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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

#291

Earlier quoted context omitted.

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 deni…

These are all great 'shoulds' and most people would probably agree. So why do you think there isn't political support for anything close to this?

It would harm profits and maybe give the idea that an LLC doesn't give you license to break the law with impunity. The veil piercing aspect especially would be a major departure from how corporate liability currently works.

I think the biggest barrier is that it inconveniences the powerful to benefit the masses.

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

#292
post #287

Earlier quoted context omitted.

Right, the ones who profit are just setting up the rules, policies, and incentive structures that those people work under.

This is a really simplistic approach and you're never going to fix it. There are numerous stakeholders who setup the rules - the government, insurance companies, hospitals, doctors, billers, etc. All of them profit from the current system, but there is no single stakeholder who decides the overall rules.

My only point is that there are people with a lot of power to decide who gets what treatments who profit from denying treatment. That’s 100% true.

Fixing it is another matter. Of course that’s not easy.

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

#293
post #265

Earlier quoted context omitted.

I'm not sure how implementing a system like Germany or Japan wouldn't impact those things at all. Why aren't Germany or Japan equal to the USA in 5-year cancer survival rates? Their systems optimize for different priorities, and those involve trade-offs. So no, it obviously doesn't go without saying. If we want to cut overall health system costs or improve access then we might have to accept some reduction in service…

Perhaps because the US is the home of a number of prestigious colleges and to be with your peers you have to relocate there? You act like the broken healthcare system is the only possible explanation for cases where the US provides better care, but I'm yet to see that proven. Intuitively it doesn't track because many of the issues with the system don't pertain to things like intensive cancer care but to simple things…

Well now you're just making things up. It's not my cancer survival rate number, it's the number published by the CONCORD programme in the London School of Hygiene & Tropical Medicine. If you had bothered to read the article I linked above then you wouldn't need to doubt because you would know exactly what they factored in.

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

#294
post #15

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Everybody knows how bad it is. Everyone wants to change it. But I don't see how it can change as long as both parties are on the payroll https://www.opensecrets.org/orgs/unitedhealth-group/recipien...

Everyone wants to change it...until you propose a concrete new system including payment mechanism. "Give me universal health care...but don't increase my taxes!...and don't take away my current insurance plan!"

>Give me universal health care...but don't increase my taxes!

Yeah, why not? The US already spends more tax dollars per person in healthcare. The excess gets funneled to the insurance companies. There's no reason why we can't implement universal healthcare without increasing taxes.

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

#295
post #289

Earlier quoted context omitted.

These "bolt on" type of solutions work but they also raise the costs. Already the administration costs of insurance are through the roof. The system is as inefficient as humanly possible. Hospitals needs hundreds of administrators and billing specialists just to make insurance work - never mind the patient and doctor time lost. And now, we also pay to audit insurance? It's too much money burning. This shouldn't be do…

Do you have a source for the administrative costs being larger than they could/should be? Obviously they'd be lower with single payer, especially on the provider side, but outside of that the system runs pretty efficiently for what it is. On the provider side, they're going to have to code up a claim. But once they're submitted, the majority of claims automatically flow through the rest of the system with low human t…

It seems you've answered your own question - they'd be significantly lower with single-payer.

But to expand, the US has, by far, the highest cost per capita for healthcare at just a bit over 12,000 dollars a year when compared to similar countries. A large part of this is due to our inefficient system, in which administrative costs are astronomically high:

"administrative expenses account for approximately 15% to 25% of total national health care expenditures, an amount that represents an estimated $600 billion to $1 trillion per year of the total national health expenditures of $3.8 trillion in 2019."

https://jamanetwork.com/journals/jama/fullarticle/2785479

There's multiple fundamental problems with the healthcare system that causes this. Again, these problems are fundamental, meaning they cannot be resolved within the constrains of a private sector insurance industry:

1. Insurance billing complexity is extremely high. There are thousands of insurers nationally, and providers are forced to navigate through that to provide adequate care. As a result, many private practices have gone out of business, because doctors spend more time managing insurance than patient care.

2. Insurance has an incentive to deny as many claims as possible. There's simply no way around this fact - the only way to remove this incentive is to remove insurance.

3. Insurance is not transparent to consumers and consumers typically have little to no choice, killing competition and allowing price gauging.

4. Providers are incentivized to charge as much as the most premium insurer in their area allows. For example, if insurer X covers 650 dollars for a treatment but insurer Y only covers 150, then the provider must charge 650. Otherwise, they leave money on the table for patients with provider X. This means that competition in the insurance space doesn't lower prices - it can only raise them. Yes, as boutique plans for employees such as CEOs gets better, your care gets more expensive.

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

#296

Earlier quoted context omitted.

If they find something suspicious during the colonoscopy, they won't bill it as a free screening anymore and you'll be on the hook for it. Ask me how I know. No regrets about getting screened though. It saved my life.

Sorry, I meant: if you do a non-colonscopy screening first and they find something, the follow up colonscopy isn't covered as preventive. And the non-colonscopy screenings have a higher false positive rate than a colonscopy screening.

Good to know. I was just adding to what you said that even if you don't get a positive result before a colonoscopy, the colonoscopy might not be covered as preventative care. Insurance just really doesn't want to cover it.

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

#297

Earlier quoted context omitted.

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...

Why the mixup of a well functioning democracy and a direct democracy?

For the same reason we might want to distinguish between well functioning government and direct democracy.

First, direct democracy is kind of a pleonasma, that is in its core democracy has to put equals duties and means to all its citizens. It's clear probably why such a system can easily attract masses, as it promises to maintain political power in the hands of those who have to obey it. Note that this definition insist more on duties and means, which is a very different promise from a populist statement on "righteous rights for everyone thanks to a turn key plan you don't even need to investigate on applicability". People certainly are interested with more democracy, so their slavers scam them with all kind of system under the label democracy which never give them these duties and means that you can expect to see attached to an effective democratic citizen.

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

#298
post #202

Earlier quoted context omitted.

Thanks for the tips. I do have a question about one thing you said: > I know better about what's preventative and what's not than them. How is that? From your profile I don't see any medical training.

The insurance companies don't have medical training either. I know far, far more about my body's medical situation than them. Doctors and medical research may supply me with additional medical knowledge, but the insurance company can go to hell. They don't know a damn thing about any of this.

"The insurance companies don't have medical training either."

Remember that.

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

#299
post #226

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What’s the source of limited supply of doctors meme? Is there a good rundown somewhere? Because anecdotally, among my friends, I’ve never known someone to not make it through the system to practicing medicine who wanted to, but I do know several who persevered despite being real idiots. I don’t see how opening the pool wider would lead to better care.

1. There is a cap on the number of doctors that the US can churn out since Medicare funds most of their training. That number is 140,000. This inherently limits supply. This is the biggest issue.[0] 2. There are limited spots in certain residency programs due to how competitive they are. Ergo those specialties are artificially more lucrative. Dermatology is a good example. 3. Becoming a doctor is temporally arduous:…

None of that answers the question.

You’ve restated the old joke, “That restaurant is terrible —- the food tastes bad and the portions are so small!”

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

#300

Earlier quoted context omitted.

Why the mixup of a well functioning democracy and a direct democracy?

For the same reason we might want to distinguish between well functioning government and direct democracy. First, direct democracy is kind of a pleonasma, that is in its core democracy has to put equals duties and means to all its citizens. It's clear probably why such a system can easily attract masses, as it promises to maintain political power in the hands of those who have to obey it. Note that this definition in…

The initial proposition was that it is pedantry to distinguish between the quality of the killing when the form of governance is not a well functioning democracy - something that would appear to be well established as the US has no issues going into other countries and kill leaders under the argument that it is not democracies.

The question is not so much the quality of the US democracy but to what extend it can even be classified as a well functioning democracy.

The US resembles an oligarchy, and when the laws are written by the rich and profit seeking that will affect how killings are perceived such as killing in the name of corporate profits will become alright.

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