My hubby forwarded this screenshot to me from a GTNH Discord server and I feel it is valuable advice for anyone struggling with American healthcare.
“What to do if I get denied healthcare”
Google: *this post*
DuckDuckGo:
Ok this is fine and all but it’s missing the time commitment required to get the insurance company to provide that documentation. And after you’ve secured this information, you still have to make your case to a claims adjuster in such a way that they know you’re serious about taking action against the insurance company. I’ve tried similar strategies with my health insurance. It’s hours of effort. I didn’t particularly like having to wait on the phone and write emails and fill out forms while feeding my child through an NG tube.
if the insurance company answers them honestly
Of course, asking them if it’s true and then casually letting them know that you’re willing to independently investigate and sue if the information they provided is found to be false may be a deterrent from lying. Depends on how ballsy their CEO is.
So shoot the CEO in the balls?
No, just deny their claim for testicular cancer treatment coverage.
Why use a gun when you can use a microwave oven?
Only after you’re sure the job is done. Don’t go for a joke shot and risk letting the monster go free.
You want Americans to read all that, follow a several point plan, and don’t fuck up?
Even me, the only true leftist on Hexbear, sees that wall of text and my eyes glaze over
It is a single-step plan.
You write them to request a list of documents that they are legally required to provide if requested, the list of documents is numbered in that screenshot.
Either they provide that information, which you can use to dispute the denial, or they repeal the denial and pay your bill.
If you struggle to this degree with reading, I recommend downloading a screen-reader. If you already use one, my apologies for not initially providing a text transcript of the screenshot.
I mean, I’m American, and I read all that.
Granted, I am acutely aware of our education crisis, and put extra effort into learning literacy to compensate for the times I become non-verbal, but anyone who values this information would gladly read it. You don’t have to if you just don’t want to, but it’s your own loss if you choose not to read it.
Either they provide that information, which you can use to dispute the denial, or they repeal the denial and pay your bill.
Or they ignore you, or lose your request, or forward you to the never-answering-the-phone department, or etc. Delaying tactics.
Still good to know about and worth remembering, but it does rely on their having some degree of responsiveness and some degree of concern of legal consequences.
I was being a bit flippant but I appreciate the tough love. The multi-tweet format in a screenshot is a little rough to parse but @AernaLingus@hexbear.net 's consolidation made it easier to read. Thank you for providing this information, comrade.
I wasn’t trying to be tough, I was trying to be respectful
Or, plug in a second controller.
I don’t understand this comment.
ahhh, I get it now lmao
Uhh this does say it hinges on the insurance company being honest…
no it hinges on the insurance companies being legally compelled to provide certain information in certain states and it relies on their being more interested in not giving you proof to give to regulators that they’re breaking the law than they are in denying you coverage
at no point does honesty really factor in unless they like, idk, just forge documents to provide when they’re compelled to provide any sort of information to begin with
nothing stopping them from just putting you through 8 hrs of waiting on a phone or having one of their reps flub info all the time
source: dealt with this before
idk what sort of individual state-by-state legal obligation these companies are supposed to have for whatever information I’m just saying if they can actually be compelled to give this information it’s not really depending on them being honest, but rather the state enforcing those obligations and the company making a profit based decision to give you coverage versus facing regulatory penaltyi’m not saying OP’s process works or it’s easy I’m just saying that at no point even if it does work is the company being honest it’s all just profit and whether there is actual penalty to be faced from the state for doing things like making you wait 8 hours for no answer to a question they’re obligated to answer (doubt)
Wow, that’s almost as convoluted as trying to access gender-affirming care in Austria.
Writing a letter is convoluted?
Also yes it does suck how hard it is to get GAC in many places, I sympathize
1 letter? Hahahahahahahahahahahaha
I’m up 4 of them now + a summary of the first 3. And I will have to get another 2, if I want an orchiectomy.
Took me 4 years just to get HRT.
That really sucks, I’m sorry. I wasn’t aware of how bad it was.
You shouldn’t be sorry. Those asshats who made that system should be.
Its convoluted because it relies on a lot of inside baseball knowledge re how the medical system works.
Ok, let’s say you go through with all of these steps and catch them red-handed in writing. Then what? Won’t you need to hire a lawyer to escalate this? And that’s gonna cost as much as the medical procedure itself, and god knows how long it delays any treatment even if you win.
It’ll suck if you’re the only one. But there’s a good chance you won’t be. If we signal boost this as a PSA and everyone keeps track of their insurance provider doing this, then class-action lawsuits will become more feasible.
Yeah, collective action is the only equalizer we have. But we have to preemptively pressure them as much as possible because time is of the essence once you have a life threatening condition. Medical bureaucracy is intentionally cumbersome to navigate as a layman without legal representation. I remember trying to negotiate some exorbitant charges to a medical bill once and they bumped me from one department to another with hour+ long wait times that was so frustrating that I eventually gave up.
It makes me tempted to start a coalition of volunteer lawyers who specialize in this. Straight out of law school, funded by a combination of donations and side jobs in law. These volunteer lawyers would have a group social media channel (probably on YouTube and other similar sites) explaining what they do and why. We’d probably also need a tip-line for submitting claims against these health insurance agencies.
Are you a lawyer too? Without the expertise and connections to get it going its a pipe dream. If you have the expertise the connections are the easier part.
I’m not a lawyer, but I am a UC Davis alumni. I’ll see what I can do.
Not being a lawyer will make it way harder. People like to see “look what I made and built and did the work for” and will work with you then. Asking people to make it for you doesn’t tend to work, its gotta be collaborative. Not to dissuade you, its just going to be a very uphill experience. As someone with a lot of experience organizing (I made my own LGBT center, do trans homelessness stuff), I suggest thinking about your profession, your background, what you share in common with others, and leverage that. Even with major disabilities and being fully online you can make a difference if you choose something relevant to you that you can always zealously pursue no matter your mood.
For me, I’ve always been a people person and hated being alone in a queerphobic world and I’ve been hurt a lot. I put all my effort into community as a result. And as a trans person a lot of trans people are more willing to work with me, particularly transfems. Every time I felt alone and traumatized I harnessed that alienation to build social gatherings and get people resources. A lot of people can do this, but if say, there was a trans ally that wanted to build a similar space, they wouldn’t have gotten nearly the same traction.
I guess my tender advice as an old ass trans woman is, follow your heart and your abilities.
Despite being a genetics and genomics major when I was in college, I found animation to be a fun hobby. I intend to get my roots in the internet as a content creator, getting my views in the open, and working from there.
It will absolutely be a long and tedious process, but I’m stubborn and persistent.
An only slightly less impractical pan would be to get 1 or 2 lawyers who can train non lawyer volunteers and occasionally advise.
But finding even those 1 or 2 who have the necessary expertise and are willing/able to participate will be a challenge.
Have you ever been involved in a project like this at any level?
I helped to organize a couple protests back when I was in college, but I haven’t done fundraising or nonprofit organisation. I volunteered to hand out food donations to impoverished families locally but I didn’t organize in that case.
OK step 1 on this plan is to get involved in something that works in a similar way so you can get some perspective on the task you are proposing.
I promise you: the reason this doesn’t exist already is not because nobody’s ever had the idea.
For that matter, maybe it does exist. Step 0 is to find out for sure if it already exists, even if it sucks. Or if it ever existed. You’ll want to know about that.
this will likely be illegal soon, too. somehow HIPAA or whatever will be used against patients.
And how many business days they can stall you on every single step of this?
Depends on whether or not you can figure out the CEO’s home phone number.
Link to the original post (what do they call them on Bluesky…beeps?)
Consolidated text
To everyone in a similar scenario: the tactic my doctor’s office has taught me is to ask, in writing, for:
- the name, board specialty, and license number of the doctor making the determination the treatment was not medically necessary;
- copies of all materials they relied on to make their determination;
- proof the doctor making the determination has maintained registration in your specific state and documentation of their meeting all their continuing education requirements;
- the aggregate rate at which similar treatments are denied vs approved by the specific doctor being used for peer review.
You are not entitled by law to all of these things in most states, but you’re entitled to some of them, and you can always ask for them.
This is, she says, a wildly successful tactic, because if the insurance company answers them honestly, it gives you evidence that the “doctors” making these determinations are practicing medicine out of scope, without proper licensing and qualifications, in areas they are not competent in.
Everyone knows this is true; it’s not a secret in any way. But it’s in violation of a number of regulations, and a LOT of times the company will just give up and pay the bill rather than handing you proof they’re violating the regs. It’s a tactic that has worked for me many, many times.
Thank you so much for commenting this!!! I wasn’t able to find the original by searching it and I didn’t want to scroll through at least 8 months worth of skeets to find it because I’m lazy
No worries! I also tried using Bluesky’s search function but found it to be less than worthless (kept either failing entirely or ignoring my search parameters), so I went with ol’ reliable: “do a websearch but put shit in quotes” (in this case,
"rahaeli.bsky.social" "determination the treatment").
GTNH should add American healthcare to the game to add to the grind
You are absolutely correct, this is genius
