<story><title>Insurance companies fill their networks with ‘ghost’ therapists</title><url>https://www.seattletimes.com/seattle-news/mental-health/how-insurance-companies-fill-their-networks-with-ghost-therapists/</url></story><parent_chain><item><author>cogman10</author><text>Up and down the board this is the game insurance companies are playing.&lt;p&gt;For example, I had need for a medical device.  My doctors office submitted the claim for that device with documentation of it&amp;#x27;s necessity 5 times over 6 months before it was finally approved.  The prior 4 times it was &amp;quot;You didn&amp;#x27;t include all the required information&amp;quot; even though each submission was identical.&lt;p&gt;There&amp;#x27;s simply far too little oversight on insurance agencies.  They are perversely incentivized to give the worst outcomes for everyone which being to command high premiums because of the relatively low amount of competition or threat of &amp;quot;switching&amp;quot; (After all, you are using your employer&amp;#x27;s insurance.  You didn&amp;#x27;t get to pick it, HR did.  And they picked it based on who&amp;#x27;s cheapest.  How did they become the cheapest?  A race to the bottom in terms of service).&lt;p&gt;All of this burdens the whole system with cost and delay.&lt;p&gt;I&amp;#x27;m all for universal healthcare, but if we can&amp;#x27;t get that can we at least get stronger regulations and punitive measure against insurance companies for playing these games?  It&amp;#x27;s crazy that everyone has stories, regardless of agency, of illegitimate claim denials.&lt;p&gt;And to be clear, they do this because it saves them money and costs them nothing.  By denying by default, a certain percentage of the population and doctors offices will ultimately just go away because of the headache it takes to convince the agency to provide the product you pay for.</text></item><item><author>didgeoridoo</author><text>My wife is a clinical psychologist who used to take insurance. She got tired of not being paid for months for patients she saw. Legally they have 90 days to pay you, but in practice it’s closer to 4-5 months. Every January they claim to have “computer problems related to the new year” and simply lose huge numbers of claims, requiring you to resubmit — oh that claim is more than 90 days old even though it was their system that “lost” it? Sorry, can’t submit! Guess you just worked for free!&lt;p&gt;She takes cash now. It was an abusive system and I’m not surprised it’s falling apart.</text></item></parent_chain><comment><author>Loughla</author><text>It&amp;#x27;s astounding that the care plan created by myself and my team of doctors is regularly denied by a statistician at Blue Cross Blue Shield.&lt;p&gt;This means my care is ultimately in the hands of someone with zero medical training.&lt;p&gt;Astounding.</text></comment>
<story><title>Insurance companies fill their networks with ‘ghost’ therapists</title><url>https://www.seattletimes.com/seattle-news/mental-health/how-insurance-companies-fill-their-networks-with-ghost-therapists/</url></story><parent_chain><item><author>cogman10</author><text>Up and down the board this is the game insurance companies are playing.&lt;p&gt;For example, I had need for a medical device.  My doctors office submitted the claim for that device with documentation of it&amp;#x27;s necessity 5 times over 6 months before it was finally approved.  The prior 4 times it was &amp;quot;You didn&amp;#x27;t include all the required information&amp;quot; even though each submission was identical.&lt;p&gt;There&amp;#x27;s simply far too little oversight on insurance agencies.  They are perversely incentivized to give the worst outcomes for everyone which being to command high premiums because of the relatively low amount of competition or threat of &amp;quot;switching&amp;quot; (After all, you are using your employer&amp;#x27;s insurance.  You didn&amp;#x27;t get to pick it, HR did.  And they picked it based on who&amp;#x27;s cheapest.  How did they become the cheapest?  A race to the bottom in terms of service).&lt;p&gt;All of this burdens the whole system with cost and delay.&lt;p&gt;I&amp;#x27;m all for universal healthcare, but if we can&amp;#x27;t get that can we at least get stronger regulations and punitive measure against insurance companies for playing these games?  It&amp;#x27;s crazy that everyone has stories, regardless of agency, of illegitimate claim denials.&lt;p&gt;And to be clear, they do this because it saves them money and costs them nothing.  By denying by default, a certain percentage of the population and doctors offices will ultimately just go away because of the headache it takes to convince the agency to provide the product you pay for.</text></item><item><author>didgeoridoo</author><text>My wife is a clinical psychologist who used to take insurance. She got tired of not being paid for months for patients she saw. Legally they have 90 days to pay you, but in practice it’s closer to 4-5 months. Every January they claim to have “computer problems related to the new year” and simply lose huge numbers of claims, requiring you to resubmit — oh that claim is more than 90 days old even though it was their system that “lost” it? Sorry, can’t submit! Guess you just worked for free!&lt;p&gt;She takes cash now. It was an abusive system and I’m not surprised it’s falling apart.</text></item></parent_chain><comment><author>briffle</author><text>I would love, love for it to become a thing for Employers to put your money in a special type of account (similar to a Roth 401k) where the only thing you can do with it is buy insurance on the open market.&lt;p&gt;Heck, even have a list of 2-3 &amp;#x27;preferred&amp;#x27; plans that employees can choose from, if they don&amp;#x27;t want to do all the research.  But seeing all that money go into their pay-stub, and then right back out for insurance is going to be very, very eye opening to people who currently just have their employer pay it, and they ever see it in their check.</text></comment>