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
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Top comments

walker9879 25

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

191 4

Comments

weveallbeenthere 30

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

3 34
BoxFullOfLazy 25

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

22 0
hfslkp47012759 28

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

22 0
cprad11 12

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

3 4
anyagrande 31

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

30 4
walker9879 25

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

191 4
zeffra13 31

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

9 3
gracehi 31

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

19 1
SOILEDIT 51

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

29 5
soactually 4

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.

87 1
domolovesyoshi 33

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

34 0
cheeeksss 29

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.

36 1
Fairyjoshy 13

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.

19 1
Axel5238 29

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.

9 1
Nyattack 14

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 !

14 1
Kiernan151 25

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.

1 2
suznmar 16

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

0 2
dafluckster 6

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.

7 2
zeffra13 31

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

9 0
Sammi0116 17

You "might" have a problem then

7 1
dorothy675 15

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!

40 3
dorothy675 15

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

5 1
williamcarter93 13

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.

2 0
UserError94 18

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

15 1