this post was submitted on 26 Jun 2023
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As someone who's been put through the wringer by a job before a lot of what this employee is saying is familiar to me. There's a couple details of the story I'd like to focus on, though.
Why is this even a thing? The guy got his prescription, who is a private company to tell the guy his doctor's prescription is wrong?
This is why we must fight against the privatization of our healthcare. Financial arguments aside, is this really the future anyone wants? Where the treatment prescribed by our doctor is unavailable to us because a private entity who's primary motivation is profit will do whatever they can to weasel out of having to provide that treatment?
Back to the topic of the article, this is about what you can expect to hear if you do get into a burnout situation. For all that mental health gets talked about in this day and age, the reality is, your health is only of interest to the extent that you're able to be at work and do the job. In terms of your long term health, most bosses aren't going to care about that. Whatever it takes to get you back on the floor so they can squeeze those last drops of juice from you.
I don't know when insurance companies figured out that just saying "you're not sick" to anyone making an insurance claim is an excellent cost-saver.
We've got to legislate that out or initiate a class-action lawsuit.
Insurance companies don't make money by approving claims. The job of a case manager or insurance adjuster is literally to tell you that you aren't covered, as much as possible, as often as possible.
To that extent, health insurance providers have their own doctors on staff, who will give evaluations that are favorable to the company. You agree to be evaluated by the doctor as part of your policy contract. This has been going on forever and that's why insurance providers make money.
Am a doctor and while I agree this is shady AF and should be further controlled, we do at least have some requirements. An insurance company has to use a licensed doctor, so their privately funded third party opinions don't usually come from someone employed by them; just chosen by them. I've actually never had an outside opinion requested by insurance that overturned my initial diagnosis, and many times they actually help with new treatment suggestions.
What happens in my experience is that if they want to keep dragging it out, which they always do, insurance will just continue to try to claim that the original doctor and the outside party requested by insurance don't really know anything and actually Karen the Case Manager at Manulife is the real expert. I've had that happen three times in the last two years. Frustrating though it was, the scathing letters I got to write to the company were sort of cathartic.
I think a very good start for all of this is that we should be generating the terms and paperwork at a provincial level and requiring all insurance companies use the same forms. You want a doctor to fill out your paperwork? Use the paperwork we've agreed on then. The first way they start miring people down is by sending out twenty page forms asking for every little detail of your medical history regardless of the claim, wasting huge public resources from doctors. From there it would be easier to standardize practice for insurance companies so that we have more ways of holding them accountable when they try to claim that the provided evidence is sufficient.
Edit to add: I don't know if most people realize this but a lot of the time once the doc has given a diagnosis insurance isn't actually trying to refute it. They're trying to drag everything out until the patient is too exhausted or broke to fight anymore. It often works, they're forced to go back to work because otherwise they'll starve. Insurance doesn't have to prove anything, just delay.
Similarly, insurance will cut off long term disability claims when there's no end in sight because it's cheaper for them to pay out a settlement than continue to pay LTD indefinitely.
All it takes is one person to get pushed way over the edge and weβll be back to work place shootings