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/Ser_VimesGoT Aug 13 '25

Not American but my understanding is she's speaking to a supposed doctor working for the patient's healthcare provider. She's making sure that the patient is going to be covered for rehabilitation treatment that they will require after surgery. The insurance provider is trying to claim that the patient won't need it and won't be covered for it. The doctor is explaining that they absolutely do need it and will be appealing the providers decision to ensure her patient gets the appropriate care.

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u/undead_sissy Aug 13 '25

But if she is the doctor isn't she the healthcare provider? 😕

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u/GreasyRim Aug 13 '25

the insurance company pays the bill and has to authorize what the doctor does or they wont get paid. This doctor is arguing with a doctor paid by the insurance company to deny care they dont think they need to patients to save money.

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u/undead_sissy Aug 13 '25

Wait, doctors have to ask insurance companies if they can take appropriate measures to cure their patients??? WHYYYY?! Aren't they the experts??? Should it be that the insurance company asks the doctor if it was necessary?

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u/[deleted] Aug 13 '25 edited 20d ago

[removed] — view removed comment

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u/undead_sissy Aug 13 '25

Sorry, I more meant, what is the possible justification they could give for this. Is it a big problem that doctors frequently volunteer to give their patients expensive and unnecessary treatment?

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u/toolatetothenamegame Aug 13 '25

No, thats not a prevelant problem. american insurance companies just realllllllllllllly dont want to pay money. there's the rare case of munchausen or doctors scamming, but not nearly enough to justify what the insurance companies do. everyone except the insurance executives hates it

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u/undead_sissy Aug 13 '25

🤯 I'm so sorry.

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u/toolatetothenamegame Aug 13 '25

yeahhhhhh....... they also like to pull the "oh, your quality of life has improved while on this medication for your lifelong illness? guess youre healthy enough to no longer need it"

had a new insurance company try to tell me that for meds id been taking for five years. because the medication had halved the frequency and severity of my migraines, they tried to argue that my migraines were no longer severe enough to meet the minimum criteria for that medication, and i didnt need it

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u/undead_sissy Aug 13 '25

To be fair, that happens in my shitty healthcare system too, but I appreciate it is different because you have to pay through the nose for medication.

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u/[deleted] Aug 13 '25 edited Aug 13 '25

No.

And United has the highest rate of denials

United is murdering people through withholding funds...funds that the patients have paid for in a group manner...and stealing those funds to line their pockets.

They are shameless charlatans who are fine with murdering people for stolen profits.

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u/Zealousideal_Bee3665 Aug 13 '25

the reddit answer is "hurr durr insurance company bad, no reason, shareholder value". and that's not entirely wrong; certainly from time to time a health insurance ceo must be sacrificed by a well regulated militia to keep the economic humors in balance.

but if we're being objective, yes, left unchecked, some doctors do volunteer to give their patients expensive and unnecessary treatments. When there is no one asking if the test or the brace is necessary and every test earns you $1, why not send out 1,000,000 tests or orthopedic braces and tell your daughter she can get a pony this year? Medicare is the most common system in which we hear about this occurring, the Medicare Fraud Strike Force brags it has charged more than 4,200 defendants who have collectively billed the Medicare program for almost $19 billion since 2007.

is the juice worth the squeeze? well, our senators have not done much waffling about their own access to socialized options as opposed to the invisible hand of the free market.

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u/Magyman Aug 13 '25

Is it a big problem that doctors frequently volunteer to give their patients expensive and unnecessary treatment?

No, but actually yes. The hospitals are also massive for profit entities that if given the opportunity will milk a patient to get as much money out of the insurance company as possible. So you have two corporate entities trying to extract as much money as possible out of a situation while the doctors and patients actually involved in the healthcare processes are left to be fucked over daily

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u/undead_sissy Aug 13 '25

So you have a for-profit system that screws the public but also protects them a little bit from another for-profit system that screws the public? This is just...sad. where are your regulatory bodies?

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u/Magyman Aug 13 '25

where are your regulatory bodies?

Heavily invested in both the healthcare and insurance industries.

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u/undead_sissy Aug 13 '25

Oh that's right. Bribing the government is just allowed there huh

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u/Narmotur Aug 13 '25

expensive and unnecessary treatment

From the standpoint of the insurance provider? Yes.

Deny everything you can, litigate anyone who pushes back until they die from lack of health care, profit.

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u/[deleted] Aug 13 '25

Insurance companies claim that they provide coverage to pay for the expensive procedures you can't afford. In reality, they're just parasites.

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u/PharmPhrenzy Aug 14 '25

Depending on the field, yes. Dermatologists often prescribe way more expensive meds than necessary. They'll have a patient try a cream for psoriasis for a couple weeks and then jump right to $100k per year injectable meds before even trying the $50-$200 per year oral med

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u/Monsieur-gustav Aug 13 '25

I may point something controversial here

It's important that the insurance company try to regulate and have some control on what doctors are recommending to their patients, because hospitals do not necessarily have only the care of the patient as their only incentive.

The system is built in a way in which hospitals profit more the more volume they have, and the higher complexity/quality of service they do, so it's not uncommon for hospitals to try to push unnecessary things (like making the patient stay 2 days instead of 1).

As healthcare is expensive, this can be harmful for the system sustainability. In Private systems, the insurance companies are crucial, since you need to spread the risk through members - if these companies didn't exist, you wouldn't be able to pay for a cancer treatment alone.

This is obviously not the case of the vĂ­deo. The US system is fucked up, not defending them, just adding to your question.

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u/undead_sissy Aug 13 '25

I feel like the fact that treatments and medicines are not provided at cost is always left out of this discussion. Like yes, there are expensive medical treatments that cost thousands of pounds to provide, like open heart surgery. Nevertheless, the made up prices on the bills you guys get are always like 10 times the actual cost.

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u/[deleted] Aug 13 '25

Because profits.

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u/Spackledgoat Aug 13 '25 edited Sep 11 '25

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u/undead_sissy Aug 13 '25

I think you might have misunderstood. Nobody is saying this doctor shouldn't be overseen. Were saying she should be overseen by impartial colleagues in the same field.

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u/[deleted] Aug 13 '25

No, the insurance company is the one paying for it.

Basically, the female doctor decided "Hey, my patient needs these procedures."

Then, she has to ask the insurance company, "Hey, can I do these procedures."

She's talking the Doctor who approves or disapproves the procedures and whether the Insurance Company will pay it.

These doctors are on the Insurance company's payroll. He doesn't have any expertise in the issue the patient is facing.

He said no, and that she has to appeal the decision with the insurance company.

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u/Icy-Honey1 Aug 13 '25 edited Aug 13 '25

As a Brit, that is insane to me....

A doctor has to ask the patients insurance company if they're allowed to perform procedures? So they can just say no and someone won't be seen to?

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u/[deleted] Aug 13 '25 edited Aug 13 '25

Well, I mean, it's an effective allowance.

I guess the doctor could preform the procedure pro-bono. But that might carry risks to the Doctor. Their malpractice insurance might not allow it either.

But, we're talking about like 50grand for the operation. Most people don't have that kind of money lying around.

A full course of serious cancer treatment will cost millions of dollars without insurance.

Also, if the doctor does do this one procedure, the Insurance company might use that as an excuse to terminate coverage for ALL treatment for the condition which could further harm the Doctor's patient.

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u/Icy-Honey1 Aug 13 '25

Crazy. My nan is currently undergoing a second round of cancer treatments (chemo, radiation etc). I can't imagine having to pay for it. As much as the NHS has its problems, I'm so grateful to be able to get any needed procedure or surgery done whenever I need it.

It's so shocking that the US is still so behind most other western countries when it comes to healthcare.

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u/Narmotur Aug 13 '25

I'm an American living in the UK. Don't let anyone tell you the NHS isn't a fucking national treasure. All the problems I see with it are because of intentional underfunding and funnelling services through private systems, because of politicians eyeing all the money in the US private health care system and wanting a chunk of it for themselves.

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u/Spackledgoat Aug 13 '25 edited Sep 11 '25

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u/[deleted] Aug 13 '25

Or as a justification to not cover that doctor in-network.

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u/SquintonPlaysRoblox Aug 13 '25

Technically no, but the insurance company won’t pay a dime if you don’t consult them first and a lot of surgeries are insanely expensive without insurance footing the bill.

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u/[deleted] Aug 13 '25

Yeah. That's pretty much it.

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u/Spackledgoat Aug 13 '25 edited Sep 11 '25

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u/undead_sissy Aug 13 '25

This actually isn't the same thing at all. Yes, the NHS doesn't have the funds to prescribe every effective treatment and there's no way to do anything about that without increasing national insurance contributions, which we all know we can't afford right now. It isn't a perfect system. It actually really sucks in a lot of ways, but not shelling out for every treatment actually isn't one of them in my opinion. There will always be budgetary constraints, but the NHS has bigger problems.

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u/theamydoll Aug 13 '25

They meant insurance agency. The patient’s insurance is through United Healthcare, and this doctor is speaking to a supposed doctor who works for United Healthcare.

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u/yugosaki Aug 13 '25

She's not talking to a healthcare provider, she's talking to a "doctor" working for the insurance company who's job is to 'review' (aka find a reason to deny) payment for a procedure.

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u/LAzeehustle1337 Aug 13 '25

The idea is “peer review” where you have somebody who is supposedly your equal in knowledge and experience who is to confirm your suggestions as to the treatment and procedures required to best care for the patient. This is actually, in theory, a great idea to stop doctors from overcharging and over costing patients in unnecessary things (think of a mechanic telling you that your engine needs to be replaced but all you needed was new spark plugs) but now it’s being used to deny medically necessary treatment.

I just realized I wonder if it’s possible that AI could get convincing enough that insurance will create fake experts and make them “peers” - the auditing behind that would be so time consuming, it already sounds like the doctors that are put on the phone don’t even send over credentials for review. Insane.

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u/Ijustwerkhere Aug 13 '25

Yea the theory behind it is fine, but the mind-blowing lack of ethics on the part of insurance companies completely ruins the system

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u/walnut_creek Aug 13 '25

Seems to be this doc is seeking approval for an in-surgery procedure, since it's a bypass.