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> A lot of these issues arise because providers fail to review payer coverage rules before deciding on a treatment plan. And in fairness to providers, this take

> A lot of these issues arise because providers fail to review payer coverage rules before deciding on a treatment plan. And in fairness to providers, this takes extra time which they don't get paid for and the rules are inconsistent between payers. The new HL7 Da Vinci Project prior authorization burden reduction standards can help automate this to an extent by giving providers an API to check coverage rules in real time. I'm sorry but how with a straight face can you really write this paragraph. The Doctor, the person who is seeing you needs to check a system of what you they are authorized to do for you? That is dystopian. FFS we had an episode of this on Star Trek Voyager showing how bad this system is and yet that is exactly what we do. What you are describing id disgusting, end of story. There is no justification of any of this. Are there corrupt doctors? Sure. But insurance should not have a right to say what can and cannot be done if here is a good reason and it should be an actual discussion instead of Insurance having all of the power. ALL

nradov 3y ago
You're arguing with the wrong person. I gave you accurate information about how the system works today, and a reference to technical information that hackers can use to mitigate certain problems. And I can do that with a straight face. Technically insurers don't say what treatments can and cannot be done. Their role is purely financial. Patients can always pay out of pocket, and some do. But in practice an insurance denial does sometimes leave low income patients without access to care. Ultimately though there does have to be some system for rationing care. Demand is effectively infinite and resources are finite. Even countries with single payer or socialized medicine restrict which treatments they make available, and often restrict patient access to expensive treatments by imposing queues. I didn't claim that the current system is a good one. I have no power to change it. Any real solution will have to be mainly political so complain to go take your proposals to Congress.

nradov 3y ago

You're arguing with the wrong person. I gave you accurate information about how the system works today, and a reference to technical information that hackers can use to mitigate certain problems. And I can do that with a straight face. Technically insurers don't say what treatments can and cannot be done. Their role is purely financial. Patients can always pay out of pocket, and some do. But in practice an insurance denial does sometimes leave low income patients without access to care. Ultimately though there does have to be some system for rationing care. Demand is effectively infinite and resources are finite. Even countries with single payer or socialized medicine restrict which treatments they make available, and often restrict patient access to expensive treatments by imposing queues. I didn't claim that the current system is a good one. I have no power to change it. Any real solution will have to be mainly political so complain to go take your proposals to Congress.