Health Coverage Exposed: The Truth Beyond the Policy

What happens when your healthcare safety net becomes a web of confusion and denial? Drawing from a personal experience fraught with misdiagnosed pain and unexpected hospital visits, I unravel the hidden influence of insurance companies on critical medical decisions. After multiple trips to the emergency room, a diagnosis of gallstones finally emerged, but not before raising questions about the role of insurers in delaying necessary care. This episode also reflects on the recent passing of UnitedHealthcare's CEO, sparking a timely conversation about the often unseen impact of insurance policies on our health outcomes.

We tackle the harsh reality faced by many who believe they're covered only to find themselves unprotected when it matters most. The emotional exhaustion and uncertainty caused by inadequate coverage demand immediate attention. We urgently call for transparency and accountability from healthcare insurers, recognizing the weight this bears on grieving families. By spotlighting the prevalence of insurance fraud and the need for clarity in coverage, we encourage listeners to examine their options closely, ensuring their healthcare plans truly serve their intended purpose. Prepare to rethink your approach to healthcare coverage and join us in advocating for honest and reliable insurance practices.

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Chapters

• 0:13 Healthcare Insurance Denials
• 6:55 Reviewing Health Insurance Coverage

Transcript

Speaker 1: 0:14

Yes, it's another day and another episode of what Part of the Game is that? This particular episode that I'm going to do today was originally meant for almost a year ago, for almost a year ago, and I didn't do it because I like to bring about information that will help the masses, things that will help and bring to light information that would help many people and not just a situation between a single individual. Well, last year, this is how the story went I had to leave work several times, three times to be exact, because I was going through some major, major pain. Because I was going through some major, major pain and I went to the hospital the first two times and it seems as though the doctors could not find what was going on. Then, the third time, I had this episode, which was about probably three, four months after the second one, I left and immediately went to the hospital. Again, the pain is getting increasing, it's becoming even greater. I go into the hospital this time and they decided that they needed to do some CAT scans and all types of scans. So they did the scans and this time they come back with I had gallstones and that I needed an operation immediately and if I didn't have it, the gallstones could move and it could be a life or death situation. So now I'm faced with a life or death situation. So now I'm faced with a life or death situation gallstones that are beyond the possibilities of being dissolved and must be removed by having your gallbladder removed and I'm like, wow, I never had a a. Well, I have had one other major operation, but this was slightly different. You know what I mean. This seemed to be uh, you know I'm not too keen on having operations. Anyway, I sat for about an emergency room for roughly about six hours before I finally contemplating on whether or not I should get this operation before I finally made the decision Okay, you know what, go ahead and do it. So I go, I get this operation done, I come out, I'm on recovery for about six weeks after the operation before I go back to work.

Speaker 1: 3:18

When I go back to work, I'm talking to my superiors and the boss and you know we're discussing. You know how I'm feeling and what I went through the whole episode and I was telling my boss. I was like, you know, it's weird how I went to the hospital the first two times and they acted like they couldn't do anything or didn't know what the problem was. And it wasn't until a third time that they finally came up with what the problem was. So I was wondering was the hospitals the first two hospitals incompetent in doing their job? And this is what was flowing through my mind. But then my boss was telling me he says no, that's not the situation. You want me to tell you what's wrong, what happened? I said sure.

Speaker 1: 4:20

He says when it comes to dealing with insurance companies, you have people within the insurance companies that will make the decision as to whether or not a person gets a certain operation or not. As to whether or not a person gets a certain operation or not, and the first two times they had obviously denied, you know, doing certain tests or whatever at the hospital. And so for that reason you were sent home without being diagnosed with whatever problem you had, which was the actual gallstones. And he says this happens because you know they don't want to pay that money. And I was like, wow, and I wanted to do this episode a year ago. But I was like, well, you know it's kind of isolated. I'm not trying to do a personal episode about my experience in the hospital because everybody goes through. You know I can't say everybody, but a lot of people go through situations in the hospital and that sort of thing, but maybe not necessarily the same situation that I went through. My goal, once again, is to enlighten people on situations that affect the masses so that we all will be well aware of what's going on.

Speaker 1: 5:47

If this happened a year ago, what prompt or prompted my decision to do the episode now? And, as you may know and I'm not sure if this is the reason why, but we had in New York the CEO of UnitedHealthcare was killed, gunned down. Now I don't know why that was and I don't know the full details, but if someone was mad at the healthcare system because of the way it operates and its logistics and how it makes a decision and its strategies on what it should do and what it should cover people, you know they work hard. You know they work hard. You have jobs that you're told that you have coverage, only to find out that once you get sick it's not covered. You know what I mean and I'm sure a lot of you know.

Speaker 1: 6:56

Healthcare companies probably get sued because you know people thinking they have coverage and you imagine if you know your loved one gets sick or something and you think you have coverage and then, let's say, the loved one passes away on something that could have been, or should have been, covered. You know this is a sad feeling. It puts people through a lot of trauma and you know, you know we got to find a better way, guys, because you know, they say you, you know insurance scams and insurance fraud and all this. It seems like there's just as much insurance fraud on the street as it is within the company itself. There are probably more insurance fraud and scams within insurance companies than it actually is on the street.

Speaker 1: 7:55

Not saying it doesn't exist on the street, but I'm just saying, come on, guys, people should understand in full detail what their health care coverage will cover and how much it will cost to cover it, and stop playing these games with these fancy names of health care if it doesn't serve no purpose. You know you're supposed to come out with all these different type of health care plans for the people and so forth and so on, and it's it's not worth the papers written on, and so, with the things that have been happening in the news lately and what I went through in the past year, start taking a second look at our health care, our health care coverage and who we have to cover us and what it's actually covering. And that's my message for today. Yeah, that's my message, and this is your pod host, og GOAT, and I'm signing off.