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submitted 21 hours ago by Blaze@sopuli.xyz to c/AskUSA@discuss.online
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 I changed jobs and changed insurance earlier this year, and I need a drug called Humera that among other things, prevents my spine from solidifying into 1 solid piece. My new insurance denied my claim because I had not tried to treat my disorder with Tylenol. Yeah, ok. Seems legit. So I challenge the claim and am told by my new insurance that "they'll get their best people on it and be done in 2-3 business days". I call a few days later for updates and they tell me the exact same thing. This goes on for 2.5 months with absolutely no changes, and I'm now about 3 months behind on treatment. 
 Finally, I get aggressive with the rep on the phone and she reluctantly agrees to check my profile more closely. Then she says, "oh, it looks like everything's all set and I just have to do this one thing... And now you'll have your claim approved." How long was I waiting for that one last step I wonder? If that medicine was a matter of life and death, I would have died or ended up in the ER. Just an absolutely pathetic and infuriating experience. 
[-] OpenStars@discuss.online 2 points 4 hours ago

The last time I needed care I went to an "urgent care" facility (for anyone outside of the USA who doesn't know: we have a whole range from "clinics" e.g. a headcold that needs antibiotics to "urgent care" for some routine items to "emergency room" that has everything), they sent me to the ER where I had to wait for 6 hours and ended up with a $1k bill even after insurance.

Sadly, many people lack insurance entirely or it's not reliable so what it seems that many people do lately is wait and wait, doing nothing, then also end up in the ER. We are all connected: what affects others will affect us too - I wish people would remember that more readily, whenever they go to the polls.:-(

[-] gofsckyourself@lemmy.world 9 points 14 hours ago

I live in the US. All my healthcare experiences are 'American healthcare' experiences.

I was basically raised to just avoid ever going, because it's just not affordable.

[-] braxy29@lemmy.world 1 points 13 hours ago

you got it. i spent a couple of years dealing with the kind of problem where you're supposed to go to the ER right away; needless to say, i just. didn't.

[-] Pandantic@midwest.social 11 points 15 hours ago

I had been getting the same medicine at the same pharmacy for quite some time, always costing something like $4. I go to the pharmacy to pick it up one time, and it’s $40. I need the medicine so I pay it (I can luckily afford it), but I call the insurance company to see what’s up. They tell me the manufacturer raised the price, there’s nothing they can do. I ask why I wasn’t informed that my medicine would be 10x the price, they say that “there isn’t a system in place to do that.” I ask what I am supposed to do, and they say, “there’s other manufacturers for this medicine that are cheaper.” I ask what pharmacy has those manufacturers, and they say they don’t know. So I have to call the pharmacys, get the manufacturer’s names, then call the insurance back and ask them the cost.

Also, I had the thing where the doctor was “in network” but the lab (right down the hall) was not, so I got an unexpected bill. I spent hours on the phone arguing, and they finally took the charge off.

My experiences have been infuriating, inconvenient, and frustrating, but not life-threatening luckily.

[-] fan0m@lemmy.world 8 points 15 hours ago

My family member spent about half a day in the emergency room and died. No insurance for various reasons. We got a bill for $86,000.

I wish this was made up.

[-] shani66@ani.social 4 points 13 hours ago* (last edited 13 hours ago)

A niece of mine was almost killed by a hospital. She had a horrendously high fever but they just did nothing ('observation' my ass) until she had to be air lifted to a better hospital. Basically everyone I've ever met knows someone who has died or almost died there, even a drifter who was only staying in town a few months had a story. It's not just the insurance industry, although that needs to die too.

[-] shawn1122@lemm.ee 2 points 3 hours ago

Business interests in hospitals certainly have a role to play but that is in part an extension of the for profit health insurance system in America. Hospitals have hired legions of middle men dedicated to obtaining adequate reimbursement for services provided while insurance companies have legions of people working to deny claims. Doctors and nurses are often left with completely inadequate resources and staffing and patients suffer as a result.

[-] turtlepower@lemm.ee 10 points 18 hours ago

I have many, but the one I'm willing to share:

So I have a dead tooth that is broken at the root, so it requires major invasive surgery to be removed. Well, insurance will only cover localized anesthesia. Local anesthesia doesn't work on me; I can still feel it. Not to mention that they are going to have to go deep to get the root. So I have been living with this for years.

A couple years ago it got infected. I went to the local hospital — Forbes Medical Center in Monroeville, PA. I walked in the emergency room, delirious from fever and pain, and checked in. I sat there for HOURS. Then, the abscess ruptured. I run up to the desk, trying to get help, or at least a fucking barf bag or something because I now have a mouth full of puss and infection. Well, the useless bitch at the desk did literally nothing; just went back to fucking around on her phone. So I went in the bathroom, spit it all out in the sink without washing any of it away so they can fucking deal with it, and walked the fuck out. I was stopped by the security guard at the entrance asking me if I was ok. The goddamn rent-a-cop gave more of a shit about my wellbeing than that fucking shithole of a "hospital". I will bleed out and die in the gutter before I ever go back to that fucking place.

[-] JakenVeina@lemm.ee 4 points 14 hours ago

Was just in the ER for the past 2 days, actually.

My 9-year-old very suddenly had a lump in his abdomen, with mild pain. We waited for 4 hours to see a doctor, and by the time he did make it in, the lump was gone. We're presuming it was a mild hernia, and we'll be following up with a pediatric surgeon.

Now, I'll mirror the sentiment from a few comments here that everyone we interacted with was great. Every member of the staff was friendly, accommodating, and professional. The staff was very forthcoming about what was going on, the hospital's only pediatrician at the time had been pulled into an emergency C-section procedure upstairs. Very understandable. One staff member even went and tracked me down a portable phone battery somewhere, when I asked for a charger.

Point being here is that even when the industry is FULL of top-notch professionals doing all the important work, there's still a big problem in the system. This particular hospital is HUGE, it services hundreds of square miles. Why is there only one pediatrician on staff at-a-time, in the whole place?

[-] OpenStars@discuss.online 2 points 5 hours ago

B/c the goal of any hospital should not be to provide care and rather to make money.

- capitalism

[-] TachyonTele@lemm.ee 23 points 21 hours ago* (last edited 21 hours ago)

I had to spend the weekend in the hospital. At somepoint I woke up and there was a lady asking me about my insurance. I didn't have any. She asked me what insurance would I like? I was pretty out of it, and just said "whichever one you would want to have".

Best thing that's happened to me. That nice lady looked out for me and got me really good insurance for free. No copays or anything. Every thing is free for me. Tests, medication, extra things, cabs, eye dental everything. I have yet to find anything it doesn't cover. And im at various dr appointments every week.

I was really lucky she was there for me.

[-] AnarchistArtificer@slrpnk.net 8 points 19 hours ago

I'm glad to hear that. It makes me think of a few times when I have been helped by someone who is a small cog in the machine showing me some compassion

[-] TachyonTele@lemm.ee 7 points 18 hours ago

Nurses for the most part have always been very nice in my experience. I don't know if that lady was a nurse or what, but it fits with all the other nurses in my area.

[-] Confused_Emus@lemmy.dbzer0.com 6 points 17 hours ago

I have UHC insurance and am prescribed fluoxetine (Prozac). Prescriptions that you take for longer than three refills must be ordered through their mail order pharmacy, OptumRX. Seems like they always take about a week to process and mail out the prescription, and then I’m waiting on USPS who take their time to get it to my mailbox.

All that mess instead of my doctor just sending my prescription to the pharmacy that is literally across the street from my apartment, where I could get it filled the same day. Been thinking about just starting to pay for it out of pocket so I can use my own pharmacist.

[-] PhilipTheBucket@ponder.cat 18 points 21 hours ago

Family had big surgery, had excellent insurance, went to rehab, something went wrong and his bones started coming apart and he reported agonizing pain and popping sounds in his reconstructed bones, and they ignored him and told him it was normal. By the time they realized it was a real issue, his whole anatomy was falling apart and he had to have multiple surgeries all the way across the state to fix it, traveling back and forth while not in great shape, and still isn't okay and probably will not be again. I got in a shouting match with one of the nurses that tried to tell me it was basically his fault.

Other family member had major abdominal surgery, they sent her home after and only after she collapsed at home and came back did they realize that nothing they'd done the first time had actually addressed what was causing the problem. They did surgery again, this time fixing the actual issue, and then sent her to rehab for a few days and then back home before she could walk again. If I or someone hadn't been around to help her out she probably would have starved to death or something.

Friend had a fairly minor health condition, had insurance, went to the doctor, insurance refused to pay the claim for basically no reason, wound up with bill collectors chasing her for thousands of dollars after she had paid out-of-pocket to have health insurance. Lawyer said there's not much to do that wouldn't cost more than they wanted to extract from her. Sorry.

I went to the doctor evading the whole system, just said that I had something wrong with me and wanted it checked by a specialist without waiting six months for a referral and wanted to pay for the visit. They said fine and quoted a price, I said fine. A lab sent me a separate bill for the lab work which the office hadn't told me about, I called the office to ask about it, they said lol good luck.

There really is no way out, other than not to have health issues.

[-] turtlepower@lemm.ee 4 points 17 hours ago

Oh, there's a way out, but we're not allowed to say it. Pray to St. Luigi for guidance...

[-] OpenStars@discuss.online 1 points 5 hours ago

All they'll do is make sure to make even more profits to cover the cost of a bodyguard next time.

Even if you were right though and it did work, will someone simply move on to the next target? and the next? and the next? Negotiations with such "terrorist" activities (literally: with the design to inspire fear in the minds of the recipient) usually never ends well... b/c even if you mean well, the next person seeing that and following along does not. i.e. where does it end?

It opens the floodgates to a breakdown of law & order in society. And for the sake of argument let's say that's a good thing: what then? Who is prepared to build back up a new & better one - especially against the onslaught of literal kids making ghost guns and having learned that Might Makes Right, goes around vigilante-justice killing anyone who offended them, e.g. the person who most recently dumped them? (how dare they, don't they know that i'M sUcH a NiCe GuY!?)

It's short-term thinking at best. Also: I don't see how "healthcare" would result from any of this?

But you are right: we aren't allowed to say much here, on Discuss.Online. The acronym agencies are watching us right now, and moreover that's just not what this instance is all about - there too, if someone wants to build something "better", like a community where deeper discussions could be had, then someone needs to step up and actually do it. I'd add a link to it in the sidebar fwiw.

[-] PhilipTheBucket@ponder.cat -4 points 17 hours ago

I don't think shooting executives is actually going to improve the healthcare, though.

Almost every movement that started randomly assassinating people from among the enemy side in order to reform civil society wound up making things quite a bit worse, in the long run.

[-] turtlepower@lemm.ee 4 points 17 hours ago

Yeah, randomly. This isn't random, and needs to go beyond just CEOs. There are entire boards that make these decisions to murder us. Like potato chips, you can't stop with just one. They don't like us murdering them? Then they need to stop murdering us.

[-] PhilipTheBucket@ponder.cat -3 points 17 hours ago

And then, when the violence turned around on him, with a gang of deputized Proud Boys breaking into his workplace and starting to execute people for being "woke" and ruining the country, he looked around, like "we're all looking for the guy that did this."

I'm not trying to say this particular CEO didn't deserve it. But also, what the outcome is, is important. Calling for killing as the easy answer is something people do when they're not familiar with killing.

[-] Warl0k3@lemmy.world 13 points 20 hours ago

One of the medications I take (treatment for an exotic form of seizure) is a Schedule 2 drug, and thus requires a full prescription to be issued monthly. Said prescription can only be written at most two days before the prescription is due to run out, because fuck you you filthy little addict. As a result I have never, not once, been able to get these prescriptions approved by my insurance before I start having withdrawals from the meds.

So, yeah. Monthly withdrawals because a $30 generic medication that I've taken for years absolutely must be carefully evaluated to make sure I'm not selling it under the table to professional golfers or something.

[-] bitchkat@lemmy.world 14 points 19 hours ago

My son has the exact same problem. He ended up skipping a day here and there until he has a 7 day buffer.

[-] Bassman1805@lemmy.world 14 points 20 hours ago* (last edited 4 hours ago)

My wife broke her ankle, spent the night in the hospital hooked up to IV pain meds, and had surgery the next day.

Insurance said that the overnight stay was medically unnecessary, as the care could have been provided in a more appropriate setting. They only approved overnight stays in instances where the patient's pain needed constant management or they were having surgery. Bonus points: there was a footnote on the denial papers saying that the person who denied the coverage had a medical background...in OBGYN. Not orthopedics.

Spent literally months appealing that before they begrudgingly agreed that it was covered, which makes us the lucky ones in the US Healthcare system.

[-] sharkfucker420@lemmy.ml 15 points 21 hours ago* (last edited 21 hours ago)

The meds I need in order to do anything cost $250/month but other than that I have fortunately avoided hospitals.

Wait no, I got the flu real bad and had to go to the ER. Cost me over 2k and all I got was a tylenol and a 8hr wait

[-] Limonene@lemmy.world 11 points 20 hours ago

I take a medicine which typically costs $600 per month. If I don't take it, I won't feel any different, but I could suddenly die (expected rate of one incident per 6 years).

For some reason, my insurance, which is really terrible most of the time, is covering it at $0 per month, despite not having even met my deductible this year. If this changes on January 1st due to plan changes (or changes at any other time, for whatever reason) then I'll probably just be screwed.

So I just have to live with this uncertainty.

(What do people do when they have a $10,000 deductible and have to take this med?)

[-] shani66@ani.social 3 points 13 hours ago

At that point just apprentice with the local meth lab to learn chemistry and start making it yourself.

[-] DrabPoultry@midwest.social 7 points 19 hours ago

I had to have an incredibly painful procedure (with no pain relief or anesthesia) to determine if I had endometrial cancer. My insurance "covered" it, but I still owe over $2000 for it.

[-] CubbyTustard@reddthat.com 5 points 18 hours ago* (last edited 18 hours ago)

ruptured a disc in my back so bad my legs gave out and i couldn't walk properly. When i made it into an ER a day later they gave me pain meds (which i didn't want or ask for i wanted diagnostics) and then turned me away and wouldn't help me.

I went to the urgent care clinic next door but when they found out i was on state healthcare they said they couldn't treat me even if i paid.

I bought a bunch of beer to numb the pain and spent the next few months in bed until i could walk again.

every time the subject of back pain came up they got incredibly stupid and just wouldn't even look. i did get an xray that didn't show much so they all assumed i was lying.

Is been 5 years and i still can't ride a bicycle for more than 5 minutes or lift very much or i'm in bed the next day. can't sit without lumbar support for more than 30 minutes.

I can walk though so i'm grateful i have mobility! I am going to physical therapy finally in a couple weeks but still haven't gotten an mri.

[-] inv3r5ion@lemmy.dbzer0.com 1 points 4 hours ago

Maybe you should follow St Luigi’s goodreads account for back pain books 🤷🏻‍♀️

[-] GBU_28@lemm.ee 4 points 18 hours ago

I needed an MRI and blood work. It was covered.

My point is one problem this movement faces is that folks have been treated wildly differently by the system. And if they aren't as attached to the same online communities, they don't see near as much discussion on the topic, and therefore normally don't think of it as much.

[-] inv3r5ion@lemmy.dbzer0.com 1 points 4 hours ago

Most of America is staunchly conservative at least economically and of the pull yourself up by your own bootstraps mentality until they personally need help.

[-] JokeDeity@lemm.ee 3 points 18 hours ago

Title should be Lack of Healthcare Story.

this post was submitted on 14 Dec 2024
57 points (96.7% liked)

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