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My wife works in autism services. Insurance companies are the bane of her existence. Every six months (sometimes less), she has to write a huge report justifyin

by cael450 1mo ago

My wife works in autism services. Insurance companies are the bane of her existence. Every six months (sometimes less), she has to write a huge report justifying services. These reports are frequently over 100 pages and she is only slotted so much time to do it, so she ends up doing a ton of unpaid work. The entire business model is to drown the practitioner in paperwork then use “peer reviewers” who are nurses that don’t know anything about the treatment to deny claims then waste the practitioner’s time on appeals in the hopes that people will give up. AI has obviously made this process easier and the insurance companies absolutely hate it. People have no idea how inefficient the U.S.’s healthcare system is. And it isn’t just the private companies. A ton of states purposefully overburden and underfund their Medicaid systems for ideological reasons. Then the private insurance companies adopt the same practices later.

throwaway2037 1mo ago
From time to time, I see similar claims like this on HN: "doing a ton of unpaid work". The full quote: > These reports are frequently over 100 pages and she is only slotted so much time to do it, so she ends up doing a ton of unpaid work. What if she refuses to do the work unpaid? This seems like an open-and-shut case with the US Dept of Labour. There is a whole page that explains how to make a claim here: https://www.dol.gov/agencies/whd/contact/complaints https://www.dol.gov/agencies/whd/contact/complaints Also, if she is part of a labour union, she can raise concerns with them. > A ton of states purposefully overburden and underfund their Medicaid systems for ideological reasons. Can you provide some evidence for this claim? Also, does this affect the state(s) where your wife works? From what I found, 66% of Medicaid is paid for by the federal gov't, and the remaining share is funded by each state.
- nearlyepic 1mo ago
  > What if she refuses to do the work unpaid? Then her client doesn’t get the help they need? That should be obvious. > This seems like an open-and-shut case with the US Dept of Labour. Even if it wasn’t for the “u” in labor I could tell you don’t live in the US.
  - titanomachy 1mo ago
    I’m not sure they live in this universe at all.
- dam_jackalopes 1mo ago
  The most obvious example were the 10 States which refused to accept increased Federal funding for Medicaid that was made available with the passage of the ACA, which seems largely ideologically driven. Otherwise the situation is more complex than the original comment suggests, and I can only speak to one state (Idaho), but I don't think the scenario is uncommon in other GOP controlled states and isn't limited to Medicaid. Idaho has cut taxes in the state for five consecutive years, largely (IMO) on an ideological basis. This had the result, desired by many in a deeply conservative legislature, of creating budget deficits. Even the GOP is normally wary of espousing cuts directly to the state's contribution to Medicaid, but the deficit gives them cover to reduce funding and introduce barriers to service like caps on authorized services and new work requirements. Even when revenues were higher than expected for FY 2026, the governor's office had to act to actually retain those unexpected revenues as it was pretty clear that the Legislature was going to look to claw them back and continue drive down State spending. It's worth noting that health services, including Medicaid funding, represent about a third of the State's budget and their largest portion of the budget. This whole process has been playing out in public education funding in the State for years as well. Coincidentally, charter school enrollment has increased by roughly 35% over the same 2021 - 2026 period. Attacking a policy, program or institution financially and then pointing to the deficiencies of those same programs to further fuel funding and efficacy reductions is a pretty well established tactic in US politics as I'm sure it is elsewhere.
- Gareth321 29d ago
  > What if she refuses to do the work unpaid? Depending on the competition for her job and the state laws, she would either be put onto a performance management program, or fired. I've been through this before. The HR approved response is that they expect those 100-page reports to be complete within normal working hours, and a failure to achieve that means you are unable to fulfill the requirements of the job. Of course those in high demand who can easily move to better employers will often do so. However there is a lot of friction when moving jobs. It's very time consuming, mentally demanding, and risky. I've seen incredibly talented staff treated awfully in my years, and they refuse to leave for various reasons.
  - throwaway2037 29d ago
    If enough people are fired for this reason and file complaints with DoL (US Dept of Labor), then surely the DoL will open a case against the company for unpaid wages. If I recall correctly, for a while, Amazon used to force staff to arrive early (before shifts) but did not pay them for it. DoL got involved and the rules changed. To be clear: It is difficult, but not impossible, to make labor practices change with the help of DoL. EDIT This part should have appeared first: I agree that your scenario is the most likely outcome, even if I think it is reprehensible!
pelotron 1mo ago
I've always enjoyed the question, "how many layers of profit are between you and your doctor?"
- SpicyLemonZest 1mo ago
  In most states, the answer is fixed by law at either zero or one depending on whether you count insurance, because medical practices must be wholly owned by doctors.
  - jmm5 1mo ago
    Yes, but that's still like 20 states that don't have strict CPOM laws.
    - SpicyLemonZest 1mo ago
      It does, but how often do you see people argue that California and Texas are paradises where healthcare is affordable because the profit-seekers have been driven out?
infamouscow 1mo ago
And then people are shocked when insurance executives are publicly slayed.
bitexploder 1mo ago
Inefficiency is their business model. They just soak $$ into their system. More overall revenue even if most of it is some rube goldberg machine of apathy.

by cael450 1mo ago

throwaway2037 1mo ago

From time to time, I see similar claims like this on HN: "doing a ton of unpaid work". The full quote: > These reports are frequently over 100 pages and she is only slotted so much time to do it, so she ends up doing a ton of unpaid work. What if she refuses to do the work unpaid? This seems like an open-and-shut case with the US Dept of Labour. There is a whole page that explains how to make a claim here: https://www.dol.gov/agencies/whd/contact/complaints https://www.dol.gov/agencies/whd/contact/complaints Also, if she is part of a labour union, she can raise concerns with them. > A ton of states purposefully overburden and underfund their Medicaid systems for ideological reasons. Can you provide some evidence for this claim? Also, does this affect the state(s) where your wife works? From what I found, 66% of Medicaid is paid for by the federal gov't, and the remaining share is funded by each state.

nearlyepic 1mo ago
> What if she refuses to do the work unpaid? Then her client doesn’t get the help they need? That should be obvious. > This seems like an open-and-shut case with the US Dept of Labour. Even if it wasn’t for the “u” in labor I could tell you don’t live in the US.
- titanomachy 1mo ago
  I’m not sure they live in this universe at all.
dam_jackalopes 1mo ago
The most obvious example were the 10 States which refused to accept increased Federal funding for Medicaid that was made available with the passage of the ACA, which seems largely ideologically driven. Otherwise the situation is more complex than the original comment suggests, and I can only speak to one state (Idaho), but I don't think the scenario is uncommon in other GOP controlled states and isn't limited to Medicaid. Idaho has cut taxes in the state for five consecutive years, largely (IMO) on an ideological basis. This had the result, desired by many in a deeply conservative legislature, of creating budget deficits. Even the GOP is normally wary of espousing cuts directly to the state's contribution to Medicaid, but the deficit gives them cover to reduce funding and introduce barriers to service like caps on authorized services and new work requirements. Even when revenues were higher than expected for FY 2026, the governor's office had to act to actually retain those unexpected revenues as it was pretty clear that the Legislature was going to look to claw them back and continue drive down State spending. It's worth noting that health services, including Medicaid funding, represent about a third of the State's budget and their largest portion of the budget. This whole process has been playing out in public education funding in the State for years as well. Coincidentally, charter school enrollment has increased by roughly 35% over the same 2021 - 2026 period. Attacking a policy, program or institution financially and then pointing to the deficiencies of those same programs to further fuel funding and efficacy reductions is a pretty well established tactic in US politics as I'm sure it is elsewhere.
Gareth321 29d ago
> What if she refuses to do the work unpaid? Depending on the competition for her job and the state laws, she would either be put onto a performance management program, or fired. I've been through this before. The HR approved response is that they expect those 100-page reports to be complete within normal working hours, and a failure to achieve that means you are unable to fulfill the requirements of the job. Of course those in high demand who can easily move to better employers will often do so. However there is a lot of friction when moving jobs. It's very time consuming, mentally demanding, and risky. I've seen incredibly talented staff treated awfully in my years, and they refuse to leave for various reasons.
- throwaway2037 29d ago
  If enough people are fired for this reason and file complaints with DoL (US Dept of Labor), then surely the DoL will open a case against the company for unpaid wages. If I recall correctly, for a while, Amazon used to force staff to arrive early (before shifts) but did not pay them for it. DoL got involved and the rules changed. To be clear: It is difficult, but not impossible, to make labor practices change with the help of DoL. EDIT This part should have appeared first: I agree that your scenario is the most likely outcome, even if I think it is reprehensible!

pelotron 1mo ago

I've always enjoyed the question, "how many layers of profit are between you and your doctor?"

SpicyLemonZest 1mo ago
In most states, the answer is fixed by law at either zero or one depending on whether you count insurance, because medical practices must be wholly owned by doctors.
- jmm5 1mo ago
  Yes, but that's still like 20 states that don't have strict CPOM laws.
  - SpicyLemonZest 1mo ago
    It does, but how often do you see people argue that California and Texas are paradises where healthcare is affordable because the profit-seekers have been driven out?

infamouscow 1mo ago

And then people are shocked when insurance executives are publicly slayed.

bitexploder 1mo ago

Inefficiency is their business model. They just soak $$ into their system. More overall revenue even if most of it is some rube goldberg machine of apathy.