21–30 of 434 posts
This is the reason we need universal public healthcare.
“We thought it might fall into a legal gray zone,” said the former Cigna official, who helped conceive the program. “We sent the idea to legal, and they sent it back saying it was OK.” Reading this article is just maddening. I've been dealing with different insurers for the past 7 years or so, and it's my experience they must all do something similar. Anyone with any kind of serious health condition is regularly driv…
Had it not been for their constant denials of a drug I had been on for over two years prior, I might still be taking that medication instead of having developed antibodies for the 6 months they denied.
My doctors office gave me free samples as long as they were able, but in 2022 they were wiped out as all patients that were on that drug were being denied coverage.
Worse still, insurance recommended "use drug X, which is similar"... but I couldn't because I was on drug X—until I had anaphylaxis from it!
Privatized health care as a person's sole option for care is an absolute dystopian nightmare. Any system that requires balancing human suffering against profitability is inevitably going to optimize for profitability. The fact that this is even a thing is mind boggling.
Public health care can be similarly dystopian in other ways: Very long wait times due to limited resources, subpar medical care, limited prescription options and drugs, beauracracy. No matter what society you live, the advice is the same: try not to get sick.
Privatized health care as a person's sole option for care is an absolute dystopian nightmare. Any system that requires balancing human suffering against profitability is inevitably going to optimize for profitability. The fact that this is even a thing is mind boggling.
Public health care can be similarly dystopian in other ways: Very long wait times due to limited resources, subpar medical care, limited prescription options and drugs, beauracracy. No matter what society you live, the advice is the same: try not to get sick.
You realize we're discussing the US which has all this?
> beauracracy.
It's funny you mention this, because the US spends vastly more on bureaucracy in its health systems than other developed nations.
Earlier quoted context omitted.
Public health care can be similarly dystopian in other ways: Very long wait times due to limited resources, subpar medical care, limited prescription options and drugs, beauracracy. No matter what society you live, the advice is the same: try not to get sick.
I moved from a third world country with both socialized and private healthcare, to the United States. I pay vastly more for worse healthcare than anywhere I've lived. The fact that you, your doctor can agree that a certain procedure is required, only to be denied by a third party with no medical qualification is absolutely dystopian.
Earlier quoted context omitted.
Public health care can be similarly dystopian in other ways: Very long wait times due to limited resources, subpar medical care, limited prescription options and drugs, beauracracy. No matter what society you live, the advice is the same: try not to get sick.
> Very long wait times due to limited resources, subpar medical care, limited prescription options and drugs, You realize we're discussing the US which has all this ? > beauracracy. It's funny you mention this, because the US spends vastly more on bureaucracy in its health systems than other developed nations.
“We thought it might fall into a legal gray zone,” said the former Cigna official, who helped conceive the program. “We sent the idea to legal, and they sent it back saying it was OK.” Reading this article is just maddening. I've been dealing with different insurers for the past 7 years or so, and it's my experience they must all do something similar. Anyone with any kind of serious health condition is regularly driv…
Wife is a nurse. Required surgery for lifesaving/severe disability (inherited congenital, killed her father). Insurance was Aetna and Hospital Self Insured. Surgery recommended by world class surgeon she worked with. Finally pre-approved on 3rd appeal after 8 months and 150pages of documentation of every piece of every single communication (who, when, response, expected next contact) only weeks before surgery schedul…
How did you find out about the automatic rejection/identity of the reviewers?
This is the reason we need universal public healthcare.
That won't help you there. Germany's public healthcare system denies plenty of things too, and will only pay for treatment when you sue (or know someone who works there). Germany's private healthcare system on the other hand is usually better (I'm sure there are exceptions and some insurance company that sucks).
60,000 / 20 workdays in a month / 8 hours in a workday => this guy rejected about 375 claims per hour, on average. Over six claims a minute. He spent less than 10 seconds on each claim, for a full month of work time.