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[flagged]

dang 2y ago
You can't post like this here, and we ban accounts that do, so please don't post like this again. If you'd please review https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and stick to the rules when posting here, we'd appreciate it. We detached this subthread from https://news.ycombinator.com/item?id=42336090 https://news.ycombinator.com/item?id=42336090.
freeone3000 2y ago
His company was not an outlier; you have similar stories from Signa, AIG, and Blue Cross Blue Shield. BCBS had unveiled new rules to stop covering anathesia during surgery after the scheduled end time, regardless of if the surgery was still in progress. Those were rolled back after the killing. American healthcare is like this. Your doctor wants to give you some treatment, some other person decides how much it costs, then insurance, who you paid ahead of time, who you are legally required to have, who has never and will never see you, decides that it’s too expensive to pay out. Even though that’s what insurance is for. They get rich off of this; you suffer.
- SoftTalker 2y ago
  The thing we pay for called "health insurance" is really not insurance. Real insurance covers catastrophic unpredictable losses up to a pre-defined limit. That's all. What we have is some sort of forced pre-payment for routine medical care combined with some limited coverage for the unknown.
  - aaomidi 2y ago
    It’s a maintenance and repair plan that has a massive terms and conditions
  - wmf 2y ago
    What's stopping you from getting a high-deductible plan and paying cash for routine care? I'll admit you have to negotiate down the fake prices yourself.
    - SoftTalker 2y ago
      I do have an HDHP+HSA plan, but you still have to run all your routine care through the insurance, (a) so they negotiate a lower price and (b) so it is applied to your deductible. Truly "paying cash" for routine care would be difficult as most doctor's offices have no idea how to quote a cash price for services, unless you go to one of the very few cash-based practices.
    - freeone3000 2y ago
      Because there is nothing about a high-deductible plan that insures better against catastrophic outcomes.
- tdeck 2y ago
  > BCBS had unveiled new rules to stop covering anathesia during surgery after the scheduled end time, regardless of if the surgery was still in progress. Those were rolled back after the killing. Sounds like some positive outcomes already.
  - thaumasiotes 2y ago
    That was going to be rolled back anyway. There is zero chance it could ever have applied to anyone.
  - tptacek 2y ago
    You paying more for surgery is not a positive outcome, unless you are an anesthesiologist, in which case: well played, your trade group dues paid off mightily here.
    - tdeck 2y ago
      So if you're under the knife and a surgery is taking longer than expected, which would you prefer? a) The surgeons just stop the procedure early and close you up b) They continue but send the anaesthesiologist home, or c) They continue but you wake up to a massive surprise bill that you need to pay out of pocket?
      - 93po 2y ago
        d) Overhaul of medicine in the US that makes timing life-saving care less sensitive to scheduling and profits
      - tptacek 2y ago
        Are you being serious? Rationing anesthesia during surgeries is not a thing. The least expensive general anesthesia surgeries I can find already greatly exceed the out-of-pocket annual maximums for ACA market insurance plans (which have worse out-of-pocket maximums than the employment-based insurance plans most people have). You are not paying the money Anthem was trying to get anesthesiologists to stop overcharging! This is a dispute between two giant corporations, and people are inexplicably (and literally murderously) taking the side of the one that is making more money, and is resisting Medicare's guidelines. I'm not kidding: the messaging heist anesthesiologist trade groups pulled off here is unreal. They're some of the highest-paid specialists in the entire profession, and people are literally talking about giving their lives to protect their right to overbill you.
- tptacek 2y ago
  There's a long discussion about this on another thread, but if you're complaining about the BCBS anesthesia thing, you should look into how much you actually understand medical billing, because your complaint would also imply you find Medicare unconscionable as well.
  - fuzzybear3965 2y ago
    Okay. Deal.
- rsanek 2y ago
  they were an outlier. as has been discussed, they denied claims twice as often as is average https://www.bostonglobe.com/2024/12/05/data/unitedhealthcare-claim-denial-rates/ https://www.bostonglobe.com/2024/12/05/data/unitedhealthcare...
- blackeyeblitzar 2y ago
  These companies also outsource to middlemen companies that do some of the claim denying dirty work for them (see evicore). That’s why they all universally provide a bad service. But I have to say, Aetna is by a long shot worse than others. Look up stories of moms being denied coverage for a routine delivery. Aetna seems to regularly deny first, and then force these exhausted and vulnerable women through long drawn out appeals process. It’s just a way for them to delay payments and change their cash flow. Executives should be in jail.

[flagged]

dang 2y ago

You can't post like this here, and we ban accounts that do, so please don't post like this again. If you'd please review https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and stick to the rules when posting here, we'd appreciate it. We detached this subthread from https://news.ycombinator.com/item?id=42336090 https://news.ycombinator.com/item?id=42336090.

freeone3000 2y ago

His company was not an outlier; you have similar stories from Signa, AIG, and Blue Cross Blue Shield. BCBS had unveiled new rules to stop covering anathesia during surgery after the scheduled end time, regardless of if the surgery was still in progress. Those were rolled back after the killing. American healthcare is like this. Your doctor wants to give you some treatment, some other person decides how much it costs, then insurance, who you paid ahead of time, who you are legally required to have, who has never and will never see you, decides that it’s too expensive to pay out. Even though that’s what insurance is for. They get rich off of this; you suffer.

SoftTalker 2y ago
The thing we pay for called "health insurance" is really not insurance. Real insurance covers catastrophic unpredictable losses up to a pre-defined limit. That's all. What we have is some sort of forced pre-payment for routine medical care combined with some limited coverage for the unknown.
- aaomidi 2y ago
  It’s a maintenance and repair plan that has a massive terms and conditions
- wmf 2y ago
  What's stopping you from getting a high-deductible plan and paying cash for routine care? I'll admit you have to negotiate down the fake prices yourself.
  - SoftTalker 2y ago
    I do have an HDHP+HSA plan, but you still have to run all your routine care through the insurance, (a) so they negotiate a lower price and (b) so it is applied to your deductible. Truly "paying cash" for routine care would be difficult as most doctor's offices have no idea how to quote a cash price for services, unless you go to one of the very few cash-based practices.
  - freeone3000 2y ago
    Because there is nothing about a high-deductible plan that insures better against catastrophic outcomes.
tdeck 2y ago
> BCBS had unveiled new rules to stop covering anathesia during surgery after the scheduled end time, regardless of if the surgery was still in progress. Those were rolled back after the killing. Sounds like some positive outcomes already.
- thaumasiotes 2y ago
  That was going to be rolled back anyway. There is zero chance it could ever have applied to anyone.
- tptacek 2y ago
  You paying more for surgery is not a positive outcome, unless you are an anesthesiologist, in which case: well played, your trade group dues paid off mightily here.
  - tdeck 2y ago
    So if you're under the knife and a surgery is taking longer than expected, which would you prefer? a) The surgeons just stop the procedure early and close you up b) They continue but send the anaesthesiologist home, or c) They continue but you wake up to a massive surprise bill that you need to pay out of pocket?
    - 93po 2y ago
      d) Overhaul of medicine in the US that makes timing life-saving care less sensitive to scheduling and profits
    - tptacek 2y ago
      Are you being serious? Rationing anesthesia during surgeries is not a thing. The least expensive general anesthesia surgeries I can find already greatly exceed the out-of-pocket annual maximums for ACA market insurance plans (which have worse out-of-pocket maximums than the employment-based insurance plans most people have). You are not paying the money Anthem was trying to get anesthesiologists to stop overcharging! This is a dispute between two giant corporations, and people are inexplicably (and literally murderously) taking the side of the one that is making more money, and is resisting Medicare's guidelines. I'm not kidding: the messaging heist anesthesiologist trade groups pulled off here is unreal. They're some of the highest-paid specialists in the entire profession, and people are literally talking about giving their lives to protect their right to overbill you.
tptacek 2y ago
There's a long discussion about this on another thread, but if you're complaining about the BCBS anesthesia thing, you should look into how much you actually understand medical billing, because your complaint would also imply you find Medicare unconscionable as well.
- fuzzybear3965 2y ago
  Okay. Deal.
rsanek 2y ago
they were an outlier. as has been discussed, they denied claims twice as often as is average https://www.bostonglobe.com/2024/12/05/data/unitedhealthcare-claim-denial-rates/ https://www.bostonglobe.com/2024/12/05/data/unitedhealthcare...
blackeyeblitzar 2y ago
These companies also outsource to middlemen companies that do some of the claim denying dirty work for them (see evicore). That’s why they all universally provide a bad service. But I have to say, Aetna is by a long shot worse than others. Look up stories of moms being denied coverage for a routine delivery. Aetna seems to regularly deny first, and then force these exhausted and vulnerable women through long drawn out appeals process. It’s just a way for them to delay payments and change their cash flow. Executives should be in jail.