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Feds help health insurers hide their dirty secret: denials on the rise

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Re: Feds help health insurers hide their dirty secret: denials on the rise

#271

Post by seanmcdirmid »

throw9002939 wrote: post #173
seanmcdirmid wrote: post #138

Earlier quoted context omitted.

It is really common to be out on full anesthesia for a colonoscopy. I’m confused by your comment. At least in the USA, I think it is standard and they don’t really talk about any other options.

I am in former soviet country. My relative is refusing to go for optional surgery, bcos they would put her under full anesthesia. She already had "too many anesthesias" in her life, and her brain may not take it well. Anesthesia in many cultures is seen as a "drug use" and avoided. It has several risks, including death. In many cases it includes needle into backbone.

I’ve only been under twice: did a colonoscopy and for wisdom teeth removal. In both cases, it was simply finding a vein on my arm and I was out cold pretty quickly with a weird gap in memory when I came back. It didn’t sound like taking a risk, at least as it was sold to me.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#272

Post by SauciestGNU »

Eddy_Viscosity2 wrote: post #264
ethbr1 wrote: post #205

There's an easy solution to this that the Federal Employee Program (aka FEP) [0] uses -- regular, external accuracy audits. The relevant metric to customers isn't "What percentage of claims are denied?" given the substantial amounts of medical claim fraud. It's "What percentage of claims are denied... that should have been approved ?" So you regularly audit a random sampling of denials, publish the results of that au…

The auditors would either be captured or rendered powerless in short order. There is a great deal of money that can be used for effective lobbying.

Wrongful care denial should be considered a serious felony on par with assault with intent to do grave bodily harm. It should be a veil piercing crime that exposes every insurance company employee involved in denial to personal legal jeopardy should they wrongly deny claims. Reasons for denials must should be required to be extremely detailed and provided to the institutions requesting coverage. Upon receiving a denial, the health care institution should be able to evaluate the denial for validity and choose to refer the denial to local prosecuting attorneys if the denial is medically unsound.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#273

Post by SauciestGNU »

consteval wrote: post #268
antisthenes wrote: post #223

Earlier quoted context omitted.

Will never happen. Doctors have strong lobbying of their own and they really like their second vacation homes and Porsches.

Most doctors are not very rich at all, upper middle class. I make more than many doctors I know as a software engineer, and this doesn't even take into account their debt. Care is expensive because of insurance. Hospitals needs hundreds of administrators and billing specialists. Very little of that money goes to the doctor.

Doctors deserve to be rich. They do incredibly specialized work where the outcomes are extremely critical, to put it mildly. I don't want doctors performing unnecessary treatments to line their pockets, but I don't think we're actually in danger of that.

The difference between a rich doctor and a rich insurance exec is that the doctor helps people, and the insurance exec makes their money withholding necessary care from people, in effect torturing and killing them.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#274

Post by consteval »

SauciestGNU wrote: post #273
consteval wrote: post #268

Earlier quoted context omitted.

Most doctors are not very rich at all, upper middle class. I make more than many doctors I know as a software engineer, and this doesn't even take into account their debt. Care is expensive because of insurance. Hospitals needs hundreds of administrators and billing specialists. Very little of that money goes to the doctor.

Doctors deserve to be rich. They do incredibly specialized work where the outcomes are extremely critical, to put it mildly. I don't want doctors performing unnecessary treatments to line their pockets, but I don't think we're actually in danger of that. The difference between a rich doctor and a rich insurance exec is that the doctor helps people, and the insurance exec makes their money withholding necessary care f…

This is the problem with insurance in general. The incentive of insurance is at direct odds with patients and doctors.

It's a tug of war, and even if insurance "loses", it doesn't matter, because you lost trillions of dollars in that tug of war. It's artificial inefficiency caused by privatization, very much a Dark Night burning a mountain of money situation.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#275

Post by SauciestGNU »

PittleyDunkin wrote: post #3

"No industry malfeasance could ever excuse murder." AND YET

Of course not legally, but I think there's a philosophical exercise here for ethicists to debate the boundaries and efficacy of community self defense.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#276

Post by SauciestGNU »

analog31 wrote: post #69
mrbungie wrote: post #33

Earlier quoted context omitted.

The point here is that "democratically passed legislature" is not at people's service.

An elected legislature is a pipe dream in a country with gerrymandering.

Forget gerrymandering, a representative government is impossible as long as the Senate still gives the same weight to the 15 people in North Dakota as it does the 40 million in California.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#277

Post by SauciestGNU »

consteval wrote: post #274
SauciestGNU wrote: post #273

Earlier quoted context omitted.

Doctors deserve to be rich. They do incredibly specialized work where the outcomes are extremely critical, to put it mildly. I don't want doctors performing unnecessary treatments to line their pockets, but I don't think we're actually in danger of that. The difference between a rich doctor and a rich insurance exec is that the doctor helps people, and the insurance exec makes their money withholding necessary care f…

This is the problem with insurance in general. The incentive of insurance is at direct odds with patients and doctors. It's a tug of war, and even if insurance "loses", it doesn't matter, because you lost trillions of dollars in that tug of war. It's artificial inefficiency caused by privatization, very much a Dark Night burning a mountain of money situation.

Yeah I'm in favor of a single payer system, but I think that's even less likely than adding some guardrails to what we have now.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#278

Post by refurb »

wat10000 wrote: post #104
refurb wrote: post #57

Earlier quoted context omitted.

One issue is that if denying medical care is murder then every healthcare system is guilty. In the US it’s insurance companies (or the government through Medicare or Medicaid) but in the UK it’s NICE, in Canada it’s CADTH and the provincial health authorities. Since there are finite resources spent on healthcare, trade offs are made all the time. If spending $10M on treatment A saved 10,000 lives and $10M on treatmen…

The difference is that patients in the US are being denied by people lining their own pockets with the savings. In sane countries, there’s at least some basis of trying to do the most good with the resources at hand, which sometimes means denying care for person A because those resources would be better spent on person B. With private insurers in the US, it means denying care for person A because they think they can…

> With private insurers in the US, it means denying care for person A because they think they can get away with it and it will increase their profits.

The person at the insurer who denies a claim is not making more money because they denied it. The company as a whole might, but not the person denying it.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#279

Post by refurb »

OutOfHere wrote: post #99
refurb wrote: post #57

Earlier quoted context omitted.

One issue is that if denying medical care is murder then every healthcare system is guilty. In the US it’s insurance companies (or the government through Medicare or Medicaid) but in the UK it’s NICE, in Canada it’s CADTH and the provincial health authorities. Since there are finite resources spent on healthcare, trade offs are made all the time. If spending $10M on treatment A saved 10,000 lives and $10M on treatmen…

Your argument is completely bogus for multiple reasons. Firstly, people are paying here for insurance, a lot. Secondly, it's the FDA's job to approve treatments which it does. Thirdly, we do not have a uniform privatized determination across the country of what is approvable or not by insurance companies. They deny numerous legitimate treatments and procedures at their whim.

I’m not sure how that makes my argument bogus.

Plenty of treatments are denied in other countries. Not to mention most other countries have private insurance layered on top of public and it’s the same issue - private insurers denying a treatment through their own process.

If US insurers are guilty of murder than most of the worlds insurers are too.

Re: Feds help health insurers hide their dirty secret: denials on the rise

#280

Post by refurb »

Miner49er wrote: post #72

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.

This makes no sense.

Plenty of healthcare is not covered by insurance. Cosmetic procedures are healthcare and not covered.

Not to mention errors in claims, claims that include care well outside guidelines, etc.

You’d expect a pretty consistent level of denials even if all medically necessary claims are approved.

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