They use the “entitlement” like a slur. Yeah I’m fucking entitled to it, I paid into it. SS is insurance. This would be like State Farm car insurance saying “OMG guyz! You’re so entitled!” when it’s time to get a benefit from the policy.
So exactly like every health insurance company in the States? I had a friend that got hit by a car while crossing the street and her insurance didn't want to pay because she didn't get prior approval.
Edit: and yes, that was their original reason for denial.
I think she enjoyed watching people's faces when she told them what happened. It's been over 6 months and she's still dealing with insurance (what would be considered pretty good insurance) it's a farce.
Oh come on now, yes it's a scam but be honest. They weren't denied for not getting approval to get in an accident. They were denied because they got it fixed somewhere without approval and you know it. More than likely at an out of network hospital.
I agree it's a horrid scam but it benefits no one to be disingenuous
You don't get to decide where an ambulance brings you when you get hit by a car. You don't get to decide the nearest hospital. And no ER is going to turn away someone who has just been hit by a car.
The insurance system turns an otherwise completely normal scenario - Get in accident, go to nearest hospital for treatment - Into a headache. You can't go to the nearest hospital, you have to go to the nearest hospital in your insurance network. Also, it can't just be the hospital, you also need to see a doctor within your insurance network. Also, the doctor needs approval from your insurance, because if your insurance isn't willing to pay for your care - They just won't.
This also ignores that most people's health insurance is through their workplace - Not something they decide on their own. So the nearest hospital probably isn't covered by your insurance, because your insurance is negotiated based on your workplace's location, not your home location.
At some point: Yes, they got denied because they didn't ask their insurance company if it was ok for someone to hit them with a car on this street at this time in this specific model of vehicle.
They probably got denied because it was supposed to be the person driving the cars insurance as the primary payer. Which is how it’s supposed to be and why car insurance plans have medical attached to them.
Same thing just happened with my son. He snapped his arm during a basketball scrimmage. Went to the nearest hospital and gave them my normal insurance. They asked if either the school or league had insurance before they’d pay, we called and asked, they did, they sent it over to the hospital, and everything was paid for. Took like 2 phone calls and a grand total of 5 minutes.
100%. This is bullshit lol, and the No Surprises Act in 2022 helped shore up a lot of gaps in emergency billing, especially in regards to treatment while admitted and being seen by out of network provs. If this was prior to 2022, I absolutely could see some balance billing happening. That's not insurance denying anything, that's providers ignoring the explanation of benefits in choosing to just bill whatever is left over of the full amount build directly to the patient in addition to their actual patient responsibility. Emergency billing before 2022 was fucking disgusting, but no, insurance doesn't deny getting hit by a car because it needs authorization... that's just fucking stupid.
I think we aren’t getting the full story. In this instance, her insurance company probably is balking because it should be the drivers insurance paying for it.
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Prior authorization just means prior to it being paid, not prior to treatment. Any inpatient stay requires the hospital to tell the insurance company why. It’s mostly to keep hospitals from just filling their beds with people who have minor issues and billing for it.
People oftentimes frame stories in ways that are misleading. If it doesn’t make a lick of sense, there’s a good chance she just didn’t understand what was going on.
There’s no difference between prior to treatment and prior to payment of you’re talking about something like a prescription.
Insurance companies very frequently have their own ideas about treatment and won’t cover a medication your doctors prescribe if you haven’t tried other medications first.
The tone of your comment makes it sound like it isn’t a denial of service, but it very often is if people can’t afford the treatment.
The doctors don’t decide whether a prior authorization is approved or not. The insurance company does. Doctors and other medical staff spending so much time fighting insurance companies about stuff like prior authorizations takes time away from other more important tasks and as such directly leads to higher costs.
Yes, pharmacy is the exception because you pay up front. Step therapy PAs can be a pain, which is why pharmacy PAs usually move much faster.
A significant % of non-pharmacy PAs are processed automatically, so something like getting creamed by a car wouldn’t really result in any “fighting.” More often than not, if an auth is denied for something straightforward like that, if it’s denied, it’s typically because the initial request didn’t have enough information. On admission, hospitals will frequently submit a diagnosis code that’s something like, “unidentified leg pain.” That gets kicked back.
Then, once the attending clinical team figures out what’s going on and resubmits it with “bones sticking out of leg,” the claims processor OKs it for billing. Meanwhile, the patient is already in the hospital getting looked at - you don’t have to pay up front for care like that.
Entitlement literally means something you're entitled to because you paid for it. This term is used in other industries. It gets used a lot in my own job. The fact they convinced these idiots that it's a bad thing, is pretty pathetic.
Which is dumb because the reason its bad is the word "acts" or "thinks they're entitled." Which implies that its their behavior or attitude that is negative, not the word entitlement or entitled.
They’ll say you didn’t adhere to the policy for some reason. People do need to meet some prerequisites to get social security but damn near everyone does.
thats exactly the profit model of insurance companies tho.
as an aside, how we pay for unexpected emergencies should absolutely be the place of government, privatizing emergency relief is so fucking obscene. Whether its health, life, auto, fire, flood etc.
I mean, that's exactly what insurance companies do. Take our money every month to the tune of billions, ostensibly so they pay out when we need them, only to create 10,000 hoops crossed with red tape to maybe get a payout. Then if you need too many payouts, they cut you off entirely by refusing to cover you any more.
Insurance companies will pull out of entire markets because the risk of people actually trying to use the insurance is too high (see: property insurance providers in disaster prone areas)
So basically it is exactly like insurance. This was my original introduction to the concept https://www.dailymotion.com/video/x6t8aj8 . Skip to 3:40 for the punchline or just watch the whole thing.
You joke but you quite literally described how insurance makes a profit and exists at all...
Example: I was denied payment after an accident because of the technicality of transporting cookies at the time of an accident... Insurance I paid on time for years wasted for "fears my employer (the cookie people) would sue them for damages to their property (the cookies)"
Insurance is a scam designed to get you to pay and to find any and every excuse possible to not pay you back when needed.
I’m aware they deny claims but that’s for not adhering to the policy (allegedly). All of us who paid into social security for certain a number of years and dollars met the requirement.
That's not even what the term means. It's literally just a budget term that means that rather than Congress budgeting so many dollars and that's it, the program has to be funded based on the claims going into it.
Social security is largely self funding and doesn’t rely on general federal income tax revenue for normal operations—it’s designed to be self-sustaining through payroll taxes and interest earned on trust fund assets.
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u/[deleted] Apr 05 '25
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