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Comment by projectileboy | Hacker News Reader

I’m 51 and had this conversation too many times to indulge this. All I can say is that I wish you luck if you or your loved ones ever have a serious medical issue in the US. And you may be lucky. Or you may spend years on telephone calls trying to get a pharmacy benefits manager to send you the prescription your doctor prescribed. Or calls with your insurance company to get them to pay what they are supposed to pay.

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Yeah been there with my partner. She spent at least two days a week on the phone with the insurance company from 2021 to January of this year. Private insurance is the worst, and open enrollment is terrible. We should’ve outlawed employer-provided insurance but required employer stipends for insurance and forced everyone to buy through the marketplace with open enrollment once a month. As a patient you have zero control over your insurance while your employer has no incentive to get good insurance.

I have a close family member who has had multiple significant surgeries, and it was all covered, and they didn't pay a penny over their annual out-of-pocket maximum.

Maybe the difference is that it was all "elective" and therefore planned out weeks or months in advance, with ample time for insurance pre-approvals?

I've had a harder time getting reimbursed for psychotherapy than they had getting covered for their surgeries.

Interesting, I’ve had somewhat similar experiences. Big one-time events were handled no problem. But chronic illnesses have always been a nightmare - for my daughter to get her meds, she pretty much has to have the same chain of conversations once a quarter with doctor, pharmacy benefits manager, and insurance. PBMs are the worst though, by far.

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