I assumed health plans always say "no" the first time you submit, to weed out people who give up too easily.
How often do health insurers say no to patients? (2023)
21–30 of 103 posts
Re: How often do health insurers say no to patients? (2023)
#22All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300. The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. I was raised a die-hard ca…
1. A properly competitive marketplace
2. Socialized medicine
3. What we have now
I would like to see #1 tried but at this point I’ll gladly accept #2
Re: How often do health insurers say no to patients? (2023)
#23All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300. The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. I was raised a die-hard ca…
> The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for.
The employees of the managed care organization are often just using the criteria of the payer (often times the federal or state government for Medicaid/Medicare/federal employee or other large self funded plans).
The US government leaders are in a good spot. They get the managed care organizations (MCOs) to take the heat for denying coverage, while setting the rules to deny the coverage. MCOs even get audited and fined for approvals that don’t meet criteria.
In any case, all systems with limited resources will have to have someone approving or denying payments, whether it be a government employee or someone contracted out by the government.
But the most salient metric here is all the MCOs earn only 2% to 3% profit margins. And their market caps are tiny, and returns abysmal. (Except UNH, but that is due to its significant provider and software business).
Blame MCO employees all you want, but you will be doing exactly what government leaders want you to do.
Re: How often do health insurers say no to patients? (2023)
#24All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300. The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. I was raised a die-hard ca…
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Re: How often do health insurers say no to patients? (2023)
#25I thought I saw a meme about denail rates when that healthcare CEO got shot? Where did those numbers come from?
FYI the shooter has received $1.2m in donations for his defense fund, and counting.
Re: How often do health insurers say no to patients? (2023)
#26Earlier quoted context omitted.
Yes, but you'll often find that in a high-deductible plan the insurance company gets a "discount" of your $1k med down to $200, which they brag about in your EOB… but the medication's cash price for uninsured people would be $20. You're out of pocket $180 more than you should be, and paying the $20 cash price out of pocket means your deductible doesn't budge.
What if the medicine costs 100$ to produce, should uninsured have to pay that rather than a subsidized 20$?
What if the medicine costs $0.01 to produce and both are getting hosed?
Re: How often do health insurers say no to patients? (2023)
#27All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300. The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. I was raised a die-hard ca…
1. A properly competitive marketplace 2. Socialized medicine 3. What we have now I would like to see #1 tried but at this point I’ll gladly accept #2
I just don't think #1 is possible, how can you have a functioning marketplace for a good when the demand is hard to forecast for an individual, almost completely inelastic and often extremely time sensitive. I'd say the US really tried and the incentives just aren't there for a stable system.
Re: How often do health insurers say no to patients? (2023)
#28I thought I saw a meme about denail rates when that healthcare CEO got shot? Where did those numbers come from?
FYI the shooter has received $1.2m in donations for his defense fund, and counting.
The accused shooter.
Firstly, Luigi Mangione is presumed innocent until proven guilty.
Secondly, there's a fair amount of real evidence that Luigi is being set up as a scapegoat by the NYPD—a police department with a known history of planted evidence.
Re: How often do health insurers say no to patients? (2023)
#29All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300. The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. I was raised a die-hard ca…
Healthcare, when you actually need it, is an inelastic demand very often combined with an inelastic supply (or more exactly, an inelastic supply of suppliers) due to IP laws and the realities of specialization.
It is not at all surprising that capitalism fails miserably here, IMO.
Re: How often do health insurers say no to patients? (2023)
#30For what it's worth, I've been thrown in society's waste basket altogether on this one.
No insurance, none, of any kind.
I've got a Free h D in hillbilly medicine though. I've accomplished some amazing shit, but it's unraveling a bit now, and I'll be super surprised if I last much longer.
One can certainly say such a hit to morale is just collateral damage in the beautiful face of our wondrous mutant hive, but what are you guys gonna do when we start stinking up your streets en masse? One way or another, you'll be smelling the smoke.
Soylent Green is here. Read your labels carefully.
Proudly Made in the USA with Harshly Sourced Ingredients. I was free roaming though, if that matters.
Edit: returned to clarify that I was pulling myself up by me bootstraps. It's just that it's getting tough to hold on to em tightly enough. No shoes no service though, I guess.