Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

"Not Medically Necessary": Helping America's Health Insurers Deny Coverage

propublica.org

Post reply on HN
Print view View original

21–30 of 224 posts

Re: "Not Medically Necessary": Helping America's Health Insurers Deny Coverage

#21

Post by jmspamerton »

ervine wrote: post #11
d_burfoot wrote: post #6

America cannot, as a country, discover a reasonable approach to managing health care costs because Americans do not have a sufficient core set of shared political values. The solution is to end regulation at the federal level, and allow the states to determine what regulations they may deem appropriate. As a New Hampshire libertarian, I do not want Californian progressives telling me how our state must manage health…

What's a libertarians take on how health care should work? Completely privatized, completely socialized, somewhere in between?

The fact that the hospital doesn't know what a procedure costs (they make it up based on deals with medicare, medicaid, and individual insurance companies) should give you a hint.

Yes, the patient needs skin in the game. People need to take care of their own health. Most procedures are given to grossly unhealthy people.

Yes, completely privatize it. Make people pay for their care so their daily decisions are weighed against what affect it will have on their overall health.

Re: "Not Medically Necessary": Helping America's Health Insurers Deny Coverage

#22

Post by ceejayoz »

jmspamerton wrote: post #21
ervine wrote: post #11

Earlier quoted context omitted.

What's a libertarians take on how health care should work? Completely privatized, completely socialized, somewhere in between?

The fact that the hospital doesn't know what a procedure costs (they make it up based on deals with medicare, medicaid, and individual insurance companies) should give you a hint. Yes, the patient needs skin in the game. People need to take care of their own health. Most procedures are given to grossly unhealthy people. Yes, completely privatize it. Make people pay for their care so their daily decisions are weighed…

> Most procedures are given to grossly unhealthy people.

Well, yeah. That's the idea behind "medically necessary". We don't do elective heart transplants on healthy people for funsies.

Re: "Not Medically Necessary": Helping America's Health Insurers Deny Coverage

#23

Post by outside1234 »

jmspamerton wrote: post #16
f33d5173 wrote: post #10

Earlier quoted context omitted.

I think the vast majority of people agree on the generalities and care enough about solving the issue to be able to come to an agreement on the particulars. The problem is that the people who get rich off the current system won't agree to any solution that reduces their profits, and have thus far managed to fillibuster attempts at such a solution through a combination of buying politicians and propagandizing certain…

so, your answer is OMG, they are making money!11! It's not a money probelm, it's a resources problem. We simply don't have enought hospital resources to serve everyone in the us. it's not making money, it's not having enough beds and skilled people to do the work. Get an MD and help out, then you'll discover how you really DONT want the government to tell you which patients to serve.

Honestly, after stories like these, I don't want a corporation telling me which patients to serve even more. At least government is theoretically accountable for their decisions.

Re: "Not Medically Necessary": Helping America's Health Insurers Deny Coverage

#24

Post by jmspamerton »

ceejayoz wrote: post #17
jmspamerton wrote: post #16

Earlier quoted context omitted.

so, your answer is OMG, they are making money!11! It's not a money probelm, it's a resources problem. We simply don't have enought hospital resources to serve everyone in the us. it's not making money, it's not having enough beds and skilled people to do the work. Get an MD and help out, then you'll discover how you really DONT want the government to tell you which patients to serve.

> It's not a money probelm, it's a resources problem. Most people would consider money a resource, and quite a few rural hospitals are closing because of a lack of that specific resource. > you'll discover how you really DONT want the government to tell you which patients to serve Yeah, wait until you hear about private for-profit insurers doing that instead.

[flagged]

Re: "Not Medically Necessary": Helping America's Health Insurers Deny Coverage

#25

Post by outside1234 »

ervine wrote: post #11
d_burfoot wrote: post #6

America cannot, as a country, discover a reasonable approach to managing health care costs because Americans do not have a sufficient core set of shared political values. The solution is to end regulation at the federal level, and allow the states to determine what regulations they may deem appropriate. As a New Hampshire libertarian, I do not want Californian progressives telling me how our state must manage health…

What's a libertarians take on how health care should work? Completely privatized, completely socialized, somewhere in between?

"I don't want to be forced to pay for insurance, but will move to a state with subsidized insurance the second I need it."

Re: "Not Medically Necessary": Helping America's Health Insurers Deny Coverage

#26

Post by CalChris »

Medicare has a similar issue. When you sign up at 65, you have to make a first big decision, Traditional Medicare (yay!) or private Medicare Advantage (boo!).

Traditional Medicare consists of Part A (hospitals), Part B (doctors) and Part D (drugs). Part A+B don't cover everything so you have a Medigap plan. I have Plan G which has very little paperwork. All up, I spend about $400/mo and I'm very happy with A+B+G+D.

With Medicare Advantage you sign over your Medicare rights+benefits to a private insurer. This may save you some money, especially early on. In fairness, not really a lot and the $0/mo plans are a scam. With Medicare Advantage, you will then have to argue with an insurance company for the rest of your life. You'll have to deal with preauthorizations and a restricted network.

With Traditional Medicare, what's covered is spelled out pretty clearly ahead of time. Docs know it. You know it. There's literally an app for that. With Medicare Advantage, medically necessary is at the discretion of the private insurance company.

Here is the scenario from a relative: he had a heart event which ended up needing a stent. He had to argue with Kaiser while this was going on. Kaiser is 240,000 people. He is one.

Medicare Advantage is very profitable.

It is possible to switch back from MA to TM which really revolves around your Medigap plan. You are guaranteed issue for Medigap plans for about 3 months before/after you turn 65. After that, you will have to undergo medical underwriting.

Re: "Not Medically Necessary": Helping America's Health Insurers Deny Coverage

#27

Post by jmspamerton »

ceejayoz wrote: post #22
jmspamerton wrote: post #21

Earlier quoted context omitted.

The fact that the hospital doesn't know what a procedure costs (they make it up based on deals with medicare, medicaid, and individual insurance companies) should give you a hint. Yes, the patient needs skin in the game. People need to take care of their own health. Most procedures are given to grossly unhealthy people. Yes, completely privatize it. Make people pay for their care so their daily decisions are weighed…

> Most procedures are given to grossly unhealthy people. Well, yeah. That's the idea behind "medically necessary". We don't do elective heart transplants on healthy people for funsies.

[flagged]

Re: "Not Medically Necessary": Helping America's Health Insurers Deny Coverage

#28

Post by ceejayoz »

jmspamerton wrote: post #24
ceejayoz wrote: post #17

Earlier quoted context omitted.

> It's not a money probelm, it's a resources problem. Most people would consider money a resource, and quite a few rural hospitals are closing because of a lack of that specific resource. > you'll discover how you really DONT want the government to tell you which patients to serve Yeah, wait until you hear about private for-profit insurers doing that instead.

[flagged]

> If you're under 26, you've probably never paid a medical bill.

Sure you have. Copays and deductibles are still a thing. I wish my kids didn't have medical bills!

Re: "Not Medically Necessary": Helping America's Health Insurers Deny Coverage

#29

Post by throwanem »

vanc_cefepime wrote: post #3

“The algorithm cannot say no, however. If it finds problems, it sends the request for review to a team of in-house nurses and doctors who consult company medical guidelines. Only doctors can issue a final denial.” As a physician, I’ve had to speak to these so called “peers” in a peer to peer denials with both my clinic and hospital setting. They are usually people who aren’t physicians as a first line of their defens…

[flagged]
Post reply on HN