227
submitted 5 days ago* (last edited 5 days ago) by certified_expert@lemmy.world to c/youshouldknow@lemmy.world

Well known health influencer explains how to fight back health insurance denials in United States.

  • explains (in simyle terms) how insurance companies work.
  • shows basic steps to create a solid appeal.
  • recommends some online tools (AI based) to craft the appeals.
top 48 comments
sorted by: hot top new old
[-] Buffalox@lemmy.world 94 points 5 days ago* (last edited 5 days ago)

If you read the above headline without thinking it's insane, chances are you are American.
No developed country is as insane as USA, not even close, not even remotely close.
If you are sick, you shouldn't need to fight for treatment, only in a sick society is that necessary.

Land of the fee. Home of the [wage] slave.

[-] WongKaKui@piefed.ca 21 points 5 days ago

"America" isn't the only country with these issues

My family emigrated from China... its about the same on the other side of the ocean... (honestly don't know what the "free healthcare in China" stuff came from... certaintly didn't apply to my family from Taishan with Taishan Hukou)

They're so used to this lol, they think this is just normal

Also: Young people are expected to fund their parents retirement... its a crime to just abandon your elderly parents who cannot afford their living (unless you have proof of abuse)

[-] Buffalox@lemmy.world 11 points 5 days ago

China is coming from extreme poverty and a feudal society until not that long ago, and is a different culture. USA is coming mostly from European culture, but is doing worse in this field than any European country, despite being far richer than most European countries.
China has made a lot of progress the past 50 years, conditions in China are now without comparison better now than they were 50 years ago. In USA conditions are in many ways worse for the average worker than they were 50 years ago.

honestly don’t know what the “free healthcare in China” stuff came from

I have no idea what you mean. AFAIK China does not have healthcare for all, or free healthcare. But apart from that IDK how healthcare actually works in China.

[-] WongKaKui@piefed.ca 7 points 5 days ago* (last edited 5 days ago)

I have no idea what you mean. AFAIK China does not have healthcare for all, or free healthcare. But apart from that IDK how healthcare actually works in China.

Common rhetoric I get told in the Fediverse... I mean if you look in World News comms, you'll see those...

Which just confuses the fuck out of me since its a contradiction to my parents first-hand accounts (and also some of what gets told by my aunts (and other relatives/people in my parent's social circle in China))

[-] Buffalox@lemmy.world 0 points 5 days ago

I see the world news sub every day, and I have never seen that claim.

[-] Tempus_Fugit@lemmy.world 9 points 5 days ago

I've never heard healthcare is free in China, but I have heard it is much much more affordable there. Again, I've never been, but that's not a hard bar to clear in comparison to the USA.

[-] bdonvr 1 points 5 days ago

Who says there is free healthcare in China?

[-] vorpuni@tarte.nuage-libre.fr 1 points 5 days ago

Every workplace accident I've had has been denied at first due to technicalities. In France, touted as the great communist system where you pay nothing (which is of course wrong).

[-] Buffalox@lemmy.world 3 points 5 days ago* (last edited 5 days ago)

In the workplace you hopefully had help from your union. Americans rarely have that luxury.
Also it's only in USA that France might be considered communist, because that's completely moronic extreme right propaganda, since France has a free market economy like the rest of EU.
At least in EU insurance is under better regulation than in USA, but it still sucks to have to make insurance claims, that the insurance company has every interest in rejecting.

[-] vorpuni@tarte.nuage-libre.fr 3 points 3 days ago

Unions at least know good lawyers but it wasn't necessary at all, the first denial was just to waste my time. Sadly union membership in France is becoming insignificant so they're not as good as they once were.

And I was saying France is “communist” in jest.

The regulation is all right in France but insurance definitely has some very favourable laws (many delays for notifying them are quite short to the point where with shortages of GPs you have to waste everyone's time at the ER if you really need to be off work).

[-] quick_snail@feddit.nl -4 points 4 days ago

I live in America, and healthcare is free in my country.

I think most countries in America have free State healthcare.

[-] Buffalox@lemmy.world 3 points 4 days ago* (last edited 4 days ago)

No you don't, you probably live in the Americas, huge difference. The language we use here is English, and unless you live in USA, you don't live in America by definition of how English works.

https://en.wikipedia.org/wiki/United_States

The United States of America (USA), also known as the United States (U.S.) or America

This is how the word America is used in English, completely disregarding whether you like it or not.

[-] NatakuNox@lemmy.world 38 points 5 days ago

Non Americans

[-] humble_boatsman@sh.itjust.works 39 points 5 days ago

No. We absolutely should not know how to do this. Because our elected officials should be working to curb Insurance Corporations and Corporat abuse and fraud in the most general sen..... Oh wtf am I talking about. Just hoping when I get sick its a fast death

[-] Apytele@sh.itjust.works 13 points 5 days ago

yeah it would be cool to not die painfully while waiting for that. quickly sure but maybe not neurodegenerative disease or smthg

[-] humble_boatsman@sh.itjust.works 5 points 5 days ago

The new American Dream

[-] certified_expert@lemmy.world 10 points 5 days ago

1000% agree with you. But this is the old dilema of being idealistic vs being practical:

Yes, there is abuse and it is horrendous. Yes, the system must be changed. But if you are ill, right now, you shouldn't try to change the system, you should try to get better. And even when it is sad to have to resort to these tactics. It is practical to use them, given the current state of affairs.

[-] Tronn4@lemmy.world 25 points 5 days ago
[-] 404found@lemmy.zip 10 points 5 days ago* (last edited 5 days ago)

I once owed $1100 for bloodwork a teledoc ordered. I had a wellness exam and they ordered a bunch of bloodwork which I got done at a major well known national lab. My insurance said the claim is out of network and refused to pay on some of the bloodwork orders.

Although my teledoc was licensed to practice medicine in my home state, my insurance plan stated it is billed for the providers primary state. In that state, my insurance plan is not contracted with the lab that it's contracted in my state.

[-] zkfcfbzr@lemmy.world 12 points 5 days ago* (last edited 5 days ago)

I know someone who works for a major insurance company in the US, in the appeals department. I don't know the intimate details of everything about their job, but one thing I always remembered is if you have an expedited appeal (for a medical emergency), and they're requesting documents that you don't send within the 72 hour deadline an expedited appeal has, the denial gets an automatic administrative overturn - the appeal is approved. Presumably for liability reasons, combined with that the company gets fined if an expedited appeal takes over 72 hours to process. Potentially a usable strategy if you have an expedited appeal that's weak enough to have a chance of the denial being upheld in the end, and they're also requesting documents. Probably a pretty rare combination of factors though.

But I've also been told by them that most denials end up being overturned on appeal in the end. And that they see people appealing denials on a daily basis, where they were denied the absolute stupidest reasons - people who obviously should never have been denied in the first place. Hard to say if this means most denials are bullshit, or if it just means people only bother trying to appeal the most obviously bullshit ones.

[-] certified_expert@lemmy.world 14 points 5 days ago* (last edited 5 days ago)

In any case, it is just companies just dragging the process to make people tired and hopeless...

That on itself is pure evil: to mentally abuse people already in mental distress and potentially fighting for their lives.

[-] AnimalsDream@slrpnk.net 4 points 4 days ago

I work in pharmacy, and what I see between prescription prices and insurance adjudication processes... it's a fucking eugenics program, plain and simple. I feel awful for people who need insulin and adhd medication in particular.

[-] thenextguy@lemmy.world 8 points 5 days ago

I’m going to assume it says that we shouldn’t use ‘the Mangione method’.

[-] certified_expert@lemmy.world 3 points 5 days ago

Yeah... it is basically a practical guide to fight within the current (evil) system.

Definitely something nobody should need to do in a civilized society.

[-] corsicanguppy@lemmy.ca 6 points 5 days ago

insurances

I think mass nouns do not work like that.

[-] certified_expert@lemmy.world 1 points 5 days ago

thanks! Fixed

[-] Treczoks@lemmy.world 3 points 5 days ago

No, I don't need them. We have real healthcare here.

[-] certified_expert@lemmy.world 2 points 5 days ago

That's awesome! Where are you from? Could you please share a bit about how things work where you live?

[-] Treczoks@lemmy.world 2 points 5 days ago

I pay somewhere around €500 a month in health insurance. This insurance is mandatory, the payment depends on income, is free for people who cannot afford it, and covers my whole family.

Co-pays are minimal: €5 for prescribed medication, €10 per day in hospital. Some stuff cost extra, if you want something beyond basic services. I pay e.g. for better fillings (non-amalgan) at the dentist, 50-80€. Dentures and such are pricy, but there are extra insurances you can buy for that.

[-] certified_expert@lemmy.world 2 points 5 days ago

The copays sound super reasonable. Based on the currency, I assume it is Europe. May we know which country?

[-] Treczoks@lemmy.world 2 points 5 days ago
[-] Bbbbbbbbbbb@lemmy.world 3 points 5 days ago

Throw ****** ********* at the ***** of these corporate overlords, located at ************ or searchable through ***************

[-] otp@sh.itjust.works 8 points 5 days ago

Why did you write "hunter2" so many times?

[-] thesohoriots@lemmy.world 3 points 5 days ago
[-] quick_snail@feddit.nl 1 points 4 days ago
[-] certified_expert@lemmy.world 1 points 4 days ago* (last edited 4 days ago)

It's a youtube video. I don't think there is a written article

this post was submitted on 08 May 2026
227 points (97.1% liked)

You Should Know

45835 readers
371 users here now

YSK - for all the things that can make your life easier!

The rules for posting and commenting, besides the rules defined here for lemmy.world, are as follows:

Rules (interactive)


Rule 1- All posts must begin with YSK.

All posts must begin with YSK. If you're a Mastodon user, then include YSK after @youshouldknow. This is a community to share tips and tricks that will help you improve your life.



Rule 2- Your post body text must include the reason "Why" YSK:

**In your post's text body, you must include the reason "Why" YSK: It’s helpful for readability, and informs readers about the importance of the content. **



Rule 3- Do not seek mental, medical and professional help here.

Do not seek mental, medical and professional help here. Breaking this rule will not get you or your post removed, but it will put you at risk, and possibly in danger.



Rule 4- No self promotion or upvote-farming of any kind.

That's it.



Rule 5- No baiting or sealioning or promoting an agenda.

Posts and comments which, instead of being of an innocuous nature, are specifically intended (based on reports and in the opinion of our crack moderation team) to bait users into ideological wars on charged political topics will be removed and the authors warned - or banned - depending on severity.



Rule 6- Regarding non-YSK posts.

Provided it is about the community itself, you may post non-YSK posts using the [META] tag on your post title.



Rule 7- You can't harass or disturb other members.

If you harass or discriminate against any individual member, you will be removed.

If you are a member, sympathizer or a resemblant of a movement that is known to largely hate, mock, discriminate against, and/or want to take lives of a group of people and you were provably vocal about your hate, then you will be banned on sight.

For further explanation, clarification and feedback about this rule, you may follow this link.



Rule 8- All comments should try to stay relevant to their parent content.



Rule 9- Reposts from other platforms are not allowed.

Let everyone have their own content.



Rule 10- The majority of bots aren't allowed to participate here.

Unless included in our Whitelist for Bots, your bot will not be allowed to participate in this community. To have your bot whitelisted, please contact the moderators for a short review.



Rule 11- Posts must actually be true: Disiniformation, trolling, and being misleading will not be tolerated. Repeated or egregious attempts will earn you a ban. This also applies to filing reports: If you continually file false reports YOU WILL BE BANNED! We can see who reports what, and shenanigans will not be tolerated. We are not here to ban people who said something you don't like.

If you file a report, include what specific rule is being violated and how.



Partnered Communities:

You can view our partnered communities list by following this link. To partner with our community and be included, you are free to message the moderators or comment on a pinned post.

Community Moderation

For inquiry on becoming a moderator of this community, you may comment on the pinned post of the time, or simply shoot a message to the current moderators.

Credits

Our icon(masterpiece) was made by @clen15!

founded 2 years ago
MODERATORS