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How often do health insurers say no to patients? (2023)
- vjvjvjvjghv 1y agoIs there any hope to clean up the US health system in any foreseeable future? How did the health lobby get so much power and get away with all this abuse?
- bobthepanda 1y agothere's a bunch of problems with the setup but a major one is that employer health plans are tax deductible. employees don't really get market choice, and employers really only care about reducing their own expense in regards to healthcare. ending this would be very expensive and disruptive for both employer and employee in the short term, and people have a strong preference for the devil they know vs. the devil they don't (either a public option or fully market-based healthcare) it's worth noting that the healthcare system has a couple of antagonistic components and right now probably insurers are the only group actually fully happy with the situation. medical providers, pharmacists, and patients are all getting shafted.
- jmcgough 1y agoThere's a lot of problems you can point at: - Through extensive lobbying, the US passed the HMO act of 1973 which requires that all employers offer an HMO plan to employees. HMOs were created to keep costs down, but United really took this to the extreme, making it as hard to use your health insurance as possible, and creating vertical monopolies like OptumRX. United takes so long to pay providers for the work they do that they now offer payday loans to doctors offices, which is crazy. - The US uses a fee-per-service model that priorities procedures over preventative treatment or patient education. Some other countries have moved towards reimbursement based on health outcomes. - The Affordable Care Act banned physician owned hospitals, which were growing in popularity and had better outcomes for less fees to patients. - Private Equity is swallowing up hospital systems, emergency departments, etc. The most common seller is another PE firm, so they try to make a quick return through heavy cuts and then flip it 5 years later.
- FireBeyond 1y ago> and creating vertical monopolies like OptumRX Aetna "forces" you into using its pharmacy by refusing to authorize any prescription with more than a 30-day supply unless through its wholly-owned pharmacy-by-mail subsidiary.
- kstrauser 1y agoI’d much rather go to the pharmacy once a month with Aetna than with UHC, because at least Aetna actually pays for things. They’re both awful in their own ways; don’t read that as me endorsing Aetna.
- vjvjvjvjghv 1y ago"vertical monopolies like OptumRX" This should be illegal. I have read that UNH also owns around 10% of providers so they own the whole chain.
- jmcgough 1y agoYes, they are even buying up therapy clinics.
- s5300 1y ago[dead]
- lostdog 1y agoI'm not sure if there's any hope of US healthcare improving for a long while. The ACA was the only recent improvement. It was a small change, but the electorate decided that it was bad, pushed its supporters out of office, and elected a series of people who promised to "repeal and replace" it, but weren't really serious about any improvement. And then when the "repeal and replace" crowd failed, they were not held accountable, but reelected anyways. There also isn't much interest in improving healthcare from either side right now. The right has nothing. Their current platform is ignorant views about vaccines. The left has a stronger interest in Palestine and housing abundance right now, though all of that is dwarfed by trying to keep the rule of law going, and preventing us from falling out of a democracy. Healthcare is way way down the list for everyone sadly--even Bernie doesn't talk about it much anymore. The electorate has spoken, and they are not interested.
- vjvjvjvjghv 1y agoVery true. Trans athletes in women's sports are way more important than affordable healthcare.
- wtbdbrrr 1y agoAll the time is not a number but in Germany it's common that your legitimate insurance claim gets rejected at first and then you appeal once or twice and do the paperwork and document the proof again, citing all terms & conditions that apply and you get what you are owed or you get a lawyer to do the whole thing again and get what you are owed then. "Arbeitsbeschaffungsmassnahmen" ( German for "employment creation scheme" ) in an industry where there is not enough actual work for--and or to justify the--number of employees. One of the more useful Ponzi schemes; if you are not a real capitalist, that is. Because if you are, then this shit is just fugly drag.
- braabe 1y agoI have had this experience, but not with healthcare insurers (in Germany). I cannot remember the last time I had to contact them - the last two times they contacted me, was to explain to me, that they have expanded their preventive care offerings and they recommend I go and get them. Blanket rejections are an extremly efficient measure from the perspective of an entity when the consumer has nowhere else to go and you don't care about ethics. Just tell them no and many people will just give up. If they appeal, you can invest the work to fob them off properly or just pay and not deal with the hassle. I can barely tell the difference with the many public healthcare insurers in germany - if my insurer were to try this nonsense, I would be gone the next month. Universities, some agencies and especially the god-damned GEZ on the other hand... What frustrates me more, is that it often turns into a class indicator: Do you know how to word your letters or to handle yourself in a way that indicates, that it will be more annoying to not-deal-with-you than to deal-with-you? And if you don't: Do you have a access (network/money) to someone who does?
- wtbdbrrr 1y ago> is that it often turns into a class indicator Oh, man. One could rant for hours about this. You are absolutely right. But in the end it's not really a class indicator because info about this particular and similar schemes could theoretically be packed into a weekend long workshop. In any small company or big factory, and definitely in schools as early as grade 10. But it's a matter of character and you have to be damn lucky if you get a teacher who cares that much. Even neighbors will more often than not, NOT enlighten "the less fortunate" about stuff like this. It's pathetic. But that's why this cascade works so well to keep almost all of the "more fortunate" under perfect societal control by which I don't mean some mythological conspiracy but "Steuerungsmechanismen" (some dude who got out of some cult beautifully explained this but I forgot both his name and the title of the book), keeping almost all of them in line, mostly silent, and alienated from the inter-generational usefulness of critical thinking. And there is no irony in all this. Too many peoples mindsets never left the modern dark ages. One can only raise a brow and chuckle at all this. It's a class indicator for sure, but, in my opinion, not class in the sense of hierarchies but of intellectual style, niveau. These tactics are low, like punching drugs.
- downrightmike 1y agoSo far this year I'm seeing basically "We got $100 off! $0 paid by plan. You owe $xxx" I barely use it, but so far insurance isn't covering anything except basic $x refills
- Guvante 1y agoYou are on a high deductible plan. With those plans you pay the first $X and after that a percentage of costs (coinsurance) up to $Y. Sometimes certain things are covered before you hit your deductible other times not.
- ceejayoz 1y agoYes, but you'll often find that in a high-deductible plan the insurance company gets a "discount" of your $1k med down to $200, which they brag about in your EOB… but the medication's cash price for uninsured people would be $20. You're out of pocket $180 more than you should be, and paying the $20 cash price out of pocket means your deductible doesn't budge.
- mustyoshi 1y agoWhat if the medicine costs 100$ to produce, should uninsured have to pay that rather than a subsidized 20$?
- ceejayoz 1y agoWhat if the medicine costs $0.01 to produce and both are getting hosed?
- downrightmike 1y agoGiven US universities did the research for nearly every drug on the market, we've already paid for it. Universities need to get into the drug production business
- mindslight 1y agoIt's straightforward fraud. Both the providers and insurers goal is to mislead people into thinking the "adjustment" represents a payment from the insurance company. The pattern is even more flagrant when done with post-facto billed services, since the price hasn't even been assented to. The whole medical industry has essentially normalized many different types of fraud against patients, and yet the industry is so entrenched that state/county AGs don't bother going after them.
- spyspy 1y ago> Health Insurance CEO Reveals Key To Company’s Success Is Not Paying For Customers’ Medical Care [1] 1. https://theonion.com/health-insurance-ceo-reveals-key-to-company-s-success-i-1823515696/ https://theonion.com/health-insurance-ceo-reveals-key-to-com...
- avalys 1y agoIf it’s not up to health insurers to limit healthcare spending, then which organizational role in the healthcare system do you think is appropriate to place this responsibility with?
- kstrauser 1y agoElected representatives answerable to their constituents would be a vast improvement in health outcomes.
- firesteelrain 1y agoHow would it all be paid for if not by increasing premiums (like what happened with ACA)?
- kstrauser 1y agoThe sheer amount of overhead induced by insurance is staggering. For example, the sum of the net profits of all insurers represents money extracted from the system without contributing to health. And the amount of time doctors spend documenting patient care over and above what’s medically necessary purely to make insurers happy is time not spent seeing patients. Clinic staff spending hours on the phone each day arguing against denials is wasted money. (Anecdote: an insurer refused to authorize an MRI for a patient until my wife xrayed their damaged tendon, which doesn’t show up on xrays. She had to conduct a useless medical procedure on the patient before they’d pay for one with actual diagnostic value.) The whole overhead imposed by the useless rent seekers is money not spent on making people healthier.
- deleted 1y ago[deleted]
- kstrauser 1y agoAll the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300. The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. I was raised a die-hard capitalist and in many ways still am. When it comes to healthcare these days, I’m somewhere to the left of Marx. What we have now is a failed system. It simply does not work. The turnip has been squeezed and there’s no blood left to wring from it.
- azemetre 1y agoThese are completely human systems that can be changed any time for any reasons. The current system is achieving exactly what it was designed for: wealth extraction. There’s no reason why this system has to exist. We can make it better any time we want.
- kstrauser 1y agoThere’s a huge reason it continues to exist: exorbitant lobbying from the people profiting from the death panels. Almost everyone supports Medicare, but too many have been convinced that Medicare for all is some kind of nefarious communist plot.
- mrcommentwriter 1y agoFirst they sell you the problem, then they sell you the solution. There is no emphasis on long term planning or prevention. Everyone is grabbing with both hands.
- arwhatever 1y ago1. A properly competitive marketplace 2. Socialized medicine 3. What we have now I would like to see #1 tried but at this point I’ll gladly accept #2
- mattnewton 1y ago
- lordnacho 1y agoI thought I saw a meme about denail rates when that healthcare CEO got shot? Where did those numbers come from?
- ceejayoz 1y agoThat's an estimate, not hard numbers. https://www.yahoo.com/news/no-one-knows-often-health-202056665.html https://www.yahoo.com/news/no-one-knows-often-health-2020566... > At the same time, posts on social media have been claiming that UnitedHealthcare’s claim denial rate is the highest in the industry at 32%. This figure comes from the personal finance website Value Penguin, which said it calculated that rate from available in-network data from plans sold on the marketplace.
- carabiner 1y agoFYI the shooter has received $1.2m in donations for his defense fund, and counting.
- danaris 1y agoThe accused shooter. Firstly, Luigi Mangione is presumed innocent until proven guilty. Secondly, there's a fair amount of real evidence that Luigi is being set up as a scapegoat by the NYPD—a police department with a known history of planted evidence.
- kstrauser 1y agoFirst part: yes, definitely. That’s a critical part of how the system works. Second part: I’m not buying that for a moment. It’s way easier for me to believe that an individual working alone, screwed over by a megacorp who earns more based on how many people they can deny healthcare to, had enough and went vigilante. Vigilanteism and cold blooded murder are not OK, but it’s pretty easy to link cause and effect there. That’s vastly more likely than a shadow conspiracy that’s managed to keep its mouth shut so far.
- scoopdewoop 1y ago
- OhMeadhbh 1y agoI assumed health plans always say "no" the first time you submit, to weed out people who give up too easily.
- eth0up 1y agoFor what it's worth, I've been thrown in society's waste basket altogether on this one. No insurance, none, of any kind. I've got a Free h D in hillbilly medicine though. I've accomplished some amazing shit, but it's unraveling a bit now, and I'll be super surprised if I last much longer. One can certainly say such a hit to morale is just collateral damage in the beautiful face of our wondrous mutant hive, but what are you guys gonna do when we start stinking up your streets en masse? One way or another, you'll be smelling the smoke. Soylent Green is here. Read your labels carefully. Proudly Made in the USA with Harshly Sourced Ingredients. I was free roaming though, if that matters. Edit: returned to clarify that I was pulling myself up by me bootstraps. It's just that it's getting tough to hold on to em tightly enough. No shoes no service though, I guess.
- erikig 1y agoTLDR; 1 in 5
- refurb 1y agoDo Americans think they are special? Do they think that everything gets paid for no matter what? An endless pool of money? As a Canadian I had the pleasure of my insurer (Canadian government) denying my treatment. Multiple appeals, still a no. My doctor said it was the only thing that would treat my disease. So my only choice is paying for it in cash at $10,000+ per month, which I can't afford.
- daft_pink 1y agoAre they saying no to patients or are they saying no to providers? I’ve found numerous instances where providers have billed over $5,000 for procedures that I could get for $250 if I paid cash. They do things like seperating a test panel into 100 different separate procedures, etc. I think they need some context in the article of the interplay between providers billing practices to maximize their fees and insurer denials instead of just demonizing the insurance companies. Every denial doesn’t result in a patient not receiving care, but is sometimes pushback against overly aggressive providers/negotiation and some of that can and probably should be automated. Obviously them denying necessary treatment is really bad, but I find that propublica articles are often highly opinionated against certain interests and leave out a lot of context to create an extreme headline.