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Feds help health insurers hide their dirty secret: denials on the rise

nypost.com

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Re: Feds help health insurers hide their dirty secret: denials on the rise

#51

Post by boxed »

jimbokun wrote: post #35
tossandthrow wrote: post #5

Earlier quoted context omitted.

It is funny that the sentiment that nothing excuses a murder is being circulated in the US - a country that still carried out death sentences.

I understand what you're saying. But a murder carried out by a random citizen is still worse than a death sentence after a fair trial and convicted by a jury of your peers.

Worse... how? Shouldn't it depend on context a LOT? Like a mass murderer getting off on a technicality for example.

Considering that a lot of innocent people are murdered by the state via jury and trial in the US the distinction isn't very clear imo.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#52

Post by [deleted] »

tboyd47 wrote: post #23
weberer wrote: post #15

Earlier quoted context omitted.

Everybody knows how bad it is. Everyone wants to change it. But I don't see how it can change as long as both parties are on the payroll https://www.opensecrets.org/orgs/unitedhealth-group/recipien...

It can change once Americans break their addiction to "health care."

[deleted]

Re: Feds help health insurers hide their dirty secret: denials on the rise

#53

Post by nradov »

edwinjm wrote: post #8

It's time the US realizes how bad its medical system is.

Most people in positions of power realize that it's bad in some ways and good in others. It's bad in cost effectiveness and universal access to affordable primary care. It's (relatively) good at other things like 5-year cancer survival rates, waiting times for elective treatments, trauma care, and drug development. There is little agreement on how to fix the bad while preserving the good.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#54

Post by kstrauser »

JKCalhoun wrote: post #21
edwinjm wrote: post #8

It's time the US realizes how bad its medical system is.

Aligning with the other reply, yes, I think it's time US leaders realize how bad the medical system is.

Roger that.

I’m against vigilante killings because I don’t want to live in that kind of a society. But a couple days later, Anthem decided to end their insane time limits on anesthesia. I’m hoping the public’s reaction to all these events has put a bug in the ear of politicians who ran partly on the idea of “repeal the ACA”: maybe this isn’t a great time to start slashing coverage. People seem pretty upset about it right now.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#55

Post by xyzzy4747 »

tossandthrow wrote: post #36
xyzzy4747 wrote: post #25

Earlier quoted context omitted.

It's a little different when a jury of your peers convicts you of a crime which was democratically passed by a legislature, versus a lone gunman who feels he is the judge, jury, and executioner.

Why? Apparently something excused murder in the death row case? So expressing the sentiment that nothiong excuses murder and still having a death row is just I congruent and wrong.

In the death row case, the capital punishment isn't murder if you use classic definitions. If you change the definitions then it's only murder if you equate all homicide to murder.

And yes, both the will of the people and tradition can justify capital punishment.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#57

Post by refurb »

andrelaszlo wrote: post #2

"No industry malfeasance could ever excuse murder. Period." Murdering a murderer to save many innocents could be considered ethical by some? (Not saying that's the case here, but nypost made an interesting categorical statement.)

One issue is that if denying medical care is murder then every healthcare system is guilty.

In the US it’s insurance companies (or the government through Medicare or Medicaid) but in the UK it’s NICE, in Canada it’s CADTH and the provincial health authorities.

Since there are finite resources spent on healthcare, trade offs are made all the time. If spending $10M on treatment A saved 10,000 lives and $10M on treatment B saves 1,000 lives, then treatment A gets funded and treatment B doesn’t.

The difference is that patients in the US have an up close and personal experience with denial.

In Canada and the UK they don’t because doctors knows what is covered and what isn’t so never bring up life saving options if they aren’t paid for.

In rare circumstances like cystic fibrosis in the UK, patients become aware that they are being denied a life saving drug and protest, but generally it’s pretty rare because patients just don’t know the option exists.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#58

Post by boxed »

TimTheTinker wrote: post #41
tossandthrow wrote: post #5

Earlier quoted context omitted.

It is funny that the sentiment that nothing excuses a murder is being circulated in the US - a country that still carried out death sentences.

In the 20th century, I think the death sentence was only ever applied for first-degree murder and for treason. A claim denial that results in denial of life-saving treatment could never be counted as either of those charges.

> A claim denial that results in denial of life-saving treatment could never be counted as either of those charges.

First-degree murder is when you willingly, and with forethought, plans and carries out the killing of a human. Which seems to me to be 100% what you described.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#59

Post by toast0 »

I think we need more thorough analysis. Are the denied claims denied in error? The appeals success rate probably indicates that most of the appealed denied claims were denied in error... but appealed claims are a biased sample of denied claims, so it doesn't tell us much about the overall denied claims.

In my experience, I've seen some denied claims, because the provider submitted a wrong code. Then the provider submits a new claim with the correct code and it goes through.

Given the proliferation of plans, and their sometimes conflicting requirements on medicial coding, I could see that being a big driver of denials increasing over time. As well as a driver of increased administrative costs for providers and insurance companies.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#60

Post by dheera »

Just leaving this here for reference:

In 2022 I was denied full insurance payment of a routine, preventative echocardiogram at Stanford Healthcare to monitor my heart issues. I was balance billed $5000+. The insurance company was HealthNet. The policy clearly indicated full coverage of preventative procedures, without a deductible. They said they did not recognize the procedure as preventative. Fuck them, I know better about what's preventative and what's not than them.

I argued the shit out of it, dozens of e-mails, hours of phone calls, and it was eventually sent to debt collectors. I wrote back to the debt collectors that it wasn't my debt and to stop contacting me. I reported it to a couple of government agencies as well to give them more headaches. I did not pay.

In 2024 it was written off as uncollectible.

(a) Use a virtual mailbox with your health provider so that they don't send debt collectors to your residence. Do not give them your residential address.

(b) Use a virtual phone number with your health provider so that the debt collectors can't call you. Their only option will be mail and that leaves a paper trail which you DO want. NEVER communicate with a debt collector by phone.

(c) Freeze your credit reports with all 3 bureaus so that they cannot use your mailing address to find your residential address.

(d) If they do somehow find your residential address, do NOT answer. Only communicate by mail.

Disclaimer: IANAL, account of personal experience only

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