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I Hate Insurance Companies - Mo's Journal
July 14th, 2011
05:52 pm

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I Hate Insurance Companies
It's kind of ironic, since I partially grew up in a suburb of the Insurance Capital of the World. Still, I believe strongly that basics like public education and access to health care should not be left to the whims and greed of free market forces. I believe that in principle, but I'm also incensed personally.

My preapproval for surgery for thyroid cancer was denied because the insurance company says it can be done more cheaply on an outpatient basis and that it's "routinely" done that way. I really don't have an opinion on whether it's okay to do it outpatient but apparently it's not routinely done that way in New York City and my surgeon feels strongly I should be in hospital overnight. He says I shouldn't worry about it and he will appeal and win, but it just seems that this is yet another example of "Say No and See What Happens." Sort of like Republicans in Congress.

This reminds me of the time that we were trying to decide whether to have a new kind of laser treatment on a birth mark Kendra was born with. At the time there were only two doctors in all of NYC who did it, so we consulted both before making a decision. The insurance company said that the UCR (usual, customary, reasonable) rate for this procedure in our area was half what the doctor we chose charged, so that's what they'd pay. And our guy was the lower priced (albeit more experienced) one. How can it be usual and customary for the area if it's a lot less than everyone who does it charges? Of course now they don't use UCRs anymore, but the principal of make the patient pay is the same.

The icon, of course, shows what I wish I could do to the damn form with DIAGNOSIS: MALIGNANT NEOPLASM OF THE THYROID written like that, in capital letters, and with "Denied" on the next line.

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From:realpestilence
Date:July 14th, 2011 11:28 pm (UTC)
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Most insurance companies do that, and Medicare is the worst. If you're persistent enough, and the doctor can provide proof of medical necessity, you can get it approved. But just think how many people, especially the elderly, who give up because they think that's it, case closed?

I'm sorry to hear about yet more troubles for you, but at least your doctor is involved and backing you up. That will help.

~hugs
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From:mofic
Date:July 15th, 2011 01:08 am (UTC)
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If Medicare is the worst, that would go against my theory that it's profit motive that's the problem and single payer would solve it. But truly, my experience of single payer (living in Canada) is that it's clear what's covered and what isn't, it's evidence based, the doctors all know and go by the same rules. You might disagree with how many days you get in the hospital or whether you can have the third opinion or whatever, but everybody is treated the same. It doesn't matter if you have more money or better connections or your doctor is more authoritative.
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From:marag
Date:July 14th, 2011 11:54 pm (UTC)
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ARGL. My hatred for insurance companies is epic and legendary, although it's actually dwarfed by my hatred for the hospital billing office.

Good luck.
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From:mofic
Date:July 15th, 2011 01:09 am (UTC)
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In a single payer system you'd deal with neither!
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From:marag
Date:July 15th, 2011 01:14 am (UTC)
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This is the point where my father would say, in his driest possible voice, "Isn't it wonderful that the Republicans are protecting us from the rationing and the complicated mess that would be the result of a single payer system?"

"Indeed it is," I always reply. "It's so great that we get to stick with the rationing and the complicated mess we have now."

Then we both roll our eyes and I maybe add in a facepalm for good measure.
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From:kuriadalmatia
Date:July 15th, 2011 01:29 am (UTC)
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Having dealt with insurance denials for the past year, I know how frustrating it can be. Thankfully, it seems your doctor understands the DRG and CPT codes as well as used to dealing with denials. Sad that he has to have that expertise, though.

//hugs//
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From:mofic
Date:July 15th, 2011 10:25 am (UTC)
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I know! It should be enough for a doctor to be a good practitioner. S/he shouldn't have to be a good bureaucrat, too! I feel similarly about urban public school principals having to be good at getting grants - shouldn't they just have to be good at education?
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From:fgherman
Date:July 15th, 2011 04:15 am (UTC)
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That is so frustrating. I'm glad your doctor is going to bat for you.
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From:mofic
Date:July 15th, 2011 10:24 am (UTC)
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Thanks, Felicia. He's the same surgeon I went to before and he seems to know his way with insurance companies as much as with scalpels.
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From:lilacsigil
Date:July 15th, 2011 07:25 am (UTC)
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Fucking fuckers. Who the hell does outpatient thyroidectomies? That's extremely dangerous - the risk of complications is almost entirely in the first 24 hours!

I was told to have surgery, my surgeon booked it, it was cancelled once, then I had it. The end. Thanks universal healthcare!
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From:mofic
Date:July 15th, 2011 10:21 am (UTC)
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I know. What a system! Yet those Republicans stand up there and call it "the best system in the world" and no one says they're lying.
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From:thinking_lotus
Date:July 15th, 2011 09:07 am (UTC)
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like you need this

((hugs))
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From:mofic
Date:July 15th, 2011 10:22 am (UTC)
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Thanks. I'm really quite sure the surgeon and his office will take care of this.
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From:mofic
Date:July 15th, 2011 10:23 am (UTC)
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P.S. I was trying to figure out who you are. I forgot about your new lj name.
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From:thinking_lotus
Date:July 16th, 2011 02:25 am (UTC)
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I only hug people I know ;-)
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From:davidfcooper
Date:July 15th, 2011 02:16 pm (UTC)
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When I had my gall bladder removed it was technically an outpatient procedure, but I stayed in the hospital overnight (though not in a private or even semi-private room) and was released exactly 23 hours after I was admitted. If you're nervous about whether your doctor can convince your insurance to pay, ask hir if (s)he can get it done in 23 hours.
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From:mofic
Date:July 16th, 2011 11:39 am (UTC)
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That's exactly what the insurance company wants me to do - just stay in the recovery room for 23 hours. I really have no opinion on whether that's appropriate for this procedure but my surgeon does.
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From:litotease
Date:July 16th, 2011 07:29 am (UTC)
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I am so sorry you have to deal with insurance crap right now. Like cancer's not stressful enough just by itself.

::hugs::
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From:mofic
Date:July 16th, 2011 11:37 am (UTC)
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Yeah, I feel like even if it's a "good kind of cancer" it should merit a night in the hospital.
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