse healthcare system than you have, I've had family members die because of this system modeled after the US. I've seen you keep telling others about "oh, when you experience what I experience then u can talk", please take a seat, others here have experienced much worse than you have.

      I'm pointing out that you're attempting a straw man at the other person's response.

      Yes, you have 2 parties that try to make as much as they can. If you remove one, the insurance, you still have the medical side that's still going to try to milk the system. Removing one does not solve the problem.
      May 14
  • Finale Inventory / EnghuHG50
    Vote Bernie Sanders. We need Medicare for all.
    May 145
    • Apple ijyA68
      Because the government will give anyone whatever test they want, immediately whenever they want it 🤦🏿‍♂️.
      May 14
    • Amazon / EngKHCr70
      Actually yes that is generally how universal health coverage works.

      See how it works in Japan and you will probably think its rediculous. You basically order tests off a menu.
      May 14
    • Intel / EngWho.Dis
      So suddenly we order the tests instead of the doctor?
      May 15
    • Amazon / EngKHCr70
      If you want somthing it gets approved by your doctor, and your doctor doesnt pay for it so he doesnt give a crap.
      May 15
    • Intel / EngWho.Dis
      Interesting take....my sister has held off certain tests for people because she knew they couldn’t afford it (genetic test). She helped them navigate the system to get aid eventually, but a responsible physician doesn’t order random crap. I’ve also had a legitimate medical condition where certain doctors had an opposing view and didn’t do anything for me. Perhaps your experiences are different tho
      May 15
  • Ericsson / Engrawr🙈🙉
    Agreed. The US has to get their shit together
    May 140
  • Amazon / EngewjX55
    Its better than it was when i was a kid. At least most ppl have insurance even if its shit. Growing up my family couldn't afford it. My dad splinted my broken finger himself (its still bent). Ive had to self-diagnosis for most of my life and hope for the best.
    Its been one of the reasons i worked hard to put myself through college. I dont want my kids to be living that kinda life.
    May 142
    • F5 Networks buzz-word
      Best wishes! Glad to see you successful
      May 14
    • TripAdvisor owlwise
      Actually, a greater share of people had coverage in the 70s than they do now
      May 14
  • Microsoft hümänkïnd
    The US healthcare system is an utter racket! A good example of how monstrous late stage capitalism is.
    May 145
    • Amazon jtGV66
      It isn’t capitalism, that’s the problem.
      May 14
    • Microsoft hümänkïnd
      Please elaborate...
      May 14
    • Amazon jtGV66
      There are laws and regulations making competition almost impossible. It is a huge business opportunity with lots of room for improvement, yet nothing changes. That doesn’t happen in a market where competition is possible.
      May 14
    • Google Noogler69
      The free market works very well if you’re getting laser eye surgery or a boob job. Providers compete on price and quality.
      May 14
    • Microsoft hümänkïnd
      Health care is not a business as any others
      May 14
  • Microsoft hümänkïnd
    This sums it up pretty well...
    May 154
    • Amazon / EngKHCr70
      Data??? More like liberal propaganda!
      May 15
    • Microsoft hümänkïnd
      @KHCr70 « Data??? »
      Trouble reading? Or what is it exactly that you can’t comprehend?
      May 15
    • Apple etubrute
      I think @Amazon is being sarcastic. I hope.
      May 15
    • Amazon / EngKHCr70
      My God, I thought that was painfully obvious...
      May 15
  • Microsoft Sx23
    Most of you commenting are full of it. Take it from me, diagnosed with a very serious disease which requires $15k/mo in treatment. At first I was worried that the treatment was not preapproved until I called insurance who stated they had replied with ‘no pre-approval necessary’ letter.

    I belong to a global FB group for my disease. People (mostly European) feel sorry for us in the US, apparently for whatever they’ve read in the liberal media. But it is they who are constantly complaining about the doctors not knowing about their disease or approving their treatment or 12+ month waits for service.

    Listen, I have faced death on this and I’ll take my good ole USA healthcare system any day of the week over the promises of govt run healthcare. Sure there can be significant red tape but that is peanuts compared to my illness.
    May 144
    • Credit Karma EllisDee25
      I was misdiagnosed and then dropped by my insurance. 15 years later I got coverage at work and a correct diagnosis. I’m sure spending a decade thinking you’d be incapable of a normal life by 40 is a great deal for someone... just not me or millions of people who get sick.

      From keeping up with the competition:

      https://www.nerdwallet.com/blog/health/medical-bankruptcy/

      “In 2013 over 20% of American adults were struggling to pay their medical bills, and three in five bankruptcies in 2014 will be due to medical bills. While we are quick to blame debt on poor savings and bad spending habits, our study emphasizes the burden of health costs in causing widespread indebtedness. Medical bills can completely overwhelm a family when illness strikes.
      ...
      Finally, many question whether President Obama’s universal health insurance mandate will protect Americans from problems with medical bills. Insurance is no silver bullet. Even with insurance coverage, we expect 10 million Americans will face bills they are unable to pay.”
      May 14
    • Amazon jtGV66
      Imagine how much lower it could have been than $15k if we had the system working properly !
      May 14
    • Amazon stega
      OP
      Microsoft, what are you going to do if you lost your job, as many sick people do? Got the 15k/m stashed under your mattress?

      And then once you're dropped and you finally get a new job and hear the phrase "pre existing condition" justified by the gap in your insurance.
      May 14
    • Microsoft Sx23
      @jtHV66, if it were any lower than 15k/mo than the drugs that are saving my life would not have been developed. They’ve only come about in the last 10-15 years.

      @stega, if I lose my job then the drug company would kick in and heavily subsidize the cost. It’s just another form of taxing the rich. And pre existing condition denials ended by law in 2014. (And prior to that HHS offered pre-existing condition insurance if you could not get coverage elsewhere).
      May 15
  • Credit Karma EllisDee25
    B-b-but the market is never bureaucratic and always gives good service!!!

    🙄
    May 143
    • Amazon jtGV66
      The healthcare market is massively regulated, of course its going to wind up bad for consumers.
      May 14
    • Credit Karma EllisDee25
      Commodifying a “consumers” health is bad for the “consumer”.
      May 14
    • Microsoft hümänkïnd
      @jtGV66 I think you need to inverse the polarity of your pea brain
      May 14
  • Facebook public2
    If you are rich its the best in the world, else be ready to go bankrupt.
    May 1418
    • SpaceX uevh5
      Do you seriously think someone denied the OP's tests because he works for Amazon and that could never happen at Google or Facebook?!?!?!?!?!?!?!
      May 14
    • Facebook public2
      I don't know ops situation or insurance plan. My point was sadly there is a huge variation in insurance coverage and most large companies are self insured. Again American healthcare is the best or worst depending on your access. I'm not saying its right (or wrong) just laying out the facts. If OP is going to have continued health needs it may absolutely be worth switching plans. Some companies have a history of going above and beyond as well as modifying coverage to help employees; others don't. Interpret these facts as you wish. Best of luck to OP. I'm sorry the American system is so unfair and please vote in the next election.
      May 14
    • Amazon stega
      OP
      To be clear, they didn't deny it, they approved it, but it took me most of a day on the phone between the insurer, their third party assessor the insurer outsourced the decision to, and the clinic, to get all the right documentation to all the right people. Amazon was never involved in any way in this process.

      My point is a sick person probably doesn't have the endurance for that.

      So this isn't a "coverage" issue, contrary to what public2 is trying to claim. This is pure bureaucracy. The insurer will certainly claim this is covered and probably thinks they reached a timely decision because they will ignore how much work I had to do to make that happen.
      May 14
    • Facebook public2
      If coverage was higher there's less pushback on approvals and or many plans offer a concierge to so that for you.
      May 15
    • Amazon edyc6
      Coverage is rule driven that makes no sense.
      May 15
    • Facebook public2
      Insurance companies have a forecasted amount of payouts and work hard to keep coverage at or below it. If the bar is low they will make it harder for all involved to approve expensive tests/treatment.
      May 15
    • Amazon edyc6
      I've had insurance from several companies, cheap companies make you pay more of the premium or take away coverage for things like fertility. The clerks underneath it all aren't trained to do different things for different clients other than as dictated by the policy coverage rules. They don't even know who that is in most cases they are just processing forms.
      May 15
    • Facebook public2
      Yep, those "clerks" (I assume you mean concierge) is what makes it easy or hard based on their goals.
      May 15
    • Amazon edyc6
      Not in my experience. In my experience they have no idea who you work for. By the time it gets to them it's deep in the system.
      May 15
    • Facebook public2
      Idk what else to say here so ok. Regardless hope your situation aorks out and your results are positive (in the good way).
      May 15
  • Amazon / EngKHCr70
    At least you had insurance :)
    Brothers friend went to a concert in the US without getting insurance and hit his head in the mosh pit, got knocked out. An ambulance got called and he had to spend the night in hospital for monitoring. Cost his parents 14k
    May 142
    • Amazon / EngewjX55
      As someone who didnt have medial insurance till obamacare era, im sayimg your friend fked up. Ive had to tell people to stop calling the ambulance for me even though i probably needed it. Or have had to just dip out of the scene before they arived cuz im not trying to go bankrupt
      May 14
    • Amazon / EngKHCr70
      Yeah man. I'd have jumped out of the back of the ambulance. Even if I was unconscious
      May 14
  • Microsoft
    Tier 1

    Microsoft

    BIO
    #1 in Prestige
    Tier 1more
    Never had this issue with the Microsoft Premera plan.

    Is amazon underwriting it’s own plan? If so, they may have simply instructed Premera to be frugal.
    May 142
    • Amazon stega
      OP
      You never had an expensive test or procedure
      May 14
    • Microsoft
      Tier 1

      Microsoft

      BIO
      #1 in Prestige
      Tier 1more
      I just got over $10k in tests of dubious merit
      May 14
  • Amazon / EngKHCr70
    I dont think there are real people who actually think the US has a good healthcare system
    May 142
    • Amazon stega
      OP
      There are. They are people who have never had any major health issue. They think in abstract terms and don't realize what the reality of it actually is.
      May 14
    • Credit Karma EllisDee25
      Investors and heads of insurance companies do!!!
      May 14
  • Opus Consulting framework
    Just Half hour back, I Paid 5700 dollar medical bill even after paying expensive premiums. It sucks.
    May 140
  • Apple etubrute
    This is what happens. They don’t go to the hospital. Because they can’t afford the high deductibles. When they are forced to go, they end up in financial ruin and typically bankruptcy.

    Only after you have no more than $100 to your name will you qualify for Medicaid (Medicare for poor people). But before that happens all your retirement accounts and your home must be liquidated or completely out of your name.

    It’s a very bad system for poor people. Because to have healthcare, you need to be dirt poor. If you are middle class, you must first become poor before you’ll have healthcare that doesn’t cost you money out of pocket.

    My advice is don’t get sick. Because it’s the Wild West here.
    May 151
    • Amazon edyc6
      I met a woman once who was working part time at a minimum wage job. She had previously been working full time at a higher paying job (like 60k, a regular person's job).

      But her higher paying job was a form of self employment that didn't come with healthcare. Then she was diagnosed with a disease the was manageable with proper care but expensive to treat. Untreated, fatal.

      So she resigned her job and took the minimum wage one to qualify. She carefully manages how many hours she works so as to stay under the limit and qualify for Medicaid.

      Otherwise she dies.
      May 15
  • Google əๅɓoo⅁
    In our family we have many chronic health issues and had millions paid by insurance companies over the years.
    In my experience, PPO employer plans work fairly well and pay for any reasonable (and often unreasonable or experimental or whatever).
    Every once in a while they request additional paperwork - this is usually handled by the dr office, no need to call anybody.
    There *is* a lot of bills to keep track of - pay all the doctors, collect receipts, file claims. Not fun if you are ill. But if you get ill, you will probably lose your employer plan anyway and that would be a whole different issue.
    May 141
    • Amazon stega
      OP
      Yeah that's another "great" feature, losing your employment and therefore your insurance when you get sick. Basically a way of kicking you when you're down.
      May 14
  • Amazon jtGV66
    We need more competition, not single payer. You wouldn’t have had that shitty experience if your insurer were forced to improve the experience or go out of business.
    May 140
  • Indeed / Englty
    Do you know a survivor ?
    May 140
  • Google / Eng
    TI-REX

    GoogleEng

    PRE
    Google
    TI-REXmore
    Everything can be solved by forcing hospital provide a price list for all of their craps. Because now, they just charge whatever they feel like. My mom got a surgery last year. When the med bill came we saw that the room that she stay for 10mins before the surgery cost 4.5k, the room that she stay for 5mins got her blood drawn for a test cost 5k, the operation room cost 8k. Wut kinda room cost that much, a 5k star hotel? The entire thing cost 50k. These hospital people are literally just typing random shit in the bill and trying to charge people for it. You can try to ask them for how much it will cost and they will always say they don’t know. How ridiculous, their people, they equipments, they are the one who’s doing the test and they don’t know how much it costs. And it always takes them a month to figure it out.
    May 152
    • Apple etubrute
      I agree with the principle. But hospitals do this because they are throttled heavily by the insurance companies. They might only get 19% payout from Cigna but 15% payout by UnitedHealthcare. So they have these crazy “surge pricing”-like pricing schemes to make up the difference. There’s no transparency at all and impossible to follow.

      But even if there was up front pricing, would it change your mind? Are you going to say “I know my wife needs and emergency cesarean right now before she bleeds out, but let me shop around first”. Nope.

      The reason why single payer system work all across the world is the government steps in and sets prices. So a MRI is only $250 rather than $5k, and room charges is reasonable and standardized, and the pill of life saving medication is just $0.50 rather than $50.

      The problem with healthcare is it’s an inelastic demand. Transparent pricing doesn’t really matter because it’s not like buying something on amazon. When you need healthcare, you usually need it urgently.
      May 15
    • Google / Eng
      TI-REX

      GoogleEng

      PRE
      Google
      TI-REXmore
      I mean, of course no one will shop around to find cheaper hospitals. But the thing is hospital shouldn’t create their own random prices. My family all have insurance, so that 50k Bill is covered. What about those who don’t? After they got out of hospital then they have nothing left. That single medical bill broke their entire family. So having a price list to the public is crucial. That prevents hospital from charging people whatever they want. I’m gonna make this analogy, suppose you really need some thing and it’s a life or death situation. And there only one store that sells it and the it’s priced at 100k. Of course you grab it and put down ur credit card or bank account or get a loan right away without even thinking about it. Compare to this, you really need and and walk to a store and the owner just tell you don’t worry about the price, just take it any go and we will mail the bill to you. And they mailed you a bill with some random number that’s to guaranteed to be much higher than 100k.

      All I want is a strict upper bound on the price. If after the law was put into place and hospital really set the price to a point that no one can afford then that’s a another story.
      May 15
  • Google mksee
    I used to have Premera (when I was with Amazon) and had some trouble similar to yours. They claimed never to have received paperwork from the provider, the provider claimed they sent it, wouldn't get resolved until I collected everything myself in person, it was ridiculous. All sorts of clerical incompetence from both sides. Had much more happy experiences with Anthem PPO after I left Amazon. Now I'm in Switzerland and sorta miss my previous US health plan, believe it or not. But then again in Switzerland medical insurance is also semi privatized. I guess it depends largely on your employer and insurance company.
    May 142
    • Why do you miss US health care? Isn't Switzerland healthcare superior compared to the US?
      May 14
    • Google mksee
      I think for the average person it's better here. But for a Google employee, it's definitely better in the US.

      Medical insurance in CH is semi private. There are some regulations in Switzerland that prevent employers from providing medical insurance directly for employees. Instead we shop on the open market for medical plans, just like everyone else. Insurance premiums are tax deductible, which helps. There are laws governing what the insurance companies are allowed to charge for basic health plans, so basic coverage is essentially the same across all insurance companies in terms of costs/benefits. Basic plans are not cheap, but decent if you consider it as an average.

      I pay about $350/month as a healthy young single person for my coverage with SWICA for an above average plan but it's still not *that* great. I have a fairly high deductible (over $2000) before any benefits kick in. I have to call an advice line before scheduling any non emergency appointments. It includes no coverage whatsoever for dental or vision so I go to the dentist less now and pay out of pocket when I do. I haven't gone for any vision stuff because there's no coverage. I don't find it worthwhile to purchase dental or vision insurance, and from what I can tell most Swiss don't either. I haven't found the quality of care itself to be significantly different between the two countries. Similar appointment wait times, similar hit or miss with the quality of the providers.

      In the US, Googlers on the PPO plan get $20/$30 copay for GPs/specialist office visits, and you can schedule an appointment without a referral or calling your insurance company. There's also a 10% copay on procedures/tests. Very cheap prescription medication. The company also provides outstanding dental (two routine cleanings, check ups per year at zero cost) and vision coverage (3 prescription glasses prescription year)
      May 14
  • Google bo o
    yeah looks like your insurance sucks. but I agree, I don't know how average people get healthcare in this country. some even go bankrupt due to medical bills.
    May 140
  • Microsoft Sx23
    Why do you all keep quoting 2013/14 stats? Forgive me but I feel they may be leftover marketing charts from the Obama admin.
    May 153
    • Pinterest / EngAcGa07
      🤣🤣🤣
      May 15
    • Microsoft hümänkïnd
      I get it. Life expectancy, child mortality and maternal mortality are a joke to you. I am glad it made you happy and you could do your Obama-bashing joke placement.

      https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus
      May 15
    • Microsoft Sx23
      Nope. I actually don’t mean to be that insensitive. I’d just like to know why the stats need to be from just prior to ACA. I think a reasonable person would think it’s a reasonable question. I do lean conservative. But really I’d like to be able to have an honest conversation “across the isle” because I think both sides have great points.
      May 15
  • Logitech oXrB48
    They just go to the ER and never pay, they have to treat you. I did it all the time when I was young and poor.
    May 141
    • Amazon / EngewjX55
      It still sticks on your credit record. Idk if thats changed between wen u were young and poor and i was. But i got stuck with a 10k bill that just sat on collections for years until i got some good college grants
      May 14
  • Google 7FwU30
    Not all of them do lol
    May 140
  • Nvidia greekie
    They don't often tragically... but hey we got as many pills as you can pay for.
    May 140
  • Are there the same issues with EPO?
    May 140
  • Apple iCould
    The good thing about Kaiser Permanente is that there is no need in dealing with insurer. But the downside you can only work with in-network doctors who may not even consider the tests you want.
    May 140

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