2 ms·

Good, your insurance company should get no say on this matter. If your doctor prescribes it, insurance pays. If you think the doctor is committing fraud then y

by Spivak 2y ago

Good, your insurance company should get no say on this matter. If your doctor prescribes it, insurance pays. If you think the doctor is committing fraud then you can take that up with the doctor, not the patient. The mistreatment by insurance companies is so normal now that people are just defeated. My MIL has been trying different treatments for over a decade and finally found a drug that can manage her chronic spinal pain. She's finally mobile enough to play with my nephews. And because her work switched insurance she now going through years of needless bullshit to prove to this insurance company that no really, this is the only thing that works. And now she has to pay for it out of pocket and it's over $1000/mo. I know, I know, you would really rather pay for the cheaper thing that doesn't.

Aloisius 2y ago
No developed country gives doctors absolute power to authorize treatments. There isn't an infinite bucket of money to draw from. At some point, spending priorities have to be made and elsewhere, it's usually based on cost vs. years of quality of life improvement, so giving antibiotics to dozens of children wins out against a third MRI for acute back pain for an 80 year old. The US is abnormal in how much discretion it gives doctors and we are incredibly inefficient with our spending because of it.
- Spivak 2y ago
  The world you've envisioned sounds nice except: 1. That's not the trade that's happening. Every person in the US is paying for their own health insurance. Having Aetna tell you your claim is denied because someone else needed a heart transplant makes no sense. Also this is unrelated but the whole "years of quality of life" is such a made up bullshit thing it's laughable. It's reasonable on the physician end especially when treatments have hard recoveries but for the insurance end it's ridiculous. Can you imagine your car insurance not paying out after an accident because they decided you don't have enough years driving left? That's just patently not your job to evaluate. 2. For most treatments the fight with insurance happens after the services are rendered and even when you do get prior auths they're not binding so that's always fun for people. The money is already being paid, the only question is who. 3. Doctors aren't given absolute power under this system, they're still limited by all the same restrictions they had before—medical board, government regulations, standards of care—except there isn't a private 3rd party with a direct financial incentive to deny care inserting themselves in the middle.

by Spivak 2y ago

Aloisius 2y ago

No developed country gives doctors absolute power to authorize treatments. There isn't an infinite bucket of money to draw from. At some point, spending priorities have to be made and elsewhere, it's usually based on cost vs. years of quality of life improvement, so giving antibiotics to dozens of children wins out against a third MRI for acute back pain for an 80 year old. The US is abnormal in how much discretion it gives doctors and we are incredibly inefficient with our spending because of it.

Spivak 2y ago
The world you've envisioned sounds nice except: 1. That's not the trade that's happening. Every person in the US is paying for their own health insurance. Having Aetna tell you your claim is denied because someone else needed a heart transplant makes no sense. Also this is unrelated but the whole "years of quality of life" is such a made up bullshit thing it's laughable. It's reasonable on the physician end especially when treatments have hard recoveries but for the insurance end it's ridiculous. Can you imagine your car insurance not paying out after an accident because they decided you don't have enough years driving left? That's just patently not your job to evaluate. 2. For most treatments the fight with insurance happens after the services are rendered and even when you do get prior auths they're not binding so that's always fun for people. The money is already being paid, the only question is who. 3. Doctors aren't given absolute power under this system, they're still limited by all the same restrictions they had before—medical board, government regulations, standards of care—except there isn't a private 3rd party with a direct financial incentive to deny care inserting themselves in the middle.