A breast cancer surgeon had to “scrub out mid-surgery” to call a UnitedHealthcare representative because the insurance giant questioned whether the procedure she was in the middle of performing was really necessary.

Dr. Elisabeth Potter posted her story to Instagram this week, and the post has gotten more than 221,000 likes.

Still wearing her scrub cap, Dr. Potter began her video saying, “It’s 2025, and navigating insurance has somehow just gotten worse.”

    • Schadrach@lemmy.sdf.org
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      34 minutes ago

      Only when they start costing more than they’re expected to produce in future profits. So less like a parasite and more like a soulless corporate leech, because actual parasites at least want the host to survive until they can reproduce.

  • WhatYouNeed@lemmy.world
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    4 hours ago

    Medical insurance companies should be forced to also provide life insurance to the same customer.

    Then they have incentive to keep their customers alive.

    • RagingRobot@lemmy.world
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      4 hours ago

      Idk if it’s only for like 200k and the procedure costs more than that then they have an incentive to kill you

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        4 hours ago

        In the current scenario, they have to pay nothing if they kill you. It’s just pure savings. In the other, they have to pay $200k.

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          That’s true but it’s a business. Yes they would prefer to pay nothing but if the law passed they had to cover life insurance then they straight up have a number to beat. If it’s gonna cost $200,001 to keep you alive then nope, denied.

          • webadict@lemmy.world
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            3 hours ago

            Your logic is true, but what you’re forgetting is that they already have a number to beat, and it’s $0.

            • cashew@lemmy.world
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              3 hours ago

              Technically the number is person’s insurance premium over expected natural lifespan. But that number is still going to be lower than medical expenses. Might as well be $0.

      • rumba@lemmy.zip
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        3 hours ago

        Looking at Canada and Sweden as models, they absolutely do. Getting an actual specialist appointment takes a long long time, but they do get there eventually. And they def do a better job at getting you the meds you need in a timely fashion.

        • lordkuri@lemmy.world
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          3 hours ago

          Getting an actual specialist appointment takes a long long time

          Well, thank the gods of capitalism that I only have to wait 5 months to see a specialist (for a basic intake appointment, mind you, not even one for any real treatment) for the debilitating spinal injury that is causing me severe pain and mobility issues every second of every day. I’d hate to have affordable universal health care that might make me wait to see a specialist.

    • Hazor@lemmy.world
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      4 hours ago

      I like this line of thinking, but I expect they’d just lobby to make the life insurance payout requirements lower than the expected cost of treatment.

  • Bytemeister@lemmy.world
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    6 hours ago

    We need to make it a crime to deny claims on necessary healthcare. 10x penalty (paid to the victim directly) for denial. 30x if they were denied using AI or an automated system.

    • chaogomu@lemmy.world
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      4 hours ago

      Or, remove the ticks.

      Make health insurance illegal. Single payer healthcare where all is approved.

    • Hazor@lemmy.world
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      3 hours ago

      Just make it not up to the insurance company. If the healthcare provider believes it’s necessary care, then the insurance company pays. Full stop. They get no say in the matter, and denial is not an option.

      “But health insurance would become unprofitable!”, they’ll cry? Good. Necessity shouldn’t be exploited.

      This would incentivize abuse of the system by quacks and malicious profiteers trying to overbill, but Medicare/Medicaid seem to manage that problem just fine through fraud laws/policies.

      If the insurance company believes it’s actually unnecessary care, they can take up a complaint with the medical board and only get to claw back money if an independent panel of doctors in the same specialty agrees that it was unnecessary or unethical. A bonus from this is that insurance companies would have incentive to make sure doctors are well-trained to know what testing/treatment is actually warranted. Btw, “necessary” doesn’t only get to mean you get the minimum required to keep you from dying today; quality of life and long-term prognosis must be required considerations.

      If the insurance company believes it’s fraud, they can take it up with law enforcement too.

      Another thing that could help would be to make the medical/nursing/etc boards better equipped for investigation/enforcement of ethics complaints and to make disciplinary records follow those who would move to another state to get a new license, and also make those disciplinary records readily accessible by the public on a centralized national database. Bad actors will not be able to continue being bad actors if they lose their license, can’t get a new one, or wind up in jail.

      Even better, let’s just have a national healthcare system.

      • endeavor@sopuli.xyz
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        3 hours ago

        Healthcare providers charge people without insurance the cost of an MRI machine for using the MRI machine tho. I wouldn’t rely on their benevolence.

        • Hazor@lemmy.world
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          3 hours ago

          Sure, but in this theoretical ideal world we wouldn’t have the problem of being without insurance either. That is, if we had universal Medicare instead of a for-profit insurance industry, then no one would be without insurance. The Centers for Medicare and Medicaid services dictates what they’ll pay if you want to get reimbursement from them at all (unless you’re a pharmaceutical company, for some reason, then you can charge whatever you want), and the hospitals where MRI/CT/etc. machines are housed would all quickly crumble without any Medicare/Medicaid reimbursements (and actually would be better off financially if half their ER patients were not uninsured).

          And if we can’t rely on their benevolence, then the licensing board or law enforcement would theoretically address any problems. Ideally, anyway.

  • pjwestin@lemmy.world
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    8 hours ago

    Cigna has this cool new thing they do where, after they deny a medication for our son, they have a nurse call us and tell us why our doctor was wrong to prescribe it in the first place. You know, because a nurse who has never been in the same room as my son knows more than the fucking doctor who examined him.

  • Whats_your_reasoning@lemmy.world
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    8 hours ago

    Police recovered bullets at the scene that read, "delay, deny, defend

    Depose. Say it, DEPOSE.

    I can understand this one instance being an editorial slip-up, but I’ve seen way too many news articles that reference the bullets while omitting that one particular word - depose.

    It’s the word that scares the oligarchs the most. Which is all the more reason for us to repeat it, even if journalists won’t. DENY, DEFEND, DEPOSE.

  • Skeezix@lemmy.world
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    18 hours ago

    Well, you assholes voted in trump and the republican cabal so dont expect any change soon.

    • LifeOfChance@lemmy.world
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      3 hours ago

      Remind me again when this shit started happening? Not like it was being prevented before Trump or Biden or Obama or Bush. Honestly I could go back pretty far. Nobody is stopping these companies from doing what they’re doing it’s not gonna change.

      Fuck trump because we all know what’s gonna happen but in this specific situation nobody will do anything even if Biden or Harris were running the show.

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    24 hours ago

    I sure wish someone would do something about this.

    We need a hero. Someone who will do whatever it takes even sacrifice themselves if necessary to proclaim, “this is not okay. You will not get away with this.”

    • Lemminary@lemmy.world
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      23 hours ago

      Nah, we need to realize this isn’t on any one person’s shoulders but on everybody and start a mass movement.

      • AreaSIX @lemm.ee
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        10 hours ago

        I’ve been hearing for decades that the 2nd amendment is fundamental to the American identity, because it’s supposed to be an insurance against this type of tyranny against the American people. There you have your mass movement, making claims on that insurance, using what’s purported to be fundamental to the national identity of the country. What tyranny is the 2nd amendment protecting against if this doesn’t make the cut?

        It’s really hard to disagree with Luigi when he wrote “evidently, I am the first to face it with such brutal honesty”. Brutal honesty is what this state of affairs calls for. It’s time to water Jefferson’s proverbial tree of liberty.

      • UnderpantsWeevil@lemmy.world
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        19 hours ago

        Mass movements always exist, you just have to join them.

        But mass movements also demand a lot of your time and energy, which you may not have if you’re staring down the barrel of multiple major medical procedures. What’s more, they demand a political system receptive to their demands.

        The appeal of stocastic violence is that it doesn’t require an enormous long term collaborative good faith effort. It just requires a few vigilantes with more rage than sense.

        After decades of campaigning on health care reform (literally straight back to the 1940s) and posting a ton of Ls (particularly since Carter and the neoliberal turn), Luigi might not be transformative but he’s cathartic.

    • NoneOfUrBusiness@fedia.io
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      23 hours ago

      Nope, y’all don’t need (or deserve tbh, speaking as someone not from the US) a hero. You should try to hold your own government accountable for once; the last time that happened was the Civil Rights Movement I think?

      • endeavor@sopuli.xyz
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        3 hours ago

        How about using the wonderful internet and social media to sync calendars so you can all take out the quarter of a toilet break you americans call “paid holiday” and gather up, pool resources in order to make the federal government non functional until things improve. Rather than talking big about grabbing for the literal gun and doing drive-bys. The damn french go for the jugular for as little as government implementing points system for driving liscences.

  • JusticeForPorygon@lemmy.world
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    1 day ago

    Proud to say as of the first of the year I’m no longer insured with these dirtbags.

    I’m now insured with some other dirtbags.

    • WraithGear@lemmy.world
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      1 day ago

      Sad to say, my company was bought by another, and i am forced to change to these dirt bags. I currently have a malady that will require surgery. Not that it matters, the old company declined my last surgery anyway and i paid out of pocket

      • Cethin@lemmy.zip
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        3 hours ago

        Push back when it’s auto-declined. You can often get them to pay up even if they decline at first. They’re trying to make as much profit as possible, so they decline and hope you don’t fight back.

        • WraithGear@lemmy.world
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          3 hours ago

          I mean thats the thing right? Except it’s not that easy. The billing man at the practice has been trying, and when i call i get the, “your claim has been reviewed by a human and denied.” Canned response. And i have to go through the call carousel. And now my job changed providers, so now i am trying to get back pay from a healthcare company i don’t have an active account with. But i really don’t want to have half my jaw amputated.

  • mindbleach@sh.itjust.works
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    21 hours ago

    Doctors across the country need to adopt a “just fucking do it” attitude, and tell their legal departments to fuck off.

    On this and other topics.

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      18 hours ago

      The problem with that is that they care about their patients, and it’s their patients who will suffer the most when the insurance company tells them both to fuck themselves.

      • mindbleach@sh.itjust.works
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        17 hours ago

        The problem is not billing the company when the patient needs healthcare, regardless of what the company insists they will or won’t cover.

        Don’t tell me ‘well they can’t just charge insurers whatever whenever’ when they have no fucking issue billing patients obscene amounts months after the fact.

  • Daze@sh.itjust.works
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    1 day ago

    Calling it now:

    UHC will deny the anesthesia claim because they wont understand why they needed so much time to perform the procedure.

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    1 day ago

    My partner had this same thing happen. She needed a neurosurgery to install a nerve stimulator in her neck. Her insurance approved a surgery to implant a test device, but then when it was determined it did solve her issues, denied the surgery for the permanent stimulator, forcing her neurosurgeon to write to them to get it approved. Then, during the surgery, they sent another denial. Fortunately, U of M is fantastic, and their hospital just covered the cost of the surgery due to the level of bullshit the insurance company pulled. Otherwise she would have ended up with multiple scars on her head and neck, and nothing to show for it, other than continuing nerve pain.