ikr. we lived 5 years in USA so glad to be out, but here in romania we copied so much american bullshit. ideally we'd be normal europeans like the dutch and sweeds or at least at french and german levels of normalcy...instead we're at greece and italy levels sigh... at least we're not hungary or uk. it can always be worse.
I know UK gets a lot of flak but they cured my uncle (a farmer with minimal income) from skin cancer 5 years ago, treated his subsequent DVT, treated his parkinsons with excellent equipment including motorized wheel chair and provided round the clock assistance to his wife in his last days of life so he could STAY AT HOME!! at no cost to the family. (I never see that in the US). And this was just this past spring so not long ago.
The orthopedic surgeon I went to told me straight up: “I have to send you to physical therapy before I can treat you with what you actually need. Physical therapy isn’t going to help, but insurance insists on paying for that first before they will pay for what will actually help you. They _love_ to pay for physical therapy.”
That is very strange. I thought they didn't want to pay for treatments ever. Now they pay twice. First the treatment that doesn't work, then the treatment that will work. Seems like a waist of money to me.
@@ankavoskuilen1725 I think the idea is that some people will end up not getting the surgery because they can't afford the part they have to pay for on top of what they paid for the failed treatment.
@@kaspianepps7946 It could also be that for some people for whom would be prescribed surgery physical therapy is just enough, so, on a large scale, they save money by paying for less surgery (more costly) but more P.T. (less costly). Then again that could imply malpractice by lots of doctors, as they didn't prescribe the right treatment, soo ¯\(°_o)/¯ Anyway I think there is a good financial reason (not ethical, cause who cares about that when money), else they would have already stopped.
United Healthcare called us the other day, wanting to know if we would consider offering their employee health plans, and because of your videos, I turned them down flat. The VA provides better health care coverage than them.
Those that don't know the VA is so bad guys have killed themselves in their parking lots and gone unnoticed for days. Even their option for a civilian doctor sucks as the one I got said he couldn't help me.
I have a buddy who is a recent graduate from Physical Therapy school. Lots of growing pains. I remember how baffled and frustrated he was about the percentage of patients which were there just to prove that physical therapy was ineffective.
And they end up spending so much more money in the end by treating worsened conditions! The bean counters only know how to looks at monthly costs, or some narrowly focused costs, vs overall costs.
Yeah it sucks. PT works great for many people but there are clear cases where people NEED surgery. Now most PTs worth their salt will turn it into a prehab opportunity to set the patient up for better/quicker rehab after surgery is successful
@@adamcarman5330I'm damn lucky the PT I saw before my scoliosis surgery was a sure thing treated me like that. Ain't no way a 50+ degree curve that folded my right shoulder inward was gonna be solved by physical therapy and a brace, and he knew that from taking one look at me.
Outpatient PT here. You left out the best part! The patient only gets so many visits per year for PT. If (read: when) the patient is forced to do conservative PT FOR A COMPLETELY TORN LIGAMENT, they do not receive additional approved visits for their post-op therapy that will actually be medically relevant and necessary. They get boned on both ends. Pun, and crippling medical debt, intended!
I had uterine cancer and my doctor told me that my insurance wouldn't approve the surgery to remove it unless I tried chemo first. I had to call my insurance and force them to approve the surgery by telling them that without surgery to stop it before it spread they were risking a much more expensive treatment plan later on because of genetic inclinations for chemo to cause worse cancers to develop in my family.
"look assholes, either way you're paying, your choice is how much you want to gamble on the price." 😂 Sucks you had to take that tactic to get your healthcare paid for, but good job making them cough up the cash all the same.
I mean… if I recall correctly surgery works out cheaper in the long run especially when combined with some chemo depending on stage. Scenario 1: Chemo alone will take multiple sessions with an increased chance of recurrence and EVEN MORE CHEMO Scenario 2: Surgery alone does risk recurrence of cancer but if low stage enough can be curative. Scenario 3: Surgery with chemo has lower risk of recurrence which means less chance of the company paying for more chemo in future. The option that actually cures it is cheaper in the long run unless it’s Stage 4 and incurable.
My stepmom was required to do 6 weeks of PT before they would approve an MRI for severe neck pain. The PT didnt help, so they finally ordered an MRI. Turns out she had a very rare cancer, sinonasal undifferentiated carcinoma, that had spread to her spine and liver. She passed away 5 months later. She was only 51 years old. Had they done an MRI initially, they would have caught it earlier and maybe she would have had a different outcome. Still makes me so angry
Horrid horrid people... I wonder if any of them could sleep at night or answer to their conscience... Let's see how things are like when they're on their death beds... Or just hospital beds themselves...
I was so sorry to read your post -it’s unconscionable - AND insurance co shareholders are to blame . They are raking in $$$$$ while allowing patients like your step Mom to suffer … maybe we can start taking them to court ?
My deepest condolences on your loss. Nothing can bring back the precious time that you could have spent together with each other. AND I'm sure you miss her every day even now. In science and medicine, we are taught to look for the horses, not the zebras. So, it's the most usual diagnosis which is typically coming to our minds at first. However, your post proves that it cannot be ruled out that it's required that all patients must be evaluated carefully before a complete diagnosis is rendered. Even if the furthest probability is unlikely. Word to the wise.
@@souldancersbyjenniferThe CEO’s and all of the people at the top I’m sure sleep like babies. The rest of us who take the calls daily can’t sleep and want desperately to get everything approved because we have a soul.
As an occupational therapist, I can confirm that the last patient I ever want to see is someone who actually needs surgery (or even just a freaking MRI) but has to do their mandatory 6 weeks.
You really don't want to "fake it" or do anything they would consider insurance fraud! Receiving the wrath of an insurance company is worse than 100 denials or alternate treatments. They can fine you, imprison you and make your life a living hell. And if you ever got insurance coverage again, it would be the highest premium you ever saw and you would have to jump through hoops just to have a simple procedure. Insurance companies take insurance fraud very serious.
I’m wondering whether patients just set up six appointments and no-show just to avoid the PITA of travelling for nothing? Sure, it’s fraud. But so is United Healthcare. So it’s even.
I’m surprised he can actually get someone on the phone. I’m waiting for the video address the endless automated system loop that connects you to different people who each transfers you to a different department. All in an effort to get you to give up.
Dr G know how to avoid that. Angry secretaries who get to humans BEFORE handing the phone to the doc. (Me, I’m the angry secretary. I also did the with that got denied, probably)
As someone from a more civilized country the previous ambulance clip was an eye opener. I knew it was bad over there of course, but that is really a next level disregard for your fellow humans. But then again, if you are still thinking about whether you can afford emergency care maybe you aren't sick enough. In any event, it is a great way to make sure poor people wait longer before calling an ambulance.
I'm not a doctor or nurse (I'm a insurance auth specialist), but I usually pull out the "they've tried immobilization, icing, heat, no improvement", "Patient has significant interference with daily functions", or finally "I'll suggest to the patient to call you all directly to discuss this."
I remember working MSK prior authorization. "According to the medical guidelines we use to review, the patient has to first fail a trial of conservative care such as PT, OT, chiro, NSAIDS, or acupuncture before surgery can be approved," was typically my go-to line. I did also explain how important it was for the prior authorization request's clinical notes to document why the patient couldn't tolerate conservative care, if that was the case.
Let's not forget that in some cases they don't treat anaphylaxis as a failure. If you're allergic to the entire family of drugs they want you to fail before trying a different drug family/treatment method, you might be hosed eternally. Source: friend with eczema, went through a clinical trial of a drug that worked, insurance wouldn't approve continuing it until he'd finished a trial of one of a few other meds, all of which he was allergic to, two had caused him to go to the ER with anaphylaxis, the other ones he either didn't try bc it's in the same family as the ones he abruptly stopped at the suggestion of the ER docs, or he'd tried a much lower dose of and still reacted badly to them, cementing the idea that he's not allergic to the specific drug but the whole family. So there's like 8 or 9 drugs across two families they want him to fail three or more of, he's counted as failing 0 of them despite having tried 5 and reacting badly to all 5, including two ER visits. He's paying out of pocket for the one drug that worked (since he'd been trying to find one that worked for now 9 years and never found one that did besides that one) while fighting insurance on this moronic policy.
The drug killed you? Oh well at least it cured you... through death. Like shoving cheap peanuts down the throat of someone with an allergy to cure their hunger before trying the loaf of bread that's a couple bucks more expensive.
@@BigbyOShaunessy After the first in each family caused problems when tried at home, the smaller dosage tests of the related drugs were administered in-office, yes.
I love Ortho bro, he repaired both of my labrums and now, still years later, I have minimal pain and some if not most of my range of motion back in my shoulders. Let the real experts do their jobs!
"He has to fail something before we can try something that works." Can we just start saying it how it is? The insurance company is hoping you'll die before they pay out on your health insurance, and they're doing everything they can to make that sure that happens. Honestly, it should be treated as the attempted homicide that it is, and the very least should be combated with malpractice suits.
Exactly, their goal is denying as many claims as possible while collecting as much premium, deductible and copayments as they possibly can. They didn’t get into the insurance industry to be an insurance company.
Sadly, I believe this is true. Back in the 80s I did volunteer work with people with AIDS; this was when AIDS was a death sentence. People got diagnosed, and six months later they were dead. The guys I worked with constantly got the runaround from their health insurance companies. They had to submit claims again and again and again. I finally decided that the insurance companies were just waiting them out, hoping they would die before they reached the end of the bureaucratic runaround. The whole thing is heartless and criminal.
This was spot-on for when I destroyed my ACL windsurfing. I hobbled around on NSAIDS and crutches until the PA for UF’s superstar ortho guy brought his dog in for a check-up and asked me what happened. I went into surgery less than a week later, and I thank that PA every single day of my life. It’s been twenty-five years and my ACL has never been better.
Great video, of course. But the patients really do suffer when physical therapy is "required" before surgery is approved (spinal ruptured disks come to mind) when there is no chance PT is going to help in any meaningful way. A friend of mine is going through months of needless agony because of these "policies".
They also usually create worse health outcomes and more expensive surgeries. Typically, the sooner surgery is done for something like that the better the outcome.
@@ada5851my father is going through this right now, and he failed out of PT. But the PT didn't send the "correct" forms to send over to Ortho, so it's been an additional 2 weeks to get the right paperwork just to submit, and then an additional month waiting for approval while he can barely even move.
Several of my family members (my young adult children among them) lost health insurance and are using a local concierge medical office. Trained doctors and other staff, PHENOMENAL care, relatively low cost. They have an in house pharmacy and can dispense many common low cost meds in house. They perform many low cost labs in house. They have provided a level of care I haven't seen since my early rural childhood with an old country doctor. And a modern holistic approach. Such an eye opener. We deserve better.
That was actually one of the reasons I wanted to become an ortho/trauma surgeon for a while: They fix things. Mechanically. Stuff works afterwards. Very rewarding.
I agree, one of my surgeons referred to it as "The carpentry of medicine". He isn't wrong. He actually did very nice carpentry in his off time. Said it was nice to work on something inanimate without all the pressure. He also liked to say " Son, you just can't nail cottage cheese to the wall."
I called an insurance company a few years ago and asked to speak to the actual person who was adjudicating a claim for a peds trauma patient of mine… I was told there were no phones in the room where the adjudicator was located😂. She hung up on me when I offered to mail them a phone.
This is the best one yet; been there, done that when I had endometriosis. Took years before they would approve my hysterectomy and I wasn't even having to deal United Health Care. I am a RN and UHC is considered a bad word at our hospital. Their Medicare plans suck people in with a couple of good benefits but they are the worst when it comes to covering large dollar health care.
Ugh, my insurance denied a hysterectomy because I hadn't tried a medication....that I had tried after they finally approved it after two appeals. I got my hysterectomy. My doc was furious.
I am FINALLY at the stage where my doctors are considering a hysterectomy... the fight with my insurance is gonna freaking suck. I'm so excited to be done with the worst of the endometriosis but I'm sure they're gonna make it hell along the way.
I'm glad you're doing this, it's a great way to educate people about the horrendous state of our healthcare system. You always make me laugh, even these videos, but this series also makes me very sad.😞
im disabled, so ive been abused by insurance for many years. i absolutely love when my doctor tries to get approval for a treatment and is told to first prescribe something else that is expected to fail and usually not a suitable treatment to begin with. all it ever does is delay the necessary treatment, which often causes even more problems/complications!
I am currently recovering from hip replacement... and my Ortho had to call and yell at my insurance for trying to deny the replacement after said unsuccessful treatments... because they said I hadn't done Enough unsuccessful treatments. Thanks Doc S!
This is what literally happened to me for hip surgery!! Insurance denied it 3 times before finally approving it. All because I hadn’t tried an injection that would supposedly help my 1/3 torn labrum and keep my hip from dislocating. Maybe fine for someone who sits at a desk all day, but not for someone who’s career is as a professional contemporary/ballet dancer… we have Cigna and if my mom didn’t work for them, not sure how we would have known how to get them to approve it (she works in mental health and hates the current insurance system in the US)
Unrelated to Ortho but still a horror story: LabCorp just bought out the clinical lab at my hospital and now ships all routine labs out of state so providers are ordering everything STAT for same-day results (which charges the patient extra)🤦♀️ when everything is stat nothing is stat
It is a shame that you have to keep your guard up for things like you describe. I have found that it is better to use a lab of my own choosing based on my insurance. You have the right to insist on this arrangement.
Oh gosh. As someone who does health insurance verifications... I did not need to get my blood pressure up any more than it already gets!!! For real, Dr. G... I love you... STOP MAKING YOUR CONTENT SO FREAKING REAL!!!!
Why doesn't ortho bro prescribe something like sitting in the surgery waiting room for half an hour then when ultimate Frisbee bro fails that ortho can operate
I am an ortho nurse and had to attempt to ask for precert for these kind of surgeries. This definitely represents what goes on in getting insurance to pay for a patients surgery. Right on! This stuff would take hours of my time.
Speaking as an acupuncturist, acupuncture can be great to reduce postoperative recovery time, reduce pain, and improve overall outcomes when used along side surgery, but in this case it's not a replacement for surgery. If a patient comes in with an ACL tear I'm not going to waste 6 weeks of the patient's time before getting them the care they need. Meanwhile that same insurance company insistiting that the patient try acupuncture first probably won't even cover the acupuncture that they are insisting on.
Meanwhile, in Workers Comp land, the law office is flipping out to try to get a fusion. The claimant's paralegal runs down the hall with the paperwork, "I GOT IT APPROVED!" and the attorneys chant "fusion fusion fusion fusion!" for the 80 year old lady who may or may not survive.
as someone who had an ACL replacement surgery earlier this year, this one hits hard. especially because a reinjury/retear of the ACL is more likely the longer you wait to get surgery after the initial injury. PLUS additional injury to the meniscus and surrounding ligaments (leading to arthritis down the line) is more likely the longer the surgery is put off. you can't just mess around for 6 weeks without it risking the long term health of the patient. justice for ultimate frisbee bro and everyone else caught in the nightmare that is the US healthcare system
Had three doctors send me to PT without even trying to get me an MRI because they didn't believe insurance would cover it (it wasn't denied, they were just used to that happening). Several Xrays revealed nothing, so I was diagnosed with low back pain. They said insurance will cover Xrays and PT and that's it. Turns out I had a minor annular tear that became a very major tear after an injury that I would have been able to avoid had I known the risk. Finally got the MRI when I became unable to go to work at age 27. Annular tear with significant disc degeneration and now, chronic pain. I expect I'll be getting anual nerve ablations for the rest of my life in order to maintain employment and a basic level of fitness. I'm deeply grateful to the urgent care doc who took one look at me, said "you're too young for this," and sent me to an orthopedic surgeon with the expertise to take it seriously. I can't imagine the past few years of interventions have cost my insurance company less than one MRI, but here we are.
This is what my roommate has gone through under work comp. Doc said knee replacment was needed but other stuff first due to their cheap ass selves. Now she she's had 2 years of work comp while the knee replacement and, subsequent, rehab has been delayed by at least a year.
Had a micro discectomy and Laminectomy on a 13mm rupture. Took years to find bc mri was refused on multiple occasions including 2 er visits bc no trauma. Now surgery was apparently "successful" per mri, but still having shooting pain, was told its possibly bc the nerve damage is now permanent from 3 years of "letting" things like acupuncture,massage , 3 rounds of pt fail before surgery.
Well you have to have 6 weeks of PT first so your body has a chance to start healing with the bone and ligaments aligned wrong. That way, when you actually DO get the approval to go in surgically, it becomes more complex and painful to repair.
Damn right! I'm sick of this insurance BS. The best way to improve the well-being of all Americans is to actually provide them the care they need. Here, here for universal healthcare! We gotta vote in progressive politicians who can get the job done.
Universal healthcare free for all isn't a buffet either though. It would have medical necessity rules and there'd be competing opinions on what is medically necessary. And increased access to care would mean longer wait times. It's not all rainbows.
UH Agent: How about acupuncture therapy? He could fail that. Ortho: No. UH Agent: It’s all the rage these days. It can do amazing things. Ortho: No … wait, do you even cover acupuncture therapy? UH Agent: Hahahaha, of course not.
❤❤❤❤ omg. I love these so much. Thanks for continuing to de-gaslight the so called “consumer”. Healthcare is a Right! We paid for medical research directly through our taxes, and again through congressional gifts to corporations made on our behalf.
Thank goodness for my Ortho bro who fights for me against my insurance denying things. Appeals, Peer to peer, he eventually gets it through to them. I have Ehlers Danlos and sometimes getting them to approve even imaging is a battle. A good ortho is a lifesaver for an EDS patient. So thankful for my Ortho Bro doc. Prepping for my third surgery under his care.
I love how pouty & defiant that last, sharp "...No!" was. It got me thinking about a sulky 9 year old with his arms crossed. 😂 (But who could blame him?)
Very impressed that you knew some ultimate frisbee lingo!! So happy. Btw there is emerging evidence that the ACL can heal even when fully ruptured; cross bracing protocol
Everytime see shorts about how people who probably barely finished highschool, it just blows my mind That politicians can be legally bribed is amazing!!!
This hits close to home. United is denying my son injection treatments for psoriasis because he hasn’t “failed” other options in the last 3 years. We’re hesitant to go those other options because they didn’t work for him before and United wants a 6 month track record of not working before they’ll approve the injections. Fortunately the company making it has a program for people like us.
I’m recovering from a foot surgery in Australia right now. Universal healthcare paid for it. I’m shuddering at what I would have had to go thru in the USA
My authorisation for a procedure was rejected even after 6 weeks of failed physical therapy and they recommended I get literally any other procedure except the one that my doctor recommended.
As a child neurologist I'm very much looking forward to the neurology one. But also curious if we'll get a chance to see pediatrics brought down from Happy dappy candy land by UHC😂. Can confirm that I'm all sugar and gumdrops until I need to do my fourth peer to peer of the day to get my very sick patient prior authorization to do an MRI or get a patient with absence seizures some ethosuximide.... That's the MAIN treatment, no I didn't explore alternatives!!!!! Grrrr. I am NOT going to give the United healthcare representative a lollipop today... I think I need to give them SO MANY ouchie pokes. 😂😅😂
