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

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

#81

Post by tommilburn »

jbb67 wrote: post #77
garciasn wrote: post #47

I was just denied a colonoscopy as not medically necessary by UHC, coincidentally three days before their CEO was killed, because they don't want me to have anesthesia to do it; they argue I should be awake. When I called to refute the denial, which was denied, I asked them to find the person, if it was a person, who denied it and shove a tube up their ass without anesthesia and then reassess whether it's medically n…

But it's not usual to have an anesthetic for a colonoscopy is it? I've had two without. I was offered a light sedation but then I couldn't have driven home afterwards. It wasn't particularly awful without. It's it usual to be asleep? I've not really heard of that. Is it a US thing?

i'm not sure if it's a US thing but i think especially if they're going to take biopsies you're put under twilight, which is one step below general - i don't remember anything about any of the ones i've had, and wake up later in a recovery room

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

#82

Post by codegeek »

My solution to this mess:

- Health "Insurance" middleman mafia should not be the default b/w me and my doctor - Health Insurance should only exisit for Catastrophic events (big surgery, cancer etc) - Get rid of the regular Premiums, CoPays, Deductible, CoInsurnace, In network/Out network Bullshit. - For catastrophic events, we pay a premium (much smaller than now) - All hospitals and Doctors must offer an advertised/displayed Cash Price. No exceptions. Fine heavily if they hide - Let me pay cash for a regular doc visit. - Govt can subsidize for poor people (exdtension to medicare etc ??)

That's it. Problem Solved. This will remove so much BS, middleman stuff, overhead and with a competitive market, prices will drop significantly. Doctors will be happy not dealing with Insurance for everything.

Tell me why I am wrong.

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

#83

Post by TheCondor »

carlgreene wrote: post #7
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.)

I'm trying to figure out if these deaths caused by insurance denials could actually be considered murder. I think they would definitely qualify as being premeditated, but can you consider them "killing"? They are causing death due to omission of expected care, but can the omission of something like medical care be considered the cause of death?

There are direct measures: someone needs a transplant or something of that nature, refusal is effectively shortening their life and some aggressive prosecutors might craft a case. There are less direct things, I expect a lot of them. say people dealing with long recoveries from things, there are good days and bad days and bouts of depression aren’t uncommon; could antidepressants prevent depression on related suicides? That’s an entire can of worms, people have fallen into depression because they’ve become addicted and can’t kick it, what if it was medical pain killers you’re addicted to? Then suppose some company spent half the funds on ED pills and breast augmentation and some more medically things were denied, you can spin that both ways as they might be doing what the bulk of their customers want. That one is interesting, you could break a bone and have surgical reconstruction and hopefully get a full recovery or maybe you just set it and naturally heal and maybe it’s not 100% fixed, only 85%, there is a substantial cost difference there…

For profit medicine and for profit health insurance is just riddled with moral hazard.

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

#85

Post by athenot »

tossandthrow wrote: post #5
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.)

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.

This is because the US is not one homogenous system of thought, but rather a mosaic of people with differing views. (This goes for any other country or population for that matter.)

A more constructive observation would be to consider the overlap in groups of people who (1) hold that murder is indefensible in any case, and (2) hold that death sentences are appropriate for crimes. While not sharing that view myself, I could think of a few factors that may lead others to espouse it, such as:

- an implicit trust in authority and deterrents (follow rule, "or else");

- feeling of being mostly immune to errors in the justice system ("this would never happen to me");

- a propensity to desire revenge but only when it pertains to "others" ("I'm a good person, we must punish the bad people")...

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

#86

Post by voidfunc »

garciasn wrote: post #47

I was just denied a colonoscopy as not medically necessary by UHC, coincidentally three days before their CEO was killed, because they don't want me to have anesthesia to do it; they argue I should be awake. When I called to refute the denial, which was denied, I asked them to find the person, if it was a person, who denied it and shove a tube up their ass without anesthesia and then reassess whether it's medically n…

I've done a colonoscopy without anesthesia before... it was a non-event. This is pretty common from what I understand elsewhere in the world. Americans are just super uncomfortable with their bodies so I guess we prefer being put under?

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

#87

Post by wat10000 »

seneca wrote: post #71
boxed wrote: post #58

Earlier quoted context omitted.

> 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.

Denying a claim can not kill someone. Disease and injury killing a person. Claim denial prevents financial support for intervention in resolving a disease or injury. That is not the same thing, and equivocating them is sophistry.

I’d say that not equivocating them is sophistry. In both cases, someone takes a deliberate action that they know will result in an innocent person’s death. I fail to see why the exact mechanism should be so important.

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

#88

Post by garciasn »

jbb67 wrote: post #77
garciasn wrote: post #47

I was just denied a colonoscopy as not medically necessary by UHC, coincidentally three days before their CEO was killed, because they don't want me to have anesthesia to do it; they argue I should be awake. When I called to refute the denial, which was denied, I asked them to find the person, if it was a person, who denied it and shove a tube up their ass without anesthesia and then reassess whether it's medically n…

But it's not usual to have an anesthetic for a colonoscopy is it? I've had two without. I was offered a light sedation but then I couldn't have driven home afterwards. It wasn't particularly awful without. It's it usual to be asleep? I've not really heard of that. Is it a US thing?

I'm not a medical doctor, nor a clinician that does colonoscopies, so I have no idea. All I know is that the clinic suggested by my primary care physician set everything up and UHC denied it 10 days prior to the procedure, leaving me almost no time to work through any sort of processes to effectively change their decision--if it's even possible.

Without any real evidence except a hunch, I think it's because I've already met my deductible for the year and they don't want to pay for the entire thing and they'll do anything they can to avoid having it happen this year and hope I just go away or do it in another year when I haven't hit my deductible.

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

#89

Post by tjpnz »

jimbokun wrote: post #50
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...

Everyone wants to change it...until you propose a concrete new system including payment mechanism. "Give me universal health care...but don't increase my taxes!...and don't take away my current insurance plan!"

"Why should I have to pay for my neighbor's hip replacement?!!"

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

#90

Post by [deleted] »

tommilburn wrote: post #74
garciasn wrote: post #47

I was just denied a colonoscopy as not medically necessary by UHC, coincidentally three days before their CEO was killed, because they don't want me to have anesthesia to do it; they argue I should be awake. When I called to refute the denial, which was denied, I asked them to find the person, if it was a person, who denied it and shove a tube up their ass without anesthesia and then reassess whether it's medically n…

that's insane! everyone should get a colonoscopy, and i believe they're recommending them for people over 40 if you meet certain risk categories signed up for an account with my real name to share a doc i've been working on for a long, long time now - i've had UC since high school, and have written an extensive guide of what i've learned, if it helps you or anyone else you know who might be getting scoped: https://do…

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