I write about America’s health care system, and I got caught up in it • Hacker News Board

Re: I write about America’s health care system, and I got caught up in it

#21

Post by civilized » Sun, Jan 30, 2022, 1:59 PM UTC

lotsofpulp wrote: post #19

civilized wrote: post #17

Earlier quoted context omitted.

We went through this with a relative recently. She needed a surgical operation. We were asked to either 1. Wait for prior authorization and allow our appointment to be canceled and rescheduled (for the fourth time, having already wasted several weeks) 2. Pay out of pocket We decided to pay out of pocket, since we knew that the prior authorization could delay us by an arbitrary amount of additional time and had recent…

> The twisted thing is that you can't just get the operation done and let the prior authorization work itself out later. It truly has to be prior or you get stuck paying out of pocket, even if the operation is obviously medically necessary. I have had doctors collect payment, and then refund me once they get paid by the MCO. One more thing that would help here is decoupling employers from your MCO. That way, when you…

Well, we were told this is impossible, so either everyone involved lied to us or your experience isn't universal.

While insurance tied to your employer sucks, I think the best thing to do here is for the law to iron out the data interchange between MCOs. In a "marketplace" like the US, insurers must be under a dire legal obligation to transfer your data in a comprehensive and timely fashion to whoever is currently administering payment for your care. Especially when lifesaving medication is involved.

The patient should not be held hostage by the incompetence of MCOs at communicating medical data.

Re: I write about America’s health care system, and I got caught up in it

#22

Post by DavidPeiffer » Sun, Jan 30, 2022, 2:02 PM UTC

dannykwells wrote: post #15

Ironic that he works at Kaiser, I wonder if he has Kaiser Permanente insurance?

Kaiser Health News and Kaiser Permanente are independent organizations, through they come from the same original funder.

Here's a page going through the story.

An Arm and A Leg is a really interesting podcast partially funded by Kaiser Health News that does similar stories to this one, going through the ridiculousness of the whole US Healthcare system and how people have successfully navigated it.

https://armandalegshow.com/about-x/partners-and-supporters/k...

Re: I write about America’s health care system, and I got caught up in it

#23

Post by erenyeager » Sun, Jan 30, 2022, 2:05 PM UTC

lotsofpulp wrote: post #13

civilized wrote: post #4

Aside from someone being denied life-saving medication, the most awful thing for me in these stories is the relentless Kafkaesque quality. We never get any answers to our basic sense-making questions about the bureaucratic process: - What did the insurer expect to happen, in order for this person to keep getting their medicine? - Why did those things not happen? - Whose job was it to make sure those things happened?…

I find the article written in a circuitous way, that does not clearly lay out the timeline. This statement about what a prior authorization is is also incorrect: > They’re essentially requirements that a physician get approval from an insurance company before prescribing a treatment. Doctors need no approval from anyone to prescribe. A prior authorization is approval from the insurance company that they agree with th…

Honestly doctors don’t have enough time to juggle all this along with treating the patient. Many times it is the case that the patient cannot afford the medication and/or their insurance will not cover it. Shifting this burden on the physician and patients to figure out these economic problems interferes with healthcare.

Re: I write about America’s health care system, and I got caught up in it

#24

Post by nceqs3 » Sun, Jan 30, 2022, 2:06 PM UTC

throw8932894 wrote: post #3

> The price of my prescription without insurance was $339 per vial of insulin In most countries insulin price is around $30. I remember it was cheap in US too. Seems like another problem created by US kleptocracy. Make something prohibitively expensive, and "solve" problem by providing handouts to cover costs.

You are comparing an insured price to a cash list price (most of which does not go to the pharma co and a price which effectively nobody pays). As an insured American, I would pay 0$ for insulin.

Re: I write about America’s health care system, and I got caught up in it

#25

Post by alistairSH » Sun, Jan 30, 2022, 2:10 PM UTC

lotsofpulp wrote: post #13

civilized wrote: post #4

Aside from someone being denied life-saving medication, the most awful thing for me in these stories is the relentless Kafkaesque quality. We never get any answers to our basic sense-making questions about the bureaucratic process: - What did the insurer expect to happen, in order for this person to keep getting their medicine? - Why did those things not happen? - Whose job was it to make sure those things happened?…

I find the article written in a circuitous way, that does not clearly lay out the timeline. This statement about what a prior authorization is is also incorrect: > They’re essentially requirements that a physician get approval from an insurance company before prescribing a treatment. Doctors need no approval from anyone to prescribe. A prior authorization is approval from the insurance company that they agree with th…

> They’re essentially requirements that a physician get approval from an insurance company before prescribing a treatment. Doctors need no approval from anyone to prescribe. A prior authorization is approval from the insurance company that they agree with the treatment option and will pay for it (subject to deductible/copay/oop max).

To the consumer, the experience is the same - they can’t get a necessary drug before spending hours or days playing telephone tag with their doctors office and insurance company. Often, this happens for a drug they’ve taken their whole life. Insulin, thyroid hormone, etc.

Re: I write about America’s health care system, and I got caught up in it

#26

Post by pessimizer » Sun, Jan 30, 2022, 2:11 PM UTC

lotsofpulp wrote: post #13

civilized wrote: post #4

Aside from someone being denied life-saving medication, the most awful thing for me in these stories is the relentless Kafkaesque quality. We never get any answers to our basic sense-making questions about the bureaucratic process: - What did the insurer expect to happen, in order for this person to keep getting their medicine? - Why did those things not happen? - Whose job was it to make sure those things happened?…

I find the article written in a circuitous way, that does not clearly lay out the timeline. This statement about what a prior authorization is is also incorrect: > They’re essentially requirements that a physician get approval from an insurance company before prescribing a treatment. Doctors need no approval from anyone to prescribe. A prior authorization is approval from the insurance company that they agree with th…

I'm not seeing an important difference between the way you describe prior authorization and the quote from the article. Nobody in the world thought that doctors need to get permission from insurance companies to practice. This was about getting coverage. I doubt that many people were confused about the rationale from insurance companies for prior authorization: so the insurance company can decide if they approve of the doctor's action. That's the traditional definition of authorization.

Re: I write about America’s health care system, and I got caught up in it

#27

Post by h2odragon » Sun, Jan 30, 2022, 2:14 PM UTC

HarryHirsch wrote: post #12

h2odragon wrote: post #10

> Some suggested I go to Walmart for $25 insulin, an older type I have no idea how to safely use. I'm sorry but this erodes my sympathy significantly. Learn about the options that exist if your first choice treatment isnt available. Learn about mitigation when no treatment is available. This is your life, act like its your responsibility already.

You need to manage a chronic condition, either you need a spouse or a child who has a chronic condition or you need one yourself. Science can help, alloxan destroys the islets of Langerhans, it is used to create diabetic mice. Go ahead, take a dose, lead by example. The Walmart insulin comes up here on this website from time to time, and the overall conclusion is that long-acting insulins prevent blood sugar excursio…

> You need to manage a chronic condition,

I am. I expect to be dead before the decade is out, the doctors offer ways to make that more comfortable but shorter. I disagree with their priorities and am thus on my own for other treatment options.

"I do not need to know about other options" seems inexcusable to me, and seems to be what the author assumes is the correct attitude towards their treatment.

Re: I write about America’s health care system, and I got caught up in it

#28

Post by lotsofpulp » Sun, Jan 30, 2022, 2:14 PM UTC

civilized wrote: post #21

lotsofpulp wrote: post #19

Earlier quoted context omitted.

> The twisted thing is that you can't just get the operation done and let the prior authorization work itself out later. It truly has to be prior or you get stuck paying out of pocket, even if the operation is obviously medically necessary. I have had doctors collect payment, and then refund me once they get paid by the MCO. One more thing that would help here is decoupling employers from your MCO. That way, when you…

Well, we were told this is impossible, so either everyone involved lied to us or your experience isn't universal. While insurance tied to your employer sucks, I think the best thing to do here is for the law to iron out the data interchange between MCOs. In a "marketplace" like the US, insurers must be under a dire legal obligation to transfer your data in a comprehensive and timely fashion to whoever is currently ad…

> , there is the question of why someone with Type 1 Diabetes is being denied their medicine. I feel like the only potentially valid excuse would be if the insurer literally didn't know the person had Type 1 Diabetes.

I forgot to respond to this in your prior reply. The answer here is because insulin is not just insulin. There are many different formulations and brands with many different prices.

Even the federal government does not want to pay for all of them:

https://www.healthline.com/diabetesmine/new-medicare-program...

So one could say it is about money, or how much extra money is politically available to spend for the marginal benefit (population wise) of certain insulin.

Re: I write about America’s health care system, and I got caught up in it

#29

Post by throw8932894 » Sun, Jan 30, 2022, 2:15 PM UTC

nceqs3 wrote: post #24

throw8932894 wrote: post #3

> The price of my prescription without insurance was $339 per vial of insulin In most countries insulin price is around $30. I remember it was cheap in US too. Seems like another problem created by US kleptocracy. Make something prohibitively expensive, and "solve" problem by providing handouts to cover costs.

You are comparing an insured price to a cash list price (most of which does not go to the pharma co and a price which effectively nobody pays). As an insured American, I would pay 0$ for insulin.

No, cash list price of insulin in most countries is around $30. As uninsured person you can still buy insulin for this price in Mexico or order it from India.

Re: I write about America’s health care system, and I got caught up in it

#30

Post by [deleted] » Sun, Jan 30, 2022, 2:17 PM UTC

lotsofpulp wrote: post #13

civilized wrote: post #4

Aside from someone being denied life-saving medication, the most awful thing for me in these stories is the relentless Kafkaesque quality. We never get any answers to our basic sense-making questions about the bureaucratic process: - What did the insurer expect to happen, in order for this person to keep getting their medicine? - Why did those things not happen? - Whose job was it to make sure those things happened?…

I find the article written in a circuitous way, that does not clearly lay out the timeline. This statement about what a prior authorization is is also incorrect: > They’re essentially requirements that a physician get approval from an insurance company before prescribing a treatment. Doctors need no approval from anyone to prescribe. A prior authorization is approval from the insurance company that they agree with th…

[deleted]