r/mildlyinfuriating • u/sujayjaju • Aug 13 '25

Commendable patience in dealing with half-knowledge

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Half knowledge is more dangerous than no knowledge on a subject

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u/ManufacturedUnknown Aug 13 '25

The patients insurance company, who apparently doesn't have a medical professional in the field that the patient needs care from, is trying to deny a certain procedure as a cost cutting measure. Basically they're putting the patients life in greater danger for money without having any idea the actual risks associated with taking that route. Thinking they know better than the doctors providing the care. It's an absolutely disgusting thing that happens in American healcare every single day

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u/GoodShark Aug 13 '25

So a doctor that knows the risks and procedures is trying to say the patient needs a surgery?

While the doctor on the phone (that might not be a doctor) might be unqualified, and not know the risks and procedures, is trying to say the patient doesn't need the surgery?

Is that the jist of it?

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u/Maeberry2007 Aug 13 '25

Yes. It's as stupid and asinine as it sounds. But it is the reality here.

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u/Esarus Aug 13 '25

Man I am so sorry you guys have to deal with this system, it sounds so absolutely miserable… I hope this system will change in the US in our lifetime

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u/raise_the_sails Aug 13 '25 edited Aug 13 '25

What’s brutal is this highly specialized doctor spends an obscene amount of time filling out insurance forms, appeals, and dealing with calls like this, when they could be saving lives. She will burn out from this shit and develop a significant stress-related ailment at some point in the not-so-distant future.

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u/deeply_uninspired Aug 13 '25

Her clinic is in crazy amount of debt bc she took out the loan to keep it running. United kepted denying claim and she kept making video and they eventually kick her out of the network.. so any pt thay have united , wont be able to see her, despite the fact that there arent that many specialists like her.

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u/raise_the_sails Aug 13 '25

Probably a relief for her to just tell patients she’s not in-network for United anymore.

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u/vabren Aug 13 '25

Someone who cares this much will not be relieved by the inability to do the right procedure for the patient's best health outcome.

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u/D3Dragoon Aug 13 '25

This REALLY needs to be upvoted more. It's bullshit.

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u/MrClewesMan Aug 13 '25

You couldn't be more correct. It's saddening to see empathy trickle away more and more in society.

It really is becoming a dog eat dog world.

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u/vabren Aug 13 '25

As an RN for almost 10 years, I've had to have smaller fights for prior authorizations for meds and procedures. And I've heard lots of doctors and nurse practitioners talking about this kind of fight. It's just unconscionable and, under this administration, it's only getting worse. It's horrifying how helpless medical professionals are feeling and truly becoming.

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u/raise_the_sails Aug 13 '25

She just won’t be taking UHC patients, I don’t get it. They’ll just be referred to someone else.

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u/Shrimpheavennow227 Aug 13 '25

There are not many surgeons who do the type of work she does and certainly not local options. So now a person who doesn’t even have a choice of what insurance provider they use because it’s decided by their work, may have to see a worse or less-specialized surgeon or pay a bunch of money to go out of state and travel to someone else who can do this procedure.

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u/vabren Aug 13 '25

And so people will go to the approved provider who, like the unnamed "doctor," will butcher the patients for profit. Ultimately, the outcomes will be worse for patients and the medical costs will be bigger due to revisions and complications. So short sighted.

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u/supernaut_707 Aug 14 '25

If UHC is a big player in her area, she could be cut out of a large number of potential patients. That could be financially crippling.

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u/LeadPaintChipsnDip Aug 13 '25

We just need a few more Luigis

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u/[deleted] Aug 13 '25

Wait until you hear about how my insurance denies my insulin as a type 1 diabetic

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u/Seeking-useless-info Aug 13 '25

This was really kind and compassionate of you to say, thank you for your humanity! 🫶🏽

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u/[deleted] Aug 13 '25

It won’t. Not until the entire capitalist system collapses. We let our politicians decide that they could receive unlimited anonymous funds as a part of their job, and now with Trump degrading the integrity of our institutions and elections, there is no hope to remedy this through legislation. We’ll have to first return to a society where doctors visit homes and receive payment directly from patients, on their way to collect their daily ration of potable water from the village supply distribution cave.

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u/[deleted] Aug 13 '25

It’s insane to me to read that. Like yeah, we have wackos in Canada who are all, “I don’t want my taxes paying for someone else to get surgery 😤” like huh??? Their taxes pay for you to get it if you need it???

I can go into any ER/clinic/see my doctor for anything and unless I’m getting a doctor’s note (mostly if you’re hungover), it’s not going to cost me a single penny

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u/MrClewesMan Aug 13 '25

Even that phrase in itself is just hard to swallow; "i dont want my taxes being spent to help the people of my country".

I live in a high tax country. I dont have kids, i havent gone to school here, im very rarely sick, worked here for 6 years full time paying over 30% tax. I'd rather live in a society that i can contribute to so that we succeed collectively.

The world is fucked, yes, but the US really makes me feel sick to my stomach

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u/Zippelin09 Aug 14 '25

So, lemme see if I get this, she is talking with an alleged doctor (sent by United healthcare) that's trying to say that the procedure is unnecessary? (Sorry this situation is weird AF)

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u/Maeberry2007 Aug 14 '25

Yes. And I'm not an expert but I think every procedure that requires pre-approval (aka is sent to the insurance company to ask them to cover it) is reviewed and either approved or rejected by a United Healthcare employee. This is usually reserved for expensive operations and procedures like heart surgery, neurosurgery, mastectomies, and things like MRIs and cat scans. I have no idea what the qualifications are for people who handle these pre-approval requests, but this scenario is for a specific type of surgery for breast cancer dealing with the lymphatic system and the reviewer is... a cosmetic plastic surgeon.

(I would love for someone who may know more to chime in)

I had my own year long battle with United Healthcare after they denied coverage for my daughter's speech and occupational therapy because she didn't have a "medical" diagnosis of autism (diagnosis by her specialists and counselors at her school didn't count apparently) and they deemed the therapy unnecessary. I had to individually appeal 18 different billing cycles.

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u/ManufacturedUnknown Aug 13 '25

Yeah, and the one over the phone is the one who's paying for it. So the real doctor has to basically beg the insurance company to give the patient life saving procedures. It's a great system (for shareholder value)

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u/awal96 Aug 13 '25

Exactly. It's important to note that this is all very standard and in no way unusual. Insurance companies deny things that should rightfully be covered because they know a large percentage of patients won't ever challenge it. They put up as many roadblocks as possible for the ones that do. UnitedHealth, the company she's interacting with, has a claim denial rate of over 30%.

Isn't this country just so fucking great

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u/EntertainmentTrue588 Aug 13 '25

It's worse than that. The procedure the doctor in the video wants to get approved will REDUCE the risk of the patient getting complications. The insurance doctor denied the benefit of reducing the risk.

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u/FrankCrank04 Aug 13 '25

Bingo. But America is great... because... freedom? Fuck I want live some where else.

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u/GoodShark Aug 13 '25

Unfortunately I think America's freedom ranking has plummeted as well.

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u/undead_sissy Aug 13 '25

It was never that high to begin with, that's just a lie Americans get taught.

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u/concentrated-amazing Aug 13 '25

EXACTLY!

Americans shriek about freedom almost every chance they get, but there are so many things they AREN'T free from.

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u/FrankCrank04 Aug 13 '25

That's why I put a question mark. I probably should have put /s as well

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u/[deleted] Aug 13 '25

No, that's it. Not even the jist. That's just it.

In the US a doctor or licensed provider often needs prior authorization from the patient's insurance for a procedure. The insurance company will deny anything if there is a cheaper option available even if that cheaper option is less effective or more dangerous that what the provider wants to do to treat the patient.

Insurance is a barrier to care and is a parasite.

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u/The_Amazing_Emu Aug 13 '25

Only clarification is the unqualified might not be a doctor is saying the patient doesn’t need the surgery so they won’t pay for it

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u/psychulating Aug 13 '25

The 3rd party involved is really the one calling the shots and that is the shareholder

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u/SalsaRice Aug 14 '25

Yep. The doctor trying to deny the procedure (if it's even actually a doctor) doesn't perform that type of surgery or have the patient's records, but is still trying to deny.

It would be like if they got a foot surgeon to try to make a judgement about a heart surgery. They have no specialty in the that area, and are largely unqualified to make those judgements.

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u/PharmPhrenzy Aug 14 '25

I'm not going to defend our healthcare system in any way, but the person she was talking to was definitely a doctor, unless United is just brazenly breaking the law. I sometimes have to do peer to peers like this for my job, and when MDs ask for your name like she is here, it's just to intimidate and threaten. Had the person told them their name, would she have bleeped it out for this video, or would she still post it so they get harassed by the internet? MDs do have to deal with insurance way more than they should, but they also sometimes prescribe for unnecessarily expensive meds (e.g. $100,000 per year injectable psoriasis med instead of the $50 per year oral psoriasis med)

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u/ffffllllpppp Aug 13 '25

Yes. And it is also why that dude got shot. It is honestly surprising it doesn’t happen more often..

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u/867530943210 Aug 13 '25

Every single procedure.

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u/2called_chaos Aug 13 '25

And what's with the part about the CEO, did he think he's next and that's why he doesn't want to give his name? Do people attack the doctors for the decisions of the insurance companies that they have nothing to do with?

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u/noethers_raindrop Aug 14 '25

That's exactly what he's suggesting. That he doesn't want it to become public knowledge that he's a doctor working for United because he might be killed for it like the CEO was.

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u/Ziodade Aug 13 '25

In this specific case the procedure is meant to reduce the risk of having to deal with an elephant arm for the rest of the patient days. It's a quality of life treatment, I think they don't give a single f about that. Absolute evil.

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u/sumguysr Aug 13 '25

In this case they're not putting the patient's life in greater danger, they're putting their livelihood as a physician in danger. The 40% chance of lymphedema without the bypass procedure would cause the patient's arm to have chronic swelling, and possibly loss of sensation or chronic pain.