Caribou Gear Tarp

I hate insurance companies!

I know Joe Rogan is a hot subject in these parts. But he just had a guy from Ways to Well on his podcasts and he is talking about this very thing. What insurance companies due to healthcare providers is just terrible. One specific quote I heard is an appointment/Drug that costs 300$ gets Billed to the insurance company 1200$ so that they can ensure they get their 300$ because the insurance company never pays the full bill, and they record every billing event and go to the government with that information and get kick backs from the government. This was coming from a guy that was in the industry.

Its just sickening, frankly its straight up a scam at this point. The amount of insurance that gets paid for is down right stealing, and then you have to pay a deductible on top of that. At what point do we break. Our medical system sucks, and the good doctors out there trying to do the right thing get screwed.
 
I just started to take a common medication in October and 2 weeks ago I got a letter from them saying they will no longer cover the brand name. WTH?
Yeah, they redo the list now and then. We can get a generic version for all but one med she takes. UH set our cost at $70/month. If I remember right it lists for over $700.
 
It's flat out criminal IMO. They get away with it because everyone gets the kickbacks somewhere during the whole process. The whole system needs an overhaul. I don't see it happening though and if it does, will it be better or worse?
 
Not all drugs are created equal or even work the same. I take a maintenance pill for my arthritis. There's many companies making the same medication but only a few actually work. That's bullshit. If the pharmacy, Kaiser, substitutes another brand that doesn't work the prescription has to be refused while at the counter and the specified brand has to be reordered. That will be 3-4 days and another 75 mile round trip. The drug companies are in cahoots with the medical providers who are in cahoots with the insurance companies. Nobody gets screwed except you and me.
 
I had a screwy issue that resulted in a drawn out fight that we ended up losing...

March 2012 neck break, quad - after second incident while in re-hab, Docs figured less that a 10% chance to walk. recovery (current 70-80% of pre injury).

Aetna spent a TON on my surgeries and inpatient PT/OT four month care. $580k.
Then Community Medical Offered a new type of semi outpatient though regulated in as a day multiple PT/OT fashion 2-3 days per week. Their team called and confirmed with Aetna it was covered. "Yes". Held a phone conference and agreed it was covered. Later.... $28k Bill for 2 Months.
Aetna noted their AETNA representatives spoke in error however, even in error we are bound to written agreement. We hired an attorney as we felt that was ludicrous! Went to the State for review and it turned out the coverage wording is specific to drug/alcohol "rehab" and AETNA reps focused on the portions related to "Rehab" though not the initial Chapter text... Thus, I was found responsible. What a chit show.

In the end, every penny spent, in my setting was well worth it regardless the AETNA chitshow.
Community Med (and St. Pats - both in Zootown) were phenomenal! Examples: As a LEO, they authorized my OT activity with loading/unloading, racking the slide, etc a simunition gun and loading / unloading magazine after magazine with dummy rounds w/ Security in the room for the 20min per day OT activity. Community had me jogging (tripping/falling) across their grass fields with my full duty belt (red gun) and full vest with hard front/rear plates alongside the PT/OT. I learned how to drive again, etc. Basically nerves restart where my mind knew how to write though physically? It was pure scribble. I hear they do not have the program any longer. Sad.

Long story though background helps... And all the amazing HT support. Critical.

Side note: Wife is Type One Diabetic - I have great Federal Insurance and we pay more than I consider "reasonable" for her prescriptions though nature of "American Economics". Value and screwy.
 
Figured it out. Got another statement and it showed the medical supplies as being denied along with the visits due to the 100 visit limit being met. Called insurance AGAIN and explained the situation and asked about the supplies. After some research the rep said they should be included with the visit. I was told to appeal the claims so I got online and did that for each denied claim, copy and pasting my explanation of the issue to each one requesting a yearlong review of the supply claims being added to the visit claims to determine if the limit really was met and allowing the claims to be paid. Now I wait. More visits and supplies will show up soon to add to the total. :rolleyes:
 
Figured it out. Got another statement and it showed the medical supplies as being denied along with the visits due to the 100 visit limit being met. Called insurance AGAIN and explained the situation and asked about the supplies. After some research the rep said they should be included with the visit. I was told to appeal the claims so I got online and did that for each denied claim, copy and pasting my explanation of the issue to each one requesting a yearlong review of the supply claims being added to the visit claims to determine if the limit really was met and allowing the claims to be paid. Now I wait. More visits and supplies will show up soon to add to the total. :rolleyes:
I’m in my own fight with the insurance company. None of this is fun. Wish there was a way to act hold them accountable.
 
We need insurance against the insurance companies for when they jerk you around.
Side note,,,,Kaiser canceled another dr. appointment this morning. It took 7 weeks to get the appointment. We paid nearly 2 months of premiums for another appointment to be canceled. More bullshit.
 
That's the name of the game.. they make it next to impossible to get what you have coming hoping most won't fight it. Pieces of shit to put it lightly.
 
I hear ya Dave; dealing with some of the same crap here. It's funny how covered procedures are always denied; they have no problem raising rates… while cutting benefits or payouts. As @rtraverdavis said it’s criminal that they can be for profit.
 
I Hate insurance...its a hell of a racket. I refuse to get it until I think my body is gonna start breaking down to where I should but even then it seems insane. My ex and I had huge arguments over health insurance...because I flat out refuse to spend a dime on it. Crooks!!!
 
If it wasn't for being married and having her condition it would be a LOT cheaper. I kept my insurance from work when I retired because my out of pocket had been met and the wheelchair was ordered but not yet built and delivered. Only took a month to meet the out of pocket for this year and meds were pretty cheap so I didn't bother to change anything. Next year the premium and deductible plus out of pocket all go up. Might be time to look for something different for her. I could probably get away without for myself but better not push it after screwing up my knee. I'm getting older every day!
 
As much as we all hate dealing with insurance companies, myself included what would we do without insurance?
The major bill for surgery on my shattered ankle was $80,000+o_O
I don't know about any of you guys but I don't have an extra $80k just laying around.
 
As much as we all hate dealing with insurance companies, myself included what would we do without insurance?
The major bill for surgery on my shattered ankle was $80,000+o_O
I don't know about any of you guys but I don't have an extra $80k just laying around.
Last year our claims totaled just over $1.1 million.
 

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