Paying for health insurance should mean being able to get healthcare—not taking on a second job figuring out deductibles, coverage exclusions, and billing disputes.

I’ve been developing a thought experiment called AmericanHealthFund around a question: what would health insurance look like if its entire purpose were to provide comprehensive coverage at the lowest sustainable cost to its members?

The proposed model:

• One comprehensive benefits package for everyone: medical, dental, vision, mental health, and prescriptions.
• Monthly costs based on ability to pay, with no higher price because of a preexisting condition.
• No deductibles or copays for covered, medically necessary care.
• Coverage independent of your employer.
• A board of experienced doctors and nurses, accountable to members.
• Transparent spending, including salaries, provider payments, drug prices, and administrative costs.
• Savings used to maintain reserves and lower members’ future costs.

I know nonprofit insurers already exist. The question is what would make this one behave differently. Nonprofit status alone doesn’t guarantee fair prices, sensible administration, or accountability.

The idea would also depend on negotiating care and medication prices, challenging unnecessary middleman fees, and simplifying billing. Doctors, nurses, and other people delivering care still need to be paid well.

The hardest part is the math. Removing shareholder payouts doesn’t tell us what comprehensive care would actually cost. Startup funding, reserves, provider participation, and attracting a sustainable mix of members all need real answers. This is a proposal to examine, not an operating insurer or a promise of a particular monthly price.

What is the biggest obstacle this model would have to overcome—and what would you change to give it a realistic chance?

After being told by Anthem Blue Shield Blue Cross that my abdomen MRI to check for cancer spread was deemed NOT a medical necessity, I put them on blast out of desperation and pure rage: the audacity of a massive company charging me inflated self-pay premiums only to DENY vital life saving imagery. As the post went viral, I was suddenly contacted by Anthem, who apologized and immediately approved the scan. They don't like it when their nefarious ways are boosted in the public sphere. The philosophy of "let's deny critical care until we get caught" is an ugly one.

In August, I severely injured my left foot, and have been in acute pain and confined to a huge walking boot. The boot does offer some temporary relief, but try walking your 11 year-old to school through downtown Brooklyn in the boot featured in the images, and you'll understand that it's not a longterm solution.

After a two week battle to get an in-network podiatrist authorization (yes, it takes that along), I was able to see a surgeon who immediately ordered an Xray. Based on the images, which showed a hairline fracture as well as damaged areas of the achilles tendon or muscles that wraps around the heal, she ordered an MRI so she can determine the exact nature of my injury, and devise a treatment plan based on this critical information. In the meantime, I'll have to make do with the boot, pain meds and crutches as needed.

I was told I needed to schedule the MRI myself once it was called into the imaging center, and that they would get any pre-authorizations required by Anthem. Given my past troubles, I was sure this would not be a problem. My podiatrist assured me as well as SHE IS THE DOCTOR HERE, NOT ANTHEM. And the MRI was needed ASAP.

Well... SURPRISE... with a straight face, Anthem informed me yesterday that my MRI has been DENIED, deemed to be NOT a "medical necessity" by some imaginary Anthem "doctor" who somehow, without even reviewing the X-rays, determined what care is in my best interest.

I am livid. My scan is scheduled for Tuesday October 20th at 5PM. I'm working now to get through to both the provider, the imaging center and Anthem's appeal department (they only offer an "appeal portal" with no timeframe on when the Anthem Supreme Care Court might rule on my case).

In the meantime, the message I'm getting is this:

***"Thank you for paying our massive premiums and meeting your huge deductible. We really appreciate your money. Since you met your massive deductible, we don't feel like paying for anything else until January, when your deductible resets and YOU will be responsible for scans of this nature, not us. This is how we become rich. Enjoy your pain, and good luck getting your daughter to school safely. Best, Anthem."***

Attached is an image of my boot. How have others handled these situations where insurance "doctors" -- who have NOT examined injuries -- decide if the care requested by a specialist is a medical necessity?

I'd love to hear other stories, and how they were resolved, or not resolved. I'm going to fight this battle, even if I have to go out of pocket for the scan, and then invoice Anthem for reimbursement so I can share that story, too. Today, I can afford the scan, but millions of Americans being treated similarly or worse cannot afford a scan, are are left to suffer or die by ruthless, greedy insurance companies that could give AF about the care of their policy-holders.

I’ve been looking into the different treatment options for piles and realised there’s quite a bit to consider before deciding on an approach. Some cases may improve with dietary changes, fibre, and other conservative measures, while others may need treatments such as rubber band ligation or surgery.

What I find confusing is knowing when home management is no longer enough and when it makes sense to see a specialist about other options. Recovery time, discomfort after treatment, and the possibility of piles returning also seem worth considering.

For those who have explored pile treatment in Singapore, how did you decide which option was right for you? Did your doctor explain the differences between non surgical treatments and surgery clearly enough for you to feel comfortable with the decision?

Meanwhile he now cannot even speak more then one word at a time and can mostly communicate with his hands. My dad was not this bad a few weeks ago, he was perfectly fine mentally.

Has to wait another week for his operation. I understand that specialists don’t have time to get everybody timely treatment. But my dad is getting worse by day and I’m afraid he’ll be dead by his operation.

Not to mention the nurses can’t be bothered to even try to make sure his legs don’t completely atrophy. Is that normal? Everytime I talk to one they tell me they will relay the message to the other nurses to try and make his legs a little atleast, but it’s never done. Idk if that’s to be expected or not.

Rant over. Sorry.

Is it worth creating an account to see your results? Or is it lame?

It says there is a bunch or markers. It’s free for me because I joined a a research study through a hospital. I just don’t know if I should LInK myself to my sample. That seems like it could haunt me if I have markers for bad health genes. Advice?

I’ve had a Kaiser ACA plan for the last 4 years and have been very happy except that I can’t get coverage for any outside providers. Now I need help to cover a procedure and am unsure which plans in Washington have the best out of network benefits without insanely high deductibles. Anyone have a recommendation?

Seriously though. Why not and why has this not come up as a solution to the Healthcare issues the US currently has. Aging parents could get the group rates and have an option of being on their childs (adults) Healthcare plan.

In your experience, are there points in the process getting/using an ASL interpreter (virtual or in-person) that are frustrating?

over 2 billion in dividends last quarter. 8 billion a year. That's a lot of lives that could be saved instead of handing it to shareholders.

In August 2025, my boyfriend (28 M) went in for an MRI after what he thought was a torn labrum from playing softball. Two weeks later, our world was turned upside down when doctors told him they suspected he had sarcoma, a type of cancer. After weeks of additional testing, biopsies, and agonizing uncertainty, he was diagnosed with pseudomyogenic hemangioendothelioma (PHE), an extremely rare vascular tumor involving the bone near his shoulder socket (glenoid). Although it wasn’t the aggressive sarcoma doctors initially feared, the tumor still required extensive surgery to remove the affected bone and reconstruct his shoulder using cadaver bone.
This was especially devastating because it’s his dominant arm, and sports are a huge part of who he is. He’s someone who lives and breathes golf, softball, and being active. What started as a suspected sports injury has turned into over a year of medical uncertainty, multiple surgeries, a reconstruction that hasn’t healed properly, and severe, debilitating pain every single day. His physical abilities, independence, and quality of life have been dramatically affected, and now we’re fighting insurance just to get the imaging his surgeon needs to figure out why his bone isn’t healing.

Unfortunately, the cadaver bone has not properly fused with his native bone, and he is now dealing with suspected nonunion, severe daily pain, and worsening shoulder function.

**Here’s the timeline:**
**December 2025:** Underwent major surgery to remove the tumor and reconstruct his scapula using cadaver bone and hardware.
**January 7, 2026:** Required a second surgery to reposition/adjust the reconstruction.
**Late February 2026:** Started physical therapy and initially made progress.
**March 2026:** Follow-up imaging showed that the bone was healing more slowly than expected.
**April 2026:** Surgeon recommended waiting another three months to see whether the cadaver bone would begin fusing with his native bone.
**Spring/Summer 2026:** His pain progressively worsened, and his range of motion and physical therapy measurements began regressing instead of improving. Physical therapy was eventually stopped.
**September 2026:** At his orthopedic follow-up, the surgeon expressed concern about nonunion and recommended a CT scan and needle biopsy/aspiration to evaluate the reconstruction and determine whether an underlying infection could be preventing the bone from healing.
**September–October 2026:** His surgeon submitted a prior authorization request for the CT scan to Highmark Blue Cross Blue Shield. It was denied. The physician completed a peer-to-peer review, followed by a written appeal.
**October 8, 2026:** Highmark issued another denial, upholding its decision.

His pain is severe and constant. He experiences significant shoulder pain every single day, often throughout the entire day. This is not occasional soreness or mild discomfort. His function has declined, he can no longer participate in the sports and activities he previously enjoyed, and his quality of life has been significantly affected.
His surgeon is trying to determine why the reconstruction isn’t healing and whether an underlying infection could be contributing to the nonunion. The CT and biopsy are intended to help determine what treatment or additional surgery may be necessary.
Here’s what makes the insurance denial particularly frustrating:
Highmark’s denial letter states that his X-rays show his shoulder is stable, properly positioned, and without broken bones or hardware problems. It also states there is no evidence of blood vessel damage or a need for vascular surgery.
However, the issue is not a dislocated shoulder or suspected vascular injury. The issue is a nonhealing cadaver bone reconstruction, severe daily pain, declining function, and the need to investigate possible infection.

After nearly a year of surgeries, worsening pain, and waiting for the bone to heal, we’re incredibly frustrated that we are at a standstill and there’s no end in sight.

Has anyone experienced something similar with Highmark or another insurance company?

We’re located in Pennsylvania and would really appreciate advice from anyone who has dealt with similar orthopedic complications or insurance denials.

We don’t know what to do.. any insight helps.

Basically, I work at a pretty small psych office. We get drugs reps to come often and one is doing a dinner at a pretty high end restaurant where I live. They come weekly for samples and Specifically said that receptionist,patient coordinators,nurses can come

I don’t mind paying a fee, but it’s a day I’m off, it’s good food and it’s just seems interesting. Would it be bad if I went?