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US doctor forgives $650k in medical bills for cancer patients

bbc.com

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Re: US doctor forgives $650k in medical bills for cancer patients

#221

Post by kayodelycaon »

lotsofpulp wrote: post #176
ruined wrote: post #170

Earlier quoted context omitted.

> It’s also not the case in 99% of US claims. [...] Surely, there are mistakes made, but there is no standard operating procedure at insurance companies to deny healthcare. This is so out of sync with the experience of everyone i know that i wonder if you've interacted with the healthcare system at all beyond checkups and occasional antibiotics.

If it was true that insurers are routinely erroneously denying care, then people would be taking advantage of the ACA law that mandates external review of all claims and subjects insurers to the external’s reviewers’ decision.

I’m bipolar and every month I’m dealing with insurance medication denying extreme common, proven, and relatively cheap first-line medications. My insurance constantly requires exemptions and referrals for every step of my treatment. Even for things that have already been approved.

At this point, it would be cheaper and easier to manage everything myself. The only problem is, if I don’t use my insurance, the out of pocket maximum for inpatient treatment would be so expensive I’d refuse treatment and risk killing myself or harming other people. (Which is very much non-zero.)

As a child, my parents constantly fought insurance to get life-threatening allergies treated.

Re: US doctor forgives $650k in medical bills for cancer patients

#222

Post by zip1234 »

pg_bot wrote: post #82
atmosx wrote: post #48

A good question would be what can be done to fix healthcare in the US ? My understanding is that most voters don't support universal healthcare. IIRC even Obamacare was labeled as controversial. Current model costs way more, the model is clearly broken, why there is no pressure to fix it? ps. I don't want to get political or anything by mentioning Obamacare. I'm genuinely curious because the problems of the current h…

A lot needs to be fixed. Most of our problems boil down to lack of competition and regulatory capture. As a regular citizen, I would do the following. See if your state has certificate of need laws and ask your state representatives to repeal them. If your state has these laws you are likely paying 5% more for medical services with no difference in quality of care. Look into direct primary care clinics. Oftentimes yo…

Also, published prices in a standard format available on the web would go a long ways. Current state of system: How much does something cost? You will find out after the fact.

Re: US doctor forgives $650k in medical bills for cancer patients

#223

Post by zelos »

Areading314 wrote: post #11

One of the most unfair characteristics of US healthcare is that if the health insurance company does not cover a claim, then the patient is responsible for the payment. It is unrealistic in practice for a patient to know or understand the process by which claims are made (since they are made by an error prone and disinterested provider administrator, and are made in a non-transparent and highly complex way), and also…

My one experience of private health care in the UK was bad enough: the medical care was great, it was relatively minor elective surgery, I verified everything as carefullly as I could, but I accidentally used an out-of-network aneasthetist and ended up having to pay £300 out of my own pocket because the insurance wouldn't cover it.

Scaling that up to something like cancer care, where the patient is by definition not in a good way and the care is vastly more complex and I find it kind of incomprehensible.

Re: US doctor forgives $650k in medical bills for cancer patients

#224

Post by lotsofpulp »

valenterry wrote: post #212
lotsofpulp wrote: post #121

Earlier quoted context omitted.

Overall health is not insurable. It’s a misnomer. There is a 100% chance of everyone needing healthcare in the future. US health insurance does a few things: 1) premiums partially serve as a tax to transfer wealth from young and healthy to old an sick 2) insurers healthcare recipient from the big costs (over out of pocket maximum - $7k to $13k per year), subject to in network providers 3) Negotiates pricing and deter…

> There is a 100% chance of everyone needing healthcare in the future. 1) that's not true. One can die in an accident and not cause an future healthcare costs. 2) health care costs are of course insurable, why not? Just because everyone will create costs with a high chance does not mean that everyone will always create the same costs. The insurance is there for when you have some illness that causes more costs than y…

I didn't feel like writing 99.9999% chance at the time, so I rounded up to 100%.

It's not insurable in the sense that at some point, the losses are so large and so frequent, that the insurer needs to collect premiums from almost everyone in order to cover the costs. At that point, the premiums start to resemble a tax. I actually do consider the premiums a tax for the following reasons:

1) there is a mandate to purchase health insurance (although now neutered in most states due to removal of federal tax penalty)

2) the maximum premium is set to 3x the lowest premium (means young people subsidize old people)

3) premiums can only vary based on age and tobacco use

4) there is an annual in network out of pocket maximum

Another example of an uninsurable risk is insuring homes on the Florida and other Gulf states coastline for flooding. No private insurer would touch this market since the losses are so high, so the government created the National Flood Insurance Program, which is the federal taxpayers taking on the liability for flood damage for those homes.

Re: US doctor forgives $650k in medical bills for cancer patients

#225

Post by rsynnott »

unishark wrote: post #19
Areading314 wrote: post #11

One of the most unfair characteristics of US healthcare is that if the health insurance company does not cover a claim, then the patient is responsible for the payment. It is unrealistic in practice for a patient to know or understand the process by which claims are made (since they are made by an error prone and disinterested provider administrator, and are made in a non-transparent and highly complex way), and also…

> One of the most unfair characteristics of US healthcare is that if the health insurance company does not cover a claim, then the patient is responsible for the payment. As a general rule this is not an unusual characteristic. Get a procedure done in another country that turns out not not be covered and they presumably will bill you for it. The mess comes about because of attempting to control prices with networks a…

So in Ireland we have a split system. The public system, it's not an issue; the state pays. If you have private health insurance and go to a private hospital, they'll... check with your insurance that it's covered beforehand. Which just seems like common sense, really; do they not do that in the US?

I suppose emergency medicine is done in US private hospitals, which to a large extent doesn't happen here; private hospitals would typically do elective stuff. But presumably that doesn't apply in the case in the article, so why on earth wasn't the hospital required to check first?

Re: US doctor forgives $650k in medical bills for cancer patients

#226

Post by francisofascii »

alphabettsy wrote: post #28
shakezula wrote: post #13

Earlier quoted context omitted.

And even if you can contest the denial, it can take days to months to get it back, meanwhile you’re shouldered with the burden of paying full price for your treatment with the _hope_ that they’ll reimburse you later. My fiancée has cancer, and we regularly joke that dealing with insurance companies is worse than the actual stage 3 cancer she has. They constantly deny her coverage for medications she’s been on for yea…

It’s intentional. They save billions using this practice because some people don’t have the time, knowledge or resources to dispute.

Exactly. Dealing with the back and forth between the insurance company and the provider today, actually. What a hassle. Only over $150 for charging me for an annual preventative care visit which should be covered by insurance. Normally I would just pay to avoid the hassle, but this I will try to fight it.

Re: US doctor forgives $650k in medical bills for cancer patients

#227

Post by protomyth »

atmosx wrote: post #48

A good question would be what can be done to fix healthcare in the US ? My understanding is that most voters don't support universal healthcare. IIRC even Obamacare was labeled as controversial. Current model costs way more, the model is clearly broken, why there is no pressure to fix it? ps. I don't want to get political or anything by mentioning Obamacare. I'm genuinely curious because the problems of the current h…

My understanding is that most voters don't support universal healthcare.

One part of our population does have universal health care: Native American tribes on reservations. It is perhaps the worst health care in the country, particularly if you get sick as the budget runs out ("don't get sick after June" is a documentary on the subject). If the United States is incapable of providing decent health care for a very small percentage of the population then what chance does it have for the greater population? I will believe in US universal health care when they can do it right at a small scale.

Re: US doctor forgives $650k in medical bills for cancer patients

#228

Post by alistairSH »

lotsofpulp wrote: post #179
kmos17 wrote: post #173

Earlier quoted context omitted.

Where is your data to backup this claim? Maybe you are right that claims are approved most of the time but in my experience the problem with our health care system is not just denial of claims, but about the cost of medical services and medicine. In my anecdotal experience I have had insurance deny claims on medicine prescribed by my doctors frequently, in one case they would not cover a medicine costing $50 over the…

> Where is your data to backup this claim? I’m claiming that insurers do not erroneously deny claims in the hopes that people give up. I don’t have data for it, but I’ve also never seen data that shows insurers deny coverage just to dissuade people (post ACA). > experience the problem with our health care system is not just denial of claims, but about the cost of medical services and medicine. Yes, I agree here about…

I’m claiming that insurers do not erroneously deny claims in the hopes that people give up.

You keep saying "erroneously" but I'm not sure what you mean by that.

My experience is that for any major change in medication (either dosage or brand, but for the same chronic condition) the insurance will initially deny the claim. This kicks off many hours of phone tag between my family, the insurance, and the doctor. Eventually the insurance company will pay up, but usually well after we've already paid out-of-pocket for the first month, which then requires another few hours on the phone to get reimbursed.

This isn't a single insurance provider. This has spanned decades, 4 employers, 5 insurance companies, and at least 3 medical providers.

Re: US doctor forgives $650k in medical bills for cancer patients

#229

Post by protomyth »

lotsofpulp wrote: post #111
atmosx wrote: post #48

A good question would be what can be done to fix healthcare in the US ? My understanding is that most voters don't support universal healthcare. IIRC even Obamacare was labeled as controversial. Current model costs way more, the model is clearly broken, why there is no pressure to fix it? ps. I don't want to get political or anything by mentioning Obamacare. I'm genuinely curious because the problems of the current h…

> ps. I don't want to get political or anything by mentioning Obamacare. Then try referring to the legislation by its actual name, ACA - Affordable Care Act.

https://www.healthcare.gov/where-can-i-read-the-affordable-c...

The law has 2 parts: the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.

If you actually do read it, note that many of the items in the bill required rule making and have entries in the federal register with the final rules. I don't know of an index that points to all the final rules.

Re: US doctor forgives $650k in medical bills for cancer patients

#230

Post by krapp »

protomyth wrote: post #227
atmosx wrote: post #48

A good question would be what can be done to fix healthcare in the US ? My understanding is that most voters don't support universal healthcare. IIRC even Obamacare was labeled as controversial. Current model costs way more, the model is clearly broken, why there is no pressure to fix it? ps. I don't want to get political or anything by mentioning Obamacare. I'm genuinely curious because the problems of the current h…

My understanding is that most voters don't support universal healthcare. One part of our population does have universal health care: Native American tribes on reservations. It is perhaps the worst health care in the country, particularly if you get sick as the budget runs out ("don't get sick after June" is a documentary on the subject). If the United States is incapable of providing decent health care for a very sma…

The US would be perfectly capable of providing better healthcare to Native Americans if it wanted to. It doesn't want to.
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