But if you get admitted, that can be a different story, as some physicians might be out of network even if the hospital is in network.
I did have one experience where, after accepting a job offer, I changed my mind when I got additional information about the health insurance (one of my wife’s specialists had serious issues with the new plan).
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It’s not just a massive information asymmetry, it’s also an information inconsistency. I have a friend who was recently pre-approved for a surgery, had the surgery, and then was retroactively denied coverage for the surgery. What was she supposed to do differently, even conditioned on full understanding of her policy?
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This must have been nasty. If this happens is your route to litigate it?
Admitted? I specified “stitches or broken bone”. What percentage of broken bones on children end up with admissions?
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When that happened to my wife (approved for surgery, had surgery, claim denied, $75k billed). After exhausting appeals, I was able to catch the attention of someone at the state AG’s office.
State didn’t have jurisdiction (employer-provided plan), but nevertheless the state official reached out to a contact they had, and the expression of interest was sufficient to get the matter resolved.
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“‘We understand that you were actively “bleeding out,” but this does not exempt you from exploring lower-cost care pathways,’ the post said.”
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I watch the local TV news. Those words come right off the personal injury lawyer’s ads.
Older white men in suits in fancy office looking at an insurance claim – “Deny, Delay, Defend” (actually, I recall hearing the first two more frequently than the third)
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AHH, thanks for that.
Am I the only one who thinks domestic issues are the ones that are going to torch the republic? It’s like in recent years we have more and more extreme behaviour becoming normalised. The people that did Jan 6 will likely get a pardon soon. Now we have vigilante justice appealling to the people. Imagine if the guy gets mitigating circumstances then a low sentence.
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So basically insurance companies are planning to deny a certain # of claims to make up for claims they can’t deny. That makes so much sense. 
And what, just hope that person learns to live with the pain? Nah, that person didn’t have a good enough reason for an MRI. So they can’t walk or sit at a desk anymore or even stand at a desk. That’s a problem for their disability insurer.
So glad I’m not in major med.
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That was one of my options/pivot when I was laid off…now I’m glad it didn’t take.
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I did it early in my career when the trends were so much higher than they are now. I guess we weren’t denying enough claims back then.
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That was poorly worded. I’m not really suggesting denying those claims, I’m suggesting what others here have and that is educating patients such that they seek less heroic end of life care and opt for hospice or other less expensive treatments for end of life situations. But as others have said, the real problem becomes determining just who will recover and live reasonably comfortable lives after that vs those who would either die anyway or not recover enough to have a decent lifestyle after treatment.
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I heard a take that it may also be a reference to the book: “Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It.”
I have to imagine the “what you can do about it” isn’t just one sentence reading “Kill the CEO,” but I haven’t read the book myself.
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Based on reviews & the Table of Contents this seems to be more about P&C?
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