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UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

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Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#231

Post by rich_sasha »

quitit wrote: post #115
lenerdenator wrote: post #70

The events of the last week are just what happens when a company decides to refuse to meet its customers in the marketplace of sane ideas. You could probably have gotten away with what UNH did if the money wasn't so ridiculous. Thompson himself had a compensation package worth $10.2 million[0] a year. It's reasonable to think that other c-suiters at the company, along with those of its parent organization, made simil…

>People will say that this is necessary to remain competitive, but it just isn't. In other countries there are private health funds that return all of their profits to their members by simply covering more types of care and lowering premiums, all while still giving their staff very good, very attractive pay. That is clearly a win:win setting without being a government-run entity. A person doesn't need to earn 100M-20…

Within the US, could you have a cooperative-style insurance scheme that pays any excess to its members?

I believe these days most insurance companies farm out most of the risk to reinsurers anyway, so you could do it at a relatively small scale.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#232

Post by belter »

internet101010 wrote: post #147
lenerdenator wrote: post #70

The events of the last week are just what happens when a company decides to refuse to meet its customers in the marketplace of sane ideas. You could probably have gotten away with what UNH did if the money wasn't so ridiculous. Thompson himself had a compensation package worth $10.2 million[0] a year. It's reasonable to think that other c-suiters at the company, along with those of its parent organization, made simil…

Yeah even with "good insurance", there is a high likelihood that getting cancer will mean someone's life savings will be vaporized and replaced with bankruptcy levels of medical debt. People spend their adult life paying for future use of a product every two weeks. Then when it comes time to use said product the seller tells them no. Meanwhile, the company they paid all of this money to posts record net income and it…

> even with "good insurance", there is a high likelihood that getting cancer will mean someone's life savings will be vaporized and replaced with bankruptcy levels of medical debt

Only in the US....

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#233

Post by mgraczyk »

maronato wrote: post #167
SoftTalker wrote: post #89

Earlier quoted context omitted.

Please point to the public health care system that does not have limits on what drugs and treatments are approved.

In Brazil, health is a constitutional right. Brazil has free, universal, and unlimited healthcare. Public hospitals in large cities are on the same level as private hospitals, and both are excellent. If you want faster non-emergency care from a private hospital, you can purchase health insurance. Doctors don’t need approval from the insurance company to perform treatments or prescribe drugs. If the drug or treatment…

The therapy described in the article would not be allowed in Brazil

https://www.mdpi.com/2077-0383/12/7/2672

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#234

Post by lijok »

SpicyLemonZest wrote: post #229
lijok wrote: post #203

Earlier quoted context omitted.

So are you saying the doctors contracted to review the treatments need access to the clients insurance policies in order to make a decision on whether the treatment is appropriate? For what purpose? My, arguably naive, understanding is that the reviewer should only need to provide two things for the adjuster to take it from there; whether the treatment is appropriate, and alternative potentially cheaper treatment opt…

The policies consist largely of guidelines regarding what the most cost-effective treatment option for a condition is likely to be. Good insurance companies do try and discuss with providers rather than firing off denial letters willy-nilly, but of course that still ends up being a conflict where your insurance might not let you have the treatment your doctor thinks is best. This conflict is why I've always subscribe…

That sounds very strange to me. If the adjuster has this information, why the need for a review from a consulting doctor? And why would the consulting doctor not be expected to know the costs of these treatment options, at least in relation to alternative options?

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#235

Post by maronato »

anothername12 wrote: post #153

Is it possible for my/my employer’s insurer to convince my employer to fire me if my or my dependent’s health needs are “too expensive”? Could they eg. Give my employer a lower rate as an incentive to do that?

Your employer wouldn’t be on the hook for the costs, so I can’t see why they’d care. The legal and social risks would be gigantic for both your employer and the insurance company.

I imagine insurance companies have other easier tricks to delay or deny treatment before considering something like this.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#236

Post by dragonwriter »

marssaxman wrote: post #143
dragonwriter wrote: post #107

Earlier quoted context omitted.

> That will be part of the defense argument presented to the jury. Intent matters tremendously in the legal system (mens rea). It does, but “he did bad-but-legal things that morally justify my client’s premeditated homicide” is only legally relevant to proving premeditation, which doesn’t help the defense, and which the prosecution will be more than happy to stipulate to rendering the evidence irrelevant. > This isn’…

In terms of the jury's willingness to convinct, however, it is likely to weigh heavily.

The fact that evidence is likely to make the jury act on factors outside of the law, combined with it being irrelevant to any legally relevant point in dispute, weighs heavily against it being allowed to be presented at all.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#237

Post by peitho_pls »

maronato wrote: post #219
mgraczyk wrote: post #204

Earlier quoted context omitted.

One costs $60/year, the other is over $2M/year and not tested and not widely used outside the US

If the doctor prescribed it, it shouldn’t be the insurance company’s decision to deny it. That’s how it works in most countries. Too bad it’s expensive, but that’s why people pay a lot more than $60/yr for insurance.

I'm genuinely curious, what countries work this way? I've never heard of it, every system has some form of rationing as far as I know.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#238

Post by inejge »

mrangle wrote: post #189
lenerdenator wrote: post #70

The events of the last week are just what happens when a company decides to refuse to meet its customers in the marketplace of sane ideas. You could probably have gotten away with what UNH did if the money wasn't so ridiculous. Thompson himself had a compensation package worth $10.2 million[0] a year. It's reasonable to think that other c-suiters at the company, along with those of its parent organization, made simil…

> just what happens It's not "just what happens". That's a politically opportunistic narrative that seeks to incite violence and murder. No one knows why the CEO was killed. None of this type of reasoning justifies or begins to explain the murder even if this were the reason in the shooter's head. Morals aside, it's nonsensical reasoning in total. You're justifying and providing propaganda support for domestic terror…

> No one knows why the CEO was killed.

Whatever the shooter's motive was, you can't deny that the public mood is ugly. There was scarcely any sympathy for Thompson, just an avalanche of gleeful mockery and complaints about healthcare claim handling. The problems are widespread enough that having someone snap because, say, their parents' claims have been denied, is completely believable.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#239

Post by tredre3 »

teractiveodular wrote: post #195
peitho_pls wrote: post #152

Earlier quoted context omitted.

This article is about someone getting cutting edge care beyond medical literature from the one of the leading experts in the world. I've got to imagine most health funds would simply not be able to cover that type of care for an individual?

Not sure why this is being downvoted. Universal healthcare is great, but even if you're in Sweden they're not going to fly you over to Minnesota to get experimental treatment that costs $1M/year.

It's likely downvoted because it's irrelevant. Very few (if any) private plans in the US would cover it either.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#240

Post by teractiveodular »

tredre3 wrote: post #239
teractiveodular wrote: post #195

Earlier quoted context omitted.

Not sure why this is being downvoted. Universal healthcare is great, but even if you're in Sweden they're not going to fly you over to Minnesota to get experimental treatment that costs $1M/year.

It's likely downvoted because it's irrelevant. Very few (if any) private plans in the US would cover it either.

Some plans, like the one in the article, obviously do.

This is the paradox of US healthcare: it's probably the most advanced in the world if you/your insurer can foot the bill, but that's an enormous if.

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