Wow great timing, I just got a $22,000 bill 2 hours ago for a surgery that UHC approved 2 months ago (in a written letter from them) because they refused to pay.

Long read; these bits were notable to me:

> But the insurer’s defense went even further, to the very meaning of “prior authorization,” which it had granted women like Arch to pursue surgery. The authorization, they said in court, recognized that a procedure was medically necessary, but it also contained a clause that it was “not a guarantee of payment.” Blue Cross was not obliged to pay the center anything, top executives testified. “Let me be clear: The authorization never says we’re going to pay you,” said Steven Udvarhelyi, who was the CEO for the insurer from 2016 to 2024, in a deposition. “That’s why there’s a disclaimer.

> At the trial, Blue Cross revealed that it had never considered any of the appeals — nor had it ever told the center that they were pointless. “An appeal is not available to review an underpayment,” acknowledged Paula Shepherd, a Blue Cross executive vice president. The insurer simply issued an edict — the payment was correct.

> On several occasions, though, Blue Cross executives had signed special one-time deals with the center, known as single case agreements, to pay for their wives’ cancer treatment.

This is the frustration that leads to getting a dictator wanna-be elected President. People are SICK SICK SICK of these shenanigans and seriously want it to change.

Because people are desperate for something to change. The status quo is literally killing people.

I'm not saying I agree with their voting decision, but I can, in part, understand their frustration.

30% of Americans would rather have nothing than see people who they consider undesirables have anything.

Desperation makes most intelligent beings, including humans, less rational - not more.

People are getting screwed every which way so any change seems like an opportunity for improvement. Even Ukraine was excited to see Biden leave office so they could at least have a chance for a better arrangement with America.

Boggles the mind that people like this exist, it’s like everyone lives in an entirely separate reality.. how do we fix this?

Responding to a now-deleted comment that seemed to suggest a violent response:

What would be the point, honestly?

Calling for his assassination would, rightly in my opinion, be prosecutable.

I'm too demoralized at the moment to hope for what I'd consider an appropriate response by state or federal governments / courts.

The third most likely solution, revolution / civil war, would probably cause far more suffering than any fixes it might enable.

I'm curious if America will soon reach a tipping point where a sizeable portion of its population actually makes an effort to emigrate, rather than just talking about it.

I think the provider side will be the breaking point. You'll start seeing hospitals stop accepting insurance, especially if Medicare goes away, and everything will be cash based. Things will be expensive until hospitals have cut enough fat/figured out the real cost of everything, and this will be a dangerous time to have an illness.

Whether this will usher in a free market utopia remains to be seen, but I think the health insurance industry is going to collapse under the weight of its own greed.

> What would be the point, honestly?

Changing insurer's incentive landscape.

I’ve seen people use this argument, but I think it fails to consider the complexity of the situation.

The moment a company capitulates as the result of murder, they’ve now incentivized more murder.

Such attacks on the people running these companies can only impede change I think by forcing companies to become more entrenched in their existing practices.

How? Congress has abdicated its role. Trump and his cronies aren’t interested. And the GOP is actively disenfranchising anybody that they consider “other”. State and local governments are only slightly better.

I’m with the poster who suggested emigration. If this chaos continues, I’ll be tempted to renew my UK passport and/or apply for an Irish passport.

I've called my insurance company to check whether they'll cover certain medical procedures. And they'll actually play a recording before transferring your call - something like "Statements of coverage during this call are estimates, and are not actual guarantees of payment."

I also learned that they have a whole bureaucracy already in place for appealing of payments. (People whose job it is to field all the rejected and then appealed claims, and write multi-page letters explaining their reasoning...) So I took my complaint to my state's consumer complaints department. Let the two bureaucrats explain things to each other.

And in the end, the insurance company paid me.

There is basically no way to make progress here, as far as I can see. If the insurance companies weren't running open-loop before, they certainly are now.

Stop having employer provided insurance and make health insurance like buying car insurance ("free market") or do single payer ("communism"). The current status quo of insurance cartels is terrible for everyone involved--employers/employees get fleeced, providers get stiffed, and America gets more unhealthy.

> make health insurance like buying car insurance ("free market")

This option doesn't work because healthcare can't be a free market. Car insurance companies have to compete not only with each other but with alternatives like not owning a car at all. There is no alternative to being alive, so health insurance companies can effortlessly collude to raise prices across the industry knowing that they have the most captive customer base possible.

I agree but I don’t see a way to get there… Why would the donor class want that? They’d rather have medical insurance as a limit on job mobility for us peons.

This!! We will never have any form of HC reform as long as it's tied to employment.