We do indeed ignore at our peril what has happened to our health care systems. I count myself fortunate to have never received the kind of healthcare that engenders such rage. We have apparently entered a second gilded age where those with money and power make their own reality and those who are damaged by the system are pushed to rage and even violence.
When another layer of anger and disillusionment over health care or government surfaces, I do my best to channel it by reaching out to my elected officials to share my concerns and ask them to take action and inform me of their intentions with regard to the particular important issues. It helps me feel a sense of agency, though I do feel much more disillusioned about the Democrats willingness and ability to intelligently fight/rein in/halt the nonsense & chaos.
So I called Senator Alex Padilla's office to share about this Steady article and the huge response and asked what the Senator intends to do in response, to meeting the moment and acting in response to the groundswell of anger toward health insurers. He'd pass on my comment. No specific response.
I shared my concern that no one elected Elon Musk & that he's clearly manipulated Trump so as to grab power.
What will Senator Padilla & the Dems do in response? Are they equipped to intelligently, fiercely, shrewdly take them on?
He will do what he can to vet cabinet nominees.
And, BTW, have many other constituents called with the same concerns? The staff person said that he is not able to answer that question. Super impressive.
I love your take on this. Thank you Dan. You are always the common sense column.
I, too, have been infuriated with United Healthcare over the years. I am a very healthy 68 year old woman with normal age problems. I am on Medicare and have United Health Care as my supplement. I have been denied 3 times for an MRI from them.
Let me be clear... my Doctor recommends this procedure and... they deny. This is not life threatening for me or a child of mine, but makes me furious that an insurance company can override my Doctor.
When I read, "You will be heard", it took my breath away. I am surprised by how important that tiny little sentence is. Gosh, if the relationship of government and citizenry included that sentence, violence like this would be redundant. As it stands now, it's not redundant at all. Sadly, the murderer was the one who "heard" the cries of the people.
I normally am completely on board with you, Mr. Rather. A voice of ethical reason in a sea of sensationalist nonsense, your insights often help me to cling to hope. However on this one I feel that you are too far removed from the war zones that what was once middle America inhabits.
Corporations are golems for gain. They serve as wealth extractors for those who are already wealthy, preying upon those who have less. They're robots built out of paperwork.
100 years ago our food, water, shelter, access to health care, and energy needs were not under the control of corporations. When the Great Depression hit, people had backyard chickens, vegetable gardens, and country doctors who'd barter for treatment.
Right now, these essentials of survival ARE under the control of corporations, and the vast majority of human beings in this country are literally suffering and dying because of these wealth-extraction devices- and the majority of humans here are NOT "shareholders".
You are far removed from these trials- and you've well earned that, no question. But know that there is a vast sea of suffering now, in the American landscape.
More than 600,000 people a year are going bankrupt and/or becoming homeless due to medical debt. 60k and more people are dying dismal horrible deaths due to rejected claims that deny them care that's required just to keep their misery to a dull roar.
Doctors have been posting about insurance denials of seizure medication for young people, who have to suffer massive seizures in order to finally have the denials reversed. Elders who are in massive pain are begging to be 'put down' rather than receive end-of-life care and a death of dignity- because they don't want to saddle their grandchildren with debt.
The essential business model of an insurance company is to collect premiums and deny claims.
This is fundamentally antithetical to the entire concept of providing care.
And we are the sole country IN THE WORLD to be abrogating the BASIC HUMAN RIGHTS [see "W.H.O."] of its citizens while allowing a certain class of people to gorge on their suffering and dying. Not to mention their impoverishment and homelessness [which also are creating suffering and dying].
This is a war of attrition- a class war of attrition [all those Wall Street boiz reading Sun Tzu in the 90s are in it, I'm sure], and I'm afraid you aren't reporting from the front lines on this story.
I don't blame you. Most of the people who have decent coverage- who haven't been affected by a major medical incident- have no idea what will happen to them when the vultures swoop. Not until it happens.
But larger and larger numbers of us are on the other side of that devastation, and so shooting the briefcase Visigoths feels like a tiny bit of justice, sad as that is.
I've seen many memes lately comparing the wealth inequality of the US right now to that of France in 1789. I don't think they're wrong. I believe that our Democracy has been completely suborned by wealthy corporatists [Mussolini's word] and they have taken the lead in murdering- usually slowly and painfully- our citizenry.
There will, sadly, be repercussions. How bad they'll be will be determined by the perfidy of the thieves, liars, and murderers who currently are making off with the looted hopes, dreams, and aspirations of this nation. And yes, health insurance executives are among the most reviled of them all.
The American people are suffering. The bell curve is needle-shaped, and the vast majority of us have been put on the outside. And this has been coming since Prescott Bush started manipulating things back during the Nixon administration.
Amen! A kindred spirit. You get it. I wholeheartedly agree with your take on it.
While the murder is horrible, the groundswell of rage and then the many comments here have provided a bizarre comfort only in that, at long last, I don't feel like the only person who has been through a horrific, life-changing, financial and health-harming ordeal thanks to insurance, in my case, Blue Shield of CA.
And that I'm not the only person who sees the issues in the way you've described them.
Going through these ordeals is horrifying. What's even worse is the dismissive "oh well"-ness of so very many people, whether that's insurance employees, elected officials who take contributions from insurers, regulatory agencies, doctors, or others who haven't been through such a thing, so they don't get it and don't believe you.
These are quite isolating experiences to navigate.
It's like you go through such a thing & so many involved expect that it should not bother you in the least. People turn off their humanity to play their part in the movie. I think that's just as evil as the intentional refusal to pay so as to increase profits.
Can you imagine the impact it would have to not have so many employees tied up in that way working for evil companies?
Imagine all the humanity that could be unleashed and harnessed for good rather than harming sick people.
Today's episode of Democracy Now focuses on the role or the Press in subduing the response to the violence agaonst the CEO at the request of the HealthCare industry. The Investigative Journalist who published the Manefesto of theman accused of this violent act has also found evidence of considerable concern and disgust among Insurance Group employees about the actions of their employers. Unionizing Nurses and Social Workers to counter "edicts" that come from the corporate level concerning care and coverage for care may be the best way to stop such destructive policies. IF you are having problems getting care approved, ask for a Nurse Case Manager to assist you. Encourage them to unionize and ask for a place on the Corporation Board of Directors to begin the process of positive change and consumer protection above profits.
Winning without war implies Winning with just and abiding laws. The Constitution of the United States provides just and abiding law.
Established with the sacrifice of the blood of patriots since the Revolutionary War. I am the descendant of numerous such patriots.
Pleeeeeeease get someome to create and submit the following for Congressional action. ASAP. We can act on this and prevent Trump from taking the oath of the office of president. He is ineligible.
" An Act to Remove the Amendment XIV Sec. 3 Disability of Donald J. Trump.
Whereas at least Colorado, Maine, and Illinois found Donald J. Trump to have participated in an insurrection therefore let it be enacted,
Section 1. The Amendment XIV Sec. 3 disability of Donald J. Trump to take the Office of the President of the United States of America occasioned by his participation in an insurrection is hereby removed."
As Laurence Tribe said:
"It might be good to remember that, ***as an adjudicated oath-breaking insurrectionist,***
Mr.Trump is constitutionally disqualified under Sec. 3 of 14th Am from taking the oath as president on 1/20/25 unless 2/3 of both houses lift the disqualification."
Dan Rather writes what we should all be thinking and feeling but a hidden, dark, antisocial part of me feels that law/order, justice, fairness for the wealthy, connected, powerful just NEVER applies to all Americans. Legal cases, lawyers cost too much, take too long for the "little people" to pursue/enforce the foundations of our social contract with US Constitution, honorable, unbiased Representation, Bill of Rights and Courts. Now WE have a US President who is immune from prosecution for any, undefined yet, "official act." How much do WE take before WE enforse our powers, our wasted taxes on a corrupt SCOTUS, impotent/stalled/Do-Nothing Congress/lying/criminal/grifting leaders? Have WE reached our limits for frustration, propaganda, ineptitude, ignorance, Project 2025 aims, SCOTUS writing new laws-erasing precedents, states manipulating their cases to get them to SCOTUS to overturn more precedents about privacy, marriage, mailed birth controls, merging ch-here WE urch and state.
Sorry, it is my vent for the day. I AM very angry, dismayed. So much of what has happened to USA and our peoples' "life, liberty, pursuit of happiness, equality, voting rights etc. was unimaginable in my long lifetime-and YET here WE are.
"Wouldn’t it be great if we had politicians who had the guts to do something about this mess?
The system can be fixed, but it would take elected officials willing to have the government do more, not less, at least when it comes to health care." Questions are being asked by the FTC, DoJ and HHS, but so far only Josh Hawley and Elizabeth Warren have had the guts to go after the tip of the iceberg. Here are comments consistent with government action from one group of eminent doctors in response to a request for information on consolidation in the healthcare industry: https://www.regulations.gov/docket/FTC-2024-0022/comments?filter=DIHR.
Sorry steady so much is true but.. there’s always a but. Corporations often are found culpable of egregious behavior and when brought to light they pay a fine and walk. Death is often part of that egregious behavior but insurance companies are NEVER prosecuted. If anything happens, judicial wise, they pay a fine and walk. I believe commoners should have the same rights. Luigi killed a corporate executive whose company is responsible for deaths due to denial of services. Luigi should pay a fine, and walk.
A tale on what can be possible, even within the crazy system as it is now...
I'd been pre-diabetic for years & wanted to dive into how to improve my blood glucose levels (Ha1c test results). I learned about Levels Health, a fantastic wellness company whose mission is to help people understand & improve metabolic health thru the use of CGMs (Continuous Glucose Monitors). I could purchase CGMs thru Levels, but wanted to have Blue Shield cover them.
My doctor prescribed them, they were denied, and I appealed. Typically, only diabetics have CGMs covered, not pre-diabetics - who could improve their health & thus save BS tons of money in diabetic care.
I respectfully & persistently made the case for BS covering them. One agent said they'd be covered, but then I ran into the disconnect w/others who didn't. So I persisted.
It actually became fun. I simply connected some dots with the truth. :)
Shared data on the huge cost of diabetes care. Shared that their marketing keeps saying they put me "at the center!" - and so how about truly putting me at the center by covering this inexpensive, preventive measure that would save them money?
When they initially said I should wait till I became diabetic to have them covered, I pointed out the ridiculousness of this, reminding them of how important it is for them to save money. They'd rather I get sicker & cost them a whole lot more rather than paying maybe what, $100 for CGMs? On what planet did that make sense?
I won & can get covered CGMs thru 2039. Pay $39.99/mo for 2. Since July, blood glucose levels are well in control, with life-changing impact. I've also shared w/them that this should be a wellness benefit going forward if they're serious, per their marketing, about prevention.
I once got them to cover a $600 naturopath bill by saying to a decent manager, "These cardiologists I've seen lately who you pay loads of money to aren't helping me. My naturopath is. How about you cover that instead?"
Good job in fighting the system of insane decisions of coverage so that CEO's, stockholders etc. can make millions off of patients and pre-patients.
It is all about money. Now, it seems useless to worry about coverage. If you are sickly, society wants you to move on, not be a drain on limited dollars-die. If you cannot contribute, pay taxes or work, you are not valuable to insureres, companies, governments. During COVID, some felt rationing of care naturally should start with the elderly, infirm regardless of any other considerations. Remember that?
Having aired my residual frustrations with the system in this thread, I'd like to share discoveries & strategies I've found helpful for navigating the system over the past 10 yrs in case it might be helpful. Once I realized what I was dealing with, I did not want to let them win, i.e., bankrupt me, so I pushed back. Yes, while sick.
Be proactive.
For anything more involved than an office visit, I call insurance to ask what my financial responsibility is and ask to have that in writing. I saved $6000 on an ablation after I'd been told it would only cost 2 copays. I had that letter quoting my responsibility & they reprocessed the claim accordingly.
Insurers make loads of mistakes.
I check every claim carefully because they are frequently processed incorrectly. I call & ask the Claims Dept agent (I have Blue Shield of CA) to reprocess the claim while I hold. For many claims this is possible & saves time & headaches. If they refuse, I exit the call & try again. Remember, they don't expect to questioned, but that doesn't mean you shouldn't!
Info changes from one agent to another.
It sounds simplistic, but has saved me lots of money. Answers vary considerably from 1 agent to the next, so I call till I get the answer I need. It actually does work quite often.
Appeal a claim that's denied.
Remember the denial is often a strategy to not pay cause they know most people won't challenge it. File an appeal through their system. If you're overwhelmed & it's a huge costly claim, hire a Health Care Advocate. I spoke elsewhere of Mary Covington (FixMyClaim.com), whom I hired 10 yrs ago & who saved me many, many thousands of $$.
Get organized.
I have a Word doc on which I track dates, call Reference #s & brief notes to refer back to. Makes it easier to track everything.
Look for the helpers & ask for help.
There are many greedy, dreadful execs, for sure, but there actually are decent people willing to use their power to help. Finding them is my key strategy & has saved me tons of money.
When I was granted Charity Care for a $13,000 ER hospital visit bill when my insurer denied the claim, a kind billing agent suggested I ask the related providers to write off their portion because they often to if the hospital writes it off.
So I did. And wound up saving $20,000 simply by asking, "Would you be willing to write this off?" Was shocked to hear "Sure!" with several of them. It's harder today, but I always, always ask for help one way or another.
A lot is negotiable
Lots is set, such as copays, but for more extensive/expensive care, I've found that there actually can be flexibility. When BS authorized surgery w/an out-of-network provider at in-network rates, then broke their promise, it was a decent manager it took 8 phone calls to find who saved me $10,000. After fixing the claim, she had BS pay what I would've had to pay to make it up to me for what they'd put me through.
There are decent people in insurance. The key is to be persistent in seeking them out.
My attitude is that with the system being what it is, as we've discussed here, I'll do what I can to not be ruined by it. Hope others will push back, too.
I applaud you. It takes so much time to fight back but I do it too! I find the same thing about different agents give different answers-so I call several at least. Getting a letter, email sent is a new twist, I will try it.
“It is a system designed to make huge profits for the insurance companies, the drug companies, and many other industries within the system.”
Big Health Care (insurance, pharma, et.al.) have created a carve-out for themselves whereby they are immune from market forces, and apparently, immune from regulation. The GOP drive to privatize SS and Medicare would simply add those programs to the honey pot that is private health care. We would see less coverage for higher prices and no recourse from their monopolistic actions.
The fact that the killer is being praised in some circles is abhorrent. Full stop. The idea that people should simply kill those they disagree with or dislike should never become acceptable. The present course in our methods of discourse appears to be all downward.
We do indeed ignore at our peril what has happened to our health care systems. I count myself fortunate to have never received the kind of healthcare that engenders such rage. We have apparently entered a second gilded age where those with money and power make their own reality and those who are damaged by the system are pushed to rage and even violence.
When another layer of anger and disillusionment over health care or government surfaces, I do my best to channel it by reaching out to my elected officials to share my concerns and ask them to take action and inform me of their intentions with regard to the particular important issues. It helps me feel a sense of agency, though I do feel much more disillusioned about the Democrats willingness and ability to intelligently fight/rein in/halt the nonsense & chaos.
So I called Senator Alex Padilla's office to share about this Steady article and the huge response and asked what the Senator intends to do in response, to meeting the moment and acting in response to the groundswell of anger toward health insurers. He'd pass on my comment. No specific response.
I shared my concern that no one elected Elon Musk & that he's clearly manipulated Trump so as to grab power.
What will Senator Padilla & the Dems do in response? Are they equipped to intelligently, fiercely, shrewdly take them on?
He will do what he can to vet cabinet nominees.
And, BTW, have many other constituents called with the same concerns? The staff person said that he is not able to answer that question. Super impressive.
At least I got it out of my system.
I love your take on this. Thank you Dan. You are always the common sense column.
I, too, have been infuriated with United Healthcare over the years. I am a very healthy 68 year old woman with normal age problems. I am on Medicare and have United Health Care as my supplement. I have been denied 3 times for an MRI from them.
Let me be clear... my Doctor recommends this procedure and... they deny. This is not life threatening for me or a child of mine, but makes me furious that an insurance company can override my Doctor.
When I read, "You will be heard", it took my breath away. I am surprised by how important that tiny little sentence is. Gosh, if the relationship of government and citizenry included that sentence, violence like this would be redundant. As it stands now, it's not redundant at all. Sadly, the murderer was the one who "heard" the cries of the people.
Please forgive the long post.
I normally am completely on board with you, Mr. Rather. A voice of ethical reason in a sea of sensationalist nonsense, your insights often help me to cling to hope. However on this one I feel that you are too far removed from the war zones that what was once middle America inhabits.
Corporations are golems for gain. They serve as wealth extractors for those who are already wealthy, preying upon those who have less. They're robots built out of paperwork.
100 years ago our food, water, shelter, access to health care, and energy needs were not under the control of corporations. When the Great Depression hit, people had backyard chickens, vegetable gardens, and country doctors who'd barter for treatment.
Right now, these essentials of survival ARE under the control of corporations, and the vast majority of human beings in this country are literally suffering and dying because of these wealth-extraction devices- and the majority of humans here are NOT "shareholders".
You are far removed from these trials- and you've well earned that, no question. But know that there is a vast sea of suffering now, in the American landscape.
More than 600,000 people a year are going bankrupt and/or becoming homeless due to medical debt. 60k and more people are dying dismal horrible deaths due to rejected claims that deny them care that's required just to keep their misery to a dull roar.
Doctors have been posting about insurance denials of seizure medication for young people, who have to suffer massive seizures in order to finally have the denials reversed. Elders who are in massive pain are begging to be 'put down' rather than receive end-of-life care and a death of dignity- because they don't want to saddle their grandchildren with debt.
The essential business model of an insurance company is to collect premiums and deny claims.
This is fundamentally antithetical to the entire concept of providing care.
And we are the sole country IN THE WORLD to be abrogating the BASIC HUMAN RIGHTS [see "W.H.O."] of its citizens while allowing a certain class of people to gorge on their suffering and dying. Not to mention their impoverishment and homelessness [which also are creating suffering and dying].
This is a war of attrition- a class war of attrition [all those Wall Street boiz reading Sun Tzu in the 90s are in it, I'm sure], and I'm afraid you aren't reporting from the front lines on this story.
I don't blame you. Most of the people who have decent coverage- who haven't been affected by a major medical incident- have no idea what will happen to them when the vultures swoop. Not until it happens.
But larger and larger numbers of us are on the other side of that devastation, and so shooting the briefcase Visigoths feels like a tiny bit of justice, sad as that is.
I've seen many memes lately comparing the wealth inequality of the US right now to that of France in 1789. I don't think they're wrong. I believe that our Democracy has been completely suborned by wealthy corporatists [Mussolini's word] and they have taken the lead in murdering- usually slowly and painfully- our citizenry.
There will, sadly, be repercussions. How bad they'll be will be determined by the perfidy of the thieves, liars, and murderers who currently are making off with the looted hopes, dreams, and aspirations of this nation. And yes, health insurance executives are among the most reviled of them all.
The American people are suffering. The bell curve is needle-shaped, and the vast majority of us have been put on the outside. And this has been coming since Prescott Bush started manipulating things back during the Nixon administration.
Amen! A kindred spirit. You get it. I wholeheartedly agree with your take on it.
While the murder is horrible, the groundswell of rage and then the many comments here have provided a bizarre comfort only in that, at long last, I don't feel like the only person who has been through a horrific, life-changing, financial and health-harming ordeal thanks to insurance, in my case, Blue Shield of CA.
And that I'm not the only person who sees the issues in the way you've described them.
Going through these ordeals is horrifying. What's even worse is the dismissive "oh well"-ness of so very many people, whether that's insurance employees, elected officials who take contributions from insurers, regulatory agencies, doctors, or others who haven't been through such a thing, so they don't get it and don't believe you.
These are quite isolating experiences to navigate.
It's like you go through such a thing & so many involved expect that it should not bother you in the least. People turn off their humanity to play their part in the movie. I think that's just as evil as the intentional refusal to pay so as to increase profits.
Can you imagine the impact it would have to not have so many employees tied up in that way working for evil companies?
Imagine all the humanity that could be unleashed and harnessed for good rather than harming sick people.
Thank you for your comment.
Today's episode of Democracy Now focuses on the role or the Press in subduing the response to the violence agaonst the CEO at the request of the HealthCare industry. The Investigative Journalist who published the Manefesto of theman accused of this violent act has also found evidence of considerable concern and disgust among Insurance Group employees about the actions of their employers. Unionizing Nurses and Social Workers to counter "edicts" that come from the corporate level concerning care and coverage for care may be the best way to stop such destructive policies. IF you are having problems getting care approved, ask for a Nurse Case Manager to assist you. Encourage them to unionize and ask for a place on the Corporation Board of Directors to begin the process of positive change and consumer protection above profits.
Winning without war implies Winning with just and abiding laws. The Constitution of the United States provides just and abiding law.
Established with the sacrifice of the blood of patriots since the Revolutionary War. I am the descendant of numerous such patriots.
Pleeeeeeease get someome to create and submit the following for Congressional action. ASAP. We can act on this and prevent Trump from taking the oath of the office of president. He is ineligible.
" An Act to Remove the Amendment XIV Sec. 3 Disability of Donald J. Trump.
Whereas at least Colorado, Maine, and Illinois found Donald J. Trump to have participated in an insurrection therefore let it be enacted,
Section 1. The Amendment XIV Sec. 3 disability of Donald J. Trump to take the Office of the President of the United States of America occasioned by his participation in an insurrection is hereby removed."
As Laurence Tribe said:
"It might be good to remember that, ***as an adjudicated oath-breaking insurrectionist,***
Mr.Trump is constitutionally disqualified under Sec. 3 of 14th Am from taking the oath as president on 1/20/25 unless 2/3 of both houses lift the disqualification."
https://bsky.app/profile/tribelaw.bsky.social/post/3lbrh5vrdw22a
I am certain 2/3 of both houses will not lift the disqualification.
Now is the time to act. It is the way of upholding the US Constitution you took an oath to do so.
Dan Rather writes what we should all be thinking and feeling but a hidden, dark, antisocial part of me feels that law/order, justice, fairness for the wealthy, connected, powerful just NEVER applies to all Americans. Legal cases, lawyers cost too much, take too long for the "little people" to pursue/enforce the foundations of our social contract with US Constitution, honorable, unbiased Representation, Bill of Rights and Courts. Now WE have a US President who is immune from prosecution for any, undefined yet, "official act." How much do WE take before WE enforse our powers, our wasted taxes on a corrupt SCOTUS, impotent/stalled/Do-Nothing Congress/lying/criminal/grifting leaders? Have WE reached our limits for frustration, propaganda, ineptitude, ignorance, Project 2025 aims, SCOTUS writing new laws-erasing precedents, states manipulating their cases to get them to SCOTUS to overturn more precedents about privacy, marriage, mailed birth controls, merging ch-here WE urch and state.
Sorry, it is my vent for the day. I AM very angry, dismayed. So much of what has happened to USA and our peoples' "life, liberty, pursuit of happiness, equality, voting rights etc. was unimaginable in my long lifetime-and YET here WE are.
Very grateful for this forum. There is a lot of wisdom here. Thank you to the contributors in the community, Dan & Steady Crew.
The Death of Expertise-book by Tom Nichols-is a flashing red light of the turn from trusting experts to believing conspiracy theories.
Killings are first. Disappearances are next according to Timothy Snyder’s book “On Freedom.”
Dr. Snyder’s is the voice that we should be listening to along with Ruth Ben-Ghiat. After all, they are the experts.
Thoughts?
Just ordered the Tom Nichols book as I’ve noticed this phenomenon. Thanks for mentioning it.
Yes, wouldn't it be great if we had politicians who had guts. Period.
"Wouldn’t it be great if we had politicians who had the guts to do something about this mess?
The system can be fixed, but it would take elected officials willing to have the government do more, not less, at least when it comes to health care." Questions are being asked by the FTC, DoJ and HHS, but so far only Josh Hawley and Elizabeth Warren have had the guts to go after the tip of the iceberg. Here are comments consistent with government action from one group of eminent doctors in response to a request for information on consolidation in the healthcare industry: https://www.regulations.gov/docket/FTC-2024-0022/comments?filter=DIHR.
Sorry steady so much is true but.. there’s always a but. Corporations often are found culpable of egregious behavior and when brought to light they pay a fine and walk. Death is often part of that egregious behavior but insurance companies are NEVER prosecuted. If anything happens, judicial wise, they pay a fine and walk. I believe commoners should have the same rights. Luigi killed a corporate executive whose company is responsible for deaths due to denial of services. Luigi should pay a fine, and walk.
A tale on what can be possible, even within the crazy system as it is now...
I'd been pre-diabetic for years & wanted to dive into how to improve my blood glucose levels (Ha1c test results). I learned about Levels Health, a fantastic wellness company whose mission is to help people understand & improve metabolic health thru the use of CGMs (Continuous Glucose Monitors). I could purchase CGMs thru Levels, but wanted to have Blue Shield cover them.
My doctor prescribed them, they were denied, and I appealed. Typically, only diabetics have CGMs covered, not pre-diabetics - who could improve their health & thus save BS tons of money in diabetic care.
I respectfully & persistently made the case for BS covering them. One agent said they'd be covered, but then I ran into the disconnect w/others who didn't. So I persisted.
It actually became fun. I simply connected some dots with the truth. :)
Shared data on the huge cost of diabetes care. Shared that their marketing keeps saying they put me "at the center!" - and so how about truly putting me at the center by covering this inexpensive, preventive measure that would save them money?
When they initially said I should wait till I became diabetic to have them covered, I pointed out the ridiculousness of this, reminding them of how important it is for them to save money. They'd rather I get sicker & cost them a whole lot more rather than paying maybe what, $100 for CGMs? On what planet did that make sense?
I won & can get covered CGMs thru 2039. Pay $39.99/mo for 2. Since July, blood glucose levels are well in control, with life-changing impact. I've also shared w/them that this should be a wellness benefit going forward if they're serious, per their marketing, about prevention.
I once got them to cover a $600 naturopath bill by saying to a decent manager, "These cardiologists I've seen lately who you pay loads of money to aren't helping me. My naturopath is. How about you cover that instead?"
He agreed.
It really pays to ask & make the case.
Good job in fighting the system of insane decisions of coverage so that CEO's, stockholders etc. can make millions off of patients and pre-patients.
It is all about money. Now, it seems useless to worry about coverage. If you are sickly, society wants you to move on, not be a drain on limited dollars-die. If you cannot contribute, pay taxes or work, you are not valuable to insureres, companies, governments. During COVID, some felt rationing of care naturally should start with the elderly, infirm regardless of any other considerations. Remember that?
Having aired my residual frustrations with the system in this thread, I'd like to share discoveries & strategies I've found helpful for navigating the system over the past 10 yrs in case it might be helpful. Once I realized what I was dealing with, I did not want to let them win, i.e., bankrupt me, so I pushed back. Yes, while sick.
Be proactive.
For anything more involved than an office visit, I call insurance to ask what my financial responsibility is and ask to have that in writing. I saved $6000 on an ablation after I'd been told it would only cost 2 copays. I had that letter quoting my responsibility & they reprocessed the claim accordingly.
Insurers make loads of mistakes.
I check every claim carefully because they are frequently processed incorrectly. I call & ask the Claims Dept agent (I have Blue Shield of CA) to reprocess the claim while I hold. For many claims this is possible & saves time & headaches. If they refuse, I exit the call & try again. Remember, they don't expect to questioned, but that doesn't mean you shouldn't!
Info changes from one agent to another.
It sounds simplistic, but has saved me lots of money. Answers vary considerably from 1 agent to the next, so I call till I get the answer I need. It actually does work quite often.
Appeal a claim that's denied.
Remember the denial is often a strategy to not pay cause they know most people won't challenge it. File an appeal through their system. If you're overwhelmed & it's a huge costly claim, hire a Health Care Advocate. I spoke elsewhere of Mary Covington (FixMyClaim.com), whom I hired 10 yrs ago & who saved me many, many thousands of $$.
Get organized.
I have a Word doc on which I track dates, call Reference #s & brief notes to refer back to. Makes it easier to track everything.
Look for the helpers & ask for help.
There are many greedy, dreadful execs, for sure, but there actually are decent people willing to use their power to help. Finding them is my key strategy & has saved me tons of money.
When I was granted Charity Care for a $13,000 ER hospital visit bill when my insurer denied the claim, a kind billing agent suggested I ask the related providers to write off their portion because they often to if the hospital writes it off.
So I did. And wound up saving $20,000 simply by asking, "Would you be willing to write this off?" Was shocked to hear "Sure!" with several of them. It's harder today, but I always, always ask for help one way or another.
A lot is negotiable
Lots is set, such as copays, but for more extensive/expensive care, I've found that there actually can be flexibility. When BS authorized surgery w/an out-of-network provider at in-network rates, then broke their promise, it was a decent manager it took 8 phone calls to find who saved me $10,000. After fixing the claim, she had BS pay what I would've had to pay to make it up to me for what they'd put me through.
There are decent people in insurance. The key is to be persistent in seeking them out.
My attitude is that with the system being what it is, as we've discussed here, I'll do what I can to not be ruined by it. Hope others will push back, too.
I applaud you. It takes so much time to fight back but I do it too! I find the same thing about different agents give different answers-so I call several at least. Getting a letter, email sent is a new twist, I will try it.
Good for you! A kindred spirit. :)
“It is a system designed to make huge profits for the insurance companies, the drug companies, and many other industries within the system.”
Big Health Care (insurance, pharma, et.al.) have created a carve-out for themselves whereby they are immune from market forces, and apparently, immune from regulation. The GOP drive to privatize SS and Medicare would simply add those programs to the honey pot that is private health care. We would see less coverage for higher prices and no recourse from their monopolistic actions.
The fact that the killer is being praised in some circles is abhorrent. Full stop. The idea that people should simply kill those they disagree with or dislike should never become acceptable. The present course in our methods of discourse appears to be all downward.