By DeathbyWording - 29/04/2016 17:05 - United States - Vernon

Today, my doctor said I "might" have an enlarged heart and an irregular heartbeat. It "could" be seriously life-threatening and I "should" go to a specialist for further tests. My insurance refuses to cover my consultation with the specialist because the doctor's wording is too uncertain. FML
I agree, your life sucks 16 368
You deserved it 1 271

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Try going in to see another doctor, a second opinion would be good in this situation anyway.

You mean your "doctor."

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You mean your "doctor."

pretend to have chest pains, call an ambulance. now it's fully covered.

And that's one of the reasons why insurance rates are what they are.

...you still have to pay for ambulance visits. At least where I'm from in the United States.

That doesn't seem like the best idea, but I could be wrong.

What the fuck if u wanna go see a specialist you should be god damn able to what the fuck is wrong with america

Try going in to see another doctor, a second opinion would be good in this situation anyway.

That's what the insurance is denying. OP probably would if they could.

OP can see any general practice doctor who accepts his insurance. It's seeing the specialist that the insurance company won't cover.

You "might" be in need of a new doctor.

But... that's how medicine works. The doctor can't say for sure whether that's the situation; that's what the specialist and the further tests are FOR. The problem isn't your doctor, it's the insurance company.

Damn fucking straight it's on the insurance, fucking blood sucking murderers

Very true. The doctor worded it that way because he isn't a specialist for that particular area (which is why he said OP should go to them). The doctor thus cannot properly diagnose OP. It definitely faults with the insurance company. Can't stand how money hungry they are.

34, I wouldn't be surprised if insurance companies regularly change what terminology would require them to cover something - cheating people out of treatment is how they make their money, after all.

Most insurance companies try to avoid paying unless it's fairly clear cut and even then they may only pay part of it. It's still a buisness regardless.

Wow... This healthcare system is nuts, they're basically denying people the right to (urgent) medical care, letting people die ! I'm glad to be in Europe !

I don't know about all of your guys health care, but mine isn't like that. I jist have a limit to how many times I can go to my doctor in one month (15) and if I surpass that I have to pay for it myself.

The doctor could easily fine this out with an echocardiogram and EKG these are basic tests you don't need a specialist for

I'd be finding a new doctor

You mean insurance company.

Well, an irregular heartbeat isn't difficult to objectively figure out, but the enlarged heart and anything else requires further evaluation to be sure. That's horrible.

It's difficult if it's not consistent. Like seizure tests, it can be hit or miss.

You "might" have a problem then

Here's what you can do: 1) call your insurance company and ask with the HIPAA Compliance/Privacy Officer 2) Then ask them for the names as well as credentials of every person accessing your record that made the decision of denial. 3) They will probably reverse the decision rather than admit that their committee has low paid high school graduates who usually do this decision making by looking for "criteria words" to deny healthcare. 4) If they refuse any of this it should be reported to the U.S. Office of Civil Rights Hope this helps!

My apologies. Number one meant to say *ask to speak with

this is bullshit, okay. First of all, HIPAA non-compliance has its own website. It's not civil rights. Civil rights is like race and gender and sexual orientation, protected classes like that. Secondly, the people who are on insurance panels are usually former medical professionals, not pure HS graduates. This stupid picture was spreading on the internet and it's a lie. If diagnostics and coverages were that easy to get reversed nobody would ever have problems. I hate the US system of healthcare too but spreading stuff like this helps NOBODY.

Your insurance agency "might" have a stick up its ass.