Seeing my health insurance deny hospital claims that were pre-authorized has been insane. The hospital checked in advance with my insurance that several operations would be covered and the insurance approved. Now that the bill comes, the insurance company has repeatedly denied and denied their claims. Health insurance companies are horrible and parasitic to everyone involved.
I've had BCBS reject prescriptions they've already pre-approved multiple times. First time, they denied all knowledge of the REQUEST (when my doctor has their APPROVAL fax in hand). Second time they acknowledged they had approved it but had to contact their pharmacy group to put in an "override".
I've submitted a complaint with the state insurance regulator though I doubt it goes anywhere.
Anyone for a class action lawsuit on the grounds of bad faith breach of contract and medical malpractice for obstructing access to care they already admit is medically necessary (by denying something already pre-approved)? I don't even want money. I want a Consent Decree enforced by the court that strikes fear across their whole industry.
Audio record every interaction you have with insurance and tell 'em you're on a recorded line.
The big problem with health insurance is that it accounts for 17% of the US GDP, so although it's parasitic for everyone involved, it's basically indispensable to the economy. That's a big reason why the Affordable Care Act panned out the way it did, as a partnership with the insurance companies.
This happened in our family a few years ago. It was a penny dropping moment when the hospital revealed to me thar they routinely record all calls with insurance companies. So they had a recording of the insurer approving the procedure. They still refused to pay nevertheless.
Private insurance in the US needs to be completely dismantled, and we need to go to a single payer system. Not a panacea, of course, but what we have is so broken and irredeemable, it's the worst of all worlds. The US has best-in-class (if crazy expensive) health care despite our insurance system, not because of it.
I will never forgive Lieberman for killing the public option, which would at least have force private health insurance to compedte with the government.
I'm of the opinion that either a real free market or single payer would be better than what we currently have.
The main thing everyone should agree on is that the employer healthcare mandate that ties health access to W-2 employment is responsible for this situation and should be revoked.
What comes next matters less; every system has its drawbacks but ours is the worst. It has all the drawbacks and none of the benefits of everyone else's systems
I'd like their to be a single payer for my healthcare but I'd like that single payer to be me and not the government and not an insurance company. Just like I am the single payer for all my food and my housing why can't we have a world where I pay for my healthcare too?
I haven’t seen any measure where the US is the best concerning healthcare. I usually see it in the teens for outcomes and generally other measures are worse. It’s just bad.
However we basically have 1 solution, and its not legal. And naturally, its the solution in this article.
To be completely fair, just from the people who I know who have terminal uncovered diseases, I'm surprised more "direct action" hasn't been done. Desperate people with no good options can and do take the terrible options.
The by far best system I've witnessed was the Swiss healthcare system, which is NOT a single-payer system.
Some features: (1) health insurance is obligatory for all residents (2) must be private, cannot be purchased/sponsored by company (3) minimum coverage is specified by law (4) health insurers are private companies, often (mostly? always?) non-profit (5) they cannot reject applicants, and can only discriminate (by price) on: (a) age, (b) residence (i.e. more expensive city/area => more expensive health insurance) (6) all procedures are paid - 10% copay is mandatory (up to a certain yearly amount) (7) health insurers make extra money on better health insurance ("private coverage") offering better service, more experienced doctors, private hospital rooms, extra coverage (e.g. for mental health, abroad etc.) etc. - those can discriminate on much more features, including existing health conditions sex (e.g. for young women it's more expensive, because of pregnancy)
A single payer system is politically impossible :/. But there are ways to get the system without overturning it completely. But they all come down to cutting or eliminating insurance profits in some way, I think.
For example, prohibjt insurances from making profits at all - earnings must go into savings, future rates need to go down when savings are getting built up beyond a safety buffer.
Another idea: a government mandated catalog of services that have to be covered, including fixed costs (maybe plus a small effort scaling factor based on provable additional needs for a patient). If a doctor claims medical necessity, the insurance is automatically required to pay that fixed amount - no rejection possible. If the claim is fraudulent, they can sue the doctor later.
Why? US healthcare costs have nearly nothing to do with insurance and everything with doctor and hospital payments.
I think the best way to improve US healthcare is to off all the righteous idiots. Just kidding!
The 2nd best way is outlaw health insurance of any kind except maybe genuinely catastrophic, like lump sum cancer insurance or emergency room coveragr. Don't provide any public option. Once everything is out of pocket the outrageous provider prices will be forced to come down either economically or politically (my preferred option is easy immigration and the recognition of medical degrees from OECD countries)
The costs just get worse as our understanding of disease prevention and chronic illness grows. The costs of neglecting early intervention are ultimately borne by society through programs like Medicare, as individuals age with significantly poorer health than they would have if they had received earlier treatment.
It's much cheaper to repair a roof that has a small leak than it is to clean out and rebuild a house rotted with mold.
I had to look up what “single player payer system” means since I thought it meant something like “each individual pays for themselves”, the opposite of a social safety net.
I was completely wrong. Single payer means there is a single (gov) entity paying health care for everyone. 1000% this is what we need.
Everyone needs to care about their health. When we need healthcare it’s so often for things out of our control, like cancer. Putting the burden on the individual is cruel.
Capitalism as applied to human health is fundamentally inhumane (literally, profit valued over human life). I’d be interested to heard arguments otherwise.
Of course, a universal healthcare system should take notes from capitalist markets to be efficient, but have the primary goal of maximizing human well-being
What class is US healthcare best in? It’s probably among the best in quality you can get as a rich individual, but as a system it’s deeply flawed in many factors. US doesn’t even make it into the list of best 50 countries by life expectancy or maternal mortality ratio. Which is batshit crazy for such a rich country.
In Netherlands we have a free market for health insurance, however there are regulations and pretty much all essential care is included. Also the insurance company is not allowed to reject any person. Furthermore, every person is required to get health insurance. So healthy people pay for the old.
"Single payer" really just means "no choice, and no competition". I wouldn't really expect things to get better under such a system, and worse it would put a much larger percentage of our freedom on the chopping block.
Just look at the all the stuff they pulled over COVID. It would usher in a terrible era where everything you do is free for someone else to say no to, because "we all pay for that".
I give it 10 years under such a system until we have a similar supreme Court ruling to the one we got for interstate trade. Except this time blowing out their scope of power to anything and everything, with no more limits
Our "insurance" sucks because of all the government involvement. Putting government completely in control would solve some problems, but I personally would like to see how things go if we do the opposite and take government out of it completely.
One of the most interesting things about this whole situation is that nobody is trying to even pretend that the current system is fair or effective. The tone in media and from corporate PR, business leaders, and politicians is either silence or some version of "hey stop talking about that / well it's not MY fault." Everyone knows the system is unfair, parasitic, and literally murderous, but no one in power is willing to take responsibility of any kind or show real leadership in bringing change.
It's not just denials. This is anecdotal but my company moved from Aetna to UHC starting in January, and there are already dozens of threads in our internal slack about drug co-pays jumping 10-100x, despite the UHC rep's assurances that the plans were equivalent with what we had before.
Suing (or threatening to sue) everyone and anything that speaks poorly about the company is an interesting PR response, isn't it? I'm used to companies just ignoring the issue and hoping it goes away.
It's an extremely common response. I think you're used to remembering stories as "companies just ignore the issue and hope it goes away", summarizing away all the day-by-day coverage of letters they sent telling people to stop being mean, and that's probably how most people will remember this story in a few years too.
I had a baby. Months later, UH retroactively denied all birth and baby care claims. They claimed I had other insurance, which I don’t. Now I get to prove a negative. So fun.
Maybe there should be a government mediated system for "DMCA", denied medical claim arguements, where anyone could send in a DMCA against a health insurance company and automatically involve the formal legal court system at no cost to themselves. Normally I would not want to involve government but in situations relating to life and death I think it is justified (like other things govs regulate involving life/death).
Insurance contracts are not allowed to be cancelled in lieu of the fulfillment of the liabilities created by the insurance contracts. That's literally fraud and laws were made in the late 1800's and early 1900's to deal with insurance companies that ran this scam for life and fire insurance.
The answer is to eliminate health insurance entirely.
This is what you get when profit is prioritised over every other factor. i'm not sure why anyone finds this surprising. Social democrats recognise the role of government is to put in place regulations that temper this kind of behaviour. under Trumps 'slash and burn' approach to regulation expect things to get worse on every field
>If stuff like voluntary plastic surgery wasn't covered, what the hell kind of medical fraud would there be?
Off the top of my head: going to a doctor, conspiring with him to make an insurance claim that you had some sort of procedure done even though none was actually done, and splitting the claim check? Not saying this happens, but it's not hard to think of frauds you could perform even if "voluntary plastic surgery wasn't covered".
You can peruse Medicare fraud prosecutions for all kinds of scenarios. See for example https://www.justice.gov/archives/opa/pr/doctor-sentenced-54m.... If you convince a confused elderly person that they need some device, and submit paperwork falsely certifying you agree they need it, that's not trivial to detect.
This is what’s frustrating with the current political situation. Since we are already wielding the sledgehammer, why not take it to this system, which would actually solve some real problems for every day people?
And they wonder why so many people are supporting Luigi. I could never condone murder, but I understand and deeply sympathetic. United is the comcast of health insurance
It’s disappointing we don’t get any further investigation into this he said/she said argument.
The cynic in me is inclined to believe the company is denying it to the press without regard to the truth, because they can. No one will hold them accountable, so there’s only upside to lying publicly. (We’re currently seeing this strategy play out in national politics as well.)
[+] [-] inamberclad|1 year ago|reply
[+] [-] Nomadeon|1 year ago|reply
Anyone for a class action lawsuit on the grounds of bad faith breach of contract and medical malpractice for obstructing access to care they already admit is medically necessary (by denying something already pre-approved)? I don't even want money. I want a Consent Decree enforced by the court that strikes fear across their whole industry.
Audio record every interaction you have with insurance and tell 'em you're on a recorded line.
[+] [-] solumos|1 year ago|reply
[+] [-] breadwinner|1 year ago|reply
[+] [-] dboreham|1 year ago|reply
[+] [-] kelnos|1 year ago|reply
[+] [-] BobaFloutist|1 year ago|reply
[+] [-] dingnuts|1 year ago|reply
The main thing everyone should agree on is that the employer healthcare mandate that ties health access to W-2 employment is responsible for this situation and should be revoked.
What comes next matters less; every system has its drawbacks but ours is the worst. It has all the drawbacks and none of the benefits of everyone else's systems
[+] [-] changoplatanero|1 year ago|reply
[+] [-] conception|1 year ago|reply
[+] [-] mystraline|1 year ago|reply
However we basically have 1 solution, and its not legal. And naturally, its the solution in this article.
To be completely fair, just from the people who I know who have terminal uncovered diseases, I'm surprised more "direct action" hasn't been done. Desperate people with no good options can and do take the terrible options.
[+] [-] tomp|1 year ago|reply
The by far best system I've witnessed was the Swiss healthcare system, which is NOT a single-payer system.
Some features: (1) health insurance is obligatory for all residents (2) must be private, cannot be purchased/sponsored by company (3) minimum coverage is specified by law (4) health insurers are private companies, often (mostly? always?) non-profit (5) they cannot reject applicants, and can only discriminate (by price) on: (a) age, (b) residence (i.e. more expensive city/area => more expensive health insurance) (6) all procedures are paid - 10% copay is mandatory (up to a certain yearly amount) (7) health insurers make extra money on better health insurance ("private coverage") offering better service, more experienced doctors, private hospital rooms, extra coverage (e.g. for mental health, abroad etc.) etc. - those can discriminate on much more features, including existing health conditions sex (e.g. for young women it's more expensive, because of pregnancy)
[+] [-] gmueckl|1 year ago|reply
For example, prohibjt insurances from making profits at all - earnings must go into savings, future rates need to go down when savings are getting built up beyond a safety buffer.
Another idea: a government mandated catalog of services that have to be covered, including fixed costs (maybe plus a small effort scaling factor based on provable additional needs for a patient). If a doctor claims medical necessity, the insurance is automatically required to pay that fixed amount - no rejection possible. If the claim is fraudulent, they can sue the doctor later.
[+] [-] sershe|1 year ago|reply
I think the best way to improve US healthcare is to off all the righteous idiots. Just kidding!
The 2nd best way is outlaw health insurance of any kind except maybe genuinely catastrophic, like lump sum cancer insurance or emergency room coveragr. Don't provide any public option. Once everything is out of pocket the outrageous provider prices will be forced to come down either economically or politically (my preferred option is easy immigration and the recognition of medical degrees from OECD countries)
[+] [-] siliconc0w|1 year ago|reply
It's much cheaper to repair a roof that has a small leak than it is to clean out and rebuild a house rotted with mold.
[+] [-] callc|1 year ago|reply
I was completely wrong. Single payer means there is a single (gov) entity paying health care for everyone. 1000% this is what we need.
Everyone needs to care about their health. When we need healthcare it’s so often for things out of our control, like cancer. Putting the burden on the individual is cruel.
Capitalism as applied to human health is fundamentally inhumane (literally, profit valued over human life). I’d be interested to heard arguments otherwise.
Of course, a universal healthcare system should take notes from capitalist markets to be efficient, but have the primary goal of maximizing human well-being
[+] [-] zoul|1 year ago|reply
[+] [-] whazor|1 year ago|reply
[+] [-] figassis|1 year ago|reply
[+] [-] ericjmorey|1 year ago|reply
[+] [-] dude187|1 year ago|reply
Just look at the all the stuff they pulled over COVID. It would usher in a terrible era where everything you do is free for someone else to say no to, because "we all pay for that".
I give it 10 years under such a system until we have a similar supreme Court ruling to the one we got for interstate trade. Except this time blowing out their scope of power to anything and everything, with no more limits
[+] [-] krupan|1 year ago|reply
[+] [-] sheldoni|1 year ago|reply
[+] [-] fader|1 year ago|reply
[+] [-] frenchtoast8|1 year ago|reply
[+] [-] SpicyLemonZest|1 year ago|reply
[+] [-] gcapu|1 year ago|reply
[+] [-] superkuh|1 year ago|reply
[+] [-] burnte|1 year ago|reply
[+] [-] jimt1234|1 year ago|reply
[+] [-] nine_zeros|1 year ago|reply
Things become very easy when you are willing to sacrifice exec pay and investor returns - at least temporarily.
[+] [-] ericjmorey|1 year ago|reply
The answer is to eliminate health insurance entirely.
[+] [-] gruez|1 year ago|reply
[+] [-] IncreasePosts|1 year ago|reply
[+] [-] unknown|1 year ago|reply
[deleted]
[+] [-] andrewfromx|1 year ago|reply
[+] [-] tills13|1 year ago|reply
[+] [-] fungiblecog|1 year ago|reply
[+] [-] mitchbob|1 year ago|reply
[+] [-] tekno45|1 year ago|reply
We have OTHER systems to find doctors prescribing drugs, so wtf does insurance provide the consumer except a pathway to debt?
[+] [-] gruez|1 year ago|reply
Off the top of my head: going to a doctor, conspiring with him to make an insurance claim that you had some sort of procedure done even though none was actually done, and splitting the claim check? Not saying this happens, but it's not hard to think of frauds you could perform even if "voluntary plastic surgery wasn't covered".
[+] [-] SpicyLemonZest|1 year ago|reply
[+] [-] ipython|1 year ago|reply
[+] [-] hingusdingus|1 year ago|reply
[+] [-] underseacables|1 year ago|reply
[+] [-] loganc2342|1 year ago|reply
Were they there?
[+] [-] relaxing|1 year ago|reply
The cynic in me is inclined to believe the company is denying it to the press without regard to the truth, because they can. No one will hold them accountable, so there’s only upside to lying publicly. (We’re currently seeing this strategy play out in national politics as well.)
[+] [-] weare138|1 year ago|reply