The whole medical industrial complex.

Wife tears up her knee. We go to the best regarded ortho for knees in the area. He does exam tells her she has a torn ACL and torn cartilage. Tries to schedule surgery and insurer won't approve it until there is a CT to prove it so we have to pay for a CT and surprise surprise she has a torn ACL and torn cartilage.

Wife has lower right quadrant pain, slight fever. Her doctor pokes around on her belly declares she has a hot appendix. He calls a surgeon and they are going to do the surgery in two hours at 1pm. While she's being prepped surgeon's PA pops in and says the insurance company won't authorize the surgery without a CT. So we wait until they can work her in, then wait for it to be read finally get the green light and has surgery at 4:30pm. An extra 3:30 of waiting an extra test and an extra doctor paid.

I take a migraine medicine that recently went off patent. While it was on patent I was paying over $200 for nine pills. When I had met my deductible I paid only $60. BUT HERE IS THE KICKER. The drug company offered a coupon program. Sign up and they offered a $10 co-pay later $4 if I had met my deductible or a $100 discount if I hadn't. So they were charging my insurance company like $240. So I'd pay $60 and insurance $180 if my deductible was met. With the coupon, I paid $4 and insurance $180. If I hadn't met my deductible instead of paying $240, I paid $140.
Three people on the same insurance in line at the pharmacy buying the same drug could result in the sale price being $240, $184, or $140 depending on whether they had signed up for the program or met their deductible.

I have seasonal asthma and once had pneumonia. Go to my doctor for annual check-up. My doctor suggests a pneumonia vaccine and says "I don't think we can give it to you today." Nurse pops in and I ask why I can't have the shot today. "If we give the vaccine during a regular visit, insurance will deny the charge for the vaccine. It has to be at a different time, they are hoping you won't get around to coming back for it."

Specialists can be hard to see. Husband of one of my wife's friends fell on the ice and hit his head. He was diagnosed with a slow brain leak. Told him to go see a neuro. Earliest appointment he could get was in 8 weeks. In the meantime "take it easy, avoid lifting and if you get a really bad headache or dizzy and start vomiting come back to the ER".

Wife was seeing a neuro they thought she might have epilepsy or a form of narcolepsy. Six weeks to get in for the first visit. Do a few tests, things are odd but don't fit anything exactly. For one test I have to prepay the hospital $600 then the test gets cancelled. Wife then has an unrelated issue goes to the hospital. Finally going back through all the bills I realize they are still holding my $600. Call the hospital, "Oh we hold that as a credit to apply to any other bills you have." I tell them that's really odd because it didn't get applied to her last visit. Lady says, "Oh so what is it you want? You want us to mail you a check?" I tell them yes I do since they weren't really using it as a credit against other charges.

The neuro dumps her off on a PA. They try several different medications over several visits and then I notice that the last two visits were billed as if she had seen the doctor instead of the PA. Call the clinic, they tell me I'm wrong, I tell them I am more than capable of distinguish between a 55ish year old man and a female in her mid 30's. They won't correct. So I call my insurance company and get a few bucks back from the extra I had paid but we aren't welcome at the clinic any more.

Now an insurance company is trying a pilot program where they will deny your claim for an ER visit based on the final diagnosis, not the symptoms that brought you there.

Have chest pain and shortness of breath but it turns out you have a really bad case of heartburn and not a heart attack? Denied
Left side weakness and loss of vision on the left and it turns out to be a migraine instead of a stroke? Denied.
Article linked, pain from ovarian cyst consistent with appendicitis? Denied. My wife has dealt with both and the cyst hurt much worse than the appendicitis.
Now they eventually paid for the lady but only after two appeals. Not everyone will be sharp enough to keep fighting.
https://www.vox.com/policy-and-politics/...ppropriate

Doesn't matter if you have symptoms that warrant an ER trip, you have to correctly determine on your own whether the symptoms are caused by something requiring urgent treatment or not, guess wrong and you are on the hook for thousands of dollars or choose to not go because you are afraid you will be stuck with a large bill, then have a heart attack, stroke, or ruptured appendix that will require even more expensive care... if you survive.

Beyond all that crap, treatment is often a mess. My mother broke her hip and she has Alzheimer's. Nurse left a tourniquet on her arm after a blood test for six hours. Her gown hid it and she was uncomfortable but couldn't process to tell us what was going on. Discovered it by accident. Later fell when she tried to get out of bed because they forgot to put the rails up. All in 24 hours.

For my wife it turned out she had autonomia and doesn't breath enough and heart doesn't beat enough when she sleeps. The heart issue resulted in several clots being thrown. Several instances of ischemic colitis and one minor stroke. First time she had ischemic colitis (essentially a stroke in the colon) nurse suggested that her report of shitting blood was from her period starting. Wife says "I know the difference between my ******* and my ****** and I've had a hysterectomy". Then well it was gastritis so gave her a GI cocktail and came back and in a vile and disgusting fake sweet voice chirps "Well feel all better now?" No I feel worse. Only then did the effers take it seriously. Finally got a gastro in and looking over the file says "Why did you take aspirin before coming in the ambulance?" Tell him the way she was acting I thought it might be a stroke or MI. "Well you probably saved her from wearing colostomy bag."

There are some incredibly great doctors and nurses out there because I've dealt with them.

But the entire business side of medicine is a damn cancer on the country.