5 ms·

>It took 3 hours of my time. About 3 hours of medical assistant time and about an hour of two different doctors time to get this simple 5 minute CT approved. Th

by ezoe 7y ago

>It took 3 hours of my time. About 3 hours of medical assistant time and about an hour of two different doctors time to get this simple 5 minute CT approved. This is all on top of the time of admins at the insurance company. At this rate, most of the costs are human wages, not the medical equipment and its operating cost. If we can cut all these unnecessary middle men whose job is just confirm/deny the requests, the cost will be a lot cheaper. That's UK. Why the insurance companies has a privilege to deny a medical test when fully-qualified doctor said it's necessary in the first place? If the government regulation set the standard medical procedures and its price, insurance companies has no privilege to deny the requests, only the fully-qualified doctor decide the treatments, it can also cut some costs and more importantly, it's fair. That's Japan.

lotsofpulp 7y ago
> Why the insurance companies has a privilege to deny a medical test They aren’t denying the test, they’re denying payment for it from the insurance company. Also, many times, the insurance company is not making its rules, but they are implementing them per the payer’s instruction. The payer can be the government, who outsourced Medicare and Medicaid administration, it could be employers that self fund employee’s insurance, etc.
- ezoe 7y ago
  That's denying, or more like denying the the whole purpose of insurance. Also, it's bad design of incentive. The insurance companies has an incentive to deny the payment, because it does reduce the cost and increase the profit. For profit companies try to increase the profit that's not wrong, but in this context , it's morally bad. So the better incentive design is not to allow the insurance company to deny the payment. Take a look at my country(Japan) and my insurance company for example. They offer a free cancer test. Why? The treatment of later stage cancer costs so much money. Since they can't deny the payment, it's better to find the cancer as early as possible. That will reduce their cost, increase their profit. It also lead to healthier people as a bonus.
  - lotsofpulp 7y ago
    Then who will contain costs? Healthcare providers are also for profit, and have an incentive to get paid. US insurance companies can’t deny providing insurance, but they can dictate following established guidelines, and requiring justification for straying from them. They are also requiring to pay out 80% of the premiums they collect. It is not an ideal system, especially with stories like the above, but in the US, there is a ton of money being extracted in the healthcare field, and someone must be the arbiter to prevent waste and abuse. In many countries it’s the government, but absent that, who will? Note that since the ACA law passed, healthcare costs have stopped rising at the meteoric rates they used to. Again, the system isn’t close to perfect, but someone with knowledge (doctors in government or insurance company) must be used to prevent abuse by healthcare providers billing excessively. Or at least in a lower trust society. I have a close family member who is a doctor works at health insurance companies and sees doctors trying to experiment with off label uses of medications that cost thousands of dollars per month. If the insurance company approved every one, the premiums would have to skyrocket for it to stay in business, so they follow the CDC and FDA and other research to create rules so that it’s used in cases where it has a chance of working.
  - gridlockd 7y ago
    > Also, it's bad design of incentive. The insurance companies has an incentive to deny the payment, because it does reduce the cost and increase the profit. For profit companies try to increase the profit that's not wrong, but in this context , it's morally bad. A for-profit company has no incentive to deny a test that may prevent even costlier treatments down the line. It must stay within budget, however. Socialized systems also have a budget and they also deny/limit/delay treatment all the time. Also, look at the profit margins of insurances, they aren't that great (about 5% tops). If you sincerely believe a government bureaucracy can do a better job at this for less than the profit margin of a private company, by all means, vote for it.
  - greedo 7y ago
    Cancer testing absent symptoms has come under increasing scrutiny in terms of effectiveness. A "positive" test puts immense pressure on care providers to do something, even though doing something may not actually improve outcomes. It also adds immense stress to the patient.
- M2Ys4U 7y ago
  >They aren’t denying the test, they’re denying payment for it from the insurance company. What's the difference?
  - lotsofpulp 7y ago
    The difference is the person can still get the test.
    - M2Ys4U 7y ago
      Only if they're rich!
      - lotsofpulp 7y ago
        Then the solution is taxpayer funded healthcare, not private insurance companies.
gridlockd 7y ago
> If we can cut all these unnecessary middle men whose job is just confirm/deny the requests, the cost will be a lot cheaper. Not true, administrative overhead accounts for less than 10% in healthcare costs in the US [1]. NHS sets a price for services, which providers have to follow. That evidently leads to waiting times and shortages, as well as lower wages and inferior equipment. There's no free lunch, you need to pick your poison. There's also a difference between costs and prices. Labor costs in the US are higher, because all staff earns better than in the UK. The industry is highly regulated and liabilities are high as well. In the US, lots of hospitals run a loss for treating Medicare patients, as well as people who end up not paying. In order to stay in business, hospitals charge as much as they possibly can, and it's very opaque. If you get a huge hospital bill, you must negotiate. Lastly, technology in the US needs to be up-to-date all the time, otherwise you run the risk of costly lawsuits. That's not the case in countries where settlements are far lower. Ultimately, the headline is wrong, a CT does not cost $1100, it costs whatever you or your insurance pays for it. You can get it for 450$ or even less. You need to shop around, but it's quite difficult, because prices are not transparent. [1] https://www.americanprogress.org/issues/healthcare/reports/2019/04/08/468302/excess-administrative-costs-burden-u-s-health-care-system/ https://www.americanprogress.org/issues/healthcare/reports/2...

by ezoe 7y ago

lotsofpulp 7y ago

> Why the insurance companies has a privilege to deny a medical test They aren’t denying the test, they’re denying payment for it from the insurance company. Also, many times, the insurance company is not making its rules, but they are implementing them per the payer’s instruction. The payer can be the government, who outsourced Medicare and Medicaid administration, it could be employers that self fund employee’s insurance, etc.

ezoe 7y ago
That's denying, or more like denying the the whole purpose of insurance. Also, it's bad design of incentive. The insurance companies has an incentive to deny the payment, because it does reduce the cost and increase the profit. For profit companies try to increase the profit that's not wrong, but in this context , it's morally bad. So the better incentive design is not to allow the insurance company to deny the payment. Take a look at my country(Japan) and my insurance company for example. They offer a free cancer test. Why? The treatment of later stage cancer costs so much money. Since they can't deny the payment, it's better to find the cancer as early as possible. That will reduce their cost, increase their profit. It also lead to healthier people as a bonus.
- lotsofpulp 7y ago
  Then who will contain costs? Healthcare providers are also for profit, and have an incentive to get paid. US insurance companies can’t deny providing insurance, but they can dictate following established guidelines, and requiring justification for straying from them. They are also requiring to pay out 80% of the premiums they collect. It is not an ideal system, especially with stories like the above, but in the US, there is a ton of money being extracted in the healthcare field, and someone must be the arbiter to prevent waste and abuse. In many countries it’s the government, but absent that, who will? Note that since the ACA law passed, healthcare costs have stopped rising at the meteoric rates they used to. Again, the system isn’t close to perfect, but someone with knowledge (doctors in government or insurance company) must be used to prevent abuse by healthcare providers billing excessively. Or at least in a lower trust society. I have a close family member who is a doctor works at health insurance companies and sees doctors trying to experiment with off label uses of medications that cost thousands of dollars per month. If the insurance company approved every one, the premiums would have to skyrocket for it to stay in business, so they follow the CDC and FDA and other research to create rules so that it’s used in cases where it has a chance of working.
- gridlockd 7y ago
  > Also, it's bad design of incentive. The insurance companies has an incentive to deny the payment, because it does reduce the cost and increase the profit. For profit companies try to increase the profit that's not wrong, but in this context , it's morally bad. A for-profit company has no incentive to deny a test that may prevent even costlier treatments down the line. It must stay within budget, however. Socialized systems also have a budget and they also deny/limit/delay treatment all the time. Also, look at the profit margins of insurances, they aren't that great (about 5% tops). If you sincerely believe a government bureaucracy can do a better job at this for less than the profit margin of a private company, by all means, vote for it.
- greedo 7y ago
  Cancer testing absent symptoms has come under increasing scrutiny in terms of effectiveness. A "positive" test puts immense pressure on care providers to do something, even though doing something may not actually improve outcomes. It also adds immense stress to the patient.
M2Ys4U 7y ago
>They aren’t denying the test, they’re denying payment for it from the insurance company. What's the difference?
- lotsofpulp 7y ago
  The difference is the person can still get the test.
  - M2Ys4U 7y ago
    Only if they're rich!
    - lotsofpulp 7y ago
      Then the solution is taxpayer funded healthcare, not private insurance companies.

gridlockd 7y ago

> If we can cut all these unnecessary middle men whose job is just confirm/deny the requests, the cost will be a lot cheaper. Not true, administrative overhead accounts for less than 10% in healthcare costs in the US [1]. NHS sets a price for services, which providers have to follow. That evidently leads to waiting times and shortages, as well as lower wages and inferior equipment. There's no free lunch, you need to pick your poison. There's also a difference between costs and prices. Labor costs in the US are higher, because all staff earns better than in the UK. The industry is highly regulated and liabilities are high as well. In the US, lots of hospitals run a loss for treating Medicare patients, as well as people who end up not paying. In order to stay in business, hospitals charge as much as they possibly can, and it's very opaque. If you get a huge hospital bill, you must negotiate. Lastly, technology in the US needs to be up-to-date all the time, otherwise you run the risk of costly lawsuits. That's not the case in countries where settlements are far lower. Ultimately, the headline is wrong, a CT does not cost $1100, it costs whatever you or your insurance pays for it. You can get it for 450$ or even less. You need to shop around, but it's quite difficult, because prices are not transparent. [1] https://www.americanprogress.org/issues/healthcare/reports/2019/04/08/468302/excess-administrative-costs-burden-u-s-health-care-system/ https://www.americanprogress.org/issues/healthcare/reports/2...