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> The insurance industry’s lobbying arm, AHIP, said in a February letter to the Centers for Medicare & Medicaid Services that prior approvals and other similar
by KittenInABox 3y ago
> The insurance industry’s lobbying arm, AHIP, said in a February letter to the Centers for Medicare & Medicaid Services that prior approvals and other similar reviews protect patients by reducing “inappropriate care by catching unsafe or low-value care, or care not consistent with the latest clinical evidence.”
Reminder of the orthopedic surgeon whose recommendation for surgery was denied from insurance citing an insurance-paid doctor who is lifetime banned from doing surgery for installing a hip in backwards
Edited to add:
> Studies show that Medicare Advantage costs taxpayers more per beneficiary than the traditional program. But the plans enjoy the backing of many lawmakers, especially Republicans, because of their popularity.
Ugh. Ugh. Of course they're popular, the upfront costs are small, and the united states has literally over 10% more food insecurity in the past year alone[0]. Americans literally can't afford medicine, not because they just really really love Medicare Advantage!
0. https://www.cbpp.org/blog/food-insecurity-increased-in-2022-with-severe-impact-on-households-with-children-and-ongoing https://www.cbpp.org/blog/food-insecurity-increased-in-2022-...
- gopher_space 3y agoI wonder what sort of liabilities insurance companies open themselves up to by automating approval. Having a quack on staff isn't surprising, doctors who'd put their license on the line like this probably don't have too many options.
- shigawire 3y agoMost do have automation in place. In fact, the big EHRs are now working with payors to help facilitate automatic interoperability for insurance claims. So the insurer can directly pull up the patient's chart and use discrete data elements for claims processing.
- jjk166 3y agoOdds are there's something buried in the insurance policy's terms that gives them permission to do stuff like that.
- sokoloff 3y agoThat insurance-paid doctor seems like they are a genuine expert on "unsafe or low-value care, or care not consistent with the latest clinical evidence".
- borski 3y ago> Reminder of the orthopedic surgeon whose recommendation for surgery was denied from insurance citing an insurance-paid doctor who is lifetime banned from doing surgery for installing a hip in backwards Source? I believe you, I just really want to read about this.