It’s also pretty shocking to find out what y’all have to deal with. German healthcare can be mildly annoying at times (the bureaucracy of finding the right form to fill out to get something like psychotherapy approved can be tedious), but I’ve never heard of anyone here getting their request dismissed without a good, legally predefined, reason. Apparently American Healthcare companies can just say no just because they feel like it?? whack.
my ukrainian coworker recently was dealing with something with our healthcare company and she was like “wait. y’all weren’t exaggerating? you actually have to fight for your right to get medical care here?” and we were like “we been saying. america’s online presence is a cry for help”
I’ll never forget when I was prescribed a medication for a heart condition, literally crucial for me to continue living, and the insurance company denied the claim. Without insurance it was $600/mo at a time when I was making $5.25/hr.
Coworker that was a double breast cancer survivor was denied coverage for the drug that kept the cancer from coming back again. Like, they want you to die so you don’t cost them money.
Maybe this is the time Americans actually think about the value of an institution who’s only purpose is to extract wealth from normal people.
I really don’t get how your insurance company can be like “you need this treatment to live” (Or anaesthesia is vital for an operation, and an insurance company just be like “nah…”.
I remember the phone call with the insurance clearly. I asked the lady on the phone, “I don’t understand - my doctor says this is crucial but you’re saying I can’t have it?” And she said, verbatim, “I’m not saying you don’t need it or can’t have it. I’m saying we’re not going to pay for it.” And when I told her “Then you’re giving me a death sentence.” she went silent. I ended up stretching my one month doses over 3 months so it was “only” $200/mo.
Then I feel for her…end of the day we all only go to work cause we have to.
My GF used to work for a company that provided in home care and facilities for the elderly, there were people whose job it was to phone up families and basically say “I know died last week but you owe us this money/equipment…”. That mustn’t have been fun.
She probably had no authority to do anything about it. Delay, deny, defend…she’s part of deny/defend. She’s there to tell you that you were rejected, not to explain why or appeal. If a doctor calls, they’ll go into “you didn’t submit X step of paperwork declaring the patient has Y, and so even though you noted it elsewhere we’re denying”
Going off script risks her job, and for what? By design, she can do nothing to actually help
TBH it was hard for me to wrap my head around Europe’s healthcare, I’ve was always told that it was similar to where I’m from (Scotland) but I would read about insurance and employer healthcare and be really confused, since up here everything (prescriptions, glasses, teeth) is free and there’s no insurance.
There’s been stories of tourists asking where to pay / show their insurance card and the receptionist at the hospital would shrug and say that they don’t know what to do.
That sounds nice and simple! I don’t 100% understand the German system either, I just know that it costs about 15% of my income each month (half is paid by my employer), and if my doctor writes a prescription on a pink sheet of paper, the meds don’t cost me more than like 5-10€ (apparently it’s some sort of co-pay thing).
We also have a system for private health insurance, because people employed by the government aren’t allowed to benefit from the government-subsidized health insurances. But I’m not earning enough to know specifics about it haha
It’s all gone electronic very recently, but the “pink” medicine is considered optional in a way. It’s mostly QOL-improving stuff like aspirin or ibuprofen. It used to be free, but the decision has been made to further disadvantage the poorest part of society for which 5 € can make quite a difference.
Interesting! Is there a color for medicine that is absolutely necessary? I know that when I was seriously messed up and needed Antibiotics those were put on a pink slip, idk how optional those were :o
I’ve also seen the green papers, which are for completely self-paid stuff (so like, weird unproven teas and supplements)
It was even worse before the ACA. Before then, insurance could kick you off your plan for no reason and refuse to cover new users for pre-existing conditions.
In practice, the way this worked was quite simple: You got cancer, your insurance canceled your plan, and then they would refuse to give you a new plan because you had a pre-existing condition - cancer.
I had a knee surgery last year and while dealing with my insurance company was a pain about equal to the surgery itself, they ultimately had to pay for rehab because they couldn’t disagree that rehab after a surgery like this is absolutely necessary
When I went in about my hernia, because it was hurting really bad, they ended up finding another hernia that wasn’t causing any pain. But because the other one wasn’t causing any pain, UHC denied my surgery to fix the one that wasn’t causing pain because it wasn’t deemed medically necessary.
So basically when I went in to fix the one hernia, the doctor couldn’t fix the other hernia because UHC wouldn’t cover that half of the surgery.
So I’m sitting here years later with a hernia that I’m just waiting on the day that it starts hurting so that I can go spend another few thousand dollars fixing all because UHC didn’t want to pay for preventative maintenance.
Edit: And I almost forget the best part, after the surgery they took 5 months to pay because they wanted to ensure that the other hernia wasn’t fixed. And because they took so long to pay when I had to pay it was a nightmare for me using my FSA account for it.
It’s also pretty shocking to find out what y’all have to deal with. German healthcare can be mildly annoying at times (the bureaucracy of finding the right form to fill out to get something like psychotherapy approved can be tedious), but I’ve never heard of anyone here getting their request dismissed without a good, legally predefined, reason. Apparently American Healthcare companies can just say no just because they feel like it?? whack.
my ukrainian coworker recently was dealing with something with our healthcare company and she was like “wait. y’all weren’t exaggerating? you actually have to fight for your right to get medical care here?” and we were like “we been saying. america’s online presence is a cry for help”
Thankfully, your coworker was from ex-republic. And not any, but from U in RUB.
I’ll never forget when I was prescribed a medication for a heart condition, literally crucial for me to continue living, and the insurance company denied the claim. Without insurance it was $600/mo at a time when I was making $5.25/hr.
And this applies to all treatment.
Coworker that was a double breast cancer survivor was denied coverage for the drug that kept the cancer from coming back again. Like, they want you to die so you don’t cost them money.
Maybe this is the time Americans actually think about the value of an institution who’s only purpose is to extract wealth from normal people.
My dad survived colon cancer but then any further colonoscopy was denied for five years because it was no longer “preventative”.
I really don’t get how your insurance company can be like “you need this treatment to live” (Or anaesthesia is vital for an operation, and an insurance company just be like “nah…”.
I remember the phone call with the insurance clearly. I asked the lady on the phone, “I don’t understand - my doctor says this is crucial but you’re saying I can’t have it?” And she said, verbatim, “I’m not saying you don’t need it or can’t have it. I’m saying we’re not going to pay for it.” And when I told her “Then you’re giving me a death sentence.” she went silent. I ended up stretching my one month doses over 3 months so it was “only” $200/mo.
That’s inhumane. I wonder if the person on the other end of the phone just didn’t give a shit or what…
I think she did. I could hear pain in her voice.
Then I feel for her…end of the day we all only go to work cause we have to.
My GF used to work for a company that provided in home care and facilities for the elderly, there were people whose job it was to phone up families and basically say “I know died last week but you owe us this money/equipment…”. That mustn’t have been fun.
She probably had no authority to do anything about it. Delay, deny, defend…she’s part of deny/defend. She’s there to tell you that you were rejected, not to explain why or appeal. If a doctor calls, they’ll go into “you didn’t submit X step of paperwork declaring the patient has Y, and so even though you noted it elsewhere we’re denying”
Going off script risks her job, and for what? By design, she can do nothing to actually help
TBH it was hard for me to wrap my head around Europe’s healthcare, I’ve was always told that it was similar to where I’m from (Scotland) but I would read about insurance and employer healthcare and be really confused, since up here everything (prescriptions, glasses, teeth) is free and there’s no insurance.
There’s been stories of tourists asking where to pay / show their insurance card and the receptionist at the hospital would shrug and say that they don’t know what to do.
That sounds nice and simple! I don’t 100% understand the German system either, I just know that it costs about 15% of my income each month (half is paid by my employer), and if my doctor writes a prescription on a pink sheet of paper, the meds don’t cost me more than like 5-10€ (apparently it’s some sort of co-pay thing).
We also have a system for private health insurance, because people employed by the government aren’t allowed to benefit from the government-subsidized health insurances. But I’m not earning enough to know specifics about it haha
It’s all gone electronic very recently, but the “pink” medicine is considered optional in a way. It’s mostly QOL-improving stuff like aspirin or ibuprofen. It used to be free, but the decision has been made to further disadvantage the poorest part of society for which 5 € can make quite a difference.
Interesting! Is there a color for medicine that is absolutely necessary? I know that when I was seriously messed up and needed Antibiotics those were put on a pink slip, idk how optional those were :o
I’ve also seen the green papers, which are for completely self-paid stuff (so like, weird unproven teas and supplements)
I’m English, I’m jealous of the eyes and teeth thing.
Scotland seems almost utopian.
It was even worse before the ACA. Before then, insurance could kick you off your plan for no reason and refuse to cover new users for pre-existing conditions.
In practice, the way this worked was quite simple: You got cancer, your insurance canceled your plan, and then they would refuse to give you a new plan because you had a pre-existing condition - cancer.
I had a knee surgery last year and while dealing with my insurance company was a pain about equal to the surgery itself, they ultimately had to pay for rehab because they couldn’t disagree that rehab after a surgery like this is absolutely necessary
I’ve got UHC and I recently had a hernia surgery.
When I went in about my hernia, because it was hurting really bad, they ended up finding another hernia that wasn’t causing any pain. But because the other one wasn’t causing any pain, UHC denied my surgery to fix the one that wasn’t causing pain because it wasn’t deemed medically necessary.
So basically when I went in to fix the one hernia, the doctor couldn’t fix the other hernia because UHC wouldn’t cover that half of the surgery.
So I’m sitting here years later with a hernia that I’m just waiting on the day that it starts hurting so that I can go spend another few thousand dollars fixing all because UHC didn’t want to pay for preventative maintenance.
Edit: And I almost forget the best part, after the surgery they took 5 months to pay because they wanted to ensure that the other hernia wasn’t fixed. And because they took so long to pay when I had to pay it was a nightmare for me using my FSA account for it.
Fuck UHC.
Numerous times since the 50s USA health insurance companies have decided some policies are costing too much money, so they have cancelled the policy.