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queen-of-deans-booty: “mistressofallthingsgeeky: “help-my-ocs-breached-containment: “nerdgasrnz: “ teratomarty: “ dreamingofmotherhood93: “Just an FYI for those in the US with insurance issues ” Important information! Insurance coverage decisions are...

queen-of-deans-booty:

mistressofallthingsgeeky:

help-my-ocs-breached-containment:

nerdgasrnz:

teratomarty:

dreamingofmotherhood93:

Just an FYI for those in the US with insurance issues

Important information! Insurance coverage decisions are made by medically ignorant bean-counters. Until we can dismantle the whole shitty system, know how to scare them into submission.

This is like that procedure Mr. Incredible told that old lady

Reblogging for visibility

Reblogging as a chronically ill human in the US. This could literally save lives if someone needs medication and their insurance denies it. Or a medically necessary procedure.

‼️‼️

nothorses:

nothorses:

nothorses:

today in material transphobia:

my insurance asks for my AGAB as well as my gender, then uses my AGAB as my de-facto gender marker on all documents without telling me.

my adderall (which I have to order by mail because I’m on an island) is then stuck in “processing” for a week, and I am forced to call just to find out why. Its because the gender my psychiatrist and pharmacy use is “male”, but my insurance has me listed as “female”, so they can’t give me my medication.

when I call my insurance to fix this, a man argues with me about why I need to be listed as “female” even though my gender has been “male”, legally, to the state as well as the federal government, since before I signed up for this insurance in the first place. he says there are “internal biological differences”, then that people cannot access or get coverage for care they need without the “female” gender marker- pap smears, abortion, birth control, etc.

so now my options are:

1. change my gender marker to “female” for all of my medical information/documentation, including dental (bc it’s the same insurance), even though the vast majority of my medical care has nothing to do with my AGAB- I don’t need to be “female” to need adderall, for example- or

2. give up all access to and coverage for medical needs related to my reproductive system.

anyway, I got my gender marker changed to “male” with my insurance, since that was the fastest way to get my medication. I guess we’ll see what happens when I need a pap smear next.

btw this is why abortion is not a “women’s issue”.

legally, materially, men need access to abortion, too.

I feel like I should also stress that this is Washington state. Notably progressive and, afaik, the most trans-friendly state overall in the US.

I am on state health insurance, which is legally required to cover all trans-related care (from HRT to surgery!) 100%. This is the same state that was one of the first to adopt self-ID, including the third “X” gender marker option.

They asked for my “gender assigned at birth”, using that language, in the signup process.

Which means a couple of things:

1. Progressive areas are still systemically transphobic. Trans people in your life are not unaffected by things like this if you happen to live in a Very Progressive Area.

I know what yall are like in these kinds of places, and you can’t just handwave this stuff as belonging to “backwards” southern or conservative areas. This is your problem.

2. Language =/= safety. Systems and people can use the right language to be just as transphobic (or otherwise bigoted) as they would be using the worst or most outdated language possjble.

3. Trans men cannot access abortion in WA state unless their gender marker is “female” under insurance and all related medical documentation.

Even in a state where abortion is fully legal and widely available to cis women, it is still not available to trans men (without intentionally misgendering ourselves to, and being misgendered by, every vaguely medical-related professional we have contact with).

4. This is a problem that would not exist if men were also granted access to abortion.

fromthemindofatwentyorotherlycan:

wayfaringmd:

dynamite5ftjewishbitch:

Fun, someone said the words “prior authorizations” around me and now I’m pissed off at 730am on my day off. I go off on this rant all the time. ALL THE TIME.

Oof. This man gets it.

Every time I have to send a fax to a doctor saying “hey this med needs a PA” I get violently angry.


Hint: if your PA gets denied call your insurance and ask for the credentials of the person who made that call. Usually they will approve it instead of admitting they hired some 18-year-old with no relevant training or experience to scan for buzz-words and just deny everything

dr-archeville:

sonneillonv:

cannibalcoalition:

sonneillonv:

prochoiceamerica:

Glad Republicans took the time to understand how health insurance works before they put together a health insurance bill that will impact millions of Americans.

Oh my fucking god.

I am a licensed insurance agent, let me tell y’all something.

There is a thing in our lives called RISK, okay.  Risk exists because there is a chance of loss.  If you have a car, you could crash the car.  You would then have to pay to fix the car, pay for your injuries, pay for someone else’s injuries, pay for THEIR car, and also pay any fines and tickets you might have incurred thanks to the crash.  Plus if they sue your ass for more money, you have to pay for a lawyer.  That’s the RISK of having a car.  How do you get rid of this risk?  You don’t have a car.  Having a car is what we call ‘exposure’ - the circumstance that opens you up to the risk of a loss.

Y’all with me so far about risk and exposure?

There are four key methods of managing risk.  The first is Avoid.  In this instance, you can Avoid the risk by not having a car.  Of course, this method isn’t perfect because other people could still hit you, a pedestrian, with their cars.

You can Retain the risk.  Basically, this means you own the car and you don’t have any insurance.  Shit happens, you pay for it.  A digression, but some states actually have laws in place for this - if you’re rich enough to conceivably pay all your own loss bills, you can prove it by putting up a $50,000 bond with the state insurance board, and then you are formally excused from having to buy insurance.

You can Reduce the risk.  Buy a very safe car, follow all traffic laws, drive very seldom.  You can minimize your risk this way, but you haven’t eliminated it, so there’s still the chance of a serious loss, especially because there are other people on the roads and some of them are careless and stupid.

So here we have three methods of managing risk.  One only works for the super rich.  The other two are far from foolproof.  So what the hell are we supposed to do, so that a car accident, which happens every day, doesn’t cause such a catastrophic financial event that we’re in debt for the rest of our lives because we missed a stop sign?

That’s why insurance exists.  Insurance is a manifestation of the final and most successful method of managing risk: TRANSFER.

When you transfer your risk, someone else agrees to share that risk of loss with you.  You both help insulate one another against loss.  When large communities pool their risk, the entire community has better financial stability and better protection against catastrophic loss.  Yes, it means some people may pay for a service they never use, but they are part of the community too.  What helps the community helps them, whether they recognize it or not.

For instance, let’s say that it wasn’t required to buy car insurance to drive (I’m aware that in at least one state it’s not, just bear with me please, and don’t all look at New Hampshire at once, it’s rude and they might shoot you).  Buying car insurance is an absolute choice.  Only those who actively choose to pool their risk do so.  Think about how much they would have to pay if only a few people were members of the pool.  Think about the rates we’d have to charge to ensure these people were covered in the event of a catastrophic loss.

When EVERYONE pays a little, EVERYONE pays less.  That’s a fundamental aspect of risk transfer.

Now we’ve been talking about auto insurance, which is my wheelhouse.  But let’s talk about Health Insurance.

Every single person here has a human body.  BEING ALIVE exposes us to health risks, and there is no Avoiding it.  Only the truly wealthy can afford to Retain that risk but thanks to the fuckery of various incarnations of our government, many of us are FORCED to, and as a result, if we suffer a catastrophic loss, we are helpless in the face of exactly the sort of life-destroying debt and retribution that insurance exists to insulate us from!  Sure we can reduce the risk in a few ways, by trying to be healthier, but many conditions are hereditary and some people just plain don’t have that fucking option - they were born broken and they’ll always be broken and they are not served in any way by others telling them “JUST DRINK MORE WATER”.

The ONLY REASONABLE METHOD of managing health risk is widespread transfer.  It’s creating a massive pool into which everybody pays a little, so the money is there when someone needs a lot.  And if you don’t believe me, look at the other countries that are doing this successfully and waving it in our goddamn faces because fucking Americans can’t get our act together.

Now you have read a handy primer on what the fuck insurance is, why it’s necessary, and how it works.  Please spread this like wildfire, because ignorance hurts everybody, kind of like how really fucking expensive opt-in health insurance hurts everybody except people who were already rich enough not to need it.

So… put in these words… (correct me if I’m wrong- I’m kind of making a mental leap and a lot of the insurance stuff was never actually explained to me.)

Insurance already works on a socialist model of co-operative payment. You pay your share, and if you don’t use your share it goes towards a possible emergency in the future OR someone else’s emergency. Which is why it’s important to have as many people in as possible- because it (in a perfect world) would lower the cost. 

Am I understanding this right? That the phrase ‘socialized healthcare’ is kind of a redundancy?

Yes, you are understanding it right.  The entire concept of insurance is based on socialized transfer of risk to remove the burden from individuals so that everyone can actually be covered.

That is LITERALLY the entire point.

If only one person is paying into the insurance pool, and that person has a $20,000 loss, then that person has to pay the $20,000, whether or not they can afford it.  The insurance company, to make sure they have the money to indemnify (a word that means ‘restore to their condition prior to the loss’ or ‘make whole’) that person, has to collect $20,000 in premiums in order to pay out on that $20,000 loss.

If 20,000 people are paying into the insurance pool and someone has a $20,000 loss, then all those people only have to pay one dollar.  The Insurance company would only have to collect $1 from those 20,000 people in order to cover that $20,000 loss.

The way insurance premiums work is the insurance company looks at loss information.  Sometimes they purchase studies and reports from third parties who literally exist to do NOTHING ELSE but track certain kinds of loss.  They figure out how much of that loss they will be financially responsible for in a given fiscal year, as well as their administrative costs, and they divide that number by the number of people paying premiums.  That’s how you get your insurance premium.  It’s literally called the Law of Large Numbers - we figure out how much we have to charge you by figuring out how much risk we’re taking on by studying thousands of people who are, in this case, driving cars and having accidents.  

If, for example, in Tornado Valley the number of claims for hail damage have gone up thirty percent since last year, then we will have no choice but to charge 30 percent more for the coverage that pays for hail damage to your car.  Car insurance costs have gone up recently because more people are texting while driving, so the number of accidents have gone up sharply.  Car insurance costs have gone up recently because medical payments have increased in cost, and we also cover that.  Car insurance costs have gone up because a bumper that used to cost $200 to fix now contains sensors and back-up cameras that cost $5000 to fix.  

If we didn’t rate for that, you’d be on the hook for all those increased costs… not indirectly, by a relatively small increase in your premium, but DIRECTLY, to the tune of thousands of dollars.

There are arguments to be made about American healthcare and how it’s tantamount to price gouging.  There are also arguments to be made about how if you’re extremely wealthy, you should contribute more to the insurance pool than people who are making very little money (which would occur anyway, we hope, because health insurance is contributed to through taxes, not through private companies charging premiums).  But the fact remains that the very institution of insurance RELIES on huge pools of people paying in so that nobody is financially destroyed by a loss.

Excellent commentary/explanation.

elodieunderglass:

anamatics:

thevelvetdevil:

smallercomfort:

luchia13:

hey guys psa regarding hospital bills

don’t just pay it. do not automatically pay the hospital bill when you receive it. call your health insurance provider and POLITELY say, “excuse me, i just received a bill for $1200 for my hospital visit/ER visit/etc., is that the correct amount i’m supposed to pay?” because hospitals bill you before your health insurance and they will take your money no matter how the amount due may change based on your health insurance looking at it. 90% of the time, if your health insurance is in any way involved in the payment of that bill, you do not have to pay as much as the hospital is billing you for. call your health insurance provider first, and POLITELY request clarification, always remember that the person you are talking to is human and this is just their job, and then you will very likely find out you actually only owe $500.

don’t shout at anyone about it, don’t get mad, just understand that this is The Way Things Are right now and call your health insurance provider before paying the bill your hospital just sent you. there’s a chance the hospital bill might be correct, true, but call your health insurance provider.

THIS IS SUPER IMPORTANT. after my car accident last year the hospital billed me ~$8000. They sent me letters asking me to pay, and I called them back saying my insurance was processing the claim. This is also what I told the collection agency when they kept calling me about the $1000 emergency room fee (billed separately from the hospital fee, mind you). Once everything got straightened out, all I was actually liable for was my $200 emergency copay.

!!!!!!! things my ass didn’t know !!!!!!!!

Yes this is a life lesson my adulting ass didn’t know I needed and I’m out 80 bucks for an anti-nausea pill. 😒😒😒😒😒

Reblogging for American friends.

Also, it is important [for people receiving medical care in the USA] to carefully read all of the items on the medical bill and look for errors and overcharges. I know that the normal feelings of avoidance and dread can make it hard to look at scary hospital bills, and that’s okay! But as the OP mentions, private orgs like hospitals don’t monitor overpayment of bills - they are motivated to charge you extra - and it is basically impossible to get your money back. Read the bill carefully and make sure that the charges are correct, using the links below for help if you need. If they haven’t sent you an itemized list, you can ask for one. Sometimes you will be charged extra for items or treatment you didn’t receive. Most people don’t know that you can dispute medical bills! But in 2009, Consumer Reports stated that 8 out of 10 medical bills scrutinized by a watchdog had errors, and generally you are not obligated to pay for someone else’s error.

You may be charged for using medication that you actually brought into the hospital with you - that’s easy to dispute! You may be charged for the consumables used during your stay such as sheets, gloves, gowns, etc - the hospital should actually cover that under its running budget. You may be charged for a brand name drug if the generic was available for cheaper - the links below explain how and when you can dispute this. You may be charged a surprisingly expensive “oral administration fee” (where a nurse puts pills for you to take in a little clean paper cup and then hands it to you) but that’s worth disputing if you were actually able to take the pill out of a bottle and put it in your own mouth. And so on.

8 Things You Should Know About Challenging a Medical Bill (FORBES) (includes links to sites that help you calculate how much a procedure/treatment usually costs in your area, if the costs seem super high)

7 Tips for Fighting and Paying A Huge Medical Bill (FORBES) This explains briefly how to negotiate costs, and payment plans.

10 Common Medical Billing Overcharges You Can Prevent (Bill Advocates) A breakdown of errors and overcharges to double check.

Check medical bills for errors: Overcharges are fairly common, and correcting them can save you thousands of dollars (Consumer Reports) More of the same with links to some groups.

Avatar
Anonymous: Should i even bother renewing my healthcare from the aca if theres a chance it will get repealed?
Avatar
plannedparenthood:
image


Yes, you should still enroll in coverage before the January 31 open enrollment deadline. When you enroll in coverage, you and the health insurance company enter into a contract that is generally binding for a year (no matter how the law changes). This means that if you enroll in coverage now then you will have coverage throughout 2017.

plannedparenthood:

In case you missed it:

Yesterday, we hosted a tumblr Issue Time about the Affordable Care Act. Here’s our most popular question. You can sign up for health insurance and have it for 2017 if you sign up by tomorrow (1/31/17). 

Sign up now and spread the word>>

Why a Single-Payer Healthcare System is Inevitable

robertreich:

The best argument for a single-payer health plan is the recent decision by giant health insurer Aetna to bail out next year from 11 of the 15 states where it sells Obamacare plans.Aetna’s decision follows similar moves by UnitedHealth Group, the nation’s largest health insurer, and by Humana, another one of the giants.

All claim they’re not making enough money because too many people with serious health problems are using the Obamacare exchanges, and not enough healthy people are signing up.

The problem isn’t Obamacare per se. It lies in the structure of private markets for health insurance – which creates powerful incentives to avoid sick people and attract healthy ones. Obamacare is just making this structural problem more obvious.

In a nutshell, the more sick people and the fewer healthy people a private for-profit insurer attracts, the less competitive that insurer becomes relative to other insurers that don’t attract as high a percentage of the sick but a higher percentage of the healthy.

Eventually, insurers that take in too many sick and too few healthy people are driven out of business.

If insurers had no idea who’d be sick and who’d be healthy when they sign up for insurance (and keep them insured at the same price even after they become sick), this wouldn’t be a problem. But they do know – and they’re developing more and more sophisticated ways of finding out.

Health insurers spend lots of time, effort, and money trying to attract people who have high odds of staying healthy (the young and the fit) while doing whatever they can to fend off those who have high odds of getting sick (the older, infirm, and the unfit).

As a result we end up with the most bizarre health-insurance system imaginable: One ever better designed to avoid sick people.

If this weren’t enough to convince rational people to do what most other advanced nations have done – create a single-payer system that insures everyone, funded by taxpayers –  consider that America’s giant health insurers are now busily consolidating into ever-larger behemoths.

UnitedHealth is already humongous.

Aetna, meanwhile, is trying to buy Humana in a deal that will create the second-largest health insurer in the nation, with 33 million members. The Justice Department has so far blocked the deal.

Insurers say they’re consolidating in order to reap economies of scale. But there’s little evidence that large size generates cost savings.

In reality, they’re becoming huge to get more bargaining leverage over everyone they do business with – hospitals, doctors, employers, the government, and consumers. That way they make even bigger profits.

But these bigger profits come at the expense of hospitals, doctors, employers, the government, and, ultimately, taxpayers and consumers.

There’s abundant evidence, for example, that when health insurers merge, premiums rise. researchers found, for example, that after Aetna merged with Prudential HealthCare in 1999, premiums rose 7 percent higher than had the merger not occurred.

What to do? In the short term, Obamacare can be patched up by enlarging government subsidies for purchasing insurance, and ensuring that healthy Americans buy insurance, as the law requires.

But these are band aids. The real choice in the future is either a hugely expensive for-profit oligopoly with the market power to charge high prices even to healthy people and stop insuring sick people.

Or else a government-run single payer system – such as is in place in almost every other advanced economy – dedicated to lower premiums and better care for everyone.

We’re going to have to choose eventually.

rainekitty:

hollowedskin:

luchia13:

hey guys psa regarding hospital bills

don’t just pay it. do not automatically pay the hospital bill when you receive it. call your health insurance provider and POLITELY say, “Excuse me, I just received a bill for $1200 for my hospital visit/ER visit/etc., is that the correct amount I’m supposed to pay?” because hospitals bill you before your health insurance and they will take your money no matter how the amount due may change based on your health insurance looking at it. 90% of the time, if your health insurance is in any way involved in the payment of that bill, you do not have to pay as much as the hospital is billing you for. call your health insurance provider first, and POLITELY request clarification, always remember that the person you are talking to is human and this is just their job, and then you will very likely find out you actually only owe $500.

don’t shout at anyone about it, don’t get mad, just understand that this is The Way Things Are right now and call your health insurance provider before paying the bill your hospital just sent you. there’s a chance the hospital bill might be correct, true, but call your health insurance provider.

This counts for outside the US too, I get billed for things covered by my insurance all the time from the same hospitals which will also automatically bill my insurance first.
It makes zero sense and seems to be fairly hit or miss whether they’ll send it straight to you or via your insurance.

Very true. I had to have surgery for a life threatening thing, and I was billed $15000. Luckily, I had insurance. I only ended up paying $45. Less heart attack inducing.