Feds help health insurers hide their dirty secret: denials on the rise • Hacker News Board

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

#101

Post by Noumenon72 » Fri, Dec 13, 2024, 3:37 PM UTC

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…

You were not denied a colonoscopy, but anesthesia during a colonoscopy, which is not medically necessary[1]. Tough line to draw though.

1: https://www.mayoclinichealthsystem.org/hometown-health/speak....

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

#102

Post by drweevil » Fri, Dec 13, 2024, 3:37 PM UTC

joejohnson wrote: post #45

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.

And which is currently fighting multiple wars around the world, or justifying support of many proxy wars which are killing thousands daily.

This. The cognitive dissonance is jarring. And no "that's different!" is no argument. Like it or not, our government leads by example. And the example is not a good one.

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

#103

Post by AdmiralAsshat » Fri, Dec 13, 2024, 3:37 PM UTC

tboyd47 wrote: post #65

dgfitz wrote: post #44

Earlier quoted context omitted.

Huh? I don't know a single person who ENJOYS going to the doctor, or needing medical treatment. What are you on about?

There are lots of people who get freaked out and go to the hospital for every little thing. We used to have a term for that: "hypochondriac." Now it's become socially acceptable, so you don't hear the term as much. Everyone knows Americans pay the most for medical treatment, but the life expectancy is not that high. If you know your behavior isn't good for you, but you can't stop yourself, well, that's an addiction.

On the contrary, if the healthcare system in the US weren't such shit, more people would probably be going to primary care doctors and getting Preventative Care before it becomes an emergency, and requires a trip to the hospital.

But many people don't, because visiting a primary care / walk-in clinic / urgent care is expensive, so they ignore it, until it becomes un-ignorable. Now it's an ER visit.

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

#104

Post by wat10000 » Fri, Dec 13, 2024, 3:37 PM UTC

refurb wrote: post #57

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 treatmen…

The difference is that patients in the US are being denied by people lining their own pockets with the savings. In sane countries, there’s at least some basis of trying to do the most good with the resources at hand, which sometimes means denying care for person A because those resources would be better spent on person B. With private insurers in the US, it means denying care for person A because they think they can get away with it and it will increase their profits.

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

#105

Post by caseyohara » Fri, Dec 13, 2024, 3:38 PM UTC

kstrauser wrote: post #80

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…

Good god. I went to get one, and in the pre-screening, the anesthesiologist asked if I wanted to be awake for it. “Doc, I don’t want to be awake, I don’t want to feel a thing, and I don’t want to remember a thing. Put me out.” Requiring people to be awake is a good way to guarantee they don’t get the procedure. Which mathematically makes it far more likely for the insurer to incur enormous colon cancer treatment expe…

> for the insurer to incur enormous colon cancer treatment expenses

This presupposes the insurer isn’t going to deny claims for that treatment, too.

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

#106

Post by wk_end » Fri, Dec 13, 2024, 3:38 PM UTC

amarcheschi wrote: post #17

lopalimpa wrote: post #12

Earlier quoted context omitted.

"Murdering a murderer to save many innocents could be considered ethical by some?" This is a heavy statement. More I read, heavy it gets. Kill people it never the answer. The ideia that "I" have the power is weak. People, together, have power, however they don't know what to do. In his case the easiest way to win is pressuring the government, with the people, for clear changes.

Killing people is not the answer but somehow another Healthcare company backtracked on not covering anymore long anesthesia. Perhaps n = 1 is too low of a value? We should research this field more, some people may die but it's a chance I'm willing to take

Although it should be noted that the anesthesia thing was dumb and bad. So maybe policy by mob justice isn’t a good thing.

https://www.vox.com/policy/390031/anthem-blue-cross-blue-shi...

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

#107

Post by OutOfHere » Fri, Dec 13, 2024, 3:38 PM UTC

aaomidi wrote: post #27

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.)

Consent has been manufactured that if you kill through indirect means then you’re good to go!

Yes, mass media exists to manufacturer consent, and this shooter forced their hand.

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

#108

Post by AdmiralAsshat » Fri, Dec 13, 2024, 3:39 PM UTC

dheera wrote: post #60

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 bett…

That might have gotten them to stop bugging you, but I imagine your credit score still took a hit?

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

#109

Post by DennisP » Fri, Dec 13, 2024, 3:39 PM UTC

Miner49er wrote: post #72

It shouldn't even be legal for health insurance providers to deny claims. It's essentially them practicing medicine without a license, because they're making calls about what healthcare a person needs or doesn't need, only a person's doctor(s) should be able to make those decisions.

Agreed. France, Germany, and Japan have health systems similar to the ACA, with the following differences: insurance is nonprofit with an effective mandate, there's a national price list for medical services, and claim denials are prohibited for anything on the list. Germany has an especially effective digital system that guarantees payment within a week.

All three systems get better health results than the US, by measures like survival time after diagnosis of major disease. And all three spend a significantly lower percentage of their GDP on healthcare.

Source: The Healing of America by T.R. Reid.

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

#110

Post by stuaxo » Fri, Dec 13, 2024, 3:39 PM UTC

refurb wrote: post #57

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 treatmen…

The US spends the most budget per patient for the least amount of care, the rest goes into inefficiency and profit (a second kind of inefficiency).

Medicare per-capita spending is more than NHS per capita spending, but the NHS covers everyone.

Of course healthcare is denied in any system (in other systems this is triage), but nowhere to the level United Health does it: over 30%, it's on a completely different scale.