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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Episode Transcript

Speaker 1 (00:02):
Yes, it's another day and another episode of what
Part of the Game is that?
This particular episode thatI'm going to do today was
originally meant for almost ayear ago, for almost a year ago,

(00:26):
and I didn't do it because Ilike to bring about information
that will help the masses,things that will help and bring
to light information that wouldhelp many people and not just a
situation between a singleindividual.

(00:47):
Well, last year, this is howthe story went I had to leave
work several times, three timesto be exact, because I was going
through some major, major pain.
Because I was going throughsome major, major pain and I
went to the hospital the firsttwo times and it seems as though

(01:17):
the doctors could not find whatwas going on.
Then, the third time, I hadthis episode, which was about
probably three, four monthsafter the second one, I left and
immediately went to thehospital.
Again, the pain is gettingincreasing, it's becoming even
greater.
I go into the hospital thistime and they decided that they

(01:40):
needed to do some CAT scans andall types of scans.
So they did the scans and thistime they come back with I had
gallstones and that I needed anoperation immediately and if I
didn't have it, the gallstonescould move and it could be a

(02:01):
life or death situation.
So now I'm faced with a life ordeath situation.
So now I'm faced with a life ordeath situation gallstones that
are beyond the possibilities ofbeing dissolved and must be
removed by having yourgallbladder removed and I'm like

(02:22):
, wow, I never had a a.
Well, I have had one othermajor operation, but this was
slightly different.
You know what I mean.
This seemed to be uh, you knowI'm not too keen on having
operations.
Anyway, I sat for about anemergency room for roughly about
six hours before I finallycontemplating on whether or not

(02:48):
I should get this operationbefore I finally made the
decision Okay, you know what, goahead and do it.
So I go, I get this operationdone, I come out, I'm on
recovery for about six weeksafter the operation before I go
back to work.
When I go back to work, I'mtalking to my superiors and the

(03:12):
boss and you know we'rediscussing.
You know how I'm feeling andwhat I went through the whole
episode and I was telling myboss.
I was like, you know, it'sweird how I went to the hospital
the first two times and theyacted like they couldn't do

(03:33):
anything or didn't know what theproblem was.
And it wasn't until a thirdtime that they finally came up
with what the problem was.
So I was wondering was thehospitals the first two
hospitals incompetent in doingtheir job?

(03:54):
And this is what was flowingthrough my mind.
But then my boss was telling mehe says no, that's not the
situation.
You want me to tell you what'swrong, what happened?
I said sure.
He says when it comes to dealingwith insurance companies, you
have people within the insurancecompanies that will make the

(04:19):
decision as to whether or not aperson gets a certain operation
or not.
As to whether or not a persongets a certain operation or not,
and the first two times theyhad obviously denied, you know,
doing certain tests or whateverat the hospital.
And so for that reason you weresent home without being

(04:40):
diagnosed with whatever problemyou had, which was the actual
gallstones.
And he says this happensbecause you know they don't want
to pay that money.
And I was like, wow, and Iwanted to do this episode a year
ago.
But I was like, well, you knowit's kind of isolated.

(05:00):
I'm not trying to do a personalepisode about my experience in
the hospital because everybodygoes through.
You know I can't say everybody,but a lot of people go through
situations in the hospital andthat sort of thing, but maybe
not necessarily the samesituation that I went through.

(05:20):
My goal, once again, is toenlighten people on situations
that affect the masses so thatwe all will be well aware of
what's going on.
If this happened a year ago,what prompt or prompted my

(05:40):
decision to do the episode now?
And, as you may know and I'mnot sure if this is the reason
why, but we had in New York theCEO of UnitedHealthcare was
killed, gunned down.

(06:01):
Now I don't know why that wasand I don't know the full
details, but if someone was madat the healthcare system because
of the way it operates and itslogistics and how it makes a
decision and its strategies onwhat it should do and what it

(06:24):
should cover people, you knowthey work hard.
You know they work hard.
You have jobs that you're toldthat you have coverage, only to
find out that once you get sickit's not covered.
You know what I mean and I'msure a lot of you know.

(06:44):
Healthcare companies probablyget sued because you know people
thinking they have coverage andyou imagine if you know your
loved one gets sick or somethingand you think you have coverage
and then, let's say, the lovedone passes away on something
that could have been, or shouldhave been, covered.
You know this is a sad feeling.

(07:07):
It puts people through a lot oftrauma and you know, you know
we got to find a better way,guys, because you know, they say
you, you know insurance scamsand insurance fraud and all this

(07:28):
.
It seems like there's just asmuch insurance fraud on the
street as it is within thecompany itself.
There are probably moreinsurance fraud and scams within
insurance companies than itactually is on the street.
Not saying it doesn't exist onthe street, but I'm just saying,
come on, guys, people shouldunderstand in full detail what

(07:53):
their health care coverage willcover and how much it will cost
to cover it, and stop playingthese games with these fancy
names of health care if itdoesn't serve no purpose.
You know you're supposed tocome out with all these
different type of health careplans for the people and so
forth and so on, and it's it'snot worth the papers written on,

(08:17):
and so, with the things thathave been happening in the news
lately and what I went throughin the past year, start taking a
second look at our health care,our health care coverage and

(08:42):
who we have to cover us and whatit's actually covering.
And that's my message for today.
Yeah, that's my message, andthis is your pod host, og GOAT,
and I'm signing off.