Costs for various treatments are already negotiated ahead of time and hospitals/doctors bill insurers directly.
If the insurer thinks you received some kind of treatment you shouldn't have, it's between them and the hospital/doctor.
Of course there's always the odd/fancy treatment people insist on getting that is not covered. In that case you'll be billed by the hospital.
In neither case you'll be fighting any insurance company personally.
Can't say I'm too fussed about impoverished people getting a few boxes of diapers, and using ambulances for transit reveals an underlying societal problem more than individual greed.
If people are willing to go through that much trouble just to get from A to B or to save a few dollars on diapers, there's something wrong.
They're investing hours and go through quite a hassle just to possibly save single digit amounts of dollars.
You don't do this if you don't think you have to.
The ambulance rides do tie up the system however. I have a cousin who is an EMT and between rescuing overdoses he has regulars they have to taxi because they have a cold, or something else trivial. There is public transportation, but even that would cost them personally and requires waiting. It's probably better to let a few selfish people take advantage of the system in the long run, but it amazes me how selfish some people can be when there's people in real need out there.
Canadian health insurers haven't been involved in any of the surgeries or pregnancies in my family. Where they were involved: dentists, massages, medications, I've never had any hassle.
Dealing with a pet insurer was eye opening. I can't imagine having to deal with that while a loved one was sick.
The GP post is exaggerating quite a lot.
There are of course disagreements, but it's the exception rather than the rule. I just two weeks ago went to a specialist and got a prescription, with no questions asked.
The American health insurance system is broken. Time to toss it out and try something else.
There are also private health insurance plans that cover things not covered by the public insurance, optometrists and dentists fall under that category as do most paramedicals. When Canadians talk about 'health insurance' we're typically referring to the private kind.
The concept itself of fighting either my health-care provider or my (state-mandated) health insurance to get coverage is completely foreign to me and I'm only familiar with it thru the Internet by reading what people from the USA write.
The last few times I can think of paying for anything other than glasses/contacts:
- $40 for a doctor visit and x-ray when I sprained my wrist and had forgotten to renew my health card. Reimbursed when I did renew.
- $25 for a month supply of bupropion (Zyban) for quitting smoking
- $9 for a bottle of Tylenol-3 after my knee surgery (completely covered otherwise)
Things that have been covered 100%:
- stitches when I got kicked in the head while tubing behind a boat
- stitches when I sliced my finger open with a knife (stupid kid stuff)
- appendectomy
- knee surgery #1 - meniscus cartilage tear when I was a kid, didn’t start acting up until my 20s. This included an MRI, a consult with a sports medicine surgeon, and the surgery
- knee surgery #2 - same knee, tore it up again 5 years later while skiing. Only cost here was optional physiotherapy afterwards, at $50/session.
The big problem seems to be the soaring prices due to the fight between insurance companies and the hospitals. Depending on who you ask, you get a different opinion on who's fault it is.
Overextending yourself, glossing it over with an extended warranty, and abdicating your pet's health to corporate cost-optimization is not a nice thing to do. The hard-to-hear responsible thing is to not get a pet until you're in the financial position to take care of them!
Let us hope this whole idea of "pet insurance" will be history in several years, rather than it succeeding in turning the veterinary industry into an overfinancialized clusterfuck like human healthcare.
Social media gives us a biased impression, as selling your truck and maxing out your credit cards to pay for your dog’s chemotherapy gets upvoted as a heartwarming feel good story, regardless of the wisdom of doing so.
On the other hand, I had a vet tech friend who said that most people would opt out of treatments that cost more than $200-$300. That's how much they value their pet.
Worthless political echo chamber hyperbole and demonstrably false.
Just off the top of my head: Virtually every American with health insurance can get flu shots for free, paid for by their insurance carrier. Ditto for women who want birth control pills (though that is usually a legislative mandate).
A friend works for a small insurance company, and she says it paid over a billion dollars in claims last year for fewer than 50k members.
The American health insurance industry is completely fucked if you think it has anything to do with providing healthcare and isn't entirely about maximizing profits for the inner circle. People are literally dying because we have the least efficient health insurance system in the world. And it's designed that way because some people are getting ridiculously wealthy from other people's pain and suffering.
Then check with your state's attorney general. In many states, insurance companies are required to provide it at no cost. Certainly in the last three states in which I've lived.
If it's not required in your state, then contact your legislators and try to get a law passed.
For example, the first back injection was denied the first time one the basis that "it was not inhibiting her daily function". The notes from the doctor submitted to insurance specifically said "the pain in her back is inhibiting normal daily function." They reject it just to see who will fight back. Furthermore, insurance is only required to look at notes from appointments and will ignore comments from doctors if they aren't tied to anything. So in order to fight an insurance claim requires another appointment with the doctor which costs more money just to get the insurance company to look at the claim again and get it approved.
It's a terrible game.
These tend to make financial sense for insurers - flu shots are cheap and a lot cheaper than hospitalizations, same thing for avoiding pregnancy... and even then, both were explicitly made free via the ACA, not the kindness of health insurers.
These aren't the sorts of claims insurers kick up a fuss over.