241–250 of 301 posts
Earlier quoted context omitted.
It is funny that the sentiment that nothing excuses a murder is being circulated in the US - a country that still carried out death sentences.
I understand what you're saying. But a murder carried out by a random citizen is still worse than a death sentence after a fair trial and convicted by a jury of your peers.
A site properly presenting the facts is due for launch in the lead up to Germany's upcoming federal election. Until then, you can find a teaser here:
Any claim related to outpatient treatment which outside the ordinary requires prior approval there. You cannot opt to pay in advance and seek reimbursement later.
In the state of Bavaria the doctors at a government agency have been practicing without a medical license going back many years because their supervisor let this slide. I discovered her problem randomly in the course of litigation and it impacts probably a million case.
The person responsible for her staff of hundreds lacking a current medical license was later hired to lead the qualifications department at the medical board. That is, after I got her fired from her position and then from a job at a hospital (a felonious psychologist is unacceptable risk for patients). Politics would prefer to see her problem covered up.
I think we need more thorough analysis. Are the denied claims denied in error? The appeals success rate probably indicates that most of the appealed denied claims were denied in error... but appealed claims are a biased sample of denied claims, so it doesn't tell us much about the overall denied claims. In my experience, I've seen some denied claims, because the provider submitted a wrong code. Then the provider subm…
"A key congressional committee asked insurance giant Cigna on Tuesday to provide corporate documents so that lawmakers can examine the company’s practice of denying health care claims without ever opening a patient file." https://www.propublica.org/article/cigna-health-insurance-de...
Acupuncture has a CPT code and can be billed; do you think a patients file is required to deny it?
Removing a skin tag is considered cosmetic unless it's causing significant issues or is suspected to be cancerous.
This is an opinion piece. Its main claim is that the ACA requires denial rates to be available to consumers but they aren't. Additionally, it reports that denial rates have increased 10x in 10 years, based on the following chain: - "UnitedHealthcare nixed 1.1%, Humana 1.9%, Aetna 1.5% in 2013, per the American Medical Association." - "By 2022, major insurers were refusing to pay, on average, 15% of claims, according…
Excellent summary. I'd like to address the denials in particular. As the article says: "No industry malfeasance could ever excuse murder." With that in mind, we should remember that every death that happens because a valid lifesaving claim was denied is a kind of murder, and no amount of fraud could ever excuse denying valid lifesaving claims. The stakes are too high: all claims should be approved, then adjudicated l…
Fraud is only a small part of the systemic problems. There is an enormous amount of waste and abuse by providers who deliver treatments that are ineffective or unnecessary or excessively expensive. The dominant fee-for-service financial model incentivizes over treatment. We can argue about where to draw the line but payers (whether commercial or government) have to push back on this to keep the system from collapsing. Healthcare is already ~20% of the US economy. It can't continue expanding, we simply don't have the resources to pay any more. Every other country rations care in some way; no country delivers unlimited lifesaving care to everyone.
https://peterattiamd.com/saumsutaria/
https://www.npr.org/sections/health-shots/2019/10/22/7673763...
In December 2021, the American Hospital Association issued the following statement regarding United Healthcare's plans to closely scrutinize medical claims for ER visits. [0] UHC subsequently reversed itself and delayed the plan for 6 months. That was in 2021-2022. It's now 2024-2025. Around that time many insurers, not just UHC, began implementing AI-assisted claims adjudication. It was a bumpy ride with a steep lea…
https://www.cms.gov/marketplace/private-health-insurance/med...
If anyone wants to see real reform then eliminating employer sponsored health plans is one potential way to get the incentives more properly aligned.
My solution to this mess: - Health "Insurance" middleman mafia should not be the default b/w me and my doctor - Health Insurance should only exisit for Catastrophic events (big surgery, cancer etc) - Get rid of the regular Premiums, CoPays, Deductible, CoInsurnace, In network/Out network Bullshit. - For catastrophic events, we pay a premium (much smaller than now) - All hospitals and Doctors must offer an advertised/…
People will probably avoid going to the doctor if they have to pay cash, missing the opportunity to detect the big things early.
It shouldn't even be legal for health insurance providers to deny claims. It's essentially them practicing medicine without a license, because they're making calls about what healthcare a person needs or doesn't need, only a person's doctor(s) should be able to make those decisions.
Agreed. France, Germany, and Japan have health systems similar to the ACA, with the following differences: insurance is nonprofit with an effective mandate, there's a national price list for medical services, and claim denials are prohibited for anything on the list. Germany has an especially effective digital system that guarantees payment within a week. All three systems get better health results than the US, by me…
Earlier quoted context omitted.
> Until the day we can point to a country that implements a direct democracy with a fair way to obtain citizenship for whoever is involved in its society, all laws will always remain a tool of a minority to arbitrarily rule a majority. There's Switzerland.
Switzerland definitely shows interesting political paths, they nonetheless don’t pretend to be a direct democracy. https://www.swissinfo.ch/eng/democracy/swiss-democracy-in-an...
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> Everyone knows Americans pay the most for medical treatment, but the life expectancy is not that high. Sure. > If you know your behavior isn't good for you This doesn't follow. Our healthcare system might be worse than some but that does not imply it's bad for you. That same logic would imply getting punched in the face is good for you because it's better than getting shot.
> Our healthcare system might be worse than some but that does not imply it's bad for you. Well, if you have that mindset, then you'll never achieve anything better, will you? It's not necessarily bad for us, so we'll just keep doing it. It's like the people who vote for the same set of loser politicians every 4 years and then complain that nothing ever changes.
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The affordable care act is the most reasonable path from the current american system to a system on par with other first world countries. This especially given the sort of republican opposition it's liable to face. It's current form is due in substantial part to the republicans gutting it, so you can't really blame the dems for it not working very well.
The Affordable Care Act received precisely zero Republican votes in Congress. It was entirely a Democratic product.