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Just because you paid for insurance doesn't mean you should get it (lemmy.world)

submitted 5 days ago* (last edited 5 days ago) by [email protected] to c/[email protected]

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https://mas.to/@MikeBeas/113666556469008087

EDIT: I think you should get the service you pay for, just so that's clear.

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[–] [email protected] 7 points 5 days ago (1 children)

Even if a claim gets denied the fact that it was submitted means you already got the treatment.

That's quite often not true. There are tons of procedures/tests/etc that don't get run until a "prior authorization" has been granted by the insurance company. Also medications and durable medical equipment are not dispensed until insurance has been approved. If the prior auth is not granted or the medication is not covered, they usually will not be performed/provided unless the patient pays up front, and without the negotiating power of the insurance company, the patient will be paying 5 to 10 times what the insurance company would have paid.

I've personally been dealing with medical issues the past 3 months and the amount of prior auths I've seen go by is astounding. Tomorrow I actually go in for some more tests that they couldn't do a few weeks ago because these ones in particular needed some prior auths that are harder to get.

[–] [email protected] -2 points 5 days ago* (last edited 5 days ago)

Generally speaking, uninsured medical costs and medication are cheaper than what the insurance company pays. SOURCE

Hospitals and Insurance companies do this because it's a write-off for the insurance company and it makes the patients feel better about their coverage plan.

You likely could get the treatment without the authorizations if you pressed, I sincerely doubt the hospital would try to stop you, but that would put you into debt so obviously don't do that.