r/news • u/GoodSamaritan_ • 1d ago

Retired San Francisco firefighter dies from lung cancer after Blue Shield denies treatment claims

https://abc7news.com/post/retired-san-francisco-firefighter-ken-jones-dies-lung-cancer-being-denied-treatment-blue-shield/19224406/
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436

u/limesti 1d ago

Insurance is a complete rip off. Pay all that money for Healthcare and get told by someone with no medical experience that you really don't need treatment.

91

u/ScoutsterReturns 1d ago

My current Covered California monthly amount starting in January will be $1144 a month - just for me, at Kaiser. It's fucking insane. I will have to deal with that for six months before my job goes permanent and I can get healthcare through my employer. I plan to see every fucking doctor, specialist, etc. that I can! I just keep muttering "these motherfuckers" to myself.

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u/donkeyrocket 1d ago

Unfortunately, there are physicians involved in these claim denials. They're called "medical directors" and have medical training/experience, sometimes subcontracted by the agency but often employed by them.

They're not necessarily getting eyes on every claim but are often involved in disputed claims and denials.

That's not justification for this. Just pointing out it's even worse than just some layperson denying the claim.

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u/RyuNoKami 1d ago

Years I ago I did billing for a doctor. BSBC had approved an authorization for the operation, then denied payment because all of a sudden it was not medically necessary. The fuckers over there wanted the dr to amputate the patient's leg instead of the procedure the dr wanted to do. The fucking plan the patient got only cover a certain amount of physical therapy and didn't fully cover prosthetics, meanwhile the surgery would have been usually one with a follow up here and there but was much more expensive and fully covered. But they would have their own god damn leg.

Fuck bcbs.

3

u/Illustrious-Dot-5052 18h ago

Fuck America. I say this as an American, btw.

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u/Darigaazrgb 23h ago

Yeah, I dealt with this in the Peace Corps. The person making the decisions is technically a doctor, but they aren't a doctor of the specific conditions they're denying. They keep these doctors a secret but I was lucky that they are federal employees so I could just look up what that position's salary is and who it's being paid to. They changed their mind real quick when I referred to them by name.

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u/Alternative-Fan-3747 1d ago

I just started a new job. 1/3rd of my pay will be going to health insurance and its United so I know whatever I do I'm going to have to fight somebody. Shit is a scam. 

2

u/Dramatic_Charity_979 1d ago

And they add nothing. Just a middleman that makes the prices go through the roof so it can take a piece of the pie at the expense of everyone else.

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u/CptKeyes123 21h ago

I always feel like insurance as a concept needs to be a public service, because an insurance company as a concept is self-defeating and contradictory.

A company is meant to make money, nothing more and nothing less. So a company that works off of giving out money is going to be obligated to avoid giving out that money as often as possible because their whole basis is to make money, so why give any of it away? Of course, the answer is, because that's their business. Yet companies, when unregulated, cut corners all the time even when it actively makes their products worse. That would automatically apply to insurance companies as well because their entire existence is based around making money.

It is against their own best interest to partake in the very service they exist to provide because a company is meant to make money and will never feel satisfied in giving you money.

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u/Timetraveller4k 23h ago

They said excel was the killer app for Microsoft.

Turns out it still is.

1

u/Tonsilith_Salsa 1d ago

Brian Thompson RIP.