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How often do health insurers say no to patients? (2023)

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Re: How often do health insurers say no to patients? (2023)

#31

Post by SamoyedFurFluff »

arwhatever wrote: post #22
kstrauser wrote: post #14

All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300. The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. I was raised a die-hard ca…

1. A properly competitive marketplace 2. Socialized medicine 3. What we have now I would like to see #1 tried but at this point I’ll gladly accept #2

How can we have a competitive marketplace? I’m not a doctor (and therefore cannot informed evaluate the services) and even if I was I can’t search for my preferred cardiologist when I’m having a heart attack.

Re: How often do health insurers say no to patients? (2023)

#32

Post by arwhatever »

SamoyedFurFluff wrote: post #31
arwhatever wrote: post #22

Earlier quoted context omitted.

1. A properly competitive marketplace 2. Socialized medicine 3. What we have now I would like to see #1 tried but at this point I’ll gladly accept #2

How can we have a competitive marketplace? I’m not a doctor (and therefore cannot informed evaluate the services) and even if I was I can’t search for my preferred cardiologist when I’m having a heart attack.

Is all of your healthcare 100% heart attacks?

Re: How often do health insurers say no to patients? (2023)

#33

Post by kstrauser »

arwhatever wrote: post #22
kstrauser wrote: post #14

All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300. The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. I was raised a die-hard ca…

1. A properly competitive marketplace 2. Socialized medicine 3. What we have now I would like to see #1 tried but at this point I’ll gladly accept #2

I agree in theory, but I no longer believe #1 is possible in reality. #2 would make tens of millions of lives better than the dystopian nightmare #3 we have today.

Re: How often do health insurers say no to patients? (2023)

#34

Post by avalys »

spyspy wrote: post #8

> Health Insurance CEO Reveals Key To Company’s Success Is Not Paying For Customers’ Medical Care [1] 1. https://theonion.com/health-insurance-ceo-reveals-key-to-com...

If it’s not up to health insurers to limit healthcare spending, then which organizational role in the healthcare system do you think is appropriate to place this responsibility with?

Re: How often do health insurers say no to patients? (2023)

#35

Post by kstrauser »

azemetre wrote: post #20
kstrauser wrote: post #14

All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300. The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. I was raised a die-hard ca…

These are completely human systems that can be changed any time for any reasons. The current system is achieving exactly what it was designed for: wealth extraction. There’s no reason why this system has to exist. We can make it better any time we want.

There’s a huge reason it continues to exist: exorbitant lobbying from the people profiting from the death panels. Almost everyone supports Medicare, but too many have been convinced that Medicare for all is some kind of nefarious communist plot.

Re: How often do health insurers say no to patients? (2023)

#36

Post by arwhatever »

mattnewton wrote: post #27
arwhatever wrote: post #22

Earlier quoted context omitted.

1. A properly competitive marketplace 2. Socialized medicine 3. What we have now I would like to see #1 tried but at this point I’ll gladly accept #2

I just don't think #1 is possible, how can you have a functioning marketplace for a good when the demand is hard to forecast for an individual, almost completely inelastic and often extremely time sensitive. I'd say the US really tried and the incentives just aren't there for a stable system.

When did the U.S. really try?

Re: How often do health insurers say no to patients? (2023)

#37

Post by kstrauser »

avalys wrote: post #34
spyspy wrote: post #8

> Health Insurance CEO Reveals Key To Company’s Success Is Not Paying For Customers’ Medical Care [1] 1. https://theonion.com/health-insurance-ceo-reveals-key-to-com...

If it’s not up to health insurers to limit healthcare spending, then which organizational role in the healthcare system do you think is appropriate to place this responsibility with?

Elected representatives answerable to their constituents would be a vast improvement in health outcomes.

Re: How often do health insurers say no to patients? (2023)

#38

Post by SpicyLemonZest »

kstrauser wrote: post #14

All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300. The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. I was raised a die-hard ca…

> The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for.

The key insight, though, is that this is fundamentally unavoidable. Someone, somewhere has to decide how a limited healthcare budget will be allocated among all the various healthcare it could go towards.

You and I agree that it would be best to have a system where this is never the patient's problem. Someone determines a standard of care that will achieve the best patient results with the resources available, and then any patient can get whatever treatment's best for them within that framework. That's why I have and recommend Kaiser, they do a good job of presenting that abstraction.

Other people are terrified of the idea of having the standard of care determined by some centralized committee, because what if they decide a treatment that my doctor and I like isn't appropriate? I think the fear is wrong, to be clear, but it's genuine and does deserve to be addressed. Thus all the promises about "if you like your plan you can keep your plan".

(A third group of people believe that healthcare is only limited because of shenanigans, and with the appropriate reforms we could build a system where anyone is entitled to any treatment that might reasonably help them. I'm never quite sure what to tell them, since I don't think that's true but I don't know how to prove it beyond the lack of examples.)

Re: How often do health insurers say no to patients? (2023)

#39

Post by randycupertino »

spyspy wrote: post #8

> Health Insurance CEO Reveals Key To Company’s Success Is Not Paying For Customers’ Medical Care [1] 1. https://theonion.com/health-insurance-ceo-reveals-key-to-com...

I worked at a Health Tech Silicon Valley company and our clients were healthcare companies. Our job was essentially to delay and put up barriers to care. So before they could see a doctor they would have to call us, go through the computer system, get routed to a phone doctor who would suggest cheaper things than what they really needed, give them a bunch of hoops to jump through before they could really get the thing they needed.

A big part of my job was to re-route people who needed wheelchairs into getting cheaper things. Our clients were United Healthcare, unions, large health insurers.

It sucked working there it was a total hellhole. I quit when they actually defrauded medicare. Their glassdoor reviews were wild. The owners daughter bragged about dating a glassdoor exec and that he would take down all the honest bad reviews for her.

Re: How often do health insurers say no to patients? (2023)

#40

Post by kstrauser »

danaris wrote: post #28
carabiner wrote: post #25

Earlier quoted context omitted.

FYI the shooter has received $1.2m in donations for his defense fund, and counting.

The accused shooter. Firstly, Luigi Mangione is presumed innocent until proven guilty . Secondly, there's a fair amount of real evidence that Luigi is being set up as a scapegoat by the NYPD—a police department with a known history of planted evidence.

First part: yes, definitely. That’s a critical part of how the system works.

Second part: I’m not buying that for a moment. It’s way easier for me to believe that an individual working alone, screwed over by a megacorp who earns more based on how many people they can deny healthcare to, had enough and went vigilante. Vigilanteism and cold blooded murder are not OK, but it’s pretty easy to link cause and effect there. That’s vastly more likely than a shadow conspiracy that’s managed to keep its mouth shut so far.

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