This made me do a lot of pondering. Re: Health care terms.

[LuckyCharms]

Somebody posted this on Reddit, and I copied it and saved it into a document.

I believe the post was written by someone who lives in a country that has a national single payer health plan, but I'm not sure which country that is.

Here is the post. You can come to your own conclusions.

"I’ve been keeping track of every term and concept Americans are supposed to understand to deal with their healthcare system. It’s inhuman. Here's everything you need to learn to use American healthcare".

Payer
Individual Deductible
Family deductible
Utilization
co-pays
Coinsurance
Lifetime caps
Pre-existing conditions
Medical bankruptcy
Medicaid expansion
Cost sharing
Premiums
Capitation
Premium subsidies
Recission
Statement of benefits
Explanation of benefits
Explanation of coverage
Benefit denials
Denial appeals
Case review
Review board
Underwriting
Indemnity
HMOs
PPOs
EPOs
ACOs
IPAs
In network
Out of network
Service price
Insurance rate
Cash rate
Denial of coverage
Backdating
Retroactive coverage
Coverage gap
COBRA
Health savings accounts
Coverage verification
Referrals
Coverage Exclusions
Donut hole
Exchanges
Marketplace
Dependents
Out-of-pocket maximums
Waiting periods
Termination dates
Effective dates
Coordination of benefits
Benefit year
Calendar year
Allowable charges
Usual Reasonable & customary
Formulary
Nonformulary
Tiered coverage
Ambulatory care
Assignment of benefits
Reimbursement
Grievance
HIPAA
ERISA
Managed care
Medical necessity
Open enrollment
Point of service
Participating provider
ICDM codes
DSM
Behavioral health
Application for coverage
Qualifying event
Rating (premium rating)
Primary Service area
Secondary service area
Subscriber
Self-referrals
FSAs
HFSAs
Tertiary care
Third-party administrator
Claims
Fee-for-service
Fee schedule
Paymaster
Broker
Uninsured
Underinsured
Elimination period
risk pools
HRA
Individual mandate
Preadmission certification
Prior authorization
Drug schedule
HSA
rollover
Pre-tax contribution
Subsidy
Pharmacy benefit management/managers
PBM
Chargemaster
Health Reimbursement Account
Third-party administrators
Stark Law
TPA
Obamacare
PCP
Primary care physician
Medical group
JCAHO
Joint commission of accredited healthcare organizations
Sentinel event
IRB
Institutional review board
Inpatient
Outpatient
Specialist
Subscriber
EMTALA
Emergency Medical Treatment and Labor Act
Stark Act
Load-leveling
Allowed amount
ACA
Household
APTC
Advanced premium tax credit
FPL
Federal poverty levels
Charity care policy
Extra Help
Low Income Subsidy
Coverage determinations
Tier exception
HDHP
High deductible healthcare plan
Pre-approval
HIA
Health incentive account
EAP
Employee Assistance Program
Step therapy
Hard bill/soft bill
Itemization
Balance billing
Surprise billing
Facility fee
Provider fee

[Marthe48]

1. And that's just page 1

[MOMFUDSKI]

2. It is a joke.

I just spent days and a bazillion phone calls trying to get an appointment for MRI and EMG. My great insurance agent helped me out and admitted “they” don’t make anything easy. Comes down to the almighty dollar.

[Rebl2]

7. Just a question

When I have had to have an MRI or other procedure, the doctors office usually helps set that appointment up. The only thing I don’t get help with is mammograms. I have to do that on my own, and where I go it’s usually easy to make an appointment.

[yellowdogintexas]

27. the mammogram center I use books my appointment for the

next one during my checkout.
About 6 weeks out from the appointment, I get text reminder

[Joinfortmill]

3. Holy shit!

[maspaha]

4. Can I add...

Pre-approval
Pre-determination

The difference cost us $12,000. Bastards.

[Rebl2]

8. Been there

Luckily it wasn’t nearly that much.

[twodogsbarking]

5. Death.

[Mister Ed]

6. And the worst of them all, in my view: using the term "health care" to mean "health insurance."

"Health care" is what your doctors and their staff provide. What your insurance company offers is - obviously - not "health care", but health insurance.

[pandr32]

11. 100% this.

[CousinIT]

22. Except for Medicare/Medicaid, the entire system is simply "wealthcare"

Since it's for-profit and designed to deny care and keep billionaires wealthy and sate stockholders.

[peppertree]

9. We've rejected single-payer health care in favor of surprise billing health care

Qué será.

[KS Toronado]

10. Unless I missed it, Doctor, Hospital, Emergency Room wasn't on the list.

[Scottie Mom]

12. Let me add one term that irritates me to hell and back.

"Primary Care Physician"

Care???? Hardly!!! This is a medical gatekeeper to prolong as much as possible the treatment a patient really needs so that the insurance company does not have to pay a higher price for treatment that is really what the patient needs. It's not necessarily the PCP's fault -- it is most likely the insurance company which only resorts to what the patient really needs unless there is a ton of pressure put on them.

I have a hereditary condition of my hands and feet and the F'ing insurance company dicked around for so long as they could that Medicare actually sanctioned them without me having to get involved. And...what did the insurance company do? They wrote me a nasty letter about "how dare you" report our good judgment to Medicare. I sent them the letter I received from Medicare. Think I got an apology???? Nooooooooo...!!!

I hate these people and the delays these assholes put you through to actually see someone who can help you.

[Farmer-Rick]

16. Wow, what entitlement

We did something awful to you, how dare you report us. These wealth extraction corporate tools think we should just turn over all our money to them, then thank them for kicking us.

[BComplex]

17. "wealth extraction corporate tools"!!!! WEALTH EXTRACTION CORPORATE TOOLS!!!! Perfect meme!

That is what the corporate overlords in this country have paid for through ownership of elected politicians. I'm saving this one, Farmer-Rick!

[Scottie Mom]

24. I didn't report them to Medicare.

I'm not sure how Medicare got involved, but they did. I am thinking that some patient rep at the facility made a complaint...but I don't think I will ever know how who made the complaint...but I am very thankful.

Seems like a founded complaint to Medicare -- the shit hits the fan.

LOL, another time I did not get what I wanted and I send a letter to the home of the CEO of the company. The name of the CEO is easy to find...it's getting the home address that takes a bit of searching.

Got what I wanted less than a week later.

[Farmer-Rick]

26. Hehe way to get the CEO to do his job

I once thought I might have a gas leak. So at midnight, I called the propane company that I buy my gas from and from whom I rent my 300 gallon tank. I got a recording that said the company had been sold.

So I do a little research and find out the company who bought it. It was a company in the Netherlands. So, I call the number listed for the CEO. I get transferred 3 times and end up talking to a very polite woman who speaks English with an accent. I think it was morning there, it was 2 am my time....I was very worried.

Of course no one could help me. They had all sorts of excuses. So, I told them if my house exploded or I'm injured from this gas leak, I would hold them personally responsible and my children would bring a law suit.

In less than an hour, a guy from the gas company shows up with a gas detector. We found the leak...it wasn't propane though, it was my septic system gone bad.

Keep fighting the good fight.

[MOMFUDSKI]

21. My agent told me whenever a Primary

refers you to a Specialist the ins co takes “points” away from them. Their job is to keep it in house. I fired my Primary for refusing me a referral to a specialist.

[Scottie Mom]

23. I absolutely HATE the primary care system.

A simple matter that a specialist could treat and remedy goes untreated for months because of this bullshit.

There is NO excuse with the profits health insurance companies make to deny immediate coverage for a matter that a PCP should not be handling. It is not rocket science to understand that a treatable problem can become permanent if there is a delay.

Fuck insurance companies.

[Artcatt]

13. US healthcare's purpose is to enrich those who run it

[lastlib]

14. ...through collecting premiums and denying claims.

Why the HELL we even ALLOW for-profit health insurance in this country absolutely mystifies me. But I guess your definition explains it.

[Farmer-Rick]

15. That's how it works with capitalism

With competition, corruption and lying about products, shoppers have to be somewhat savvy about the product they are buying to avoid being overcharged or sold a fake.

Look at all the info you need to know just to shop for wine, a car or a house. So, now we have to be experts on healthcare insurance and medical care because our medical needs have been thrown into the "free" trade, "free" market economy.

I think using the same system that you use to buy wine, to buy a life and death need like medical care, is nuts.

[Hugin]

19. Especially, when figuring this stuff out happens when one is incapacitated...

or at the very least experiencing one of the most stressful situations of their lives.

It's criminally, inhuman.

[Hugin]

18. Of them, "coinsurance" is in my opinion the most laughable...

What "coinsurance" is referring to is the amount YOU the insured pay. Which in my experience is what the service actually costs for supplies and labor.

The amount "insurance" pays for is just moving it from one pocket to another.

[RANDYWILDMAN]

20. It's like they get paid to confuse the consumers

I wonder why

[Mr. Evil]

25. As I've stated before,

health insurance companies are nothing more than legal skim operations. They take what they need off the top and increase rates if necessary to insure (no pun intended) the perpetual influx of money. They only pay out just enough benefits as mandated by law.

As with everything involving giant corporations the shareholders and upper level management are protected first.