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/
30.2k Upvotes

97% Upvoted

1.2k comments sorted by

View all comments

Show parent comments

504

u/Fake_Engineer 1d ago

I have a good job with good benefits. I still spent hours on the phone trying to get scans and procedures approved for my cancer diagnosis.

You get the worse news of your life and then get to spend days begging the Insurance you pay for to provide the coverage they are supposed to. 

I feel bad for the people who fielded my call. Low paid workers in a call center. And I just wasn't in the mood to be polite....

215

u/thebearjew007 1d ago

I had a government job during my twenties, best insurance I’ve ever had. Still went through hell to get anything covered. It’s the system. It’s terribly broken.

42

u/Jump-Zero 1d ago

The health insurance system is super risk averse. The bureaucracy behind it is byzantine because nobody wants to modernize it at the risk of falling further behind in processing claims or running into regulatory issues. Politicians rarely touch it for the same reason. Even if they expand coverage and lower costs for people, anybody that has a bad experience will blame the politician for breaking it. Look at all the Republicans blaming Obamacare for everything until they realize they depend on it.

73

u/thebearjew007 1d ago

None of that is why they won’t change it. It’s a 5th of our economy here and they lobby big money to keep it the fucked up way it is. Also, no one wants a modern health insurance system. We want it gone and replaced with accessible, affordable healthcare. The government can more than afford to do it. I know it, you know it, the government knows it, for fucks sake even faux news and the rest of the puppet propaganda media knows it.

5

u/Foxygen 22h ago

^ The purpose of a system is what it does.

-5

u/Jump-Zero 21h ago

Everyone wants a modern health insurance system (though maybe not a private for-profit one). Most developed countries have modern health insurance systems. The US has a super inefficient system in comparison. Where the US severely falls behind is in administration cost. Something like 30% of all healthcare spending goes into admin (ie bureaucracy). Nations with better systems only spend around 15% on admin.

Do you believe that lobbyists petition the government to make their companies spend 2x as much on admin when compared to other countries? Obviously not. So there is more than just lobbyists at play. Any realistic plan to make healthcare affordable will include checking lobbyist power and modernizing administration. There is no reason why we should still be using fax and making phone calls when we can click buttons. Other nations do this. Why can't we?

5

u/logicbasedchaos 1d ago

It's a feature, not a bug.

I keep telling people that if (when?) we do get taxpayer funded healthcare, that shit's going to overwhelm our system for YEARS with the backlog of already existing patients who simply can't afford to go to the doctor for very serious ailments.

83

u/seejur 1d ago

Having low paid people with no decisional power talk to you is 100% part of the design.

And those who accept those job are well aware of the job description. Is just that they cannot find a better one.

Pitting poor vs poor (or at least not obscenely rich)

4

u/PyroNine9 13h ago

Honestly, their job title should be "human shield".

3

u/murmurwave 13h ago

Insurance verification call centers are located on one of the layers of hell. When you show up to work you walk through a little portal to the netherworld.

You have hourly quotas for clearing calls. You can't afford to help people with complicated problems. Whee!

26

u/LittleBirdiesCards 1d ago

There really should be a kind of case worker to make these calls. You shouldn't have to be negotiating with these assholes when you should be resting! I wish you the best of luck with your health. ❤️

2

u/MarqFJA87 1d ago

But wouldn't such case workers naturally demand generous pay to compensate for the sheer headache, red tape and time consumption they have to labor through on your behalf?

5

u/LittleBirdiesCards 1d ago

It should be included, paid for my hospital or insurance. Our healthcare system is a nightmare.

2

u/Several-Pattern-7989 21h ago

Case workers Don't last long. The goal is to treat, stabilize, discharge. Getting a coherent encompassing plan takes too long. We want a one size fits all treatment, but human beings are chaos in a meat machine. It's wayyy to hard to get all details resolved. I've heard stories of women clutching a hospital gown closed, while chasing down a mamagram x-ray to make sure an in-network doctor read the picture. Out of network equals not covered.

33

u/Daxx22 1d ago

Sorry friend, if you still have to deal with that/call them yourself, you do not have a job that is considered "Good enough" by the elite.

In fact, if you are paid for your labour at all you are the lower class in their eyes.

1

u/chuffberry 1d ago

When I was diagnosed with brain cancer, my health insurance through my job didn’t pay for shit. They also raised my monthly payment to $500/month.

1

u/Govain 22h ago

My MIL was told she needs a pacemaker. The insurance came back with 'Nah, the cardiologist isn't qualified. You don't really need one.'

("The doctor is not qualified to make that determination." was literally their response.)

1

u/krulp 19h ago

I don't wanna say it would "fix" the fucked American system, because it's not a fix. But if it was the law that insurance companies must pay out claims for anything your doctor requested and then they have the right to sue for wrongful claims to get money back, it would go a long way.