51–60 of 224 posts
I found out that many insurance companies deliberately delayed approving procedures, in the hope that it would kill the patient.
back then, there was no AI. The decisions were made by humans.
Sometimes, people suck.
Earlier quoted context omitted.
What's a libertarians take on how health care should work? Completely privatized, completely socialized, somewhere in between?
The fact that the hospital doesn't know what a procedure costs (they make it up based on deals with medicare, medicaid, and individual insurance companies) should give you a hint. Yes, the patient needs skin in the game. People need to take care of their own health. Most procedures are given to grossly unhealthy people. Yes, completely privatize it. Make people pay for their care so their daily decisions are weighed…
The hint here is that the random pricing needs to stop. Same procedure for the same price. No market can work if participants don’t know the actual price. Insurance and hospitals probably have a very good idea but patients are being kept totally in the dark. You are expected to just accept what this opaque machinery comes up with.
“The algorithm cannot say no, however. If it finds problems, it sends the request for review to a team of in-house nurses and doctors who consult company medical guidelines. Only doctors can issue a final denial.” As a physician, I’ve had to speak to these so called “peers” in a peer to peer denials with both my clinic and hospital setting. They are usually people who aren’t physicians as a first line of their defens…
“The algorithm cannot say no, however. If it finds problems, it sends the request for review to a team of in-house nurses and doctors who consult company medical guidelines. Only doctors can issue a final denial.” As a physician, I’ve had to speak to these so called “peers” in a peer to peer denials with both my clinic and hospital setting. They are usually people who aren’t physicians as a first line of their defens…
Physician and Hospital resources is a real zero sum game, how do you fairly regulate the medical landscape so those who's lives will benefit most from a procedure will receive the procedure? Who decides this? You? Should we allow everyone in the world who needs a procedure to receive one free and get ahead in line for Americans who need the same procedure? That's what the current climate looks like with unbridaled im…
Evilcore is a fitting name. > Connecticut’s Insurance Department recently reviewed EviCore and Carelon. It found no problems with Carelon. EviCore was fined $16,000 this year for more than 77 violations found in a review of 196 files. $16k is such a low fine that it’d be funny if it wasn’t so sad. fines should be increased to actually represent a threat to the company - maybe as a % of yearly profit? our system is so…
How do you get accountable people in charge of healthcare policy?
“The algorithm cannot say no, however. If it finds problems, it sends the request for review to a team of in-house nurses and doctors who consult company medical guidelines. Only doctors can issue a final denial.” As a physician, I’ve had to speak to these so called “peers” in a peer to peer denials with both my clinic and hospital setting. They are usually people who aren’t physicians as a first line of their defens…
Physician and Hospital resources is a real zero sum game, how do you fairly regulate the medical landscape so those who's lives will benefit most from a procedure will receive the procedure? Who decides this? You? Should we allow everyone in the world who needs a procedure to receive one free and get ahead in line for Americans who need the same procedure? That's what the current climate looks like with unbridaled im…
> In 2022, Carelon settled a lawsuit for $13 million that alleged the company, then called AIM, had used a variety of techniques to avoid approving coverage requests. Among them: The company set its fax machines to receive only 5 to 10 pages. Who are the people who sleep at night after designing these policies?
There is an unlimited pool of people without empathy. Never forget that.
Evilcore is a fitting name. > Connecticut’s Insurance Department recently reviewed EviCore and Carelon. It found no problems with Carelon. EviCore was fined $16,000 this year for more than 77 violations found in a review of 196 files. $16k is such a low fine that it’d be funny if it wasn’t so sad. fines should be increased to actually represent a threat to the company - maybe as a % of yearly profit? our system is so…
Multiplier times price of necessary care denied? One can dream. How do you get accountable people in charge of healthcare policy?
Earlier quoted context omitted.
What's a libertarians take on how health care should work? Completely privatized, completely socialized, somewhere in between?
“I’ll put out this fire for you if you pay me $5000”
Evilcore is a fitting name. > Connecticut’s Insurance Department recently reviewed EviCore and Carelon. It found no problems with Carelon. EviCore was fined $16,000 this year for more than 77 violations found in a review of 196 files. $16k is such a low fine that it’d be funny if it wasn’t so sad. fines should be increased to actually represent a threat to the company - maybe as a % of yearly profit? our system is so…