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

nypost.com

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

#171

Post by psychoslave »

tedivm wrote: post #119
tossandthrow wrote: post #42

Earlier quoted context omitted.

It was not the justification of murder I was talking about. Simply the fact that murder as a solution is absolutely accepted in the US.

Murder isn't the same as homicide. By definition the death penalty isn't murder, because it's state sanctioned. Self defense, another example of legal killing, also isn't murder and most people who are against murder would consider a death in self defense to be justified and not murder.

Self defense can give mitigating circumstances in some legal systems, but it’s not an ethical joker to kill whoever we self-decreed feels as representing a threat.

For example, we can go into treacherous schemes that pushes our neighbors into paths where the only obvious option they can still perceive as a way to escape our shenanigans is an attempt to kill us, and as they come with this very real intention to kill us, press the button we had prepared to trigger some mortal trap.

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

#172

Post by ubnvfft »

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.

Stop speciously muddying the waters by either intentionally or accidentally making spurious arguments for these unethical sociopaths.

I’ve seen this argument made on this website a lot, and it always conveniently omits the vertical integration of these insurers wherein they are the providers too.

The DOJ is literally, actively, suing to block a merger between united healthcare and a provider.

https://www.justice.gov/opa/pr/justice-department-sues-block...

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

#173

Post by throw9002939 »

seanmcdirmid wrote: post #138
MichaelZuo wrote: post #133

Earlier quoted context omitted.

It does seem like the parent is confused. I haven't heard of any jurisdiction where putting someone under for colonoscopies, outside of extreme cases, is the standard expectation. Not even for fancy private hospitals, way too high of a risk-reward ratio.

It is really common to be out on full anesthesia for a colonoscopy. I’m confused by your comment. At least in the USA, I think it is standard and they don’t really talk about any other options.

I am in former soviet country. My relative is refusing to go for optional surgery, bcos they would put her under full anesthesia. She already had "too many anesthesias" in her life, and her brain may not take it well.

Anesthesia in many cultures is seen as a "drug use" and avoided. It has several risks, including death. In many cases it includes needle into backbone.

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

#174

Post by foundart »

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…

Thanks for the tips.

I do have a question about one thing you said:

> I know better about what's preventative and what's not than them.

How is that? From your profile I don't see any medical training.

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

#175

Post by lapcat »

lofenfew wrote: post #167
lapcat wrote: post #154

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 ensh…

The affordable care act is the most reasonable path from the current american system to a system on par with other first world countries. This especially given the sort of republican opposition it's liable to face. It's current form is due in substantial part to the republicans gutting it, so you can't really blame the dems for it not working very well.

The Affordable Care Act received precisely zero Republican votes in Congress. It was entirely a Democratic product.

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

#176

Post by toast0 »

OutOfHere wrote: post #121
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.

I don't doubt that numerous doubly legitimate claims are denied.

What I want is a sense of what the breakdown of the denied claims.

Ex: company sends a list of all denied claims. Auditor picks 100 randomly, gets the files for each and researches those denials to classify the denial as reasonable or not and whatever other categories apply.

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

#177

Post by walls »

forgetfreeman wrote: post #32
jimbokun wrote: post #22

Earlier quoted context omitted.

You would need to prove that murdering a health care CEO will save many innocents, first.

K. So step 1. murder health insurance CEO (no healthcare involved there), check. Step 2. watch UnitedHealth's refusal rates closely, ongoing.

It got Anthem to immediately reverse a horrible decision: https://www.nbcnews.com/health/health-care/anthem-blue-cross...

Violence works.

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

#179

Post by the_snooze »

timr wrote: post #135
garciasn wrote: post #132

Earlier quoted context omitted.

My father's mother had it. My mother's father died of it early. I am predisposed.

Fair enough. I'm making a broader argument than just your situation (which obviously I don't know). The insurance companies are not crazy for trying to control costs on this kind of stuff...however ham-handed their methods.

>The insurance companies are not crazy for trying to control costs on this kind of stuff...however ham-handed their methods.

At some point, after so many failures and edge cases, the least they can do is be actual humans and ask themselves "are we the baddies?"

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

#180

Post by harimau777 »

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?

Depends on your philosophy I suppose. For example, Christianity teaches that failing to do good is itself a sin. So that suggests that an omission could be considered to make someone guilty.

I suspect that all modern legal systems have the concept of negligence which could result in someone being considered guilty for someone's death. I imagine in that case whether that's "murder" would come down to whether you mean a legal definition (which might call it something else like "manslaughter") or the colloquial definition.

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