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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

#181

Earlier quoted context omitted.

It's the least bad system.

It's legalized corruption to the max. It's the worst implementation of the least bad system.

If the U.S. is leading the world's economy with high standards of living, maybe it is only a bad implementation in some aspects but not all.

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

#182
post #139

Earlier quoted context omitted.

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?

The doctor / hospital that refuses to treat when insurance declines is also involved in the “omission of expected care”. Would they also be guilty of premeditated murder?

Yeah.

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

#183

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.

Occult blood stool sample? Colonoscopies are a lot more accurate. Something on the order of 50% vs 90%.

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

#184
post #115

Earlier quoted context omitted.

> 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.

> 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.

Well yeah...it isn't screening then. It's a treatment. So the question becomes whether or not the treatment is necessary. If the prior "screening" didn't show definitive evidence that the treatment is necessary, then...what are you doing, exactly?

I understand that colonoscopies mix up the notion of treatment and screening, but the doctor is basically saying "our screening tests don't work very well, so we should just do the treatment without evidence because they'll pay for that."

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

#185

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 an anesthesiologist. What they denied was paying me to do it. You can still get "moderate sedation" from a nurse - a benzodiazepine and opioid. Patients strongly prefer having what amounts to a general anesthetic; your chances of recalling anything are low either way, but propofol results in a much faster recovery to full consciousness afterward. Go gain 100 pounds and develop sleep apnea. Then they'll approve it…

[deleted]

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

#186

Earlier quoted context omitted.

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.

The person I replied to didn't assert that he was a Republican. Your comment is inapposite. And the Democrat elite is also the enemy.

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

#187
post #135

Earlier quoted context omitted.

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?"

I get that, but my point is that in health insurance, you're pretty much always going to find someone complaining about being denied for something, even if the denial was completely justified on an evidentiary basis (again: not talking about OP specifically here). Literally every cost-control measure -- even if sensible -- is going to be framed as evil by someone.

A lot of health care is just really expensive superstition. For a more extreme version, consider the phenomenon of "preventative MRIs", which are just lighting piles of money on fire for no reason at all.

I replied to colonoscopy specifically here because the general public has been conditioned to believe that these screenings are medically necessary at increasingly younger ages for everyone, despite the fact that this is not the standard at all in most other countries.

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

#188
post #115

Earlier quoted context omitted.

> 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.

If they find something suspicious during the colonoscopy, they won't bill it as a free screening anymore and you'll be on the hook for it. Ask me how I know.

No regrets about getting screened though. It saved my life.

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

#189

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.

You could easily argue the opposite is also possible to be true - if by "murder" you mean "killing" in general.

It's quite possible for someone to hold that a killing in self-defense is much more defensible than the deliberate execution even after a conviction and trial of someone who is "no longer harmful to society" because they're locked up.

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

#190
post #118

Earlier quoted context omitted.

Murder is by definition an unlawful homicide. This isn’t just pedantry; it’s the most parsimonious explanation for why someone would support the death penalty and object to something like the assassination.

It becomes pedantry of the law is not right. Eg. If the law is based on an oligarchy over a democracy.

Until the day we can point to a country that implements a direct democracy with a fair way to obtain citizenship for whoever is involved in its society, all laws will always remain a tool of a minority to arbitrarily rule a majority.

The concern is not whether laws are rights or wrongs, but which privileges and which hurts they reinforce for which classes in the society where the national myth is eager to present them as the applied rules.

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