Posted 11/30/2021 9:15 PM (GMT -7)
For most of my adult life, once I started my first job out of college, I've had good employer-sponsored health and dental coverage. And, for people who need help within the "standard of care," that insurance can work fine for many issues.
Because my employers subsidized 80% or more of the policy cost, I always selected the most expensive plans available, as they had the lowest co-payments, had the lowest deductibles, and had the least restrictions. That was all fine, until I needed more from the healthcare system.
At some point, running the standard labs (e.g. CBC, CMP, lipids, etc.) over and over wasn't getting me anywhere, as none of those were the problem. That's when I started seeking out integrative/functional medicine doctors.
Like others here, I paid the high out-of-pocket costs, because these alternative doctors didn't accept insurance. I kept all the receipts and got CPT codes for anything I could, so I could submit the paperwork to my insurance company to request reimbursement.
Most of the time, my requests were denied, because the procedures were not considered valid or medically necessary. These determinations, I later found out, were made not by some doctor employed by the insurance company to review claims (which can happen), but by some non-medically-trained claims processor at the insurance company. (In the case where a doctor did review my claim and denied it, that was especially frustrating, as that doctor didn't know my full medical history.)
Once I learned to resubmit denied claims and request review by a higher level of authority by the insurance company, some of my claims -- which, again, had initially been denied -- were subsequently approved and reimbursed. There were also a few claims which I submitted that were "never received" by the insurance company. Luckily, I kept copies of everything sent, so I could submit the "missing" claims again.
This was a lot of paperwork, time, and follow up on my part.
Not only was there the need for me to make copies of the forms the alternative doctor's office provided to me (with dates, prices, CPT codes, NPI numbers, etc.), but I had to complete the claim form from the insurance company. Each form had to have all of the same information about the date of service, the provider's details, all my information, insurance plan number, etc. Omit or get even one of those items wrong and the entire submission could either stall or be denied. Sometimes, the process might have stalled within the insurance company, but no one bothered to tell me. Thus, if I didn't set a calendar reminder to call the insurance company two weeks after my submission, I could be sitting and waiting until the end of time.
Now, years later, I'm not sure all of that effort was really worth my trouble. All the paperwork, making copies of everything, filling out all the forms, dealing with the envelopes, the extra postage, the calendar reminders to go back into my files and refresh my memory of the outstanding issue before calling the insurance company to ask for an update, the denials, making copies of everything again to submit again, etc.
As I alluded at the outset, insurance absolutely can be helpful. If given the choice of having it or not, I'd have it. (Currently, I'm unemployed and uninsured.) But, I'd much prefer being financially independent and have the ability to see any provider of my choosing and get whatever test or procedure I desire. Insurance companies are, after all, businesses that exist to make a profit. I'd prefer they not impede my ability to get the care I need.
Though I don't have private insurance, I am able to get some "care" (using that term loosely) through the Veterans Administration. After seeing how they conduct themselves, I'd imagine this is what it's like to be on Medicare or Medicaid in the U.S. If so, then I see why the poorest among us have the worst health outcomes.
Lastly, the fact that any of us -- regardless of race, gender, or country -- has to suffer with our health is unforgivable, as there are enough resources available on this planet. I'd say the same for food, water, and shelter. As a species, humans do a lot of good things. But, we also have a lot of priorities wrong.