My husbands suicide shows theres something very wrong with US insurance industry

https://www.statnews.com/2026/07/20/psychiatric-insurance-coverage-suicide-denial-personal-essay/

by Jimmc414 • 2 days ago

153 105 2 days ago

petilon3• 2 days ago

Yes, there is something wrong with the insurance industry. But there is something wrong with the hospitals, doctors and drug companies too. The whole system is broken. Hospitals try to eke out the most out of insurance companies, often providing services that are unnecessary. Pharmaceutical companies charge US patients significantly higher rates than in other countries. Don't put all the blame on insurance companies.

goda903• 2 days ago

Randy needed immediate psychiatric care, and as an emergency physician I knew the options. We put our trust in the mental health team at a local crisis receiving unit, and they kept Randy overnight in temporary safe housing where he could be observed. By morning they had devised a plan to transfer Randy to a retreat-like inpatient psychiatric facility that was in-network with our insurance. The psychiatrist felt Randy was very high risk, but that he could heal with eight weeks of inpatient treatment. We were told our insurance would cover it.
But six days into Randy’s eight-week hospital stay, our health insurance company denied any further inpatient care.
The facility appealed Randy’s case, providing psychiatrist’s notes that clearly outlined his need, but the outcome did not change. Because Randy had no prior history of mental illness, the insurance company determined he shouldn’t need to be hospitalized and stopped paying for his care. A day later Randy was forcibly discharged.

This is definitely a case where the insurance company holds the majority of the blame.

rayiner4• 2 days ago

This is definitely a case where the insurance company holds the majority of the blame.

What facts are the basis of your conclusion? There is no health system in the developed world where a doctor's recommendation will guarantee expensive inpatient treatment without a layer of bureaucratic review.

EvanAnderson4• 2 days ago

Every player in the US healthcare / health insurance "system" has adapted to the regulatory niche they play in.

If Americans had the fortitude to have grown-up conversations about what should be socialized, how care should be rationed, etc, the public could exert some control over the design of the "system". As it stands, the "system" has mostly been shaped by corporate interests while the public has been distracted by inflammatory rhetoric pumped-out by all the entrenched players designed to play to partisan feelings about "fairness" and "freedom".

toss13• 2 days ago

The insurance companies are running the system more than any of the others — it is the finance "wizards" there who put the constraints on the rest of the system. I'll agree somewhat on the pharma companies too, who are also extractive.

You even said it yourself: "Hospitals try to eke out the most out of insurance companies...". Exactly! Because the hospitals and doctors are constrained to do "WHAT IS IN THE BEST INTEREST OF THE PATIENT" — that is their charter (and BTW, that is also the magic phrase to use whenever questioning what they propose to do for a patient or escalating a case). Perhaps a few hospitals or physicians occasionally overdo it, and there are some frauds, but your accusation overall is BS.

The insurance companies have no such constraint — if they do have such a mission goal, it is to OBTAIN MAXIMUM VALUE FOR THE SHAREHOLDERS. And the insurance companies are literally so amoral that they will reward agents for killing people for profit. That is not rhetoric, it is sworn testimony before congress of a person who cut off a patient's coverage, causing their death, and got promoted.

I have seen directly and personally an insurance company deny coverage for a test ordered for a close family member by the Chief Of Cardiology at Mayo Clinic. Mayo Clinic, and that physician are so overbooked they have ZERO motivation to order anything not necessary for the patient in front of them. It took days, and significant extra expense to get it reversed.

There is no way on the planet that anyone in an insurance industry should be able to override the doctors orders of the Director of Cardiology for Mayo Clinic. Or any physician, for that matter.

Medicine is one of the things that should never be run for a profit, and if I were on Luigi Mangione's jury I would acquit on Jury Nullification.

petilon3• 2 days ago

An itemized bill from the hospital for about four weeks of his hospital stay. It came to a little over $4 million. https://www.cbsnews.com/news/covid-19-deaths-families-60-min...

Woman charged $143,396.66 for a breast biopsy https://www.marketwatch.com/story/a-doctors-prescription-to-...

Numerous studies have found that when doctors have a financial stake in a hospital, they tend to order more tests and procedures, raising costs for Medicare and other insurers. https://www.nytimes.com/2011/12/13/health/policy/republican-...

elevation• 2 days ago

John Stossel explained in _Give Me A Break_ that the US once had a variety of pharmaceutical labs researching different cures and conducting trials. But US courts allowed a frenzy of frivolous lawsuits to extract astronomical payouts on behalf of former trial participants, even demanding payouts from the companies that stocked the supply and janitorial cabinets of research companies. One by one, we bankrupted our competitive machines of innovation until the few remaining pharmaceutical companies had grown large enough to defend themselves against injury claims. Big Pharma was created by lawyers.

often providing services that are unnecessary

Thank a lawyer. "Patient with symptom X would have survived if only the doctor had tested him for Y". Now every patient with symptom X is issued a $5600 scan for Y -- not because of medical science, but because of liability. Every time a courts awards 10 figure settlement because "that insurance company is good for it," all of society pays for it.

a34729t• 2 days ago

Our country is run by lawyers for the benefit of laywers. This explains much of what we see around us.

insane_dreamer• 2 days ago

the problem is healthcare is run in a capitalist "free market" model, in which all actors are incentivized to increase their profits at the expense of the other actors, and where the patient is either a customer or a commodity

it's inherently the wrong model for providing a necessary feature of life (health), and combine it with a highly litigious society, and well, this is the result

recursive3• 2 days ago

This is a far cry from the gravity of the post, but here's my personal anecdote about trying to navigate health care and insurance.

A month or two ago, I was trying to set up a pediatric dentist visit for my son. Not a medical emergency, but a matter of some urgency. I spent about three hours on a total of a dozen phone calls or so. Some to the insurer, and some to various dentist offices in the region to inquire about scheduling and logistics. I learned that I needed to switch my son's primary office before he would be eligible to receive care. This could only be done once per month. Fortunately, by luck, this would take effect at the close of business on that very day. Next I needed to find a covered provider. Of course, the insurer could not tell me which ones would have openings at short notice, so I had to call several. Then I learned that in order for a pediatric visit to be covered, it needed a referral from a general dentist. The pediatric office helped me find a dentist who could fill out this paperwork, which felt lucky. I verified that my policy worked with this dentist office. Several hours on the phone, but I had a sense of accomplishment for sorting it all out.

The day of the appointment came. The visit went smoothly. Then I found out that it wouldn't be covered because the insurance will not cover pediatric dentistry above the age of 6, but my son is 7.

I think I'm going to opt out of dental insurance altogether in the next enrollment. All the individual people seemed to be doing their best to help me, but the end result is a system that is impossible for me to use.

all22• 2 days ago

I've seriously considered opting out of health insurance altogether and stuffing away the obscenely priced monthly expense into an interest yielding account. Insurance is nightmarish, and I don't really want to deal with it much anymore.

I know this might appear foolish, but fighting with a corporation whose incentives are adverse to my own (both on the medical side and the insurance side) makes me a little sick to my stomach.

mothballed2• 2 days ago

I did that for much of my 20s and very glad I did. You are basically used parasitically by the Obamacare system as it caps the differential between young and elderly to the point it's well into the expected negative value, and you're young enough that the off chance of the bet going bad only results in declaring bankruptcy on a few years of professional salary.

EvanAnderson4• 2 days ago

If you have enough money for that gamble to pay off over the long haul the cost of health insurance would be immaterial to you anyway. You might get away with it in your youth, or you might have a catastrophic loss and have your finances wrecked.

You're often able to negotiate discounts for cash payment from providers, but back when I had insurance that excluded a pre-existing condition I ran into providers who steadfastly demanded the full list price (under threat of collections). It only takes one of those standing pat on a high 5 or low 6-figure bill to cause you to lose on your "bet".

mzs• 2 days ago

Similar story for our youngest - excuse after excuse. We just bought two round-trip tickets to Warsaw and paid privately. It was a little more but my wife and son got to spend time with friends and family for that extra. The effort we had spent in US we never got back. I hope it worked-out okay for your family as well.

usern20260720• 2 days ago

[flagged]

tracker15• 2 days ago

Fortunately, out of pocket for relatively normal dental care isn't too bad... probably because Dental insurance doesn't really help much and often easier to just pay out of pocket.. though do shop around if you do so.

starkparker• 2 days ago

Insurance refused to cover imaging to identify my spouse's squamous cell carcinoma on an ovary because initial bloodwork didn't come back positive for ovarian cancer (squamous cell required different bloodwork, at least at the time).

It took a doctor offering to misdiagnose it as a dermoid cyst to get the imaging and hysterectomy ordered and approved, and that still took 2 months. By the time it happened, the cancer had metastasized.

The imaging would've cost a few thousand dollars. The hysterectomy would've cost about $20k-40k. Chemo was unsuccessful, and she died 9 months and about $2 million in medical bills later.

OutOfHere• 2 days ago

Which insurance firm was this?

Fwiw, if one has a passport and some funds, one can travel abroad for cheaper surgery abroad. It won't guarantee an outcome, but it ought to be better than delaying it. Of course this in no way excuses the insurance firm.

BrandoElFollito• 2 days ago

In France, land of free helthcare, the problem is ultimately the same but for different reasons. We do not have enough doctors (they lobbied a law to set quotas) and finding a specialist is a near miracle.

Then the doctors complain that they are overworked because of what their seniors put in place.

The problem is never the money, though.

daheza• 2 days ago

As someone who just recently was re-diagnosed for active major depression after a major back surgery this article hits very hard. I recently discussed inpatient treatments with my psychiatrist too. I can understand what the husband was feeling... that the nothing of death was greater than the feelings of life. It's difficult to work with healthcare in general - add a mental issue on top of that and it feels impossible. You have to constantly advocate for yourself since each doctor will only do what is required for their subspecialty and you also have to fight insurance on the other side.

Specifically regarding mental related items are treated as lesser than physical issues. I have Kaiser who has actively been punished by the US Department of Labor [1](2026) [2](2021) for delays in behavioral health care and pushing for out of network therapist. They tried to push these therapist on me twice, both through RULA and it was really a terrible experience. The therapist literally ended my meeting 10 minutes into our discussion when I told him I hadn't finished reading the book he recommended. I am now with an in-house kaiser therapist that is working well. I worry about the psychiatric side of the house as well, they set me up to only meet with my psychiatrist once every three months. That doesn't feel frequent enough to get my medication tuned right.

I don't see this getting better in the future with the current leadership in the US advocating for a "return control to the patients" by reducing SSRI prescriptions. [3]

My only advice for people out there is to take their mental health seriously, if you are having suicidal thoughts talk to your doctor. It may end up being a difficult journey but its better than being alone.

1. https://www.dol.gov/newsroom/releases/ebsa/ebsa20260210

2. https://calmatters.org/health/2023/10/kaiser-permanente-cali...

3. https://www.pharmacytimes.com/view/announcing-new-initiative...

annzabelle2• 2 days ago

I recommend if you're looking into inpatient treatment and you're not an acute danger to yourself or others, look into partial hospitalization programs and intensive outpatient programs instead. I know Kaiser covers some at least in Virginia.

In my experience with family members, inpatient hospital stays at many hospitals in the US are one of the least therapeutic environments possible, and once you've gone through an ER or psych ER (which most of them make you do), you have no control over which hospital you end up at. In the end your stay is unlikely to be any more than 7 days.

PHP programs on the other hand tend to fill the role that work had previously taken in someone's life for a few to several weeks. They're typically 9-3, held in office parks, and are mostly quality group therapy with a daily or weekly psych visit.

JohnTHaller• 2 days ago

The goal of their insurance company is to make a large return for their shareholders. And, thus, a large bonus for the C-suite execs. Their goal is not to provide care.

In this particular instance, the insurance company saved money to give to shareholders and their C-suite by not treating the patient further. They lose no money by allowing him to die.

This is all by design.

ceejayoz9• 2 days ago

This happens with (theoretically) non-profit insurers, too. Like the BCBS networks.

zehaeva• 2 days ago

I nominally agree with this sentiment. BCBS does have issues like this happen, but not at the same level others, in my experience.

Anecdotally though, I've found that my current insurer (United) denies and delays care far, far, more often than when I had a similar plan with BCBS. And I'm not talking about small bills, my son was in the NICU for 41 days, at a cost of ~$150,000. Through BCBS I paid like a grand of that. United denies the most random things, a referral to a specialist, meds for on brand usage while they'll pay for other meds that are off brand, for instance.

I do have a platinum level plan, I am _extremely_ lucky to have this. I know the vast majority of Americans, most of my friends and family, fight with their insurance companies for far less than my complaints.

happytoexplain• 2 days ago

Yes, that's what people are referring to when they say "wrong".

tracker15• 2 days ago

I wish that rather than the closed govt medical programs we have... we simply funded a public, non-profit health insurance provider that is motivated by fiduciary responsibility, but not profit driven. While this may seem heartless as some would fall through the cracks, such as cases like tfa that wouldn't be covered, at least there would be more competition against the private insurance companies.

I'm not a fan of fully socializing medicine, but having a non-profit with negotiating power in the mix could only help.

mvdtnz• 2 days ago

Anyone who moans about the state of healthcare in USA should be required to reveal their voting habits. Collectively, America gets the healthcare system it desires, and deserves.

Lalabadie• 2 days ago

I've said a similar sentence on here in the past, but there's a large anti-tax sentiment in the US because their government is one of the most inefficient per dollar.

People are against paying for nothing, not against paying for services. There's just no confidence that the amount of services rendered can change away from "as little as they can get away with", so there's no enthusiasm for paying at all.

mothballed2• 2 days ago

The government is very efficient at redistributing your SS money from young broke workers to old more well off SS recipients. And at converting $ into guided missiles that blow up Iranian girls' schools. It's just that it's not practically possible to have "representatives" that actually represent the people in muh democracy in USA. See the massive unprecedent money that got poured in to make Massie lose his primary when he acted against the interest of Israel and to expose pedophiles in power.

pyuser5832• 2 days ago

I’ve been through this situation with family members. I understand the frustration and agony.

I also understand the hesitancy to pay for two months at a “retreat-like inpatient psychiatric facility.”

In publicly funded system, it’s likely facilities like this would not exist or would be strictly private pay.

I’m not aware of any country that makes such a thing available on short notice like this.

I also understand the frustration, as often times facilities like this are all that exist in terms of medium-term care. And often times some of their services are at least formally in-network.

The understanding is you pay for it by selling your house.

We’ve been tempted to do this (sell our house), but been advised against it - but the reasoning in our case is patient specific.

I wish insurance was clearer about what covered and what isn’t. I wish we had more mainstream (not retreat-like) medium term care places.

Maybe I’m misreading the phrase retreat-like.

But id this isn’t something a public system would pay for, it seems inappropriate to blame a private system to not pay for it, unless it’s clearly in the wording.

Regardless, mental health care in America stinks, and you can always argue over the details.

rayiner4• 2 days ago

It sounds like this guy needed around-the-clock, in-patient care. That's inherently expensive. While those facilities exist in countries with publicly funded healthcare, there's a huge shortage of in-patient beds, so there is some mechanism to funnel patients to outpatient care.

andrewinardeer• 2 days ago

My state has the beds available, but no staff.

orwin3• 2 days ago

For psychological care it isn't that bad. Probably because people will first get on anxiousness/depression pills, and convince themselve they are ok.

cwmoore• 2 days ago

Don't leave out jails, without insurance and significant funds, that's what democracy has decided for you.

az2262• 2 days ago

What gets me is that they probably could afford it out of pocket but didn’t want to deplete savings.

For a clear case like this, an insurance denial shouldn’t even be shared with the suicidal patient, their spouse should shield them from that and just pay from their checking account. The life of your spouse is worth more than a few more dollars in retirement.

recursive3• 2 days ago

Calling it a "few dollars" is probably disingenuous, although we don't know the personal circumstances. For many, this could be a "life-changing" quantity of money.

orwin3• 2 days ago

I also understand the hesitancy to pay for two months at a “retreat-like inpatient psychiatric facility.”
In publicly funded system, it’s likely facilities like this would not exist or would be strictly private pay.

In France, 80% is paid by the public healthcare if a psychiatrist greenlit you, which still make you liable for ~30€ per day in a room you share with another patient (and if you want a private room it's ~90€/day out of pocket) (maybe the prices around Paris are a bit higher though, i'm a country boy)

[edit] more accurate numbers, i had to check and correct them. Also, 30€ per day also covers medication if needed and a spa session

arjie5• 2 days ago

The trade-off appears to be[0]:

Le délai d’attente d’un lit disponible est en moyenne de 3 à 4 semaines

3 to 4 weeks vs. the next morning in the article. Interesting. I wonder what would have happened in the intervening weeks.

0: https://clinique-du-parc.ramsaysante.fr/vous-%C3%AAtes-patie...

garbagewoman• 2 days ago

Maybe i missed the part of the article that suggested a public system would have paid for a 2 month retreat?

annzabelle2• 2 days ago

I will note that in a lot of places in the US, the role of medium term acute psychiatric care is taken by partial hospitalization programs, where patients go to a facility (usually a few conference rooms in an office building) during the workday for intensive therapy and medication management, but go home with family in the evenings. These programs are a lot cheaper than inpatient programs, and the standard workflow in my experience (with "good" insurance) at this point is 3-10 days inpatient, followed by 2-10 weeks in a PHP, and possibly some part time program after that. A lot of people skip the inpatient part if there's no acute danger.

I'm surprised the author makes no mention of those sorts of programs in the article. It makes it sound like the options were a luxury 8 week inpatient or nothing, when there's really a lot of stuff in between.

pyuser5832• 2 days ago

Me too! I’ve seen such good come from these sorts of programs!

I didn’t want to mentioned it my initial post, but these sorts of programs seem a happy combination of keeping costs down and maximizing autonomy, while focusing on full-time on mental illness.

Some is these are technically “in-patient” at home programs, which are growing in popularity in all fields on medicine.

But they’re not appropriate all the time, and I don’t want to “recommend” them. Talk to your doctor.

Sadly it seems these sorts of programs are simply unavailable in much of the country.

anonymousiam• 2 days ago

This article makes a good case for the abolition of health insurance. If everybody had to pay for medical care, medical care would need to be affordable to survive. It's hard for me to believe that a doctor couldn't afford medical care for her husband. She just couldn't get outside of the box and consider that the treatment was more important than the cost.

ceejayoz9• 2 days ago

This article makes a good case for the abolition of health insurance.

Yes.

If everybody had to pay for medical care, medical care would need to be affordable to survive.

How would people with zero income afford it?

readthenotes1• 2 days ago

The way they used to before medical insurance took over that industry: charity

foco_tubi12• 2 days ago

It's hard for me to believe that a doctor couldn't afford medical care for her husband

Why's that? Between mortgage, repaying education debt, supporting children, recovering from a husband's failed business venture...what is hard to believe about having trouble paying for another expense, especially after you've been reassured that the expense would be at least partially recompensated and that turns out to not be the case?

RiverStone• 2 days ago

At a high income level, you should have more buffer for life’s events if you’ve made good decisions in your life. Generally speaking.

For example, that mortgage, did you stretch the very limit of your income or did you buy something reasonable?

Nobody forced you to buy a house, you could also rent or commute longer.

I lived in a crappy rental for five years and commuted and was able to fully pay off my student loans at the beginning of my career. As an example

Education debt can be put on forbearance or deferment under many life circumstances.

Given high income level, you also have many options available to you like personal loans.

jmpman• 2 days ago

An alternative approach would be health care for all - with the caveat that there is NO private pay option. The unfortunate situation is that that ultra wealthy have greater influence over the political process due to citizens united, and are also the ones who would benefit from lower funding towards public health care. With their ability to access premium treatment via a private option, their incentive is to use their political influence to lower public health care spending, without any negative impact on their own health.

tliltocatl• 2 days ago

with the caveat that there is NO private pay option

I don't think there is a society in the world that ever had that successfully executed in practice. I live in Norway, and even if the public heath system is probably as good as it gets here, I often use private providers for non-urgent things simply because waiting time can be up to six month otherwise.

And even if you somehow manage this on paper, you'll be very surprised on how markets work. They don't need legal recognition. They don't even need money. See: USSR. Health care was public and medics weren't even a particularly attractive profession because there were too much of them already. Still if you wanted to survive an appointment you'd better have a package of some deficit wares ready.

What denies public healthcare money isn't "wealthy trying to cut public spending down". It's bureaucrats wanting their share of the pork barrel.

xtracto• 2 days ago

I think for profit Health Insurance is a straight 100% scam. The only service where you pay a company for a service and when you need that service they spend as much money as possible to avoid giving you that service.

But... I've come to realize that it is impossible to make people understand it or change it.

So, I've been proposing a lesser change: In theory Insurance companies business model is to hedge against the risk of people getting sick ok? Well, let's make the bet fair and remove them the ability to decide who gets covered and who doesn't. In the case of the original article: Let a neutral third party panel of professionals be the ones that decide whether the Health Insurer has to cover or not the case.

Otherwise, Insurers are behaving like Casinos that decide to pay or not to pay to people who win a game.

arjie5• 2 days ago

In my experience, one can always continue care if one is willing to pay. Insurance companies do not deny care; they deny claims for care. In fact, numerous times they make mistakes and deny valid claims. Only the healthcare provider can choose to not provide care: either because they believe they will not get paid or they believe you don’t need it or some other such reason.

Considering this person has a high-paying job and it seems like a short-term intervention would have created a long-term positive outcome, it’s not clear to me why they didn’t simply insist on the care without insurance coverage.

My contingency plans for these situations are to pay out of pocket and figure out reimbursement later. In practice, paying out of pocket is just a promise to pay out of pocket. Often one isn’t charged until afterwards and I experienced sufficient mechanisms to delay payment until the whole thing had been sorted out.

Permanent conditions (like, say, brain death) are a different story. But in my case, the bill I was ostensibly facing was hundreds of thousands of dollars and I proceeded with it on the grounds that rapid intervention would yield results and I can figure out the payment structure later. If I were facing the worst case scenarios of a family medical bill bankruptcy or family member loss I think that usually I’d prefer the former. It’s hard to make a decision in the moment, but if the healthcare provider determines that more care is required and the insurance provider that it is not, I am more likely to follow the former though not without bound.

foco_tubi12• 2 days ago

One isn’t charged until afterwards

This is not a universal billing practice, often clinic visits are billed upfront before meeting with the provider.

arjie5• 2 days ago

Let me amend it to indicate the uncertainty I intended here by saying “often”. Most of my experience with US healthcare is with San Francisco and Austin, so readers may wish to adjust their view based on that.

tracker15• 2 days ago

I've had to go through this with treatments for my eyes... that I haven't been able to see a doctor on for about a year and a half because as a contractor my insurance sucks and even when I've had good insurance it was often problematic... wierd codes and then a back and forth call the insurance, call the provider only to ever get answers if I 3-way called them both and held them both to account.

More than once I was on the hook for a $15k set of injections that I had to run on a credit card. At this point, I'm maxed out, paying out of pocket for what I can and it sucks... I'm hoping to convert to a City employee (temp) vs contractor which at least gets decent medical, but my own experience has me doubtful even then. I've worked my whole adult life, didn't even take vacation time through my 20's and 30's... and never planned to retire... I don't want to, but I'm facing a reality that may not give me a choice in the long run.

I don't think shifting to public healthcare is the answer in the US... but would like something similar to fiduciary safeguards around medicine and insurance.

ButlerianJihad2• 2 days ago

I am an emergency physician living in the U.S., and we had one of the top commercial health insurance plans.

You see, dear, your critical error was in believing that psychiatry is “medicine”, and that mental health treatment is “health care”.

Oh for sure, they present you “doctors” and “nurses” with the same credentials, wearing white lab coats, ties, scrubs, and even stethoscopes. They can prescribe “drugs” and run “hospitals”.

From the outside, they are indistinguishable from physicians who treat the physical body, but it is all a satiric cosplay. It is done this way for reasons, chiefly not to scare people too much.

Mental health should be considered more of the “Pre-Crime Division” or Department of Corrections For Stuff That’s Not Your Fault.

Don’t ever believe they’re in “Health Care”. This is a fatal category error.

foco_tubi12• 2 days ago

By chance, are you a Scientologist?

mitchbob• 2 days ago

https://archive.ph/nLvxS

silexia• 2 days ago

She doesn't mention the root issue; her and her colleagues absurdly high salaries and the tight limits on new doctors in the US that make medical care scarce and unaffordable but keep their salaries high.

waltmck• 2 days ago

Since we're all sharing terrible insurance stories, I'll throw in my partner's. Of course this is not as bad as the OP, but it is still extremely frustrating.

We are graduate students and get a pretty good health insurance through our university's BCBS plan. She is financially independent from her parents, but she is additionally involuntarily insured on her father's EmblemHealth plan with no right to remove herself (her father could do this for her, but has refused to).

Last year she had some medical bills, and neither insurance company is willing to pay: the issue is that both plans have a clause that makes them secondary to any other insurance (this is apparently very common for student plans, and is also also somewhat common for additional family members on regular plans). For over a year now we have been sending certified mail to both insurers' coordination-of-benefits offices, but neither will acknowledge being the primary insurer and EmblemHealth has been ignoring us altogether for the last ~5 months.

The generally recommended strategy in this situation is apparently to involve regulators. However, regulation is state-by-state and and our university is in Massachusetts while her father lives in New York. Massachusetts' Division of Insurance found that the Massachusetts insurer (BCBS) was correct that the New York insurer (EmblemHealth) should be primary, but they have no jurisdiction to force the New York insurer to accept this finding.

The New York regulators were even more useless. New York's Department of Financial Services---the only state regulator for health insurance---responded that they had no jurisdiction to regulate the plan since it was self-funded (meaning that it is not technically insurance for regulatory purposes). The only remaining regulator was the US Department of Labor, but they eventually got back to us saying that they had no jurisdiction either: the problem is that my partner's father is a municipal employee of New York City, and for some complicated constitutional/political reasons the DoL isn't able to enforce labor laws on state/local governments.

I basically don't know what to do now. We have been on a waitlist for a legal clinic for about 4 months with no end in sight, and in the meantime regularly get mail from medical debt collectors. This is despite having insurance and making considerable effort to do everything "right." Clearly something here is extremely broken.

tsoukase• 1 day ago

Such stories sound like horror science fiction to Europeans. Of course preventable deaths and health related mistakes happen there too but they are rarely the fault of insurance. If such a blunt event would happen to me, I could sue the insurance for a very large sum.

euroderf• 1 day ago

Attributed to Churchill: "Americans can always be trusted to do the right thing, once all other possibilities have been exhausted."

Haven't all other (non-universal) health coverage possibilities been exhausted ?

My husbands suicide shows theres something very wrong with US insurance industry

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