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I’ve got news for you, even in countries with socialized healthcare, not all treatments are automatically approved or approved in a timely manner. There’s ALWAY

by xienze 2y ago

I’ve got news for you, even in countries with socialized healthcare, not all treatments are automatically approved or approved in a timely manner. There’s ALWAYS a cost-to-benefit ratio that is considered, and it doesn’t always work out in the patient’s favor. I suppose we’d cheer the murder of say the UK’s equivalent of this CEO as well?

salawat 2y ago
Does the UK's guy implement policies like mandatory first pass denial to encourage attrition, or try employing blackbox AI models to the task of denying care, and attempting to mathwash? I've worked in the space. Most people don't care about denials that are reasonable. I.e. escalation through "lets try these first drugs" when there isn't an established history of use. Ruling out less expensive problems before approving the most expensive operation. Thise aren't generally issues. It's capricious denials happening over and over and over again, despite well established case history. Denials that clearly don't make sense. Prior Auths being used as financial "nudges". That type of thing can screw right off. It's why I left the space after it proved absolutely impossible to get through to people that these measures were costing the lives of our customers. I bloody tried; and in the end, left for the sake of keeping what was left of my soul intact. As far as I'm concerned the industry has made their bed. They can now sleep in it.
op00to 2y ago
> not all treatments are automatically approved It's not simply approval or denial. In the US, you can still get health care for conditions the insurance company decides to deny payment for after the fact. The "insured" is then financially ruined. This is so exceedingly common in the US. It's far, far, far, far, far, far, far less likely to be financially destroyed by a health issue in the UK or any other industrialized nation.
onli 2y ago
That's not correct. In countries with real health care, all treatments that are listed for an illness are always approved. There just is no denial process that could block e.g. a cancer treatment. A doctor diagnoses it and decided the treatment, the insurance pays and has no say in the matter.

by xienze 2y ago

salawat 2y ago

Does the UK's guy implement policies like mandatory first pass denial to encourage attrition, or try employing blackbox AI models to the task of denying care, and attempting to mathwash? I've worked in the space. Most people don't care about denials that are reasonable. I.e. escalation through "lets try these first drugs" when there isn't an established history of use. Ruling out less expensive problems before approving the most expensive operation. Thise aren't generally issues. It's capricious denials happening over and over and over again, despite well established case history. Denials that clearly don't make sense. Prior Auths being used as financial "nudges". That type of thing can screw right off. It's why I left the space after it proved absolutely impossible to get through to people that these measures were costing the lives of our customers. I bloody tried; and in the end, left for the sake of keeping what was left of my soul intact. As far as I'm concerned the industry has made their bed. They can now sleep in it.

op00to 2y ago

> not all treatments are automatically approved It's not simply approval or denial. In the US, you can still get health care for conditions the insurance company decides to deny payment for after the fact. The "insured" is then financially ruined. This is so exceedingly common in the US. It's far, far, far, far, far, far, far less likely to be financially destroyed by a health issue in the UK or any other industrialized nation.

onli 2y ago

That's not correct. In countries with real health care, all treatments that are listed for an illness are always approved. There just is no denial process that could block e.g. a cancer treatment. A doctor diagnoses it and decided the treatment, the insurance pays and has no say in the matter.