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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

#141

Post by kyleblarson »

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 hate the way the press and seemingly most people are approaching this but am completely unsurprised: "You are either a heathen who supports murder or you are a virtuous supporter of the people and this man deserved to die." Two things can be correct at the same time. 1) Murder is not OK. 2) The insurance industry is completely broken as it incentivizes terrible behavior and this CEO was a scumbag who perpetuated this behavior while possibly insider trading.

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

#142

Post by tboyd47 »

AdmiralAsshat wrote: post #103
tboyd47 wrote: post #65

Earlier quoted context omitted.

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.

That's pure speculation on your part. My stance is common sense: if it doesn't work, don't do it.

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

#143

Post by bufferoverflow »

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'm going to be a bit contrarian and say that drinking that awful liquid the evening before the procedure is 100x worse than not doing it with anesthesia. I did my colonoscopy without any anesthesia, and while it's not very pleasant, it's not painful, it's just a very weird sensation.

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

#144

Post by pphysch »

staticautomatic wrote: post #79
shdksjxbcb wrote: post #61

Earlier quoted context omitted.

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.

The republican corporatist leaders are indeed the enemy. Their voters are not.

The slain CEO was a Democrat, like many of his peers. Again, it's not about political party. Red vs Blue partisan theatre is a tool used by the united ruling class to divide the exploited classes.

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

#145

Post by InitialLastName »

boxed wrote: post #51
jimbokun wrote: post #35

Earlier quoted context omitted.

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.

> 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.

~211 people were killed via trial sentence in the US in the last 10 years [0]. Presumably some of them weren't innocent. In the same time period (conservatively) 8500 were killed by law enforcement outside of the legal process [1].

Both are problematic, but calling [0] https://deathpenaltyinfo.org/database/executions?year=2024&y...

[1] https://en.wikipedia.org/wiki/Lists_of_killings_by_law_enfor...

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

#146

Post by seanmcdirmid »

timr wrote: post #115
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 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. It sounds like something is getting lost in translation. Presence or absence of anesthesia does not change the medical necessity of the procedure. > I'm 45. Colonoscopies are a thing. I had a friend die at 52 t…

When my doctor recommended mine, she said that they could do screening but if they found anything, they would have to do a colonoscopy and then it wouldn’t just be covered as screening (since it was an incident rather than preventive at that point). She said it was better just to get the colonoscopy due to health insurer rules.

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

#147

Post by dheera »

AdmiralAsshat wrote: post #108
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?

It didn't show up on my credit score at all.

I also wasn't too concerned about that because

(a) I believe medical debts don't affect credit scores for a long time.

(b) I believe medical debts are required to have complete erasure from a credit report if cleared so if I actually needed my credit score to buy a house or whatever I could take the $5K hit to restore the credit score at that time.

(c) I sent them a formal letter disputing the debt, which I assumed means they can't just take it to the credit agency, they'd have to go to court with me first. (Again IANAL, I don't know how accurate this is.) In any case I was mentally prepared to spend $10K on lawyers and court and give them a absolute hell of a time than pay $5K to pay for healthcare I shouldn't need to pay for. I made it VERY CLEAR to the debt collectors that I was ready to pay for lawyers.

(d) For the forseeable future I don't think I need my credit score for anything. I don't plan to borrow money.

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

#148

Post by amarcheschi »

wk_end wrote: post #106
amarcheschi wrote: post #17

Earlier quoted context omitted.

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...

the article cites a study that says: "5% of practitioners reported anesthesia times greater in total than what would be expected across university, community, and specialty hospitals. Furthermore, it was found that the greatest differences in expected anesthesia times were in specialty hospitals compared with university hospitals.8 However, the authors have stressed that their findings should not be interpreted to indicate fraud because fraud involves intent, which could not be determined. Because this study was a retrospective study, the authors could not rule out the alternative but unlikely explanation that the practitioners could be rounding down. The reason for caution by the authors is that the CMS has differentiated fraud from abuse by emphasizing that fraud is intentional, whereas abuse is the result of poor medical practices.2 This differentiation is important because sometimes the rounding in digits ending in 0 or 5 minutes in anesthesia time is part of the organization culture of operating rooms in which rounding is performed systematically by the operation room circulating nurse along with the anesthesia practitioner. Sun et al8 recognized this issue as being related to institutional factors, which was one of the reasons they performed a 2-step regression analysis; long anomalous times were not sufficient to establish inappropriate discretion.8"

So Anthem based on the article it might be overpaying for at worst 5% of the operations BUT the big but is that in some hospitals it is routine to round digits. So paying less workers for some rounding operations? It doesn't look as bad to me. It might be because of reasons, or might be due to media backslash.

I think it's safe to assume we definitely need more research into healthcare companies rules after healthcare companies ceo related killing

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

#149

Post by pessimizer »

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.

Not to mention that we happily do extrajudicial assassinations outside of our borders, and the news falls all over themselves to celebrate them.

Everybody knows that plenty excuses a murder, we live in murderous states and in murderous times. The question is whether this murder is excusable, and one's opinion on it is probably dependent on whether one wishes they had that guy's job. Most people wouldn't do it for any price, but plenty would.

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

#150

Post by timmytokyo »

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…

"A key congressional committee asked insurance giant Cigna on Tuesday to provide corporate documents so that lawmakers can examine the company’s practice of denying health care claims without ever opening a patient file."

https://www.propublica.org/article/cigna-health-insurance-de...

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