4 ms·

1.2 seconds! Well they're sure putting that med school knowledge to use, huh.

ceejayoz 3y ago
Yep. Don't worry, though; if they slip up and do fund your expensive treatments, all of a sudden they have lots of time to focus on you. https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis https://www.propublica.org/article/unitedhealth-healthcare-i... > At one point, court records show, United inaccurately reported to Penn State and the family that McNaughton’s doctor had agreed to lower the doses of his medication. Another time, a doctor paid by United concluded that denying payments for McNaughton’s treatment could put his health at risk, but the company buried his report and did not consider its findings. The insurer did, however, consider a report submitted by a company doctor who rubber-stamped the recommendation of a United nurse to reject paying for the treatment. > But the records reviewed by ProPublica show that United had another, equally urgent goal in dealing with McNaughton. In emails, officials calculated what McNaughton was costing them to keep his crippling disease at bay and how much they would save if they forced him to undergo a cheaper treatment that had already failed him. As the family pressed the company to back down, first through Penn State and then through a lawsuit, the United officials handling the case bristled.
- NickC25 3y ago
  Horrifying. Those "insurers" are absolute scumbags. Poor guy, I feel awful for him.
  - JumpCrisscross 3y ago
    > Those "insurers" are absolute scumbags It’s complicated. On the other hand are fraudsters and private-equity owned hospitals maxing the bill button. If the insurer is lax with payouts, it depletes its capital and could be left insolvent. It’s a scummy system more than a system of scumbags. (To be clear, there are scumbag insurers. But it’s reductive to cite that generally, or designate it as the source of the system’s troubles.)
    - justinclift 3y ago
      Taking 1.2 seconds to review claims means they are without any question "doing something wrong". "Remaining solvent" doesn't seem to be the goal, rather "maximising quarterly bonuses regardless of lives destroyed" seems a more fit description.
      - JumpCrisscross 3y ago
        > Taking 1.2 seconds to review claims means they are without any question "doing something wrong" Nobody said they aren’t. The point is, given the volume of claims, to do a proper analysis, we’d need a material fraction of doctors doing insurance reviews (instead of seeing patients). So we get a reliance on heuristics. If you’re lenient, you get targeted by fraudsters. So we get a bias towards denial. (Nobody is getting a material quarterly bonus for denying a few more claims. That nonsense occurs at the level of PBMs and other scale operations.)
        justinclift 3y ago
        > If you’re lenient, you get targeted by fraudsters. So in this scenario, it sounds like the fraudsters are the medical insurance companies, and the group being lenient are the regulators. A place taking (on average) 1.2 seconds to review each claim shouldn't be in business.
        OfficialTurkey 3y ago
        We have a system where doctors and nurses review medications and treatment options for patients. It's called _the medical system_. You know, the one where I can go see my doctor, talk to them about what's going on, and work with them to create a treatment plan that suits my problems and my goals. Why do we need to bolt on a secondary system that sucks up an untold wealth of time and money?
        lotsofpulp 3y ago
        https://www.beckersspine.com/orthopedic/54193-fake-orthopedic-companies-involved-in-48m-billing-fraud-money-laundering-scheme.html https://www.beckersspine.com/orthopedic/54193-fake-orthopedi... https://www.pbs.org/newshour/health/feds-break-up-1-2b-medicare-orthopedic-brace-scam https://www.pbs.org/newshour/health/feds-break-up-1-2b-medic... https://www.fbi.gov/contact-us/field-offices/dallas/news/press-releases/federal-grand-jury-indicts-dallas-anesthesiologist-on-health-care-fraud-offenses https://www.fbi.gov/contact-us/field-offices/dallas/news/pre... https://www.cnn.com/2023/06/28/politics/doj-health-care-fraud-scheme/index.html https://www.cnn.com/2023/06/28/politics/doj-health-care-frau...
gustavus 3y ago
I'm assuming that the drs who end up as insruance claim evaluation drs are the Dr. Murphy's of the world who everyone decided it would be better if they weren't actually practicing medicine.
- ceejayoz 3y ago
  Yes. Which makes it darkly ironic that the end result is them practicing medicine on tens of thousands of people a month each.

Yep. Don't worry, though; if they slip up and do fund your expensive treatments, all of a sudden they have lots of time to focus on you. https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis https://www.propublica.org/article/unitedhealth-healthcare-i... > At one point, court records show, United inaccurately reported to Penn State and the family that McNaughton’s doctor had agreed to lower the doses of his medication. Another time, a doctor paid by United concluded that denying payments for McNaughton’s treatment could put his health at risk, but the company buried his report and did not consider its findings. The insurer did, however, consider a report submitted by a company doctor who rubber-stamped the recommendation of a United nurse to reject paying for the treatment. > But the records reviewed by ProPublica show that United had another, equally urgent goal in dealing with McNaughton. In emails, officials calculated what McNaughton was costing them to keep his crippling disease at bay and how much they would save if they forced him to undergo a cheaper treatment that had already failed him. As the family pressed the company to back down, first through Penn State and then through a lawsuit, the United officials handling the case bristled.

NickC25 3y ago
Horrifying. Those "insurers" are absolute scumbags. Poor guy, I feel awful for him.
- JumpCrisscross 3y ago
  > Those "insurers" are absolute scumbags It’s complicated. On the other hand are fraudsters and private-equity owned hospitals maxing the bill button. If the insurer is lax with payouts, it depletes its capital and could be left insolvent. It’s a scummy system more than a system of scumbags. (To be clear, there are scumbag insurers. But it’s reductive to cite that generally, or designate it as the source of the system’s troubles.)
  - justinclift 3y ago
    Taking 1.2 seconds to review claims means they are without any question "doing something wrong". "Remaining solvent" doesn't seem to be the goal, rather "maximising quarterly bonuses regardless of lives destroyed" seems a more fit description.
    - JumpCrisscross 3y ago
      > Taking 1.2 seconds to review claims means they are without any question "doing something wrong" Nobody said they aren’t. The point is, given the volume of claims, to do a proper analysis, we’d need a material fraction of doctors doing insurance reviews (instead of seeing patients). So we get a reliance on heuristics. If you’re lenient, you get targeted by fraudsters. So we get a bias towards denial. (Nobody is getting a material quarterly bonus for denying a few more claims. That nonsense occurs at the level of PBMs and other scale operations.)
      - justinclift 3y ago
        > If you’re lenient, you get targeted by fraudsters. So in this scenario, it sounds like the fraudsters are the medical insurance companies, and the group being lenient are the regulators. A place taking (on average) 1.2 seconds to review each claim shouldn't be in business.
      - OfficialTurkey 3y ago
        We have a system where doctors and nurses review medications and treatment options for patients. It's called _the medical system_. You know, the one where I can go see my doctor, talk to them about what's going on, and work with them to create a treatment plan that suits my problems and my goals. Why do we need to bolt on a secondary system that sucks up an untold wealth of time and money?
        lotsofpulp 3y ago
        https://www.beckersspine.com/orthopedic/54193-fake-orthopedic-companies-involved-in-48m-billing-fraud-money-laundering-scheme.html https://www.beckersspine.com/orthopedic/54193-fake-orthopedi... https://www.pbs.org/newshour/health/feds-break-up-1-2b-medicare-orthopedic-brace-scam https://www.pbs.org/newshour/health/feds-break-up-1-2b-medic... https://www.fbi.gov/contact-us/field-offices/dallas/news/press-releases/federal-grand-jury-indicts-dallas-anesthesiologist-on-health-care-fraud-offenses https://www.fbi.gov/contact-us/field-offices/dallas/news/pre... https://www.cnn.com/2023/06/28/politics/doj-health-care-fraud-scheme/index.html https://www.cnn.com/2023/06/28/politics/doj-health-care-frau...

gustavus 3y ago

I'm assuming that the drs who end up as insruance claim evaluation drs are the Dr. Murphy's of the world who everyone decided it would be better if they weren't actually practicing medicine.

ceejayoz 3y ago
Yes. Which makes it darkly ironic that the end result is them practicing medicine on tens of thousands of people a month each.