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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

#121

Post by OutOfHere »

toast0 wrote: post #59

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 subm…

That's just code gaming. It's not necessarily an error. Also, numerous legitimate legitimate claims are denied no matter their code.

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

#122

Post by wat10000 »

shdksjxbcb wrote: post #61
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...

The American people need to stop seeing the other party as the enemy. As long as that’s in place, the parasites at the top will remain in power. Unfortunately, it’s easy for them to create conditions to perpetuate and widen the American political schisms. And they’ve convinced both sides the common historical solutions (nationalism, limited democracy, religion) are for low IQ bigots. Things are likely too far gone.

Consider what happened with the public option in Obamacare. Both parties played a part in defeating it. The Democrats’ part was that they had 59 Senators in support, and one single dude opposed. The Republicans’ part was that they had 40 opposed and none in favor. Because a 60% majority was required, it failed.

That does not look to me like both sides are at fault and we need to think of it differently. That looks to me like Democrats are imperfect but largely aligned with what I want, whereas Republicans are resolutely in opposition.

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

#123

Post by tboyd47 »

ElevenLathe wrote: post #70
tboyd47 wrote: post #23

Earlier quoted context omitted.

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

Do not, my friends, become addicted to water. It will take hold of you, and you will resent its absence.

Water isn't like drugs and surgery at all.

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

#124

Post by ziddoap »

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…

>Which mathematically makes it far more likely for the insurer to incur enormous colon cancer treatment expenses, erasing their profiteering.

Just find an excuse to deny those claims, too!

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

#125

Post by hgomersall »

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…

It's estimated by CRUK there are 44,000 bowel cancer cases each year in the UK. Assuming only people over 40 get it, and that's about half the population, the incidence is something like 1 in 800 annually. The rate of "serious complications" for a colonoscopy is about 1 in 300.

Given those numbers, how often should everyone get a colonoscopy?

That's before we get on to the potential harm from a false diagnosis (which is much higher without additional priors).

Yes, absolutely people should pay attention to their bowels and get a colonoscopy when it's indicated. Let's not all rush to get one though unless there's some reason for it.

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

#126

Post by drewbug01 »

dboreham wrote: post #94
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.

Otoh some medical providers like to over bill and over treat.

> Otoh some medical providers like to over bill and over treat.

This is true to some extent, but the share of medical providers that over-bill and over-treat really doesn't justify the way the insurance industry does business. It's a false equivalence.

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

#127

Post by pnutjam »

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…

Did they give you an option to poop in a box? I went with that.

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

#128

Post by josh_cutler »

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.

All large health insurers employ many physicians. You're not wrong that they may not have all of the evidence but there is a lot of licensed medical knowledge available to all Payors.

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

#129

Post by psychoslave »

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.

Maybe. But do you have an example of a society that do both death sentence and provide fair trial plus peers conviction?

Making prevailing the idea that some humans can reach a level of certainty that is high enough to put a death sentence on some people they didn’t even knew before that is telling a lot. Like, we humans never make errors, we don’t have any kind of cultural and idiosyncratic biases, we never have conflict of interest and we can’t be manipulated by miscellaneous social forces.

Murder is bad, and murder en masse committed through institutionalized legitimating mechanisms is thus extremely bad, as as many times as bad as how many people it kills.

Legal murder through institutions never prevented a society to have "random" citizen going awry and kill other people, but it never missed to add supplementary threats to all their citizen.

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

#130

Post by kstrauser »

ziddoap wrote: post #124
kstrauser wrote: post #80

Earlier quoted context omitted.

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…

> Which mathematically makes it far more likely for the insurer to incur enormous colon cancer treatment expenses, erasing their profiteering. Just find an excuse to deny those claims, too!

Have you considered a lucrative career in healthcare management!
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