We got the call saying my hubs cancer surgery would be 83K dollars and what kind of payment plan would we like? There is ONE hospital within 150 miles that does the surgery, "out of network". As if we WANT to travel out of state, pay for hotels, food, we're broke and broken old people. Waiver needed

📌

Sharing this with those that follow me maybe it'll help

I just was denied by my doctor, and when I went to urgent care as a back up they denied me too.

Coming to a greedy CEO near you:

Sadly, many of those who have been denied are already deceased.

How many unhealthy or disabled have the time, money, or energy to fight back?

Zero! They fall through the cracks, are ignored instead of helped, ridiculed over teaching. Denied benefits that would help them live a better life.

I mean... I posted several accounts from verified physicians today. Insights: insurance companies want to make money and they do that by denying care.

UHC dental approved a core build up and crown. After the work was done they denied my claim because I didn’t have documentation that there was a cavity or flaw in the existing crown that would necessitate a new crown. They say I own them $1,900. I had never had a crown on that tooth.

Just so you understand the deliberateness of the con men known as health insurance companies, I once had a claim denied because they claimed that they didn't have my office address. Not only was the office address clearly printed on the claim, they sent the denial to that address! You want names?

That was Anthem Blue Cross. This is the same company that "lost" years of claims on a patient twice, even after confirming fax reception over the phone after it was re-sent. But don't neglect AETNA, UnitedHealthcare, and all the other scum. Also:

Pre-authorizations are cruel, dangerous, unethical, and sometimes murderous. Practicing medicine without a license is illegal in every state and paying shill doctors to do the immoral bidding of their MBAs does not qualify. Don't get me started. Oops. Too late.

I worked for a predatory insurance company for 23 years. I can give you a lot of insight.

Done

I have a pending approval since April on what should be covered with an already completed deductible because a DME company can't seem to submit paperwork correctly and the insurance company won't accept what they did send.

I love that you’re doing this! It can’t continue.

My insurance didn’t deny it last year, (they approved a hysterectomy) but I got denied by 3 different OBs. Because I live in TN & they have bibles in the fucking exam rooms. Now I have to seek reapproval for it & more than likely WILL be denied this time.

This is why I’m trying to convince my daughter to get out of the red state she’s living in. I’m so sorry for what you’re going through.

When we would receive rehab patients at the SNF for short term rehab, UHC would usually cut benefits within 3 days. The intake nurses would always let therapy services know as a warning.

Currently appealing a denial for a needed test for transplant rejection.

ours was a test for Skin Cancer for God's sake and it came back as positive...unbelievable how these companies operate.

They're worse every single year.

UHC originally told my dentist my cap was approved. Afterwards they denied it, then again after an appeal. I ended up paying $1,400 out of pocket

I am a dentist. This happens with all dental insurance. We wait to do the treatment until after the authorization is received. We do the procedure as written/approved then it is denied. Extremely frustrating.

My dental team is currently helping me appeal a denied claim for the exact same situation. The receptionist said this happens all the time!

That is good news. They may have to argue back and forth. It seems the insurance companies hope that the provider and the patient will eventually give up and the cost is left to the patient. Be persistent. You or your HR may have to intervene to get some reimbursement.

Bad news for them, I’m incredibly persistent!

My dental insurance would not cover my necessary bone graft and I appealed decision 2x. I had to pay over 4k out of pocket.

Anonymous option may be helpful in getting people to open up to you???? Too much backlash by big pharma is a killer as we all know.

I have a doozy.

You can bet we almost all do.

I bet!

bsky.app/profile/brya...

JFC. The blatant evil.

Umm, people with private health insurance do not get the same access to mental health care as this who is on state medical insurance. The claims are less likely to be approved over 72 hours, which is no time to help someone in a mental health crisis or just to help someone in general find care.

Are you interested in insurance denials were eventually approved? I had brain surgery 2.5 yrs ago (just realized almost to the day). All in thanks to my amazing surgeon fighting for approval. Reading all the insurance denial stories is heart breaking and I feel guilty. I want ppl to have hope.

I recommend starting with the state departments of insurance. They should have a record of consumer complaints and state audits of the insurance companies if warranted.

Don't just share your insight on BS. Share it with someone who is elected and in office. They are the ones who actually decide. It only takes a few minutes and best of all..doesn't cost any money. We don't need money in politics. We just need people to participate. www.nationalfinancialplan.com

I want someone to explain to me like in 5 how an insurance company can deny claims for people who pay their premiums every month and it not be fraud. People are paying for a service they're not getting.

Yes I worked for United for many years and insurance is much much more complicated than just paying premiums and getting anything you want. There many odd requests and unusual requests that need to be worked through. I was a strong pt advocate by choice and degree RN CCM and quit quickly.

2/2 When all goes well everything is approved. Some things are just not covered and all you need to do is google "UHC policy on.....then put in procedure name" try it.

They request clinical from providers and that clinical is then forwarded to a physician for review for medical necessity. The good physicians request a doctor to doctor discussion b4 a denial is made. 1/2

I’ve yet to receive an answer on this, likely because it IS fraud by any reasonable definition.

It's not really fraud because the contract agreement usually spells it out in fine print legalese, like "medically necessary". But them being able to control the entire process unilaterally is bullshit and should be illegal.

United Health Care denied 1/2 of my husband back surgery he had in August. They were okay with clearing out the discs, but not the fusion. 2 days before the surgery, they approved the fusion. Doc told him not to worry, they would pay. The denial came 10 days before the surgery and was told...

It would be three to four weeks before they could get to his case.

THEY DID THE SAME THING TO ME! I’d already been in pain & disabled for months. I couldn’t sleep, was losing my mind. I didn’t have the strength to care for myself but was supposed to fight UHC’s cruelty!? I’m sorry that’s their norm and you & hubby went through that.😭 I hope he’s doing better now.❤️‍🩹

bsky.app/profile/prop...

Thank you, Becket! 🫶🏻 I saw this earlier & pulled all my old files out. I have stories to share, and the denial letters & communications to lay out the details. I’m really glad someone is finally investigating this, and really glad that “someone” is Propublica.

Medical necessity should be determined by a physician, not a claims specialist

After a claims person denies it & you dispute the denial, the insurance company will pay a doctor to say it’s not medically necessary. That counts, right? 🙃

If the market decides, the market wins.

I feel like a doctor who is paid by the insurance company has a conflict of interest. But maybe that's just me.

Is the Hippocratic Oath a thing in the USA?

It sure used to be, before DJT

America’s health “industry” has been run by insurance companies for a very long time. They spend millions & millions each year on lobbying and Congress lets insurers write their own laws & regulations.

One could argue that "famous" doctors like Mehmet Oz can be well-known and successful heart surgeons, and still do shitty oath-violating stuff; provide pseudoscience advice on national talk shows, sell shitty fake cures, and be major investors in fraudulent health insurance like medicare advantage.

Just wait til you hear about the many women dying from miscarriages because doctors are terrified of spending life in prison for performing a D&C.

sadly, we probably WONT hear about it; for the same reasons we're not hearing about infant mortality: abortion-restrictive states have disbanded the medical boards who track this, so it won't be reported. 😮‍💨

That’s the real answer: they can write their contract to say whatever they want (within the law) and the consumer has no choice. Most Americans don’t have any part in choosing their health plan, it’s just whatever their employer offers.

You’d think there was a way we could have healthcare that wasn’t tied to employment or a way to save people from going bankrupt over medical bills, but it’s not like 32 of 33 OECD countries have figured out anything else, so ¯\_(ツ)_/¯

Because that’s how all insurance works, do you not own a car or a house?

No, not all insurance IS like that. Claim refusal is actually pretty rare in property issues. You make a really good point in reverse - why is the human component more likely to be refused than a car accident?

That’s so true! I’ve had State Farm for 45 years! They have never denied a claim I’ve filed. Prompt and fair. They always ask me if I’m okay 🤷🏻‍♀️. Crazy………….

I've had a totaled car paid for at about 80% of replacement value. Sewer lines failing that are not covered, theft replacements only for what I could cite the actual value for... And I have a family member that quit being an adjuster because he hated the pressure to deny claims.

There are good companies and bad, but most of us have had pretty decent luck with car coverage v some rancid health coverage.

Claim refusal is also rare in medical insurance, insisting that you go to PT before getting an MRI is NOT refusal.

Plans often require that the PCP refer the patient to the specialist or for a procedure and a claim can be denied simply because the patient skips this step. Some forms of treatment get denied simply because there is a less expensive option the insurance company prefers.

Medical necessity is the most frequent reason. A policy states all kinds of exceptions and treatments that aren't covered etc. Patients rarely know what's covered and what isn't.

The crazy thing is even if it’s medically necessary they still will say it’s not so that they don’t have to pay. That’s been my situation three different times.

When I was fighting for my life in February 2022, I read a statistic that said an American dies every 12 minutes because they don’t have access to medication and 70% of those people that are insured.

Breach of contract

I’m a 64 y.o. Cancer survivor and just receive notice from my insurance company that they are denying coverage for a flu shot my doctor urged me to get.

I pay $450/month for health insurance. Went in for my annual physical and just got a $360 bill from the doctor. PS - I'm healthy, on no meds. WTF?

Physicals are supposed to be covered 100% .

Every form of insurance destroys. I once had to explain to a customer why his beautiful one owner car that he had lovingly maintained for 30 years was being taken by the company for a fender bender. Seems the cost of repair (like $75 in 1979) was higher than blue book on that car.

Hey Americans! We're right here in Canada with the example! We've been telling you for years! Wake up!

I had sinus surgery pre approved by my insurance. Eighteen months later I get a bill for $5500 they aren’t paying the surgical center. WTH it’s the surgery center they picked.

I had a Dr who wasn’t covered and a surgery center that was covered and labs for preventative that were covered but biopsy shows an “issue” so that isn’t covered. Throw in an anesthesiologist who may or may not be covered or they’ll just come back at you & say anesthesia wasn’t medically necessary.

Exactly. The whole scam about how preventive surgery becomes diagnostic is the biggest moneymaker for insurance companies. It's ridiculous.

It’s total BS. Paper pushers shouldn’t be telling us what we can and can’t have treated.

📌

Thank you @propublica.org for doing these stories 💙

I have regular Medicare with a supplemental plan. I have never been denied treatment. I know neighbors that have Medicare Advantage and have been denied. Look how much the Advantage plan is advertised during enrollment time. Regular Medicare is not able to advertise so people cannot compare.

Agree that assessment of denial should include comparison of types of plans; always have been in indemnity plans (non-network) and never had issues with denials.

I tried to get an advantage plan that would cover monthly infusions of my rheumatoid medication & none of them would cover it. I currently inject it myself but after so many yrs, the meds start to fail & infusions are the last resort.

Not exactly. I am 69. I buy my insurance through a licensed, local insurance agent who makes recommendations based on my medical records. I recommend everyone do this. It costs nothing but time and the agent is incentivized to satisfy you, the customer.

I did the same and went thru my agent. Not everyone knows it's free to talk to a Medicare Advisor to determine what is best for them. My concern is all the TV commercials that are on during enrollment time for Medicare Advantage. If they don't do their homework, will think it's the best option.

I always advise everyone to avoid buying any insurance off a tv ad. It’s costs nothing to use an agent. My late dad was an independent agent and taught me that.

My experience w all that, that goes along with in health care, I have had a very good experience w insurance, doctors, nurses an newbie wanna 🐝 it has not been bad! I am a mdeicare person! Nurses an wanna 🐝 they are the 🏆they definitely do care about you! In the last few yrs I've tested the system

I have an entire file of denied dental claims from a company who said “no pre-existing” when I signed up. And I was an insurance broker for 30+ years. I even emailed the carrier rep with tons of questions before I took out the group dental plan

It’s not just insurance companies, but medical equipment companies take advantage of the elderly. I know this because I sit with my elderly mother while she talks to them about her prescription socks that prevent blood clots.

Does being denied something through prior authorization and fighting it all the way to the state level, count?

Sure does.

The only insight I have is I worked in medical claims and believe me the insurance companies made me jump through hoops to get claims paid! That was about 20 years ago and it’s only gotten worse!

EXCELLENT newletter! I plan to write them, document all my denied claims, reasons they gave me, their idea of 'expedited appeals', etc. shortly. If any news outlet can make waves, they can! I might actually get the care that I need for once...

www.change.org/p/declaratio...

I have denied the private insurance companies monthly pay. Instead, i put money into a high yield investment every month. This money is to be used for medical bills only. It takes self-discipline, but it is doable.

"high yield investment every month"=High risk or long term. You would need a minimum of $100k; in available cash...for many medical emergencies which require life saving procedures. Does not include regular visits nor medication. Prescriptions can cost hundreds a Month. Out of the mouths of babes.

That's your other option.

Aha. The point is START EARLY. ASAP. If one starts early in their 20s (before age related illness sets in), there should be a good amount of money there. I'm speaking of mostly HEALTHY young adults.

You *Really* have led a privileged life... It is nearly impossible to even begin to escape the 'Rental trap' without 2 dedicated incomes. For *many* 20 somethings, home ownership is but a myth. Now...Insert $100k in medical costs. Yet another reason to support the ACA and Universal Healthcare...

I started from nothing as a foreign student, and I built wealth by saving and investing. If I could do it, anyone could. (I was also ripped off by high premiums and deductibles) I took charge and responsibility. A single peyer insurance is what America needs. Just like Medicare.

When your Dr's office calls your ins.co AmWorst, you know you have problems. My suggestion NEVER use AmBetter as your insurer. If an Insurance company sponsors a #NASCAR race, maybe they're "making" too much money. Ask yourself why. 😡

Years ago I worked for a few months in an insurance adjuster's office. The branch manager wore T-shirts that said things on the back like the holes in the knees of his jeans were from praying. He told me the white man has a target on his back. I had to ask him not to use the N word in front of me.

On adjuster who did the most business said in a letter to the home office (which I typed) that an anesthesiologist who had suffered a major brain injury was getting back to work sooner than expected. He said, "She's a nice person. I think we can get her to agree to accept less than we promised."

😡

Whenever they went out to see a client about a claim, if the client was not white, they went to the appt expecting the client to be trying to commit insurance fraud. When they came back, they recounted to each other how the smallest statements confirmed all their suspicions.

How about my 35 yo needs a psychiatrist because she sleeps all day and doesn’t shower walks like a shuffle, delayed speech. She has a psychologist There are no available appointments or psychiatrists taking patients in the Kaiser network in Washington

I have to take a prescription medication, per my doctor. For the rest of my life. If insurance would pay for it, it would be $11/month, with a manufacturer’s coupon. Without insurance, it is $1200/month!! Insurance refuses to pay for it. From Canada, it is $396/month.

People with vector borne illnesses have been gaslighted for decades; denied care and abused. This community is also known as the Lyme community. As a PhD RN, I can tell you there’s a lot of insurance denial ~ it’s criminal.

Oh, I love Chris Hedges. Following you.

the arrogance , mf was born on third base and thinks he hit a triple

You know if this clown can be the Ceo of not 1, but 4 fcking companies and run a quasi governmental org , all while gallivanting the globe addled with ketamine, then lets face it CEO isnt that fcking hard.

the greed of middle management "PRICELESS"

I'm not saying I condone killing CEOs, especially health insurance CEOs... ...but I understand it.

This is something that all media companies should be doing The insurance industry has to be put under a huge collective microscope

Medicare denies claims too

Medicare Advantage which is private insurance & a scam

How about investigating the oligarchs control of media and the abandonment of journalistic standards and principles and as the 4th estate of democracy

I wrestled hard with getting my dad's 44 treatments paid. Took over 9 months of back n forth between svc provider and ins. co. I kept records with names and dates. It was extremely challenging effort. If I hadn't been involved my 82 yo parents would have faced $$$k in debt.

I'm sharing this whenever I can...because it could quite literally save someone's life.

When I worked for a big CGM company for diabetes, I will never forget how many people begged us for supplies so that they would have to fear that they would die of hypoglycemia in their sleep while waiting for authorization. Some of them did die while waiting for auth. That shit stays with you.

That’s awful , the guys who invented insulin wanted it to be free ‘ it was a gift to the world ‘

Compare to Sweden where all insulin and blood sugar monitoring devices are free.

Same here in France for lifelong conditions like diabetes

European countries are civilized. We’re “first world” savages. Damn shame.

It feels that way sometimes

My husband’s best friend from childhood lost his job during COVID, and lost his insurance. He was a Type 1 diabetic and was trying to ration his insulin, and died of keto acidosis in 2020.

I’m so sorry that happened, that’s tragic

I covered my adult disabled son’s CGM for years because death due to hypoglycemic unawareness was a real risk. The expense was second only to my mortgage. Finally Medicare picked up the cost.

I remember having to tell people who had been on CGM for years that Medicare wasn’t going to cover it and their secondary was going to follow Medicare guidelines. It was awful. They broke down in tears a lot.

I’m beginning to think that being uninsured isn’t so bad. Maybe it can be worse.

Thank you

📌 UMR denied the Entyvio my GI recommended for my UC. Now I’m waiting (2 months) to hear if they’ll pay for the rattlesnake bite incident, including ambulance, 12 vials of the insanely expensive anti venom, 24+ hrs of required ICU time, etc. ***They did send an ominous letter, so I’m concerned***

Wicked.

When are you Americans going to embrace universal health care like other advanced countries? You are a weird mob. You allow any idiot to own a gun but you won't allow people to be looked after.

There no money in it….. we only do things for money….. cuz we suck at “United States”

The irony being there’s billions in efficiencies in it for the US, just the loss of profits for individual rich Americans, which is inconceivable.

We’re not all agreeing with our system. But the 50% that do are either not well informed, or they’re just too stupid to look out for their own best interests. It’s quite disturbing.

That's apathy & conservative pollies rely on such ignorance

Yep

The average American is not intelligent enough to know that health care SHOULD BE provided through our taxes. It's easy to take advantage of the Stupid. Signed, An Above-Average American

I think the average American would welcome universal healthcare. It's the Insurance lobby buying GOP politicians that keep it from happening. Like a lot of things, greed rules, because people are being lied to. Same with guns, prescription drugs, & now education. Stupid folk are easier to control.

And average Americans who are in favor of a national healthcare system are still voting for Republicans who are vehemently against public health care time and time again. We are not an enlightened country.

People have been voting against their own self interests for eons. That's not new.

It’s not just the politicians. A lot of dumb people bought into the death panels and “you’re gonna have to change your Drs” bs when the ACA was passed. And there are people who don’t want “their tax $$” paying for other people ie minorities. America is a truly selfish country.

Because they got brainwashed for decades. They call it „socialized medicine“ and everything with „social“ in it freaks them out. They were told it would take them month and years to get appointments and procedures. I’m a nurse and have a bunch of coworkers who believe that.

So propaganda - brain washing works. Thanks

Of course it does. Fox *news* based their whole business on it

Look no further than Jesus Entrepreneurs. They are the weird mob who love guns and hate science.

When approximately 36% of the country turn off right wing propaganda and stop voting for Republicans and licking the boots of the wealthy. So probably never.

Millions of Americans agree

The average American is lied to and told that the quality of care under universal health care would be terrible. They would have long waits and poor outcomes. It scares them so they vote against it.

But all they have 2 do is see what other countries have and do. Lots of people on Social Media talk about the virtues of their countries' Universal Health Care. I have about Australia's system. I think average American isn't interested in any other country, especially if people point out it's better

This. ⬆️

Like a favorite pair of jeans that suddenly don't fit, health insurance often seems perfect - until you actually need it. Let's unravel this mystery together, one denial at a time.

If you develop chronic illness, your insurer's 'specialist' (a psychologist who knows what they are paid to do) will assess you. You will be assessed as 'depressed' and/or 'anxious'. Your claim will be rejected because 'mental illness' exclusion. Disagree? You fraudster! Simple as that.

Check well care.

I have to say that I admire all your investigative reports. You are an example of honest and professional journalism which unfortunately, it’s hard to find now days.

Thank you for your hard work.

ProPublica, I can’t thank you enough. You guys are simply the BEST. 🫡

⬆️

Study idea. Rich spoiled ivy leaguer maniac shoots family man in the back on NY street. Find out if the maniac was justified in murder. Yeah. That’s the plan.

Are you investigating insurance companies that *approve* claims, but then refuse to pay the amount the policy dictates - so the pharmacy won't fill the prescription until they get their money from someone else?

I hope you interview Brianna Boston!!!!

Thank you for this!

My insight is that health is too important to this country to be left in the hands of capitalists. Billions in corporate profits mean billions paid by people not getting that worth in coverage. Those are dollars not spent in the economy. The sick and bankrupt cost, they don't contribute.

I’m just shocked a large law firm hasn’t filed class action lawsuits on the big insurance companies for breach of contract when denying therapy/surgery/medications.

From what ive been told, its because they aren't saying you can't get said treatment or medication, they just wont pay,knowing people cant afford it. They can make requirements, but dont need to tell us the requirements beforehand 😑 its so stupid

If a law firm had all the data in one location maybe they would be more likely to start class action

The insurance companies write the contracts and have years of experience at limiting expenses. I am betting this won't work. We can thank Luigi for getting the conversation started.

Completed the form. So tired of Cigna denying every damn claim for treatment for rheumatoid arthritis

I'm so sorry. I have rheum as well but I'm on Medicare. So far so good, no complaints. This makes me furious bc rheum is such a devastating disease. You shouldn't be denied anything.

Along with my doctor's office, we fight it and get it paid each time, but it's a pain. I get the treatment I need.

I'm glad you get what you need. Making you guys jump through hoops is foul. Be well & happy Holidays 🤘

It's almost comical that not two days after this CEO incident the cardiologist office called me saying my insurance denied my PET Scan/Chemical Stress Test that was in two days and appointment was made 3 months prior. My Heart isn't something to worry about I suppose.

If ProPublica bows down to the convicted felon-in-chief like the other MSM outlets, I'll never read another article again.

I know I'm not giving them my info.

.

#medsky #cansky

Red or white

My life saving surgery was denied but they were happy to approve a procedure that would put me in a wheelchair and extreme pain for the rest of my life. My surgeon refused to do that to me so I ended up going abroad for the surgery and I can walk and manage the pain.

Health care for all.

Pharmacy quotes $400.00 for Rx. Take a coupon from,say GoodRx, and it’s 13.95. What’s going on????

Pharm Tech here. The simplest way it was explained to me, was that it's used as an alternative to insurance companies. Retailers have contracts with GoodRx and are able to split the profits and cut out insurers by offering lower co-pays. Only, if you hit your deductible then insurance will be better

The enlightening aspect of this example is that without insurance interference the $400 Rx goes to $14 and the retailer still makes a profit.

someone is ripping you off somewhere!

With drug prices the way they are in America, I'd be more surprised if we weren't getting ripped off.

So, by retailers making contracts with these discount programs, they still make the money that would otherwise be paid out by insurance companies by marking up acquisition costs. Nothing really changes.

Thank you. Split what profits? Who else is paying? Why?

My guess would be that GoodRX has a contract with pharma companies to partially cover the cost of meds, or they’re running a program where your first few coupons are free to access but then a membership fee is required Plus all of the website ads and client clicks drive revenue

We're not really privileged with a whole lot of information of the under workings of programs like these. It still took some research for me. Even then, this is still just a best guess with how these discounts work with the experience I have.

Hi Sev, I'm following you now. Could you please write regularly about details like this that you know on your feed? I think it would be greatly informative for the rest of us. Thanks!

Thanks for the follow, but that's really all there is on this. Unless there's anything else I can try to answer for you not pertaining to discount programs but still in the arena of retail pharmacy.

👍

So, paying $13.95 from a $400 medication is a little bit of an exaggeration, but GoodRx does take the cost down to a "manageable" copay. That cost is still well above the acquisition cost of the medication. So a profit is still made. GoodRx gets a share, and a fraction of that goes to the retailer.

It’s not an exaggeration actually. Still don’t get it, sorry. Not for your lack of trying. I think part of it is a calculation on their part on how bad do you want the med? GoodRx gets a share of what? From whom?

Yeah, I wish I could help more. That's about all I was able to glean from the information I was able to find and from my work experience.

As a side note, GoodRx was found to have been sharing personal health information and has been sued in the past. So it's likely that they were also being paid to sell your information.

Good luck with any info on me. 😁

United Healthcare denied my essential mental health treatment.

I'm so sorry

I am Hamouda from Gaza. I used to work as a barber, but the war destroyed my shop with all its equipment and I was left without work or shelter. My daughter now suffers from malnutrition due to lack of food. I hope you will stand by us and help us by donating or sharing the link.

I am Hamouda from Gaza. I used to work as a barber, but the war destroyed my shop with all its equipment and I was left without work or shelter. My daughter now suffers from malnutrition due to lack of food. I hope you will stand by us and help us by donating or sharing the link.

🤢🤢🤢

Look into who is doing the denying and how much and what kind of training they are given before doing the job.

Please ProPublica, NEVER let up on this investigation! You are revealing the literal hell that so many Americans have and are going through. YOU ARE OUR ONLY VOICE that hasn’t been bought off by big insurance and big pharma. We, THE AMERICAN PEOPLE, are behind you 100% Thank You

Does this include prior auth denials too for things like medications?

Horizon BC/BS would not pay for Pap smears.

Pap smears are covered preventive care under ACA if obtained through in-network provider.

This was back around 2000. They would not cover routine tests. I had a previous scare and biopsy due to HPV and they would not cover it.

Experiences like yours are why preventive care must be covered under the ACA (Obamacare)

How many MRIs do I have to have IMMEDIATELY denied every year despite having 15 years of Fibro, RA, failed back surgery syndrome, and others and have either my doctor or I fight about it so I can get the injections and procedures I need?

I was told an MRI would cost me zero dollars and then received a bill for $400. The rep guided me to an obscure page on their site that basically stated it’d cost up to that much every time. I screenshot that webpage. I still to this day cannot locate that page.

They always insist I need an xray first, even though I have a connective tissue disorder that means I bend *long before* I break. 14 surgeries on fucked up tissue, 0 broken bones. But let’s do unnecessary tests & wait days hoping I give up on seeking necessary care.

If I’m at the dr, it means it’s already gone on for over a week and ice & pain meds haven’t made a dent. If my dr thinks it’s definitely tissue and there’s no chance of a break, why waste time & resources on unnecessary tests? Only makes sense if your goal is to delay & deny care.

Connective tissue disorder here too

EDSer?

Hi Zebra.🦓

Hello, my zebra friend! 🦓❤️

Yes. My 2 children especially. 15 & 24. One is getting checked for tethered cord and the other rechecked. It’s a mess. At least one charity gave us a wheelchair & another a ramp

I’m sending lots of hugs. If you need a good support group, send me a DM. I manage an online support group and if we’re not the right spot for you, I know a bunch of others that do good things. ❤️🦓

@consumerreports.bsky.social

Health care for all and all for one would someone please help me see why it works all around the world but won’t work for you and me? I know healthcare is big business; A big business that’s quite healthy but does it care about your health or MAKING ITS INVESTORS WEALTHY?

You'll need to hire an entire extra staff just to deal with the volume.

My primary care doctor requested an MRI for me. Insurance denied it. My primary care doctor gave me a referral to an orthopedic surgeon. The surgeon requested an MRI for me. Insurance accepted it. Wasted time, wasted a visit, cost more money.

Insurance was hoping you would not go to the ortho appointment, this, no MRI to pay for. Adding extra hoops is just one tactic they use to reduce what they spend. And it often works. Often enough for them to keep doing it at least.

thus*

Just finished.

The most disgusting I heard was an insurance company denying $1200 for a rape kit because it was an elective procedure.

☝️

Given the escalating political climate worldwide, it's clear that psychotronic technologies are being actively deployed by proponents of global anticultism. Watch the documentary "The Impact" for further insight

One of my faves is when they deny an MRI for what is obvious tissue damage, in favor of X-rays and physical therapy. PT for an undiagnosed injury, which could potentially make it worse, before an MRI is approved is just crazy to me.

Exactly! Happened to a loved one. They said minimum 6 PT sessions before they approve MRI. PT made it worse. Could barely walk. After MRI was finally approved after a lot of pain and suffering, he got back surgery.

Ya, I got a few stories they might like to hear

Research public records of all bad faith claims against health insurers for denial of coverage. The allegations in many cases are egregious. There are significant jury verdicts in almost every state. In addition, the public record, and the appellate records, will lead you to company manuals which

instruct adjusters to deny initial claims. They know that many people will not contest the denial. When the Insurance company is caught red-handed, they settle, and force their insureds to sign confidentiality agreements as part of the Release. So, nothing changes.

Denied my migraines injections. Neurologist has to give me samples. Labs, x-rays, MRIs, CTs 30% coinsurance after deductible met. I’m a stroke and endometrial cancer survivor, and recently diagnosed with early stage Parkinson’s disease. I will die with being in medical debt. 😞

This pisses me off for you! The whole insurance industry pisses me off. Sorry you’re dealing with this. Something has got to give.

Thank you 🫶🏻

📌

Michael Moore’s 2007 documentary on the ugly, devastating side of health insurance, has just been published on his YouTube channel. It’s ad free. Fantastic research journalism! m.youtube.com/watch?v=YbEQ...

And it started with Nixon! Listen to Nixon tapes on how he deceived Americans youtu.be/9QkgUkM0o6Q

en.wikisource.org/wiki/Transcr...:

👍

Oh my, I wonder why...

Thank you for your investigations pro publica

I'm surprised we don't get a surge in illegal migration from the US to the UK and Europe. I would try to claim asylum for the risk to life from the dangerous healthcare system.

I've had so many claims denied in the US. The story is too long to tell (it could be a book!) Hope you get the data you need from all the rest of us. It's been horrible.

We need to create our own insurance in which 100% of costs are also paid out, thus zero profit.

Dear ProPublica: I am a State surveyor. We enforce CMS & other regulations. My provider type is SNF. I have stories & evidence re insurance, SNF & gov't failures. These entities are entwined. DM me. Things MUST change, ppl are suffering & dying. I will spill it ALL.

The employer is vicariously liable for its employees action, so if it's employee denied a procedure and resulted in health damages or death, patients should be able to sue the insurance company for compensatory damages and emotional distress.

Everyone talks suing. Are you willing to mortgage your entire life’s earnings? Because when dealing with a company that has billions $ they can tie you up in court for eternity without resolution. It’s a mafia. ~$250-$400 per hour for a lawyer.

I have 2 health insurance, so I had no problems so far. Injury lawyers do not charge. They get their fees from the lawsuit or settlements.

My SiL had two insurance companies & needed back surgery. It took months to schedule (she couldn’t get out of bed) & there were issues up till the time of procedure. The companies are fighting over who pays for what. I’m unsure what she’s been billed.

With 2 insurance, the primary must be billed first. Then, after the primary insurance paid, the bill and what they paid should be submitted by the billing to the secondary insurance.

So, sorry about that. I have 2 PPOs and one federal employee plan, the best per Blue Cross Blue Shield. I am healthy, though, except in 2018. But I barely paid anything on hospitals, scans, doctors, meds, etc. No waiting. I know I am lucky on this matter. But it breaks my heart to hear others.

BCBS is still refusing to pay for the surgery I had for a complete rotator cuff tear and my bicep that had come almost completely off that shoulder. I had the PA, the MRI, the PT appointments all ahead. Now I get a bill for over 18k 8 mos later. I work medical so I followed all the rules. #M4Anow

It really should be criminal.

Keep digging!

We have been on a Covered California plan, aka Obamacare, for a year after decades on self insured employer plans. My theory is self insured plans are less likely to deny similar type claims than commercial insurance.

It's called the affordable car act.

Insights? No it’s pretty clear it’s for profit. They’ve created an atmosphere where people expect to be denied and so they don’t fight. Our insurance company denied my husband hernia surgery. It took a letter from me describing the outcome of no surgery. We were approved by Friday.

Been dealing with damaged/weak front teeth since childhood, as a result of taking Tetracycline while they were coming in. Dentist said I needed crowns, United Concordia denied it as "Cosmetic". So he jury-rigged fillings that need to be repaired every year.

I can tell you I received a denial for a referral from a United owned IPA 2 years ago and the rationale on the letter was ridiculous. I wish I still had the letter.

Common argument healthcare companies make is w/out them costs will skyrocket b/c doctors will overcharge, order unnecessary procedures. True which is why there has 2B rules/annual published pricing, etc. Then insurance co are not needed and healthcare outcomes will b like rest of the civilized world

It’s also important to know many preventative measures are free (thanks to the ACA) but the GOP made sure to make it difficult- like if you need a mammogram because you or your Dr actually found a lump, it won’t be free anymore. It will be a “ diagnosis” rather than “preventative” mammogram. Insane.

Thank you!

Just set up a monthly donation to you. Your reporting from women dying because of anti-abortion laws to health insurance denials is vital to our country. Thank you for not selling out.

Even though they paid for the care, I couldn't help but wonder how cartilage. ligament and torn rotator cuff surgeries are considered elective - inferring it's not needed. I remember seeing that term on the insurance documentation.

I can't even pay my mortgage because of health issues and I probably have to have another surgery. I'm out of options at this point.

Why not go full Luigi at this point? I have nothing left to lose.

I don't even care what happens to myself anymore, but my fiancee and animals deserve a stable, happy life. I can't even provide that anymore.

🫂💔

Thank you for continuing to “not shut up.” Signed—a proud monthly supporter. 👍❤️

politicalamericans.com/health-insur...

It obvious. Their policy is to deny claims as either “unnecessary” or “experimental treatment” then delay with endless appeals and finally litigate. Every day they don’t pay they invest that money on Wall Street.

Thank you!!! Everyone, including law enforcement should be!!

Does it count if you go for your annual wellness, and you're asked if anything is bothering you and you answer.... congrats you're now paying for the visit. Because actually discussing anything nulls the wellness check code. 🙄

Discussing conditions, chronic or otherwise, at an annual visit has no impact on the billing of that visit. It's when your provider takes action to address something ie: an Rx, test, referral, etc., that it crosses over to an office visit.

The year the ACA went into effect, my then doctor asked about some other thing so that she could bill for something other than an annual exam. Since she was dumb enough to tell me, she became my ex-doctor.

Not mine.

Y’all BEEN knowing this is an issue we’ve screamed it for decades c’mon now. 😔

Kamala sworn in as 47. WHEW! Read more here in the Bemidji Bugle, which has absorbed the former staff of WaPo and LA Times: www.menonpause.info/p/one-flew-o...

#saint-luigi

I do.

I had a procedure pre-approved only to be then billed $20,000. Per insurance the procedure was approved but not the hospital: the only hospital in the state with the equipment. Even the rep laughed at it the denial. He walked me through an appeal and it was eventually paid.💙

Stress test denied in 2019. Just got notice that it was approved yesterday

We want names.

Medical Directives providing clinical review know where there bread is buttered. I was at a hearing once where a bd certified Ed doc who was now a full time employee stated under path shebwould not order an MRI for a 7 yo who went head first through an Arcadia door wondow. Yeah. Right.

Medical review is generally outside the purview of licensing bds because it's considered a management function and not "the practice of medicine." Change that so docs make decisions as they practiced and "medical necessity" denials will go way down.

Can’t get decent pain treatment. They take away meds, don’t cover many of the other treatments that might help. Now patients are homebound or bed bound.

📌

A life is lost as the system did not monitor the misdeeds of corporate companies. Lives will be on the line if misdeeds and greed of corporations continue.

Look into the denial of care of the florida woman Briana Boston who may face jail time for uttering words to her insurance carrier. Make it all go viral. Time to hold health insurers to account for their actions.

This is probably why charges were dropped, BCBS refused to file charges

My eye prescription for complications from cataract surgery. I had to sign on to a more expensive monthly RX or pay $371.00 I still will have to suffer until Jan and then it will be 47.00 copay Thanks UnitedHealthcare non-care. I am retired on a fixed income. we are furious. Universal Health care!

It's not just personal health insurance denials. Work place insurers do as well. I was denied both spinal/back surgery and traditional physical therapy. The ER doctor said is was important or I'd have permanent nerve damage. Guess what, I've had permanent nerve damage for 20 years.

If you are a healthcare provider it should be illegal to deny health care. You are no longer a provider at that point and that is false advertising.

Ah, but they're not healthcare _providers_, they're healthcare _insurers_. A job which shouldn't exist, because they're a middle-man between patient and provider who add nothing but complications

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My uncle was delayed to death. He found a lump on his chest and went to his doctor right away. Each appointment took longer and longer until the lump was the size of a grapefruit and metastasisized. Shortly after they cut it out and scraped muscle and bone it popped up everywhere and he just ran out

Delay.

Hope you have a really large staff

Please repost this

Our health should be decided by doctors and not employers or insurance companies who are trying to save money at our expense. This happens by allowing them to decide what is deemed medically necessary and letting them make policy exclusions .

A friend is fighting UHC, had a miscarriage and D&C (standard procedure) and they are refusing to pay.

CVS pharmacy ( yes, I said Pharmacy) denied an allergy prescription from my Allergist. Their reason was because they sell the same medicine, at a much smaller dosage, over the counter. My prescription would have been $5 with my insurance. The less effective OTC meds were almost 5 times as much.

I definitely have insights. I have worked on the inside for many years. Now I’m retired….

I will never know if my wife wasn’t even presented an option that could have saved her life because we were in the wrong tax bracket. Dig deep.

Just shared mine about Anthem denying coverage of standard yearly physical bloodwork even though doc coded as preventative. Trying to get a detailed explanation from them has been absolutely futile.

My FEP (gov't) dental insurance was dropped 3 times by 2 different dentists. 1st met life (for 20 yrs)dentist dropped it. Got Delta basic, same dentist dropped it. Went to new dentist who took Delta basic. She dropped it. Got delta high option, she dropped it. Going w/United Concordia high option

Eager to see this story!

My denial was a LONG time ago, but I was denied a CT scan to determine if my kidney cancer had returned. Reason for denial: there was no evidence my kidney cancer had returned 🙄 Good news is I’m 21 years cancer free!

Everything is deniable. Always read the fine print

@natashadeltoro.bsky.social

We have cigna & they deny everything

You know who will never have an issue, politicians. They have he best healthcare and we pay for it. They give themselves pay raises, politicians mistresses can get abortions in a snap of finger, start careers making 175k or so, leave multi millionaire.

You are doing simply the best investigative work right now. Thank you!

Denied paying for medication that works perfectly for my heart condition. Was told to go on a lower cost drug combo that did not work - they denied me coverage for 3 years while I continued to have heart symptoms on the lower cost combo. Now paying out of pocket for the right medication that works.

...and still paying the hospital for the heart attack the lower cost drug combo did not prevent.

If you have had difficulties with health insurances claim, Pro publica want to know about it. Go to this site & let them know! If you have experience in the field, please let them know.

We’re Pro Publica could do massive service is in letting people know the massive drug cost savings that are derived by offering smaller pharmacies ‘cash’ prices for everyday drugs over using your insurance. The savings are off the charts. They have such a huge audience.

Will do. Love you guys, BTW.

Yes!

Please repost this valuable service by Pro publica. WE need an advocate org. investigating problems with health insurance industry. How can these companies demand such high premiums payments from you ( that go up higher yearly ) & yet have the nerve to deny services on their whim.

Thanks Pro Publica but we should realize that putting out a question like this could result in tens of thousands of thoughts an hour? I know no one who hasn’t been burned. The only question is by how much and by how far back do you want to go. If these were letters they’d be drowned in paper.

This entire exercise only works if you also talk about the exorbitant fees charged by hospitals and doctors. Part of the reason our insurance is so high is because medical costs are so high. You can’t fix one without the other. And personal injury fraud is yet another reason. It’s not one thing…

DPR, Do you work in medicine? It would help me explain how fees/charges are established in a medical practice if I have an idea of your experience. If you can answer, I will be happy to answer your questions.

I work in law and see the abuses in the litigation world every day. But my larger point is that our system is made up of health providers, insurers, regulators, lawyers and patients all contributing to the current (messy) system. You can’t hope to fix the system without changing all of it.

Well I concur. The system is broken & in desperate need of care. 1]. THROW HEALTH INSURENCE TO THE SIDE OF THE ROAD. 2]LIKE UNTO MEDICARE FIX FEES TO A CERTAIN THE AVERAGE GUY CAN BEAR & JAKE THEM UNIVERSAL. Your turn.

Well I don’t disagree! 👍 I just feel like the laser focus on insurance right now is missing the forest for the trees. It’s the whole system that is corrupted and just shucking insurance won’t do it.

Hearing Aids for 21 year old Deaf student. Not covered .. Zero. It’s an exclusion. You have got to talk about these deductibles and copays too. 10,000 if you get sick.. and that’s if they cover it.

Tip 3: don't give up. Pester, pester, pester in the nicest tone and language, but firmly. Convince them you're not going away.

Pestering requires time and energy, which are both in short supply for someone with a serious medical condition.

I understand that. I've been there, too. However, an appropriate friend, family member or social worker was used. They only need authorization. It works just as well.

The 2nd tip: keep going up the decision-making chain until someone really listens & uses sense. In 1985 I found one re: my daughter's mental health claim. In 24 hrs., it was resolved. I sent her a dozen roses!

I've appealed many over 3 decades. One tip in particular is you must get your treating physician behind you and have them file as many times as you do.

m.youtube.com/watch?v=YbEQ...

Is this new? It seems like this is from a few years ago.

Not sure if it applicable; however, United HealthCare unilaterally changed my plan mid year, without informing or any pushback from Civil Service.

Regretfully that's in their legal abilities in their contract with you. Almost all insurance companies have that as a catch all clause to do en masse or individuals. Former insurance agent.

What's the most depressing is that even where we do have rights, they make it so cost prohibitive and such a time suck that most can't assert them.

In the U.S. people have the rights they can afford.

📌

Sarah Palin warned us… Obama care was nothing more than rationed care by death panels Should have listened

You do know these denials have been going on for OVER 40 yrs? And it doesn’t matter whether you have an insurance through your job? It has nothing to do with Obamacare. It has everything to do with not wanting to disappoint the “shareholders”.

Like I said….OBAMA and the ACA (which drastically raised the cost of healthcare & reduced coverage as it increased deductibles) is responsible for a Great amount of this…… that’s what the “death panels” are for…..to ration & DENY care Facts are Facts regardless of the Facts hurt your feelings.

The concept of a plan will save us all.

Good for you guys to report on this.

My insurance company brags about okaying dental implants but then refuses to pay for the bone work needed to implant them They use to be wonderful Not any more Commonwealth Care Alliance

CEO Palmieri was praised as a wonder boy for allegedly raising $200M in a year. In truth, CCA is insolvent, drowning in debt and now he wants $2M just to walk away.

NOT THIS TIME The fox doesn’t get to keep the chickens AND even more for killing a great company As a member can I be part of a class action suit against him to recover the loses he created?

I hope you’re safe and getting the care you deserve.

I was there at the beginning It is time to stop this from happening the thug who did this needs to pay for his scam Don't let him get away with it I will be a name on a suit that accuses him of fraud

You should contact your representative, or One Care . Palmieri pulled the wool over everybody’s eyes.

I will do it Not sure who One Care? I am ignorant please lead me

If you’re not receiving proper care or notice a decline in your services, please contact My Ombudsman for support. Everyone deserves quality healthcare; it’s a right, not a privilege.

If you have concerns or conflicts that interfere with your services in One Care or access to benefits and services, My Ombudsman is an independent program that can help: • Phone: 1-855-781-9898 • TTY: 711

thanks

Hope you’re well!

And you’re not ignorant!

it is relevant and I feel like I'm way W A. Y BEYOND MYDELS

One Care is a Massachusetts program for people with both MassHealth and Medicare. It combines services into one plan, offering coordinated medical, behavioral, and long-term care with support from a personalized care team.

THANK YOU SO MUCH I have been watching my mouth being destroyed because of there ineptitude

Me too . I finally found a doctor to do the work!

CEO Chris Palmieri is a total fraud who should be prosecuted to the fullest extent of the law!

CEO Chris Palmieri abandoned tens of thousands—disabled, elderly, mentally ill, and indigent—amid CCA’s collapse. Lapses in care, abuse, and denied treatment soared, yet MassHealth hailed him a savant while he drove the insurer into bankruptcy. Vulnerable lives paid the price.

Finally I joined in 2015 and over the last few years I have watched it breakdown I didn't know this guy has taken over what was suppose to be a nonprofit healthcare system Please tell me more

The Boston Globe reported CCA is financially insolvent. They have no funds, and providers avoid them. One therapist even wrote that CCA is atrocious to work with—unresponsive and unwilling to pay. No the former CEO is requesting $ 2 million for his departure.

The CEO need to be charged with stealing the nonprofit's funds Arrest him and sue him for everything he has I knew something was wrong It was the greatest until COVID then a little weasel got in and started stealing everything in sight Freeze all his assets I will sign the complaint

True!

Countless CCA members have endured appalling treatment. The stories are heartbreaking. CEO Chris Palmieri’s actions demand accountability—this is more than negligence; it borders on abuse and fraud.

It would be interesting to know if patients died due to lack of coverage

One study estimated over 60k per year die due to denial of coverage.

That's a lot of murders.

Denial of coverage.