I have DIRECT experience with this.
I had them. They denied my anesthesia completely for my surgery. I broke my leg in five places as well as my thumb and needed a plate in my hand as well as a plate in my lower leg and a rod in my bone. They must have though, "Oh, the patient should be awake and aware throughout this procedure." I fought it for months and gave up. They never covered it. I feel bad for the anesthesiologist. He deserved to get paid for his services. This was over a decade ago so I no longer owe it, never paid.
The insurance suits get what they deserve.
I had friends who worked for Anthem and apparently, even in support roles that have nothing to do with claims, they have a ranking for every customer that they show employees that says exactly how much bullshit you'll put up with. Like it says "This person will endure" (mark) vs "This person active fights".
The point is, ALWAYS fight your insurance company. ALWAYS keep pushing. Even when you think you're in the wrong, embrace your inner Karen, because they're tracking how much they can fuck with you.
I also had Anthem at one point, and I kept pressing a few times even after second opinion said "no" and eventually had my claim paid. They tried to shake my wife for a year and a half on 20k procedure, just by saying "nobody knows" then not following up, but eventually we pressed until it was covered. Try and waste as much of their time as possible.
None of this is a direct reply to you, I'm sure you pressed, but I'm just sharing under you because this can be the direct-experience thread.
i understand i know it isnt directed at me but yeah i pressed for over 6 months while having a wound vac on my leg and relearning to walk but at some point i was just like, eh, whats another unpaid medical bill in america and in my state they cannot garnish wages nor do i have any assets so.... i did my part to bring down the for profit medical system to the tune of about $70k in medical debt that they eventually could not collect on and has fallen out of the statutory time to collect
Sorry for this procedure we will only pay for a metal rod to stick in your mouth like you're in a WWII movie
Actually, the metal rod costs more. We'll cover the leather strap for the patient to bite down on - the shot of whiskey is to be covered by the patient
for real it all seems so medieval
like they opened my leg and HAMMERED a titanium rod into the marrow. i dont think anyone could be awake for that
This won't make surgeons feel rushed and make mistakes. Not at all.
With any luck, more patients will die on the operating table and those chumps in malpractice insurance will have to foot the bill!
Imagining a pop-up screen for unlockable DLC that shows up in the middle of a triple bypass.
- "Remember Operation? Everyone loved that game! But it was only fun if you had batteries so there were a chance that the patient would react violently to the smallest error. We figure bringing that dynamic back will both encourage better performance from and be more fun for the surgeons."
: “Finally, a real BUSINESSMAN! What’s the matter weaklings? Can’t stand a decent challenge?”
I'm gonna guess this is a multi point market failure. the drug companies overcharge for anesthesia (because what are you gonna do, not get anesthesia?), the for profit hospitals probably abuse the hell out the fact that they can charge insurers for an arbitrary length of anesthesia and the insurance companies don't want to pay anyone for anything in the first place
yay profits
I mean that's a lot of words to say "nobody should profit off basic human needs" but go off
For those who conceived of it in the first place and pushed to make it so, it's really working quite as intended.
thought this would be the Onion but it's real
https://www.asahq.org/about-asa/newsroom/news-releases/2024/11/anthem-blue-cross-blue-shield-will-not-pay-complete-duration-of-anesthesia-for-surgical-procedures
