We've been told for years that herp derp the economy is doing amazing! If you don't agree there's something wrong with you! if you got laid off or your corpo landlord raised your rent and you're now dying in the street well then... look everybody! An evil homeless person lowering your property values with their continued existence! Git em!
You know, at face value he's absolutely right. We shouldn't claim care that is unnecessary or maybe even harmful. But where we disagree is that I think that decision should be left to our medical professionals
Really what it should be is that if a doctor prescribes unnecessary care, they should go after the doctor, not the patient. Doctors have malpractice insurance. If the health insurance can't win a case of malpractice, then they should pay the bill. Why are patients in the midfle here at all.
Really what it should be is that if a doctor prescribes unnecessary care
That's the core problem. The entity that defines unnecessary care is health insurance. And there are TONS of stories of them denying Diabetes medication for people with diabetes and anti-nausea meds to pediatric patients getting chemo.
If they were doing the right thing, no one would be pissed off. The "recent target" was the one to decided to run on AI driven denials that were denying 90% of care for months.
They are not fulfilling their duty to take the money from the subscribers and pay their righteous medical bills and instead using it as raw profit.
They are employing their own 'doctors' to prove stuff that is definitely necessary is labeled unnecessary.
This is still validating the profit incentive of private health insurance.
If the doctor prescribes unnecessary care, it should be none of these peoples' business, because they shouldn't be allowed any stake in the decision whatsoever.
Insurance claims are approved or denied by medical professionals. In the state of NY it's even required for a specialist to approve or deny specialist care.
Medical professionals that spend an average of 6 seconds per case. And keep getting caught with revoked/expired licenses. And well outside their area of expertise (the classic example is failed dentists deciding on cancer treatments).
They are done by medical professionals who have no obligation or incentive to serve the best interests of the patient. If your doctor fucks up, he can be found liable. If the insurance doctor fucks up, there is no liability whatsoever. Cases have been brought to court and then immediately thrown out because there is no legal basis for holding them accountable.
Except in this case, they used AI to help them make decisions. The lawsuit is still ongoing so I shouldn't speak in definitive terms, but considering the circumstances and evidence I think it's pretty clear than they have tried to automate some processes and didn't audit them properly.
There is a lot of crap that they’re able to instantly deny through your plan’s terms and conditions.
It’s worth reading the plan summary of what won’t be covered, even if it’s prescribed treatment. Some of the shit that’s hidden in there is fucked up.
This year someone in my family started to have to pay out of pocket for their GLP1s because their diseases didn’t progress far enough for the treatment to be covered. They’d rather you hurry up and die than pay for expensive drugs that keep you alive for longer.
I don't have sources, but I seem to recall reading somewhere that the OGs aged out or got caught, and the new gen that replaced them weren't as ideologically driven or competent or something. I think they still technically exist but aren't nearly as influential as they once were
So many internet arguments revolve around binary choices that don’t need to be binary or appeals to authority or hypocrisy as the only leg they stand on.
so does that make it ok for healthcare providers to deny coverage for procedures or medication that has been prescribed due to an illness or ailment impacting a patients quality of life?
No it doesn't but I can understand why they don't greenlight everything. This all is a glaring example why we need single payer health care and doctors that earn a flat rate and not get paid per procedure (there is a name for this, i don't know it).
A few. I had a primary care doctor who would talk my ear off. After we discussed whatever my problem was he would talk about religion and politics. He was pretty right wing, me having a catholic school education and have long paid attention to politics can hold my own. The odd thing, there was always a waiting room full of patients but he would gab on and on. Eventually I came in for an appointment and I said to his receptionist "the doctor sure doesn't rush me out of there". That's when she said "yeah most insurance companies want you out in fifteen minutes". At that moment it clicked. The doctor was always looking at his watch, if he went over fifteen minutes he could charge for another fifteen minutes. He also had a waiting room full of posters and pamphlets paid for by pharmaceutical companies. He suggested prescribing me medication for my anxiety, i just laughed. My doctor now has none of that propaganda in his waiting room. My last visit he pushed eating fresh fruit and vegetables. I told him that's why I come to him, he tells me what I don't want to hear. I had a dentist who was the same way. Also very religious and right wing.