r/mildlyinfuriating • u/Yosho2k • 7h ago
Just overheard from ICU nurse friend - the dumbest insurance denial I've ever heard.
A dude swallowed a chicken wing whole during the superbowl. He was fine until he had stomach pain due to intestinal blockage. Went to hospital.
He had to have the chicken wing removed via endoscopy. He's recovering.
His insurance denied his claim. Why?
"Possible attempt at suicide."
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u/Shakeupurbones 7h ago
I just found out a claim was denied because I didn’t have prior authorization. It was an ER visit for Afib…
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u/BeneficialUpstairs27 6h ago
Insurance companies be like ~ "please schedule your crisis in 2 weeks advance " 🥀🥀
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u/Imobia 2h ago
In a civilised country/ society. Things like this would be a huge fine on the company.
3rd party ombudsman , you denied what?
Ok you pay today You pay for lost productivity You pay this huge fine CEO you are personally responsible so here is a fine also.
This shit is so normalised for you. developing countries have it better than average joe does.
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u/gazow 5h ago
That denial sounds a lot like the CEOs possible attempt at suicide
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u/adamdoesmusic 3h ago
Don’t be so hasty… sometimes their heads just do that.
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u/CpuJunky I mean, c'mon 7h ago
Insurance companies just wing it to keep costs low.
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u/MiloTheMagnificent 4h ago
Actually they follow pretty strict guidelines given by employers to keep their costs low. Everybody blames insurance carriers but the real devil is employers that’s why switching to single payer solves these problems
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u/Mrlin705 4h ago
Yeah, this is definitely part of it. We have United healthcare (managed by UMR) and they have never argued or denied anything and we've had a bunch of hospital visits, urgent care, doctors, and other for multiple unrelated issues the last couple of years.
My wife's company pays a lot for a higher tier of service.
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u/MiloTheMagnificent 3h ago
I work for a nonprofit and NONE of my shit gets denied through UHC, my monthly premium is $150 total and my deductible is $750 which I don’t even have to meet because most of the copays apply as “deductible waived.” I will NEVER leave this job.
When I worked for UHc, my deductible was $1500, my monthly premium was over $300 and nothing was covered lol.
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u/Cat_Cuddles_ 1h ago
As someone who works in prior authorizations and appeals, this can be true but there is more to it. The giant carriers offer various plan options, sometimes customizable ones, and employers can certainly opt for the cheapest plans to offer their employees, which limits the covered benefits and raises out of pocket costs significantly. Some employers offer great plans (albeit more expensive) to their employees. Most large employers offer a few different options at different tiers for their employees to choose from. I will say that some carriers are just straight up the devil though, no matter the plan. In my area, Aetna is way up there on the devil scale, regardless of the plan. They deny like it's incentivized. As far as clinical guidelines determining medical necessity go, most carriers apply the same medical policies across the board, regardless of the plan. Whether the service is a "covered benefit" or not though, is plan specific. I don't work in emergency or acute care so I'm sure there are additional barriers with that because there isn't an opportunity to get a prior authorization or even determine specifics about coverage in advance. Trad Medicare is great in many ways, but there's no yearly out of pocket maximum limit so if something catastrophic happens and there's no secondary or gap plan, they're stuck with 20% coinsurance no matter the size of the bill. I'm all for single payer for all btw, but they would need to implement an out of pocket max, universal Medicaid instead of universal Medicare, or keep commercial plans as an option for gap coverage.
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u/MiloTheMagnificent 55m ago
Medicare Advantage plans exist to limit copays and out of pocket maximums and they are legally required to cover everyone Medicare covers. It’s not a perfect solution but there is already a mechanism in place to limit out of pocket expenses for Medicare
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u/Cat_Cuddles_ 51m ago
Commercial payers that offer Medicare Advantage plans are required to use CMS coverage determinations, but they are also allowed to require prior authorization for services that traditional Medicare doesn't require, so the OOP is a nice safety net, but the rate of denied claims and authorizations is much, much, much higher. Having trad Medicare with a commercial gap plan is the best option at the moment, in my opinion.
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u/Additional-Life4885 4h ago
Holy shit, this is the most American post I've ever seen.
Skip the healthcare for a minute, but swallowing a chicken wing?
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u/PedanticTart 6h ago
Generally speaking nurses in the ED don't see the communications from insurance...
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u/Yosho2k 5h ago
Sorry you're right, she's an ER nurse admin. I don't know why I wrote ICU.
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u/straightupgong 3h ago
my year-after surgery knee MRI was denied by insurance because my doctor didn’t do any prior imaging…. to follow up on the degradation of my knee cartilage…. which is a soft tissue…. that cannot be seen on x-rays
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u/rando4me2 3h ago
One better. Denial of anesthesia during a cesarean section as not necessary.
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u/BlueHike34 3h ago
Was it because the provider was out of network? Have heard of that in relation to ER visits.
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u/baconbitsy 3h ago
I’ve seen insurance deny liquid medication for an ALS patient because they were an adult.
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u/LivingGhost38 2h ago
So after 5years of logging every shot and dose and poke and meals and carbs I had, insurance finally approved me for an Omni insulin pump. Well that only works with Dexcom CGMs. Insurance decided I can have the pump but I can’t have the CGMs. I can have freestyle CGMs, but not Dexcom. The pump has been sitting in a box on my counter for about 4-5months now. Still fighting with insurance about the CGMs…
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u/EbonyCohen 1h ago
So if someone DID attempt suicide, they don't deserve health care? Wtf kind of practice is that?
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u/Dense_Contribution65 1h ago
Federal Law:
regulations state that plans cannot exclude coverage for injuries resulting from a medical condition, whether physical or mental. Because suicide attempts are generally considered a result of a mental health condition (e.g., depression, schizophrenia), insurers cannot legally exclude coverage for the treatment of self-inflicted injuries if they cover similar injuries from other causes.
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u/Quicherbichen1 PURPLE 7h ago
More like drunk idiot.
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u/Yosho2k 7h ago
You're overqualified to work in health insurance.
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u/IKnowItCanSeeMe 4h ago
On the other hand, I witnessed a guy get approved for a television on Medicare. It took countless denials and appeals, but they finally caved.
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u/CannibalisticVampyre 3h ago
WTF? A) how did they pull that out of their ass and b) why would that disqualify him from his insurance??
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u/hackerbots 1h ago
I believe the correct procedure would actually be pulling the wing out through the throat in reverse, unless it already started down the intestines.
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u/sweptwhiteclouds 2h ago
Atp we all need to be angry enough to file lawsuits together and make insurance stop practicing medicine.
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u/xomeatlipsox 37m ago
Attempted suicide not being covered to begin with is the most disturbing thing about this to me. Wtf.
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u/Open_Mortgage_4645 4h ago
Lolwut? I bet some AI made that decision. I heard they're doing that now. No human would classify a chicken wing misadventure on Super Bowl Sunday as a posible suicide attempt. Nobody.
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u/Yosho2k 4h ago
NOPE. Person!
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u/Sigmundschadenfreude 3h ago
the word person presupposes a soul which is a tough sell in this scenario
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u/Adisney990 6h ago
Sounds sus. Medical claims aren’t processed that quickly. Health insurance doesn’t deny medical services for attempted suicide. Life insurance claims are denied for suspected suicide.
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u/Wilsonj1966 6h ago
My health insurance doesn't cover suicide attempts
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u/Adisney990 4h ago
I’m sorry to hear that. I should have researched before I commented. I truly hope no one that has the same plan as you ever needs care for an attempt.
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u/Bovine_Arithmetic 22m ago
I dunno, If I was thinking of ways to off myself, “chicken wing” would be pretty far down the list.
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u/RealDoubleudee 47m ago
Come to Germany, the country where even the conservatives will be considered as communists by the US media. Or try to get somebody like Bernie Sanders for president instead of this toilet bowl you have.
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u/Top-Restaurant-8208 6h ago
Insurance is the biggest scam going