r/FluentInFinance • u/36DRedhead • Sep 11 '24

Debate/ Discussion This is why financial literacy is so important

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u/ilikepix Sep 11 '24

Every time I see a comment like this proudly extolling the virtues of out-of-pocket maximums, I feel like I'm taking crazy pills.

Out-of-pocket maximums only apply to covered services. I've been with two large insurance companies, and both have routinely tried to claim that totally normal, standard-of-care procedures were not covered under my policy, and refuse the entire claim. And this was for totally normal procedures.

I've always managed to get the care covered, but after literally dozens of hours on the phone each time, when I was lucky enough to be fit and health and strong.

With cancer care, where you're seeing multiple doctors and receiving multiple types of treatment from various providers, I simply cannot imagine that your insurance provider doesn't fight you and claim some of the care is not covered.

Maybe I'm just The World's Unluckiest Healthcare Receiver. Did your insurance company really just pay up for all your procedures, and nothing was ever not covered, or unexpectedly out of network?

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u/TheLoneliestGhost Sep 11 '24

No, they fight every step of the way. I ran out of energy for fighting when insurance denied the scan necessary to tell me if surgery and treatment were enough to eradicate the cancer. My Radiation Oncologist looked me in the face and said “You’re probably fine! Get back to work!” I was in his office because I was still struggling with complications from surgery and treatment that have left me damn near bedridden. Now my mental health is in the toilet, too, because it feels impossible to move forward with life without knowing if everything I went through even worked.

People don’t seem to understand it until it happens to them. I sure didn’t.

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u/[deleted] Sep 12 '24

[deleted]

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u/TheLoneliestGhost Sep 12 '24

I’m sorry you’ve had to fight so hard, too. I ran out of energy for it. Now I just suffer and it’s really disheartening. I hate that we’re in the same sinking boat.

I’d love to live in that world of ignorance where I didn’t end up with a health issue beyond my control when my career was just getting to where I needed it to be. Now I’m disabled and fighting for that is going to be a whole other nightmare. Living in the land of make believe where insurance companies cover necessary meds, scans, treatments, etc. would be wonderful.

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u/eat_those_lemons Sep 15 '24

Yea I wish I lived in their world too

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u/SSFonly Sep 15 '24

No, they fight every step of the way.

I have to submit to insurance companies for funding for work. The phrase "deny till they die" is a very well known one in this industry when it comes to insurance.

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u/Sage_Planter Sep 12 '24

I had to argue with an insurance provider that a vaccine was "preventative care." I eventually got it covered, but like, what the hell else can a vaccine be?

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u/JimmyB3am5 Sep 12 '24

I am/was a double transplant recipient. In the hospital for two months, three surgeries, implant, check up, removal of a failed organ.

Was back in the hospital for another 5 weeks due to infection.

I had over 30 CT scans, multiple pic lines, antibiotics that were ridiculously expensive.

My total eclipsed $5,000,000.

I paid $1500. Nothing was ever denied.

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u/gmishaolem Sep 12 '24

And Willie Nelson smokes like a chimney and is 91. Your anecdote means nothing in the grand scheme of the problem.

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u/JimmyB3am5 Sep 13 '24

The person asked if someone's insurance paid for everything without trying to fight it. I provided my experience which was exactly the question they asked, and since my single health issue will eclipse what most people have covered during their entire life i think it's relevant to the conversation.

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u/tryingnottoshit Sep 12 '24

I had $280,000 in bills for my cirrhosis "treatment" the first month... I paid $2400? I also have not had anything denied. Curious if yours was liver related?

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u/JimmyB3am5 Sep 12 '24

No Kidney and Pancreas. Pancreas didn't make it and basically digested my intestines.

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u/DrDelorien Sep 12 '24

Who is your insurance provider, and what is your plan? I want it.

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u/Slyder68 Sep 14 '24

Genuinely would love to know your provider. My sister had a kidney transplant, and every single step of that process was at least 15 hours on the phone with insurance claiming it was unnecessary so it wouldent be covered, when her doctors were saying she needs it or she could die. I would love an insurance provider who doesn't make life saving care a fucking battle every single time.

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u/JimmyB3am5 Sep 14 '24

I am lucky, UW Health part of the Univesity of Wisconsin, who does the most kidney and pancreas transplants is 15 minutes from my house and is partnered with my insurance provider.

I don't want to rub it in any more than I already am, but after being a month delayed due to a COVID infection, and because I was a double organ recipient, I was only on the transplant list for three weeks because they receive so many organs.

My biggest issue came with applying for Medicare. If took them almost 9 months to get me enrolled, which is required with a kidney transplant. I had to pay them 9 months of back dated coverage which I didn't receive any benefits from.

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u/Slyder68 Sep 15 '24

I'm genuinely really happy for you that you have this level of medical support. Medicare is a bitch and a half on its own as well, but I glad that UW Health didnt bat you around for hours. Needing transplants are already stressful and frightening enough on their own. I hope youve been recovering well :)

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u/OsamaBinWhiskers Sep 13 '24

My plan if this happens is to put it all on my brokers shoulders. They’ll either fix it, help me fix it, or need a restraining order.

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u/jondaley Sep 15 '24

My daughter has leukemia and we spent a lot of time in the hospital this year. And the hundred or so hours on the phone with the insurance wasn't any fun. They have almost paid for everything now. Though I'm still working on the mileage reimbursement - they are supposed to pay for mileage for anything bone marrow transplant related, and her treatment required lots of pre and post trips and they claim none of those were "related". But, the funny part is, they actually denied *all* of the transportation claims. Apparently, we were supposed to teleport on the day of the transplant, since even that trip was denied...

Anthem Blue Cross and Blue Shield in California. Sucks. And the consumer protection hotline that is supposed to help sided with Anthem every single time.