My wife is on the phone with #UnitedHealthcare because a surgery she had scheduled for Tuesday next week was denied by the insurance company.

Brad Rosenheim

My wife is on the phone with #UnitedHealthcare because a surgery she had scheduled for Tuesday next week was denied by the insurance company. The woman who is speaking to her has informed her that there is a nursing support call that is free of charge if my wife needs to discuss the emotions of getting this claim denied and to plan future care. It is such bollocks. USians generally hate our healthcare plans and these companies. Imagine facing surgery and being told that they won't pay for it, but they will pay for a nurse to call you and console you about their decision. Absolutely horrific.

Oh, and I pay over $3,000 per year for this level of health insurance for my family.

#USHealthcare
#PrivateInsurance
#MedicalCare
#medicine
#surgery
#healthcare
#insurance

plague-of-grackles 😷🍉🐈‍⬛

@Brad_Rosenheim I'm so sorry and yeah I've been through so many versions of this for years now

lower-value human capital

@Brad_Rosenheim Absolute barbarism. I'm sorry this is happening to you.

Donald Ball

@Brad_Rosenheim @inthehands I also have this insurer and have been pushed to use this feature, thankfully not due to a denial.

I vaguely assumed it was offered so that patients with complex cases could get another set of eyes on the situation to make sure they’re not being taken advantage of. Fair enough, if so, but the nurses I talked to, while nice, were hopelessly out of their depth.

I assume now they’re just gathering intel in order to help support a denial.

OddOpinions5

@Brad_Rosenheim

as far as I know, most of the money we spend on healthcare here in the US winds up, at the end of the day, as someone's salary

so cutting spending on healthcare means cutting salaries

and the cuttees are not gonna be happy about that

really not sure of the path forward, but I think (not sure) higher marginal tax rates are important

Brendan

@Brad_Rosenheim I kinda wonder what level of stuff you could get away with on the phone with this company. Like, "Hey, you know which Mario brother I like best? Just guess!" or "What was the name of the guy who did 'Feels So Good' in the 70's? Chuck something?"

Brad Rosenheim

@donaldball
Interesting thought about that. She has used a similar offering from UHC before, and it was helpful. It was for recovery. Those are the types of services one should expect from such an expensive service. But offering a nurse when one needs surgery is ridiculous.

@inthehands

Embrace Civil Disobedience

@Brad_Rosenheim I'm sure you've received all sorts of advice, from a former billing & coding person, she needs to ask for
1) the name & credentials of the person who reviewed & denied the authorization & on what grounds
2) the denial in writing, specifying the justification for the denial, code by code
3) the page number in her benefits & coverage book indicating the planned procedure is not a covered benefit

Then follow up the phone call with a certified letter signature required to dept head

Brad Rosenheim

@PattyHanson In the fog of battle, these are very useful tips to be reminded of.

jimfl

@PattyHanson @Brad_Rosenheim boosted and bookmarked

Flying Donny for Ukraine 25 47

@Brad_Rosenheim
Horrible. Good luck to your wife with getting the care she needs.

LOLoud

@Brad_Rosenheim

ProPublica has a tool for fighting denials, in case it helps:
https://www.propublica.org/podcast/health-insurance-industry-secret-external-review

acm

@failedLyndonLaRouchite @Brad_Rosenheim The original Obamacare efforts included reining in the way that hospitals bill (per procedure or test) to insert some sanity, as well as allowing for lower set drug prices. There is a *lot* of insurer profit that is *not* salaries.

OddOpinions5

@acm_redfox @Brad_Rosenheim

no, this is literally not true

1st, "profit" is an accounting term that even under GAAP is a bit elastic, but lets say around 20% right now

so, ok, you could save what 5% on the health insurance bill if you elimminated insurance profit ?
pfft

libramoon

@Brad_Rosenheim

apparently the purpose of health insurance is to insure that we are denied the treatments our health professionals profess will get us healthy

peachfront

@Brad_Rosenheim

#FreeLuigi

Ultra Verified 🇺🇦 🇬🇱

@libramoon @Brad_Rosenheim

.. purpose of "health insurance" is to ensure that a small group of powerful rich people remain powerful and rich, and untouchable.

Has absolutely nothing to do with health CARE.

Jones Murphy

@Brad_Rosenheim USians are very divided on our health care system. 49% of those permitted to vote voted to cut their own health care in order to give billionaires and trillionaire tax cuts, and that is what we are doing. Trump lost the top 18 states in life expectancy, and won the bottom 18(the most 'prolife' states).

Ciara

@Brad_Rosenheim The utter greed of them, of it. I am sorry you have to deal with all of this, both generally and specifically. Sending good wishes to your wife, I hope all goes well for her.

Inc Hulk 🧪

@Brad_Rosenheim You are paying more per year for a “no-pay” insurance, than many in the EU pay in their taxes that gives them free heath care.
The difference is that insurance companies are not stripping out all the $$$ in the EU.