The captured physician is an unscrupulous individual who was promised untold riches in exchange for his soul.

The unrealistic part is that the peer to peer doctor was immediately available. One of insurance companies' new favorite tactics is to make the peer to peer call as painful and impossible to schedule as possible. I've gotten both "the doctor will call you between 7 and 7 sometime in the next 2 weeks" and "you must call within the next 15 minutes, and it'll take 12 minutes to navigate the phone tree, speak to a rep who will transfer you and be put on hold so you really have 3 minutes to drop everything and do it now now now". It's intentionally infuriating. In completely unrelated news, UHC is the 8th most valuable company in the world, with a market cap of $490 billion USD.

Oh the irony of getting a pen by denying an epi pen…Great (and sadly too accurate) skit as always!

Here is something I found in a different comment section "Here’s how you get a denied pre-auth approved. When you get the first denial, request a reexamination of the procedure (as protocol for most major insurers). When you get the 2nd denial it means they had an actual doctor take a look BUT they never have docs that specialize in the field your trying to get a procedure done in. For example I had an obgyn deny a cardiac surgery. By law you are allowed to request info on the medical specialty of the doc who did the appeal review. When you get it and the doc who denied is ‘out of scope’ from the procedure you’ve hit jackpot. Now here’s where they fold: resubmit third time along with a request for 3rd party arbitration (basic procedure for major carriers) and in that request you state that you want it because you doubt the ability of an obgyn to make calls on cardiac patients and you wish to question them in arbitration about their experience with cardiology. That’s it. You’ll be approved without arbitration in about 85% of cases. Yes, it’s a pain that can take awhile, but passionate admin staff can get it done along with some paperwork from the docs."

I had an ophthalmologist who was about to dictate an order for PDT and told me “Pay no attention to what I’m about to say about your case. We’ve been using PDT for this for 20 years but to get your insurance company to approve it I have to make your case sound horrific.” She made it sound as if my head was about to go all “Scanners” and explode. I got the approval.

My insurance company actually denied my hip surgery, my Dr appealed it, they denied that, he requested a peer-to-peer, they granted that request, then denied it. This process took several months and was very stressful. When January rolled around, they spontaneously reversed their decision and approved the surgery. I can't prove it, but it seems to me, that since I'd already met my out of pocket cap for the year they wanted me to wait until January so I'd have to chip in more for the surgery. From a financial standpoint that makes sense to them, but damn if it didn't hurt like hell to spend a few months unnecessarily dealing with a hip socket that was so loose I would wake up with a dislocation and then have to deal with several more throughout the day. I seriously wish there were more federal restrictions on what insurance could and could not deny, like if it's medically necessary they should not be able to deny or delay it just because they don't want to pay for it.

"Hello yes the oral antihistamine failed and the child is in ICU, I'm about to document severe head trauma though..." "On the child?" "On you." 💀

“What are you mad about today?” 😂😂😂 so true The peer to peer is spot on Of course, they have to pick someone who has no experience in the area of the condition in question and has not touched a pt in the last 20 yrs 😂😩 Also…utilizing archaic references and lacking basic understanding of billing. But I digress…

I’m a Kindergarten teacher with the accompanying teacher’s salary. The price tag on my refill of epi-pens made me cry because this isn’t a medication I can choose to go without. My allergies are off-the charts, and I’ve been so traumatised from my experiences with anaphylaxis that I even developed anorexia, and had to spend years recovering. I still struggle with that anxiety and trauma. And the only medication that can save my life if/when I have another reaction costs SO MUCH MONEY. And why? There’s no reason for it. It’s horrible.

I did an exchange semester of my nursing degree is the USA (from Australia). The semester before I went to go I did an ethics unit. One of the reasons I did a nursing degree was the ability to work overseas, and the USA was on my list of options to work abroad. But that one semester in the USA about 20 years ago put me right off. I could not wrap my head off being a healthcare provider with the ethics of refusing care based on insurance companies and wealth (or lack thereof), how you can justify being one of the world’s richest countries and refusing healthcare to the poorest citizens did not sit right with me. I’ve never been back to the USA (except as a stopover to get to Canada) since. I spent 2 years working abroad in Ireland instead

Pediatric physical therapist here. I'd LOVE the chance for a true 'peer to peer' review. Closest yet was an M.D. who teaches at a state university, has been out of clinical practice for over a decade, and had no developmental pediatrics background.

Had totally had a patient at risk for severe anaphylaxis denied an Epipen within the last month so this is spot on. The only thing missing is the 5-6hour wait to actually get to the peer to peer stage and the ultimate “discussion” with the insurance company’s physician to reveal their lack of expertise in the treating area

PSA for all who may need it: Auvi-Q makes epinephrine auto-injectors that give auditory instructions when opened, and if your insurance doesn't cover it, they automatically give you a coupon for a 2-pack + trainer for $25. If brand name Epi-Pen isn't in your budget, don't be afraid to ask your doctor about alternatives. Expired epinephrine isn't as effective, so it's very important that you have an unexpired dose in case of an emergency

Here faster than insurance denying a claim to medication.

There should’ve been a voice constantly repeating “deny every medication” in the room the doc was being kept.

Your ability to simmer the whole US insurance system into these 2 min. reductions is a true art. The public needs to know this is what goes on and that it's barely satire. Thank you for raising awareness. I've done so many prior auths, and worked hard to learn the ins and outs to get as much covered as possible, and I sadly can confirm. They want to make it as difficult as possible so you will stop trying.

I'm really glad someone is actively calling out the darkness that is the medical insurance system over there. I love your skits, and these are just the cherry on top. Thanks for what you do.

One of my attendings had to do a peer to peer for a pareplegic patient to get a wheelchair and the insurance doctor was like "why can't the patient just use a cane?" and she's like "cause he's fucking spinal cord patient!"

Operating room nurse here - was once in a case with a neurosurgeon that had a scheduled call for a peer-to-peer review with an insurance company for approval of an intervention for a patient. They get on the phone, discuss things for all of a minute, before he indicates that someone else needs to get a piece of information for him because he's scrubbed in for a surgical case. (This is by no means unusual, and he had stepped away from the field for the duration of the call.) The person on the other end of the line said this was "not allowed" and that he shouldn't be on the phone in this situation (again, I'll reiterate - your surgeons talk to people on the phone during surgery if they need to talk to people on the phone during surgery, this is how it is and is ENTIRELY reasonable) and she hung up on him. For a scheduled call. Yeah this shit is nefarious

The sad reality is the insurance company gets off lighter if the patient actually dies.

My friend was being denied life saving treatment by insurance. Her care team was so outraged that they agreed to do it for free. Then the insurance company relented and agreed to pay, because they knew they'd look bad if she *lived* And that's the problem with for-profit medicine, right there. 😡

The doctor being treated like a hostage is just *mwah* magnifique

The reward pen, the epipen, and the microphone pen...comedy genius 👏

As an allergist with many food-allergic patients and who has spent tons of time and treasure on prior auths... All I can say is THANK YOU! Love your work! Keep doing what you're doing!

Another enjoyable yet sad video.

Well, we certainly don’t want United Healtcare’s CEO to make less than the $26.5 mil he made last year for providing, you know, health care. 😒

As a PA working in allergy/asthma, I can fully attest to the accuracy of this exchange. Never mind CMS’s updated list of dx codes to support need for food allergy testing… a list that excludes angioedema, flushing, urticaria, pruritus…

The presence of the second physician isn't quite realistic, but if insurance companies ever did poke their noses into the realm of medical backing for their decisions it would probably look like this. Great work as usual!

The sharpie for the headset mouthpiece I AM IN HYSTERICS😂😂😂😂 Another great sketch doc!

This exact thing happened to me! They denied the pen and asked me if benadryl would be equivalent. Spot on!

Jonathan needs to found Jonsurance for the good of all Americans

As a Medical Insurance Specialist for a large healthcare organization, I can tell you that this is all too true. Sad, but true. (U.S., private) healthcare insurance companies have a stranglehold on America, they lobby Congress more than the department of defense. 🤦‍♀️🤦‍♀️🤦‍♀️

I don't know if laugh or cry. Good video doc. Hugs from Argentina 🇦🇷

Maddening how real this is

Perfectly done. This is my life. I’m constantly trying to get meds approved for patients. I’m a lot angrier about it when they don’t cooperate. But I know it’s their job to deny. Shareholders uber alles.

I genuinely feel enraged watching these. USA you need to do something about this, asap .......

I'm a medical student "covered" by United Healthcare.. this hit home on too many levels. Insurance decided to stop covering a med I'd been on for years. I called them about it and they suggested a cheaper alternative. B*tch this has been working for me, why should I need to go through the whole process of getting adjusted to a new medication, which may or may not work as well and have different side effects? It took a lot of trial and error to get it right, and now I have to throw it out? Not cool.

I remember the huge price gouge hike. I worked in veterinary med and had a girl call me back after discharging her golden retriever with a paper Rx, she was screaming it was $600 bucks. I couldn’t believe they went up over $400 in a night. We changed the Rx to generic and showed her how to draw up her own. $30 for same med, minus the 🖊 pen. Sick they charge that.

My mother works for United Healthcare and has done nursing and health insurance her entire career. She's told me the inner workings of these companies and holy crap, what a scam they are. That $30,000 surgery you had? Well if your neighbor has better insurance than you do, they charge $130,000 for the EXACT same procedure. Hospitals literally make prices up on the spot based on what they think your insurance will pay. Insurance companies also make these prices up on the spot. Here's an actual example of how US medical insurance actually works: You: I need an operation done that will literally kill me if I don't get it done Doctor/Hospital: Sure that'll be $10,000 (the actual cost of this procedure is $600) Insurer: We think it's only worth $5,000 Now at this point the doctor and/or hospital can say 'K great, $5,000 is reasonable have a nice day' and let the insurance cover it. OR, and this is what they do normally, they can be jerks and say 'No the procedure costs $10,000' and then bill the patient for the remainder that the insurance didn't cover, even though the actual cost of the procedure is under $1,000. But the biggest proof that it's all a scam, these numbers are completely fabricated. Your neighbor might be getting charged $50,000 for the same procedure because they think the insurance will pay more. The neighbor on your other side might be getting charged $5,000 and the insurance will only cover $2,500. The prices don't actually exist and as long as they're getting paid more than the actual cost of the procedure, they should be happy. But they never are. They ruin people's lives over a few thousand dollars when they're already making a 6,000% profit.

This. I have lived this. Three and a half years of 6 month trials of unsuccessful lesser treatments as I lay bedridden with sever Ulcerative Colitis until we could finally make it down the list to the one my specialist knew would be right for me from the beginning. I was scheduling my surgical consult to have my entire large intestine removed when I finally began the medication... NOW I'm happy to say I'm 5 years 3 months symptom free! Would have been nice to have started with the right medication.

I'm not a healthcare provider and I'm more emotionally attached to the characters of this series than anything else I've ever watched

I love how you got the nail on the head on these kinds of issues. If only people in government would start listening and doing something about it. On an unrelated note, would anyone like to buy ocean front property in Arizona? It will be for sale when hell freezes and all the pigs fly away.

Dante got hell all wrong. There's no lakes of fire. It's an eternity of filing insurance claims, being denied, arguing, appealing and being subjected to nonsense rules and petty conduct. Oh and waiting on hold and being transferred multiple times only to have a lazy phone rep spike the call, forcing you to start all over again.

I’ve been fighting with my insurance for about two years because they stopped covering my migraine medication. I have a minimum of 2-3 migraines a month and this medication clears it up within a few hours, which hasn’t happened with any of the covered meds I’ve tried. I got around it for awhile because I have a savings card with the manufacturer, but now the medicine has to have a pre-auth so I’m fighting tooth and nail for them to clear it

As a physician, this is so truthful. Believe it or not. I have even recently had to do prior authorizations on very inexpensive generics. It has become absurd. Then again, the cost of many medications has become absurd.

The first 2 words of this video told me more about the content than the title, lol. "United Healthcare".🤣 I used to deal with them annually for ONE prior authorization on a medication until it was discontinued. I can't imagine what my Doctor went through for ALL of his patients!🤦‍♀️😭

Ah, the peer to peer review where they get a GI doctor to approve a medication from an hematologist to which they deny because they don't know anything about blood disorders.

I moved to the US for my postdoc a few years ago. Having grown up in the UK, I knew that the healthcare system was profit-driven and dysfunctional. I had no idea just how bad it was until I was in the system. My second kid was born there, and despite being on a good insurance plan thanks to my place of employment we still had to deal with additional costs and fighting the bureaucracy of the insurer. Getting out of that system was one of the biggest factors that eventually led to us moving back to the UK.

Here in France an Epipen is worth 69€, which is nice. And it is reimbursed at 65% by the country, which mean you pay only 24€ out of pocket, or by the private insurance. Even better, if you don't have sufficient incomes, it's totally free !

A couple of days ago I had to use my epi pen for the first time and i think it saved my life, so this hit extra hard 😬

How about the new Cares Act, that lets insurances decide to deny covering ANYTHING prescribed by a resident without a license. Interns, IMGs and residents training in the state they don't intend to practice in are all screwed for a while. I tried sending a patient a rescue inhaler on discharge, and the insurance wouldn't cover ALBUTEROL.

I was prescribed lidocaine patches for after abdominal surgery. The insurance denied it and said that they were not a approved treatment for autism spectrum disorder. Even after trying to appeal it, they still would approve. Without insurance they wanted $300 for 5 patches. I'm supposed to use 2 a day for 3 weeks. About 3 months later, they were available over the counter for about $15 for a pack of 10

I used one of your videos to tell my kids about the healthcare system and they were furious. My son (8 yo) goes “That is so dumb!” Like, yeah little buddy.

This is why the international privatisation of healthcare and issues like the defunding of the NHS are such dire problems

I am an international medical graduate and I have been looking for residency options. Honestly, I didn’t even consider US as an option and opted for Europe and UK because I cannot for the life of me handle such discriminatory medical system where I will have to deny my patients treatments and interventions because they either cannot afford it or their insurance won’t pay for it. I want to work in a system where I am paid well but not based on praying on those who may be struggling; a healthcare system that isn’t working against the people for the sake of luxury and big pharma gaining even more money.

"It has a cap!" So do our insurance policies. Isn't America just wonderful? 😁

It's time to change the law. Make our health system like Japan's. All health insurance companies are nonprofit. Insurance companies may not deny a doctor's prescription. All drug, hospital procedures, and office visit prices are negotiated every two years between doctor representatives of the Japanese Medical Association and government for the entire country. No overbilling allowed. Universal healthcare, funded both privately and publicly. Best health results in the world.

I had a PA denied because they didn’t have any of the info… which I gave to them and double checked with their pharmacy. They were like “well they’re not on any antidepressants” but has been for SEVEN years and even after that they STILL denied

I worked in a pharmacy in high school and recently worked at a major health insurer. Not only is this dangerous honest in how it goes down, it has only gotten more egregious in the last 20 years. We need to better regulate insurance pre-authorizations and denials to stop useless delays and obstructions of care in medically unambiguous situations. Using unnecessary hurdles to extract profits is a form of profiteering. The people who create such hurdles portray they are mere misers, they are not. Nay, they are profiteers and pirates. That money is not made from the efficiency of collectivization or the facilitation of improved care reducing costs for all. The excess money earned on denying necessary care, delays, and hurdles is a distillation of human suffering. It is soaked in the blood, tears, vomit, and collective pain of those they made suffer unnecessarily.

Sadly so accurate. And as a nurse of 36 years experience, I can also tell you that overall the healthcare we receive as health professionals (you know - good insurance benefits which we pay out the wazoo for) is most often not there. Funny though - I do know of 1 sector of the population that has AWESOME health insurance benefits. Want to guess? Why that would be our beloved senators and other government people. You know - the people who make major decisions for the rest of us.

I also thoroughly enjoy your thought provoking vids. Keep up the great work!

"It had a cap" Poor doctor

I work in contracting for a DME provider. And let me tell you, working with insurance companies is the bane of my existence. I swear they make their reps take an oath to be as unhelpful and unresponsive as possible.

"It has a cap!" Just like United Healthcare's expenses!

Your insurance videos make me want to cry, but are so necessary for people to see.

Love how the doc isn’t wearing scrubs but the rep is 😂

I'm not American and I'm starting to understand why Mr. Incredible threw his boss through several walls now

So what I understand is… the only way medicine and healing can work in the US is… hospitals get a bunch of people who constantly keep resubmitting the applications and constantly appeal

Excellent commentary! Thx for telling it like it be, Dr. G!

Sadly, this attitude is no longer confined to insurance companies - a LOT of conversations with pharmacists have started to look like this. "Yeah, sorry I can't approve this drug, it's a dangerous nephrotoxin - did you know that?" "...um well... the patient needs his tacrolimus so that he doesn't experience kidney transplant failure..." lol I've literally had hospital pharmacists tell me they specifically took drugs off formulary so that we wouldn't be able to order them.

I loved how you used your pen as a microphone

I´m vetenarian in Europe. Our little Pet-insurance companies, which were founded solely for profit and are not legaly considered part of public health system or critical infrastructure (unlike human state insurance companies) are making much less fuss when it comes to covering expenses. I guess with our insurance tradition they just wont dare to refuse.

This was so beautifully done. Showing the dark side of medicine while making you laugh gives me so many different emotions 😆

Your videos are so funny!! The job is so stressful sometimes, it is nice to know everyone has the same issues and problems!! Thanks!

This is why I have said that if you truly care about people, working in the medical field will tear you apart. Because seeing how much greed has tied doctors' hands and literally makes you stand by and watch as it won't let you help, if you legit care it is heartwrenching

As a pharmacist who has to occasionally bother doctors for things like opioid thresholds, I think it is valuable for us all to remember who the real enemy is....

Can confirm that peer to peer physicians carry with them a devastating soul level sadness that haunts you long after the case has been denied.

As a rheumatology patient, these insurance skits always make me laugh and grimace at the same time

I once got a pre-authorization of my expensive biological in 3 weeks. I thought a miracle happened that day, having been on this medication for 8 years over 9 insurance plans.

The american healthcare system, genuinely, truly scare me. I honestly don't want to visit since I'm afraid if something will happen to me I'll either be neglected medically or ruined financially.

as a former United Healthcare covered person, I approve and unfortunately lived this message

I love your body of work. This one hit home. When I work in a pain management and physical rehabilitation practice. Had to do preauthorization for meds and implants. What is not shown is the typical 23-35 minute wait to speak with a representative.

I was expecting the physician to be locked up in some kind of dungeon… this isn’t much different from it tho 😂

Last week I called to do a peer to peer and got transferred to a nurse as the peer. I assumed I’d misheard, and asked her to repeat name and credentials. She got super huffy with me and put me on hold to transfer to the actual physician. The moron physician seemed to have trouble understanding that a patient’s prior dx of carpal tunnel syndrome did NOT explain lower extremity symptoms, dysequilibrium, etc. 🤦🏻‍♀️ Maybe I should have just talked to the nurse wtf

You're very gifted. You can make me laugh and cry at the same time.

You are awesome. Loving the videos.

This isn't even satire, this is just truth.

Surprising that he survived a month in the box without food or water. Must have been a family medicine resident. Oh well, back in the box, before they pull out the cattle prod again.

Know nothing about medicine and I really enjoyed your video. Impressive and hilarious acting! 🤣

Another great video from the doctor. Thanks

Don't feel sorry for the second physician working for the the insurance company. That man should get his license removed. He is selling out patients to the highest bidder.

i have UHC, supposedly a good plan. pft. it’s good as long as you don’t have to use it. when you call or email them you often get conflicting information from different people. it’s all wildly complicated. I never know when I’m going to get a “surprise bill“. I want to be able to invoice UHC For the time I spend on hold and talking to customer service trying to figure shit out on my plan. The current state of health insurance in our country sucks so bad it makes me want to leave the country. I don’t know what the exact solution is but please keep making videos that illustrate how horrible health insurance companies are. thanks, dr g. dr

Will, I met you yesterday after your keynote at COA. Venting here today as I just lost a P2P battle with a Pharmacist and the MD from our favorite insurance company. I fought tooth and nail for his cancer treatment and explained the whole clinical picture over 6 months, still denied. They said "don't worry you can expedite an appeal afterwards " as if that's supposed to console me. I ended the conversation by kindly advising them that I hope one day they use their positions to advocate for patients, rather than endlessly repeating the same criteria from their manuals that the non-clinicians do from their company.

I was that kid with a severe peanut allergy. Except I live in Canada so I got the Epipen and everything turned out fine, barely had to pay anything for it.

This made my day. Thanks for the giggles.

Remember that this man is not joking on a deep level and make sure you take it into consideration when voting comes around.

just curious -- does anyone from any insurance company ever respond to these?

I had a patient at work who lost his leg (AKA) after being ran over by TWO cars consecutively and he was denied rehab by insurance because they said he "didn't need it." This is exactly how I imagine the peer-to-peer appeal went.

this is the earliest ive been for a video!

Honestly given how short and concise your stuff is about the medical system in America I think it’s only a manner of time till a progressive politician uses it to explain to representatives