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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

#151

Post by toast0 »

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!"

Here's my semi-cooncrete mechanism. Seniors seem to love Medicare...

Every year for 10 years, reduce the age of eligibility by 1 year. At N+10, it will cover 55+.

For the next 10 years, reduce the age of eligibility by 2 years per year. At N+20, it will cover 35+.

You can also set up Medicaid to cover all children in a similar way (after all, most children have no income, so should qualify if judged on personal income rather than family income). Set a date and if you're born after that date, you get medicaid until you're 20.

At year N+20, there will be a 15 year gap for young people. Which is hopefully time enough for them to earn enough social security credits to qualify for Medicare.

And yes, medicare and medicaid taxes would have to go up. But private healthcare premiums should go down.

Rolling it out over 20 years allows for adjustments to be made as things go along. Criteria based on years is for simplicity... A better method would be increasing eligible population by 1% the first year, 1.1% the second, and so on until you're done.

If people really don't want to just pay for it socialized. Just make it possible to self pay for medicare at more ages; this is something that seniors without enough social security credits can already do. Again modulating the eligible age over time to allow for a transition without overwelming the system.

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

#153

Post by wat10000 »

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…

From the patient’s point of view, it all looks the same. Treatment that should be covered gets denied.

It sounds like the insurance companies have a strong incentive to make their coding and requirements as complicated as possible to increase the error rate so they can deny coverage. I don’t think they should get a pass for those denials.

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

#154

Post by lapcat »

Worth noting: neither major Presidential candidate, nor the news media, made health care a focus of the recent election. The issue was almost ignored. And neither major political party offers much: the Democratic establishment will defend the Affordable Care Act to the death (literally in this case), despite the fact that it's not particularly affordable, becoming more unaffordable over time, and it continues to enshrine and subsizide the ruthless for-profit insurance companies. On the other hand, the Republicans paint any kind of government involvement in health care as "Communist", despite the fact that the entire rest of the civilized world have more efficient, effective, and compassionate health care systems heavily regulated by the government.

I think it's a sign of deep American corruption that we can't even have this public debate without a salacious murder occurring.

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

#155

Post by pessimizer »

jimbokun wrote: post #140
mtalantikite wrote: post #120

Earlier quoted context omitted.

I thought it was because of Joe Lieberman, a Democrat turned independent, from a state that tries to bill itself as the "Insurance Capital of the World" [2] [1] https://www.theguardian.com/world/2009/dec/16/joe-lieberman-... [2] https://connecticutifs.com/home/

So 40 Republicans and 1 Democrat.

If it had been 39 Republicans, it would have been 2 Democrats.

Obama campaigned for Joe Lieberman afterwards as an independent against Ned Lamont, who had won the Democratic primary. Lieberman tanked the public option for the Democrats, and Obama was paying his debt.

Democrats would have paid the price at the polls for getting rid of the public option. Lieberman took the hit for the rest of them; he was the cheapest, because he already publicly held right-wing positions. If they had needed another vote, they would have had to find another Democrat to risk their political career to do it. Probably with a cushy lobbyist job at a health insurer after getting voted out.

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

#156

Post by astura »

pnutjam wrote: post #127
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.

Cologuard?

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

#157

Post by kstrauser »

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.

Crack down on them, but don’t use it to justify denying healthcare to patients.

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

#158

Post by DennisP »

kstrauser wrote: post #54
JKCalhoun wrote: post #21

Earlier quoted context omitted.

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 r…

I agree with your general points, but if we can trust Vox, the Anthem situation wasn't quite what people thought. The policy was to prevent overpayment to anesthesiologists, because they get paid partly by the hour and there's evidence that they tend to inflate their times. The policy would not have increased costs to patients, because of this:

> “Say there is a contract between an insurance company like Anthem and an anesthesiologist,” Garmon told Vox. “What is always in that contract is a clause that says, ‘You, the provider, agree to accept the reimbursement rules in this contract as payment in full.’ That means the provider cannot then turn around and ask [the patient] for money.”

There was also a process for anesthesiologists to apply for extra payment if surgery went extra long.

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

They make a larger point that the main reason Americans pay so much more for healthcare is that we pay our providers a lot more. Nations with more reasonable costs and high-quality results have controls in place to keep costs down at the provider level.

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

#159

Post by MiguelX413 »

bufferoverflow wrote: post #143
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.

False dilemma.

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

#160

Post by tommilburn »

hgomersall wrote: post #125
tommilburn wrote: post #74

Earlier quoted context omitted.

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…

to be clear, i'm not a doctor or an expert, just a person with gasto problems - maybe to elaborate a little from my original comment: i think everyone over 40 should be screened (with a colonoscopy or other non-procedure testing) for colon cancer, full stop. then, say, every five or ten years depending on the results?

i also believe pre-screening (stool sample testing, mostly) is getting better, which would potentially help categorize who does and does not need an actual colonoscopy in the future

these are all US stats[0], which i'd imagine is a broadly worse-off group than the UK in terms of like, ultraprocessed foods and other risk factors, but this stood out to me:

> Lifetime Risk of Developing Cancer: Approximately 4.0 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetime, based on 2018–2021 data, excluding 2020 due to COVID.

anecdotally, i think with gastro problems there's a lot of individual latitude where serious problems might go undetected, under-reported, or assumed to have a less serious cause - i also think (but do not know) that colon cancer develops slowly, which may mean there's a long potential where it could be caught, detected, or risks flagged early by a colonoscopy, which, to me, outweighs the risks of "serious complications" from the procedure

[0] https://seer.cancer.gov/statfacts/html/colorect.html

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