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This sort of garbage will not be fixed until there's a real penalty for denied claims. Not merely pay the claim, but enough to deter misbehavior.
by LorenPechtel 4y ago
This sort of garbage will not be fixed until there's a real penalty for denied claims. Not merely pay the claim, but enough to deter misbehavior.
- whoomp12342 4y agoThere is a real penalty? I mean, even if you implemented this, they would fight the penalty just like all the claims they fight today
- mywittyname 4y agoRight now, there's no cost to blanket denials, but there's a huge incentive to do it. My partner works on the hospital side of things, and several major insurance providers deny literally every claim. And why not? At worst, it just means that the insurance company can wait a year or more before paying. At best, they never pay. Of course, it's also the insurance companies who are adjudicating the claims.
- elliekelly 4y agoIt reminds me of this thread[1] from a few weeks ago. The article was so infuriating to read. [1]https://news.ycombinator.com/item?id=34639988 https://news.ycombinator.com/item?id=34639988
- darkarmani 4y agoMake the penalty increase exponentially each time they lose. Eventually, they will stop fighting it all.
- LorenPechtel 4y agoSo long as the penalty is higher than the percent of claims they get out of with their improper denials it would be enough to deter the behavior. You just need to tip the balance to making proper behavior cheaper.
- Wingman4l7 4y agoHow much is the fine for practicing medicine without a license? This is basically what they're doing by denying claims.
- ceejayoz 4y agoThey have rubber-stamp clinicians. Here's an ortho doc getting a denial based on the opinion of a surgeon who put a hip replacement in backwards and is no longer allowed to practice surgery, so he works for an insurer now. https://twitter.com/generalorthomd/status/1630349366497095684 https://twitter.com/generalorthomd/status/163034936649709568... https://twitter.com/generalorthomd/status/1632074817607438337 https://twitter.com/generalorthomd/status/163207481760743833...
- Wingman4l7 4y agoYeah, I'm aware of this; IMO it's a loophole they've been heavily abusing. I would deem this "practicing telemedicine". We do have /some/ regulations on telemedicine (I think? I hope?) -- you could argue that they're violating those.
- mindslight 4y agoI've been thinking about this, but not enough to dig into the details. Is there a legal obligation for "insurance" companies to use licensed medial professionals for justifying denials (similar to how many fields of engineering require a PE stamp)? And if so, would it be possible to make an organized effort to go after their licenses with the relevant state boards?
- hypothesis 4y agoThose tweets include documents that show doc as restricted to “non-operative office-based medicine or administrative medicine”. Clearly they thought that he is okay in this exact position.
- mindslight 4y ago
- duxup 4y agoI had an insurance company that every year would stop paying anything at all and mail me a convoluted form claiming I had some other insurance that should be paying. Every year I had to fill out the forms saying that I didn’t have any other insurance before they paid. It felt like a straight up scam to get people to pay some bills that show up without realizing what was going on / receiving and returning the forms.
- eppp 4y agoI think this is pretty common practice. I get a letter every single year to verify that I dont have any other insurance and they will stop processing claims until I do it. I typically just do the IVR and its only a couple of minutes.
- lawn 4y agoAs a Swede, this sounds so ridiculous.
- mindslight 4y agoIt is, but our country is paralyzed by a political fallacy of "if the market is already so bad, imagine how much worse government exerting any sort of deliberate policy would make it!". And then add in the lobbying process where bills only get passed when some corporate sponsor stands to gain [0], and it's a self-fulfilling prophecy. See also the "death panel" meme, as if that isn't a term that perfectly describes the "insurance" racket we've had all along. [0] eg one of the bullet points of widely celebrated health care reform was making it mandatory to pay the cartel!
- willcipriano 4y agoWe already spend more in the US, per captia, than any other nation on earth on socialized medcine. The reason we don't have universal coverage isn't due to a lack of resources so it has to be either a lack of ability or theft, probably both.
- whitemary 4y agoHow would a penalizing denied claims generate a profit?
- whoomp12342 4y agopenalization fee goes straight to a competitor
- jgeada 4y agoIf the profit from denying medically necessary care is greater than the cost of the penalties for denying that same care, then it is profitable to deny that care. A fine that is lower than the profit isn't a fine, it is just cost of business. Our regulatory system has totally failed, which is why it is rife with these perverse incentives.
- whitemary 4y ago> Our regulatory system has totally failed, which is why it is rife with these perverse incentives. Our so-called “regulatory system” works precisely as Karl Marx expected it to 150 years ago. The so-called "perverse incentives" are fundamental characteristics of capitalism. The delusion that haunts us originated with the idea that capitalism is not a system but a set of isolated features that we can opt into and out of as we please. Karl Marx showed us 150 years ago that capitalism is in fact a complex system with many contradictions.
- CWuestefeld 4y agoAre you under the impression that funding healthcare services via Medicare has even the slightest resemblance to capitalism? I can't think of any industry that is farther away from this. I mean, Medicare is be definition run by the government, and the way that the service providers deal with it is highly controlled by the government. This looks absolutely nothing like a free market, it's entirely the product of socialist control (if I can define "socialism" as "government controls the means of production" rather than outright "owning" it).
- forgetfreeman 4y agoYou misspelled "will not be fixed until insurers are entirely eliminated from the healthcare market".
- LorenPechtel 4y agoThis is more than just health insurance. 5 years ago a woman didn't look adequately and totaled my car. No problem with her insurance (she had a stop sign, I didn't, she was cited at the scene) until it came time to pay up--and they went silent until I contacted the insurance regulators. Improper denials or nonpayment should carry substantial penalties.