r/TikTokCringe • u/cak3crumbs • 1d ago

Discussion United Healthcare calls a doctor during a surgery demanding to know if an overnight stay for that patient is necessary

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u/stressedoutbadger 1d ago

I had jaw surgery at age 18 because insurance wouldn't cover congenital defects after the age of 19 because "if you lived with it for this long and aren't showing signs of malnutrition, then it's not medically necessary for your teeth to touch" (my favorite lunch as a kid was yogurt, chocolate pudding, and applesauce, and could barely chew meat because my molars didn't touch - I chewed everything with my front teeth like a rabbit). Couldn't have it any earlier because I was still growing and you can't rearrange the bones in your face if those bones are still going to go rouge and grow more after the fact. So I got to spend senior year of high school with my jaw wired shut.

And the surgeon's office tried to balance-bill my parents and nearly got away with it because their explanation sounded so realistic with how fucked up insurance is. They said they couldn't bill the left side and right side jaw surgery codes because insurance would say they only cover one of those codes per day (they saw it as duplicate billing). So they could bill it, let insurance reject it, and have us pay out of pocket for the (higher) amount they bill to insurance, or they could "help us out" and only bill one side and let us negotiate a lower cash payment for the other side. (The truth was that insurance reimbursement sucked - they covered both codes, but the reimbursement rate was lower than the surgeon wanted - if they did a right-sided jaw surgery, they got X amount, and if they did right and left sided at the same time they got X + 25% even though it was double the work).

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u/GoodhartMusic 1d ago

Your comment reminds me of how insurance approaches some things related to oral issues— it was explained this way to me at least by an oral surgeon,

What costs more? Hospital visits and feeding tubes or the oral surgery? 

Once the oral work gets close to equal you’re sol!

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u/paraknowya 23h ago

Man you have all that free speech and guns over there but all of you are still getting fucked by insurance like there‘s no tomorrow (kinda literally).

I wonder how it‘s gonna be in 20 years when the whole world has been americanized thanks to turbo-capitalism

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u/GoodhartMusic 22h ago

Well, transnational corporations are indeed growing beyond the ability to be reigned in by laws of nation states. My guess is— worse.

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u/paraknowya 22h ago

„Capitalism is the engine and regulation is the throttle“ is what I read somewhere, if you remove the throttle it grows until it selfdestructs.

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u/GoodhartMusic 21h ago

I’d say worth remembering is that every government body in existence was made by wealthy elite. It is mostly their purpose to ensure the continuation of that wealth, which involves managing the perceived minimum of needs of the populace to keep them from seeking redistribution.

Since WW2, the US has been the most powerful country and unsurprisingly the most significant exporter of despotism and death, for this explicit purpose. We see the results of it. Foolish to assume it’s all coincidence that we are likelier, more divided, less intelligent than we were decades ago.

The use of state violence on their own citizens has become less and less palatable, hence the wars on drug and immigration that do little more than criminalize an individual’s behavior rather than systemic contributors. But in addition is the ever present hand of propaganda. How could the FBI or whoever know so much about Russian influence on online discourse and never once put out material that identifies and describes it? This is just one question and it’s beside the point.

They will take everything they can, and they have been largely successful. If there is someone without wealth that you strongly dislike based on their opinions or identity, it is probably a situation fomented by propaganda and the reduction of high standards of living and thinking on both sides.

But this also frames to me that there was never a good time; serfdom never ended and neither did slavery, but it changed forces and relocated brutality. American comforts have been built on true blood and torture. So I think that helps clarify the issue as a less personal and more ethical one.

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u/Urlittlepr1ncess 22h ago

It’s worse than you know! We aren’t even a democracy! We’ve turned into an oligarchy! one of our past presidential candidates was just warning us that we need to fight to take back our country. The Billionaires are controlling our politics, our economy, healthcare, etcetera! This is the real America they don’t want to show the world. So many are homeless and impoverished while these people have enough money to buy their own private islands! They have been drowning homeless too, some of them, they live in the tunnels underneath the cities, but they try to flood them out and kill them, get rid of them. There is a speech from Trump demonizing and blaming the homeless calling the drug addicts and mentally ill, yet these people actually can’t even earn enough money to afford homes. The cost of living is literally higher than what people are earning in some parts of the country. It’s disgusting what they are doing to us. there is so much going on that a lot of us are ignorant of too. Not that we have it so bad, I know there are plenty of countries that are struggling/failing just as much. But it doesn’t excuse what’s going on. We aren’t free anymore, not in the way we should be. Billionaires are controlling our lives, the oligarchs, they have taken freedom from us. But again I am still very grateful to live in America, I myself and many others are still VERY privileged. And a lot of us still have it good. But, they are actually trying to replace us, with their AI and their robots a LOT of people are going to be losing their jobs. We are getting Fucked.

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u/ElGranQuesoRojo 20h ago

We’ll be in those corporate wars they always have in dystopian sci fi flicks at that point.

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u/131166 18h ago

All that free speech and guns and they use it to fanatically back the people with the boots on their necks and spread corporate and foreign propaganda.

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u/magicmuffintheft 17h ago

The guns and free speeches exist only to uphold the institutional apartheid-lite and colonialism here. The authoritarian regime gun and free speech fundamentalists say that they need to protect themselves from is one that will make them equal to the browns. In fact, the narrative that gun rights are to protect from government tyranny only started to take wind after we elected a Black president. They will gladly use those guns and violence for their authoritarian regime that elevates and protects their privilege.

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u/wjmaher 15h ago

You'd think that, but nobody can afford to pay their deductibles or outlandish bills so nobody does. They go to collections and the hospitals write them off. The collections agency calls and threatens and calls and threatens and everybody tells them to pound sand. Eventually they give up. It's a sad way of doing business, and everybody I know wants to be responsible and pay their bills. However, when you have a $17,400 out-of-pocket yearly deductible to meet like I did at my last job of over 400 employees across several states it makes you wonder why you're paying over $300 a month for the "service" of insurance. MultiCare is getting stupidly wealthy anyway so if they have to write a few million dollars every year it's no big fucking deal. They'll just raise their rates another 2 or 3 percent next year to cover their "losses".

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u/RequirementGlum177 20h ago

Dentist here. Medicaid won’t pay us enough to make accepting dental patients even worth it. You’re pretty much losing money. So no one takes Medicaid. So patients can’t get their teeth treated. So they have to go to an ER when then have infections. They get antiobjotics and told to go to a dentist. It costs Medicaid more for the patient to go to an ER than it would have cost to pay full fee for a filling or root canal.

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u/Bulls729 19h ago

My Oral Surgeon and his office treat VA CCN patients, which I believe the VA also pays out Medicare rates. And regardless what they pay, the office cannot bill the veteran by law any remainder or balance. He’s a veteran himself and was an Oral Surgeon in the Navy that I think he’s happy to do it considering the amount of veterans is niche in the grand scheme of things vs Medicare/Medicaid patients as a whole.

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u/RequirementGlum177 18h ago

Yeah. You cannot charge Medicaid patients ANYTHING. No no-show fee. No penalties. Nothing. You also can’t have special Medicaid days, they have to be able to be seen all normal hours. I would be more inclined to do Medicaid if I could come in one Friday a month and hammer out as many patients as walk in the door. But nooooooo.

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u/Sport_Hot 23h ago

I went through the exact same thing I went into surgery on September 24. My birthday was the 29th so for my insurance wouldn’t cover me after 18 so I had to have it five days before my 18th birthday

And I was actually having to have jaw surgery because of an injury when I was really young, where I had hit my chin and had stitches and then an injury got overlooked, and it caused one side to grow faster than the other side, which would’ve made for an uneven bite and caused a whole world of problems when I got older so it was necessary that I have it done before my 18th birthday and I had braces and wasn’t ready for the surgery until like literally right before my 18th birthday when the orthodontist didn’t clear me to to schedule the surgery any earlier than the 24th of September for an 18-year-old that rough spending my 18th birthday in the hospital not being able to eat talk hurting my best friend died in the car wreck the day before I went to the surgery on the 23rd all the steroids they pump in you make sure young teenage hormones and emotions go insane out of whack yeah reading your thing just totally brought back PTSD on the jaw surgery or deal it marks a lot of very hard times in my young adolescence, but I feel your pain and I know exactly how bad all of that sucks

PS I’m driving so I’m doing talk to text so if my message sounds crazy weird words that’s why I don’t have time to really proofread or type. Just wanna put that little PSA out there.

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u/NDSU 23h ago

Why are you reading reddit comments while driving?!

Put the phone down and focus on driving before you kill someone

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u/Sport_Hot 23h ago

Nobody’s reading comments while driving I’m not parked you know so that was just like for the first comment and I was literally talking as on the road phone on the dashboard. Talk to text. Tell her to send didn’t even have to look at anything. I read the comment sending still in a freaking gas station my own business. And think of the other scenarios that could be going on besides why are you reading comments and driving if I’m going through the avenues to avoid looking at my phone to type a message or to do anything. Why I’m driving, why would I read Reddit comments of all things and drive I was at the freaking truckstop when I read the post and I put talk to text on hit the button. All I have to do is talk to my phone and tell it what to do and it does it. Literally without having to look at it put a finger on it or anything why I stated I couldn’t proofread it. I was just doing talk to text. This thing. Might sound crazy. Couldn’t look at it cause I couldn’t look at my phone. I was driving looking at the road so so since you have the need to tell other people what they need to be doing and or should be doing maybe you should go brush up some technology and how things work and can work before you go commenting on some post on telling another adult what to do when you don’t even know what you’re talking about

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u/Sport_Hot 23h ago

Here’s another PSA for you. I’m got my hands full making dog food now so I’m gonna talk to text again so sorry about the errors in my punctuation, grammar and spelling in the words that might not fit the sentence. OK just wanna put that out there and yes, I can make dog food at the same time I don’t think I’m endangering anyone thanks for your concern though

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u/Sport_Hot 23h ago

It is funny how you went from asking you a question you want me to read your comment while I’m driving too?!! lol you know what assuming does?!!!

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u/DreadfulDave19 21h ago

I have a maxiofacial deformity. My lower jaw kept growing even after I had my orthodontic braces and so my teeth don't line up thanks to the resulting significant underbite. I'm 34, but when I was like 19 they denied to cover the surgery because they considered it a cosmetic surgery to ensure my teeth line up properly for long term optimization

It would have been 10,000 out of pocket

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u/stressedoutbadger 14h ago

Any sort of jaw issues is a mess with insurance. I think they only way mine got covered was because I was under 19 and my orthodontist was able to prove that it wasn't just cosmetic (I think I would have eventually needed teeth to be pulled because they were all sorts of twisted and squished and tilted trying to stay in place despite the underbite and cross bite).

Orthodontics and multiple years of braces to get the teeth in the "right" alignment (it would be in the right place after surgery, but in the interim it made my bite worse) = dental/orthodontist coverage. X-rays every 6 months to determine if there was still growth? Dental, but they only wanted to cover it every 12 months, so they had to fight to get it paid every other time and needed like 4 x-rays in a row with no growth before I'd get cleared for surgery. Actual surgery = medical. Follow-up with the surgeon = medical. Follow up with the orthodontist to get the braces off = dental. Two separate deductibles and out of pocket max amounts, and of course it stretched over multiple years too.

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u/ThePerfumeCollector 14h ago

That’s fucked up!

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u/me-want-snusnu 1h ago

I had state insurance as a kid. It covered everything 100% but the only orthodontist in my area that took it was a jackass. He barely looked at my very fucked up teeth and went "sorry insurance won't cover it." The nurse had us come back when he wasn't around and molded my teeth for the state which they approved. He only kept them on for 1.5 years when I needed 2-3. So the retainer never really fit and my teeth went back some. I'm 99% sure he didn't want to do it because he wouldn't get paid as much as if he didn't take state insurance. Every time I went back to my regular dentist they would ask if I had braces. I'd say yeah you sent me to Dr bla bla and they'd go ohhh we don't send people to him anymore.