@@riorio982 Really? I haven't done enough peer to peers to gauge a sense of how those people are. I imagine they are financially motivated by how many denials they give out.
The unrealistic part is that the peer to peer doctor was immediately available. One of insurance companies' new favorite tactics is to make the peer to peer call as painful and impossible to schedule as possible. I've gotten both "the doctor will call you between 7 and 7 sometime in the next 2 weeks" and "you must call within the next 15 minutes, and it'll take 12 minutes to navigate the phone tree, speak to a rep who will transfer you and be put on hold so you really have 3 minutes to drop everything and do it now now now". It's intentionally infuriating. In completely unrelated news, UHC is the 8th most valuable company in the world, with a market cap of $490 billion USD.
Yup once you somehow navigate through the Hedge maze and slay a Minator and someone named jack Torance then you must face the final boss only to get your claim denied again even if you beat em
I had an ophthalmologist who was about to dictate an order for PDT and told me “Pay no attention to what I’m about to say about your case. We’ve been using PDT for this for 20 years but to get your insurance company to approve it I have to make your case sound horrific.” She made it sound as if my head was about to go all “Scanners” and explode. I got the approval.
Its great too because yeah you most likely need that test and it really should be approved, but to get it approved the doctor is being put in the situation where they are at the least fudging details that are going into your medical record.
Glad You got the good one that is willing to risk his job for the patients but..why is it necessary. Why... I mean,I get to learn in country where a patient needing an elective surgery is more likely to take a loan and get it done privately if they want the surgery to be sometime in the next decade but still...
Yeah just ridiculous that real doctors have to feel like their scamming the system just to get a reasonable outcome from the insurance company that is basically living off sick people by making them sicker
@@margodphd Some countries like Germany have highly regulated private insurance. Or singapore makes you pay a portion of your salary into a fund, and you help pay the costs but it's reasonable costs based on income. I don't know if the US will ever have "universal healthcare" but the costs really need to come down!
I've had quite a few doctors do something similar now that you mention it. It's a shame it has to be that way but I'm grateful some of the doctors get it and are willing to play the game health insurance companies are making them play
Here is something I found in a different comment section "Here’s how you get a denied pre-auth approved. When you get the first denial, request a reexamination of the procedure (as protocol for most major insurers). When you get the 2nd denial it means they had an actual doctor take a look BUT they never have docs that specialize in the field your trying to get a procedure done in. For example I had an obgyn deny a cardiac surgery. By law you are allowed to request info on the medical specialty of the doc who did the appeal review. When you get it and the doc who denied is ‘out of scope’ from the procedure you’ve hit jackpot. Now here’s where they fold: resubmit third time along with a request for 3rd party arbitration (basic procedure for major carriers) and in that request you state that you want it because you doubt the ability of an obgyn to make calls on cardiac patients and you wish to question them in arbitration about their experience with cardiology. That’s it. You’ll be approved without arbitration in about 85% of cases. Yes, it’s a pain that can take awhile, but passionate admin staff can get it done along with some paperwork from the docs."
Thank you for this tip. I would put this on my notepad, probably have a graphic artist turn it into something that looks like an inspirational quote, have it printed and framed then hang it on my station's wall in the future. If you could give me the OP's username, I will add it. Otherwise, this quote was said by "Sun Tzu Probably" 🤣
My insurance company actually denied my hip surgery, my Dr appealed it, they denied that, he requested a peer-to-peer, they granted that request, then denied it. This process took several months and was very stressful. When January rolled around, they spontaneously reversed their decision and approved the surgery. I can't prove it, but it seems to me, that since I'd already met my out of pocket cap for the year they wanted me to wait until January so I'd have to chip in more for the surgery. From a financial standpoint that makes sense to them, but damn if it didn't hurt like hell to spend a few months unnecessarily dealing with a hip socket that was so loose I would wake up with a dislocation and then have to deal with several more throughout the day. I seriously wish there were more federal restrictions on what insurance could and could not deny, like if it's medically necessary they should not be able to deny or delay it just because they don't want to pay for it.
Here in Europe, you just get the surgery done and insurance has to pay for it, there is no denying. There is no even asking them in case of a medically necessary procedure. Wtf is wrong with the US health system?!
I’m a Kindergarten teacher with the accompanying teacher’s salary. The price tag on my refill of epi-pens made me cry because this isn’t a medication I can choose to go without. My allergies are off-the charts, and I’ve been so traumatised from my experiences with anaphylaxis that I even developed anorexia, and had to spend years recovering. I still struggle with that anxiety and trauma. And the only medication that can save my life if/when I have another reaction costs SO MUCH MONEY. And why? There’s no reason for it. It’s horrible.
Omg this is truly a nightmare! I guess a similar situation happens with people with diabetes. You are basically forced to pay to survive. Sincerely wish well for you even in those horrible circumstances
Pediatric physical therapist here. I'd LOVE the chance for a true 'peer to peer' review. Closest yet was an M.D. who teaches at a state university, has been out of clinical practice for over a decade, and had no developmental pediatrics background.
I just want to know how this can be called peer to peer when clearly the other person on the phone is in a completely different field, and career, and hasn't even remotely been around your type of patient.
@@saysHotdogs maybe they're implying that the school isn't one with a medical school in which the faculty who teach are also practicing physicians themselves. Some people leave their fields to just teach.
I did an exchange semester of my nursing degree is the USA (from Australia). The semester before I went to go I did an ethics unit. One of the reasons I did a nursing degree was the ability to work overseas, and the USA was on my list of options to work abroad. But that one semester in the USA about 20 years ago put me right off. I could not wrap my head off being a healthcare provider with the ethics of refusing care based on insurance companies and wealth (or lack thereof), how you can justify being one of the world’s richest countries and refusing healthcare to the poorest citizens did not sit right with me. I’ve never been back to the USA (except as a stopover to get to Canada) since. I spent 2 years working abroad in Ireland instead
@@spartanB0292 an adventure. Travelling nurses also can get more pay. But most an adventure. Australia's great but seeing the world is also great and different. But sometimes in too bad of a way like re US healthcare or lack thereof.
I'd modify that to some creepy cult like slogan maybe, "denial is the way of survival" but no yelling it, just stating it in a calm and almost cheery voice. Just to emphasize the insanity of it all.
“What are you mad about today?” 😂😂😂 so true The peer to peer is spot on Of course, they have to pick someone who has no experience in the area of the condition in question and has not touched a pt in the last 20 yrs 😂😩 Also…utilizing archaic references and lacking basic understanding of billing. But I digress…
Exactly! I was denied payment on a treatment for a therapy that has been studied and written about recently. The doctor at the third party reviewer said I should have tried a local PT first... I had no clue who that was until I finally finagled that answer out of them ... Get this she has never seen a patient like me before Similar story with my spine doc, he said he spent an hour doing peer to peer review and they still denied despite him giving me several additional diagnosises fitting in the real of my symptoms... that should have helped but it didn't My spine surgeon told me he argued that "it's not illegal for you to cover this surgery" but no, until it's reviewed by the FDA and there's hundreds of patients in his study cohort, insurance will not approve There goes a quarter of my yearly salary on one operation
@@danielleo6855 nice...So how do they get the study patients when they don't approve the bill? Hoping only rich people have crabby spines?! Thats why I didn't get further into a medical career. I can't take that shit...I would end in a psych asyleem in no time.
@@lisastenzel5713 considering the condition I have is in women's sexual health, and it's super rare, and these Drs are the only ones actively studying and treating it in an organized and systematic way, and super one of those things people in the general public misunderstand and make fun of ... Yes there is no funding. I had to pay for my own surgery, but it's not out of reach for middle class people. And it's better to pay than die from suicide or from the exhaustion my body was undergoing from the 17 years of distress I suffered My doctors are saving my life and keep following up with me because they really do care. They don't want anyone else to die, so I'm grateful to thier commitment and their help. It's no thier fault that the system is messed up.
Your ability to simmer the whole US insurance system into these 2 min. reductions is a true art. The public needs to know this is what goes on and that it's barely satire. Thank you for raising awareness. I've done so many prior auths, and worked hard to learn the ins and outs to get as much covered as possible, and I sadly can confirm. They want to make it as difficult as possible so you will stop trying.
Really? It's that bad? Then why have I only ever had ONE issue where something wasn't covered without a long complicated trial of alternatives? Or is it a much more varied situation overall, but one only remembers the difficulties?
@@Gwentheferret Ah, Americans and their self delusion, never gets old, like an abused wife, they just want to remember the good parts abt being violated by their system
Sadly, healthcare today is about the bottom line. While I'm not sure if socialized medicine is the answer, the current system is focused on profit not just for the insurance companies but for big pharma, hospitals, physician groups and medical device companies. And because it's a third party system, payments range from 0$ to 10x or more what medicare would pay.
@@Gwentheferret Most likely it's because the doctor knows your insurance and they've been doing it long enough to know what they will and will not cover. I have medicade, doctors have to deal with this so much they already know to prescribe the cheapest medication that may not even help but make it worse until they can work their way up, or if they can't work their way up then they'll just increase it until it does something, regardless of what symptoms you have. My family has gone through that multiple times and has gotten a bunch more problems because of it
Had totally had a patient at risk for severe anaphylaxis denied an Epipen within the last month so this is spot on. The only thing missing is the 5-6hour wait to actually get to the peer to peer stage and the ultimate “discussion” with the insurance company’s physician to reveal their lack of expertise in the treating area
PSA for all who may need it: Auvi-Q makes epinephrine auto-injectors that give auditory instructions when opened, and if your insurance doesn't cover it, they automatically give you a coupon for a 2-pack + trainer for $25. If brand name Epi-Pen isn't in your budget, don't be afraid to ask your doctor about alternatives. Expired epinephrine isn't as effective, so it's very important that you have an unexpired dose in case of an emergency
Bear in mind a doctor is holding an epipen and the only thing stopping their life being saved is the doctor's potential personal financial harm. $700... timmy's life... $700... Better get on the phone that tesla won't buy itself! Doctors and insurance deserve each other. Except those ones that break the mould and won't charge the uninsured for emergency care. There's a few.
I always thought America was the land of the law suit...why aren't there more cases brought to court where patients are disabled or killed by insurance decisions ?🤷♀️
Same with the NHS trusts in the UK though. Perverse financial incentives are tough to avoid in this case. Emergency scan, ehhhh see you in 6 months, or if you drop dead before then we can assume it was a bad result. US doctors over treat and NHS under treats. NHS is only slightly cheaper. At least in the US doctors are nice to you and want to see you. In the UK you have to win a raffle at 7am to see if you are blessed enough to get a phone call from your doctor. Need to see them? 2 months okay? You get 8 minutes and not a second longer after the 2 month wait (not joking) And the tax is so high you can't afford private or insurance.
Operating room nurse here - was once in a case with a neurosurgeon that had a scheduled call for a peer-to-peer review with an insurance company for approval of an intervention for a patient. They get on the phone, discuss things for all of a minute, before he indicates that someone else needs to get a piece of information for him because he's scrubbed in for a surgical case. (This is by no means unusual, and he had stepped away from the field for the duration of the call.) The person on the other end of the line said this was "not allowed" and that he shouldn't be on the phone in this situation (again, I'll reiterate - your surgeons talk to people on the phone during surgery if they need to talk to people on the phone during surgery, this is how it is and is ENTIRELY reasonable) and she hung up on him. For a scheduled call. Yeah this shit is nefarious
My friend was being denied life saving treatment by insurance. Her care team was so outraged that they agreed to do it for free. Then the insurance company relented and agreed to pay, because they knew they'd look bad if she *lived* And that's the problem with for-profit medicine, right there. 😡
I'm really glad someone is actively calling out the darkness that is the medical insurance system over there. I love your skits, and these are just the cherry on top. Thanks for what you do.
The presence of the second physician isn't quite realistic, but if insurance companies ever did poke their noses into the realm of medical backing for their decisions it would probably look like this. Great work as usual!
@@andyhawrylak9396 Yep, and they usually find someone with a medical degree who has never completed a residency. It's more straight up cluelessness than being held hostage.
As an allergist with many food-allergic patients and who has spent tons of time and treasure on prior auths... All I can say is THANK YOU! Love your work! Keep doing what you're doing!
One of my attendings had to do a peer to peer for a pareplegic patient to get a wheelchair and the insurance doctor was like "why can't the patient just use a cane?" and she's like "cause he's fucking spinal cord patient!"
I'd heard nightmares about getting insurance to approve wheelchairs. I have a spinal cord injury but I can walk a bit and I've heard it's a nightmare to get them approved unless you can't walk at all. Fortunately it got approved pretty instantly, even the fancy power assist!
£350 for a wheelchair. That entire interaction cost more than that in work hours. What a waste of existence. R will tell you it can't be done and D will tell you we promise we'll make it free and ask the insurance companies to write the legislation. 'Free healthcare for all act' by name, 'mandatory insurance that covers nothing' by nature. With how big some government entities are- how on earth there isn't a proper medical insurance regulator yet boggles the mind. Not that budget issues aren't massive in a national health service. Imagine as a patient not being the customer and they get paid the same no matter the care and it is illegal to sue them. On the other hand our private care is top class as it has to compete with 'free' (though the tax burden is HUGE) and so you get immediate service and real nice treatment for ~£100 to see a specialist and a couple grand for a surgery, depending obviously. But you're free to mix and match. All these systems have perverse incentives. It makes sense why it's hard, as you're literally selling life and death. Your customer can't negotiate. Same with lawyers.
This is hilariously true, I have a SCI and while insurance approved my actual wheelchair, they wouldn't approve a seat or a back for it. You kiiiiind of need a backrest to, yk, stay upright throughout the day and not fall over, and a seat cushion to prevent pressure sores. The funny thing? Insurance easily approved the ~7k power assist wheels. The world we live in is a weird one.
So accurate, it hurts. I had to get the POST-EXPOSURE rabies vaccine series and my health insurance tried denying it because a doctor didn’t give the vaccines, a nurse did.
@@meg2249 yeah, it would only be in family medicine type practices. I’ve gotten most of my vaccinations from my family doctor. The doctor themselves, not a nurse. But clinics up here often just have doctors not nurses.
@@itstruckmeeverydaym a doctor in India. We give them 0,3,7,14,24 for intramuscular injections and human rabies immune globulin both in the wound and in the arm. So a total of 6 shots. How did you get so many? I guess you're counting the intradermal injections as 2 shots each visit?
As a PA working in allergy/asthma, I can fully attest to the accuracy of this exchange. Never mind CMS’s updated list of dx codes to support need for food allergy testing… a list that excludes angioedema, flushing, urticaria, pruritus…
I am very sure about my food allergies and have almost died from anaphylactic shock. There's no way I even want to do testing. My issue has been medical staff who don't believe I'm in anaphylaxis because my reactions don't include hives. When just minutes before that I was pale with blue lips, throat closing, about to pass out from a blood pressure drop. My EpiPen is what saved me.
As a Medical Insurance Specialist for a large healthcare organization, I can tell you that this is all too true. Sad, but true. (U.S., private) healthcare insurance companies have a stranglehold on America, they lobby Congress more than the department of defense. 🤦♀️🤦♀️🤦♀️
Do you ever run into problems with CMS? My understanding is that Medicare and Medicaid generally pay less than other insurance companies, with the added threat of a government lawsuit if they don’t like something.
Ah, the peer to peer review where they get a GI doctor to approve a medication from an hematologist to which they deny because they don't know anything about blood disorders.
Apparently you're allowed to apply for 3rd party arbitration because you doubt the ability of a gi doctor to make calls on an issue with blood disorders and in the majority of cases it will be approved without going through the arbitration. I'm British so I don't know much about health insurance but I saw a video saying that once and there's a comment here with all the text from that video somewhere.
@@violetskies14 you are allowed to do so, but you have to follow the insurance company's line of policy. First you make the request, they deny it. Then you appeal the request and get their out of scope doctor to look at it. Only then can you call them out and by now several weeks have probably passed anyways so it isn't useful for patients in severe condition anyways (who coincidentally are the people who need the doctor's recommendation approved the most)
@@violetskies14 And that's the reality for most chronically sick Americans. Yet nobody ever does anything because everyone is afraid their voice will go unheard....A thousand whispers is louder than a shout but everyone is too afraid to stand alone and get the ball rolling.
Here in France an Epipen is worth 69€, which is nice. And it is reimbursed at 65% by the country, which mean you pay only 24€ out of pocket, or by the private insurance. Even better, if you don't have sufficient incomes, it's totally free !
We got about halfway there when the Epipens lost their patent protection, now 2 epipens cost about $100 USD. Insurance coverage varies, but you can see it as low as $0-20 for copay.
NZ'er here - if a Dr. said you needed an epi-pen - you got an epi-pen on a government subsidised prescription. This would cost you the Dr visit (approx $40 NZD) + the pharmacy visit (approx. $3 NZD) . Just to point out, yes you can do a lot better supposed first world country.
My mother works for United Healthcare and has done nursing and health insurance her entire career. She's told me the inner workings of these companies and holy crap, what a scam they are. That $30,000 surgery you had? Well if your neighbor has better insurance than you do, they charge $130,000 for the EXACT same procedure. Hospitals literally make prices up on the spot based on what they think your insurance will pay. Insurance companies also make these prices up on the spot. Here's an actual example of how US medical insurance actually works: You: I need an operation done that will literally kill me if I don't get it done Doctor/Hospital: Sure that'll be $10,000 (the actual cost of this procedure is $600) Insurer: We think it's only worth $5,000 Now at this point the doctor and/or hospital can say 'K great, $5,000 is reasonable have a nice day' and let the insurance cover it. OR, and this is what they do normally, they can be jerks and say 'No the procedure costs $10,000' and then bill the patient for the remainder that the insurance didn't cover, even though the actual cost of the procedure is under $1,000. But the biggest proof that it's all a scam, these numbers are completely fabricated. Your neighbor might be getting charged $50,000 for the same procedure because they think the insurance will pay more. The neighbor on your other side might be getting charged $5,000 and the insurance will only cover $2,500. The prices don't actually exist and as long as they're getting paid more than the actual cost of the procedure, they should be happy. But they never are. They ruin people's lives over a few thousand dollars when they're already making a 6,000% profit.
This is why my dentist told me to never get dental insurance and that he will just give me better rates if I pay him directly. Some people with insurance will pay more than I paid without insurance. He gets those cases at his practice but people will insist on using the insurance because it's through their employees so they think they're somehow getting their money's worth.
Perfectly done. This is my life. I’m constantly trying to get meds approved for patients. I’m a lot angrier about it when they don’t cooperate. But I know it’s their job to deny. Shareholders uber alles.
I love how you got the nail on the head on these kinds of issues. If only people in government would start listening and doing something about it. On an unrelated note, would anyone like to buy ocean front property in Arizona? It will be for sale when hell freezes and all the pigs fly away.
I'm a medical student "covered" by United Healthcare.. this hit home on too many levels. Insurance decided to stop covering a med I'd been on for years. I called them about it and they suggested a cheaper alternative. B*tch this has been working for me, why should I need to go through the whole process of getting adjusted to a new medication, which may or may not work as well and have different side effects? It took a lot of trial and error to get it right, and now I have to throw it out? Not cool.
Are all us med students covered by UHC Student Resources? Bc it sucks. They won't cover generic of one of my meds. But it's not a drug where substitutes are allowed. So my doctor has to write for the name brand, which she never does bc for almost everyone else, the generic is best and she'd have to write twice bc no subs. So it's always twice for me and the office never remembers. Oh and they just don't cover during summer and are like, just ask your providers to trust that we'll cover retroactively when we start again in fall. Uhhhh my doctor's don't do IOUs with insurances.
I remember the huge price gouge hike. I worked in veterinary med and had a girl call me back after discharging her golden retriever with a paper Rx, she was screaming it was $600 bucks. I couldn’t believe they went up over $400 in a night. We changed the Rx to generic and showed her how to draw up her own. $30 for same med, minus the 🖊 pen. Sick they charge that.
I used one of your videos to tell my kids about the healthcare system and they were furious. My son (8 yo) goes “That is so dumb!” Like, yeah little buddy.
This. I have lived this. Three and a half years of 6 month trials of unsuccessful lesser treatments as I lay bedridden with sever Ulcerative Colitis until we could finally make it down the list to the one my specialist knew would be right for me from the beginning. I was scheduling my surgical consult to have my entire large intestine removed when I finally began the medication... NOW I'm happy to say I'm 5 years 3 months symptom free! Would have been nice to have started with the right medication.
I’ve been fighting with my insurance for about two years because they stopped covering my migraine medication. I have a minimum of 2-3 migraines a month and this medication clears it up within a few hours, which hasn’t happened with any of the covered meds I’ve tried. I got around it for awhile because I have a savings card with the manufacturer, but now the medicine has to have a pre-auth so I’m fighting tooth and nail for them to clear it
How about the new Cares Act, that lets insurances decide to deny covering ANYTHING prescribed by a resident without a license. Interns, IMGs and residents training in the state they don't intend to practice in are all screwed for a while. I tried sending a patient a rescue inhaler on discharge, and the insurance wouldn't cover ALBUTEROL.
My late father had emphysema, and the VA docs would literally give him an Albuterol inhaler every visit. He rarely used one at all. He was keeping me, my husband, and asthmatic co-worker all supplied with inhalers that would have cost us $70+ dollars with decent insurance. (And yes, it was all the same med/dose, we compared the little bottles of medication)
I had a PA denied because they didn’t have any of the info… which I gave to them and double checked with their pharmacy. They were like “well they’re not on any antidepressants” but has been for SEVEN years and even after that they STILL denied
Dante got hell all wrong. There's no lakes of fire. It's an eternity of filing insurance claims, being denied, arguing, appealing and being subjected to nonsense rules and petty conduct. Oh and waiting on hold and being transferred multiple times only to have a lazy phone rep spike the call, forcing you to start all over again.
I am an international medical graduate and I have been looking for residency options. Honestly, I didn’t even consider US as an option and opted for Europe and UK because I cannot for the life of me handle such discriminatory medical system where I will have to deny my patients treatments and interventions because they either cannot afford it or their insurance won’t pay for it. I want to work in a system where I am paid well but not based on praying on those who may be struggling; a healthcare system that isn’t working against the people for the sake of luxury and big pharma gaining even more money.
Preying* and here in the UK you get the joys of poor people non care and private medicine. There's no incentive to care or work hard in the UK. People become doctors for the pay and as an NHS patient you aren't the customer. The NHS gets paid more the worse it performs. You get a choice of public or private but you're already poverty trapped by huge taxes to pay for the NHS. Plus our governments just borrow the money to fund it. That's totally sustainable. And they make sure the NHS only secures supplies from its friends. When you find out it costs us £10,000 for a pen because of government contracts you might re-evaluate. And my wife had to interview for an expensive treatment to judge if she was valuable enough. Also- highly question giving the government any financial incentive to shorten your lifespan. Or the ability to put you on a do not treat list.
I have Huntington's. A few years ago a guy in Canada with Huntington's was in the news telling people what their lovely healthcare system was really like. He was a single father taking care of his son too. He slipped and fell one night and made the mistake of telling his aid who came by occasionally. His aid reported the fall so he was told he could either go into a nursing home or choose assisted suicide. No other options and his current treatment was completely rescinded. He went around trying to get some news coverage for how the system up there really works but no one really cared. He chose the second option by the way. People love universal healthcare until they need treatment and find out what it's really like.
I was prescribed lidocaine patches for after abdominal surgery. The insurance denied it and said that they were not a approved treatment for autism spectrum disorder. Even after trying to appeal it, they still would approve. Without insurance they wanted $300 for 5 patches. I'm supposed to use 2 a day for 3 weeks. About 3 months later, they were available over the counter for about $15 for a pack of 10
As a physician, this is so truthful. Believe it or not. I have even recently had to do prior authorizations on very inexpensive generics. It has become absurd. Then again, the cost of many medications has become absurd.
It's time to change the law. Make our health system like Japan's. All health insurance companies are nonprofit. Insurance companies may not deny a doctor's prescription. All drug, hospital procedures, and office visit prices are negotiated every two years between doctor representatives of the Japanese Medical Association and government for the entire country. No overbilling allowed. Universal healthcare, funded both privately and publicly. Best health results in the world.
I work in contracting for a DME provider. And let me tell you, working with insurance companies is the bane of my existence. I swear they make their reps take an oath to be as unhelpful and unresponsive as possible.
@@violetheise4717 I'm not very sure that is the adecuate word. And I'm not saying they are good people. That's just how they work. Lets put a simple example: a car insurance. It can easily cost $1000 per year and it can "save" a $15 000 vehicle. If 100 people buy this insurance and this 100 got accidents and lost their cars that same year, the insurance company will be in bankrupt. For they to barely survive, they need that no more than 7 people lost their cars... Or to say them that they don't qualify for the insurance because it was thursday.
@@LuisXGP omg how can this "purely unethical shit" survive if it stops doing unethical shit? "Oh I'm not saying black market for organs is good, but how will they survive if they stop profiting from homicide?" Well, you know, maybe those markets shouldn't exist, just a wild idea for you. An insurance company is an unnecessary third party that does literally nothing for society but profits of the neverending thing - human's health problems.
@@mojigreen6461 no shit sherlock, couldn't realize that if you didn't re explain it to me. Blame the people that let them to be robbed, I don't even live in that s. country
Sadly, this attitude is no longer confined to insurance companies - a LOT of conversations with pharmacists have started to look like this. "Yeah, sorry I can't approve this drug, it's a dangerous nephrotoxin - did you know that?" "...um well... the patient needs his tacrolimus so that he doesn't experience kidney transplant failure..." lol I've literally had hospital pharmacists tell me they specifically took drugs off formulary so that we wouldn't be able to order them.
Yes… That’s the point of a formulary and all hospitals have them. We don’t want you to order certain medications for various reasons. FYI - whatever pharmacists you’re speaking with probably had nothing to do with the decision. Play nicely!
@@lisal6608 That's all fine and well until a patient urgently needs flagyl and you have to daisy chain consults through infectious disease all day long because they are the only ones pharmacy will allow to put the orders in... Worth saying tho, this communication breakdown issue isn't unique at all to pharmacists, it happens frequently with surgical consults, etc. Just gotta find the humor and roll with it
I moved to the US for my postdoc a few years ago. Having grown up in the UK, I knew that the healthcare system was profit-driven and dysfunctional. I had no idea just how bad it was until I was in the system. My second kid was born there, and despite being on a good insurance plan thanks to my place of employment we still had to deal with additional costs and fighting the bureaucracy of the insurer. Getting out of that system was one of the biggest factors that eventually led to us moving back to the UK.
So what I understand is… the only way medicine and healing can work in the US is… hospitals get a bunch of people who constantly keep resubmitting the applications and constantly appeal
Sadly so accurate. And as a nurse of 36 years experience, I can also tell you that overall the healthcare we receive as health professionals (you know - good insurance benefits which we pay out the wazoo for) is most often not there. Funny though - I do know of 1 sector of the population that has AWESOME health insurance benefits. Want to guess? Why that would be our beloved senators and other government people. You know - the people who make major decisions for the rest of us.
Don’t forget that the government has the good cushy sort of insurance! But it’s only for ‘important’ people like politicians not us meager peasants who do worthless things like paying taxes.
I have said for years that if they had to live with the same insurance we gave things would change fast. There was a ruling (I think when Obamacare passed) that Congress had to abide by the same rules we did. They got that changed really fast.
@@meg2249 some people are more equal than others. Always the case. Might as well be feudal. At least without elections we didn't waste time seeing who got bribed the most and some even felt responsibility for their holdings and people.
I worked in a pharmacy in high school and recently worked at a major health insurer. Not only is this dangerous honest in how it goes down, it has only gotten more egregious in the last 20 years. We need to better regulate insurance pre-authorizations and denials to stop useless delays and obstructions of care in medically unambiguous situations. Using unnecessary hurdles to extract profits is a form of profiteering. The people who create such hurdles portray they are mere misers, they are not. Nay, they are profiteers and pirates. That money is not made from the efficiency of collectivization or the facilitation of improved care reducing costs for all. The excess money earned on denying necessary care, delays, and hurdles is a distillation of human suffering. It is soaked in the blood, tears, vomit, and collective pain of those they made suffer unnecessarily.
This is why I have said that if you truly care about people, working in the medical field will tear you apart. Because seeing how much greed has tied doctors' hands and literally makes you stand by and watch as it won't let you help, if you legit care it is heartwrenching
I had a patient at work who lost his leg (AKA) after being ran over by TWO cars consecutively and he was denied rehab by insurance because they said he "didn't need it." This is exactly how I imagine the peer-to-peer appeal went.
The first 2 words of this video told me more about the content than the title, lol. "United Healthcare".🤣 I used to deal with them annually for ONE prior authorization on a medication until it was discontinued. I can't imagine what my Doctor went through for ALL of his patients!🤦♀️😭
The american healthcare system, genuinely, truly scare me. I honestly don't want to visit since I'm afraid if something will happen to me I'll either be neglected medically or ruined financially.
I've heard that visitors are covered by their own nation's systems, though that might vary. Maybe some nations figure that if you come visit us, you are obviously taking your life in your hands and out of theirs.
@@letshavepie Depends in the country, for example in europe there is something called the Schengen area. Basically any country in this area will take care of your health stuff. Also EU people can get "EHIC" (european health insurance card) from their local insurance for free, which will cover you on your travel through the EU.
Don't feel sorry for the second physician working for the the insurance company. That man should get his license removed. He is selling out patients to the highest bidder.
ill never understand how NOT trained medical personel can decide if you can take or not that life saving medication... it baffles me beyond understanding
Will, I met you yesterday after your keynote at COA. Venting here today as I just lost a P2P battle with a Pharmacist and the MD from our favorite insurance company. I fought tooth and nail for his cancer treatment and explained the whole clinical picture over 6 months, still denied. They said "don't worry you can expedite an appeal afterwards " as if that's supposed to console me. I ended the conversation by kindly advising them that I hope one day they use their positions to advocate for patients, rather than endlessly repeating the same criteria from their manuals that the non-clinicians do from their company.
I was that kid with a severe peanut allergy. Except I live in Canada so I got the Epipen and everything turned out fine, barely had to pay anything for it.
I´m vetenarian in Europe. Our little Pet-insurance companies, which were founded solely for profit and are not legaly considered part of public health system or critical infrastructure (unlike human state insurance companies) are making much less fuss when it comes to covering expenses. I guess with our insurance tradition they just wont dare to refuse.
As a pharmacist who has to occasionally bother doctors for things like opioid thresholds, I think it is valuable for us all to remember who the real enemy is....
I once got a pre-authorization of my expensive biological in 3 weeks. I thought a miracle happened that day, having been on this medication for 8 years over 9 insurance plans.
As a nurse that has done prior auths for our clinic patients, THANK YOU for making these videos and educating the public about the evils of insurance companies. The fact that insurance companies have taken doctors, nurses, pharmacists to turn them against other doctors, nurses, pharmacists by way of prior authorization denials/reviews is insane. Patient harm is being done every time a life-saving drug is denied or made unaffordable. Between the insurance companies and drug companies, American healthcare is truly broken.
i have UHC, supposedly a good plan. pft. it’s good as long as you don’t have to use it. when you call or email them you often get conflicting information from different people. it’s all wildly complicated. I never know when I’m going to get a “surprise bill“. I want to be able to invoice UHC For the time I spend on hold and talking to customer service trying to figure shit out on my plan. The current state of health insurance in our country sucks so bad it makes me want to leave the country. I don’t know what the exact solution is but please keep making videos that illustrate how horrible health insurance companies are. thanks, dr g. dr
The best plan if you don't have to use it is "no insurance". That's also a pretty good plan if you _do_ have to use it. You have the flexibility to pick any doctor you like, and doctors usually have some trick to give discounts to the uninsured. (My favorite is "50% off if you pay in full within 24 hours" - insurance companies never pay that fast.)
Surprising that he survived a month in the box without food or water. Must have been a family medicine resident. Oh well, back in the box, before they pull out the cattle prod again.
I was a pharmacy tech for 10 plus years. Prior Authorization is such a pain! The one that always got me was when insurance wouldn’t pay for the capsule form, but would pay for the tablet (or vice-versa) form. Quite often the form they wanted to pay for wasn’t available because the other had been found to have better efficacy. And so begins the “RX do-si-do”…🤪
Last week I called to do a peer to peer and got transferred to a nurse as the peer. I assumed I’d misheard, and asked her to repeat name and credentials. She got super huffy with me and put me on hold to transfer to the actual physician. The moron physician seemed to have trouble understanding that a patient’s prior dx of carpal tunnel syndrome did NOT explain lower extremity symptoms, dysequilibrium, etc. 🤦🏻♀️ Maybe I should have just talked to the nurse wtf
I love your body of work. This one hit home. When I work in a pain management and physical rehabilitation practice. Had to do preauthorization for meds and implants. What is not shown is the typical 23-35 minute wait to speak with a representative.
Honestly given how short and concise your stuff is about the medical system in America I think it’s only a manner of time till a progressive politician uses it to explain to representatives
We can only hope. As a pediatric nurse who just took care of a family with a kid that requires every 4 hour cathing who came in with the kid near septic from a UTI. All because their insurance company only approves for a laughable amount of catheters a month. Meaning they had to resort to washing used urinary catheters the best they could to reuse them… That’s just pure evil corporate greed there…
Funny but heart breaking at the same time. It blows my mind that some Americans can claim it's the greatest place to live when stuff like this is probably common place.
Few Americans have ever even been abroad. Their ideas about the US being the greatest place on earth are based squarely on grandpappy's grandpappy relating how much better Americans live than people in newly liberated areas during and right after World War II.
The United States is no longer the greatest place to live. Of course, the available alternatives aren't much better. The U.S. medical system is screwed up because of corporations on the stock market. The stock market is inherently evil: Maximize profits at the expense of human lives. Delisting companies that have anything to do with food or medicine from the stock market would solve nearly all of the problems.
everybody can claim it is the greatest place to live when it is not even close. even north Korea do that lmao. USA was not and never will be the greatest place to live because of their believe that they are the greatest ever country.