• Nougat@fedia.io
    link
    fedilink
    arrow-up
    314
    ·
    1 month ago

    Universal health care? I don’t want government making my health care decisions! We have for-profit companies for that.

      • ShaggySnacks@lemmy.myserv.one
        link
        fedilink
        English
        arrow-up
        17
        ·
        edit-2
        1 month ago

        Frank is a busy man. Denying medical treatments, sitting on death panels. Is there nothing Frank can do?

        Oh yeah, Frank can’t approve medical treatment.

    • Kokesh@lemmy.world
      link
      fedilink
      English
      arrow-up
      33
      arrow-down
      9
      ·
      1 month ago

      Don’t be so sure it would be different. I collapsed, nearly drove off the road 3 times in one week and decided that it was enough and went to the doctor. He sent me home, wrote me in as extreme burnout (completely true, I had to sleep at work for every coffee break to make it through the day and 30 mins before driving home to actually make it). So I thought Great, I will rest for a few months and go back to work after that! Nope. The state heath insurance office said Our specialists decided, that you are perfectly fine. No sick pay. Get back to operating the industrial concrete blender. The health center doctors signed a letter, but no, I was fucked. So on top of this I got extreme financial stress. We got out of this crap by renting our cabin and starting going full into an outdoor adventure business. What a great time. Where was this? In Sweden in January 2019.

      • systemglitch@lemmy.world
        link
        fedilink
        English
        arrow-up
        32
        arrow-down
        1
        ·
        1 month ago

        Sounds like a flaw in the system. I fail to see how health insurance should ever be involved between patient and doctor in a “universal” health care system. Sure doesn’t happen where I live.

        • kungen@feddit.nu
          link
          fedilink
          English
          arrow-up
          4
          ·
          1 month ago

          Well, they got denied by Försäkringskassan, “Swedish Social Insurance Agency”. Basically wouldn’t be able to get sick-pay, but that’s about it. Which is a bit weird, as nearly all first-time requests get approved, but of course it happens.

          So it’s not really the same thing as American insurance denying; they’re still able to seek care, just that the suggested treatment for burnout (pause from working) wouldn’t be economically comfortable if Försäkringskassan denies their sick-pay.

      • AbsoluteChicagoDog@lemm.ee
        link
        fedilink
        English
        arrow-up
        20
        arrow-down
        8
        ·
        1 month ago

        It’s cute that you expect Americans to feel sympathy because your employer didn’t take your burnout seriously

      • Stovetop@lemmy.world
        link
        fedilink
        English
        arrow-up
        1
        ·
        21 days ago

        In theory a government is beholden to its constituents, a corporation is beholden to its shareholders. Governments aren’t perfect, but there are at least avenues to effect positive change without financial incentives being a prerequisite.

    • systemglitch@lemmy.world
      link
      fedilink
      English
      arrow-up
      6
      arrow-down
      1
      ·
      1 month ago

      Do people believe that there? I can assure you the government has no roll in our health care decisions, and what the doctor wants the patient can always get.

        • nelly_man@lemmy.world
          link
          fedilink
          English
          arrow-up
          11
          ·
          1 month ago

          Yep. The two main arguments were that the ACA would create death panels and that people would no longer have a choice in their healthcare providers. But both of those were, and still are, the status quo with private, for profit health insurance providers being involved in care.

  • solsangraal@lemmy.zip
    link
    fedilink
    English
    arrow-up
    225
    ·
    1 month ago

    i have a friend who’s a transplant patient and has been taking the same meds for over 10 years post transplant-- every year it’s a furious battle with insurance who, every year, decides the meds are no longer “medically necessary” and drops coverage for it. fucking helloooo these are anti-rejection pills, the textbook definition of “medically necessary.”

    it’s not that insurance companies are stupid, it’s that they’re saving money on people dying when those people don’t get what they needed to live.

    insurance is the biggest fucking scam of all time

    • Vox@lemmy.world
      link
      fedilink
      English
      arrow-up
      87
      ·
      1 month ago

      The insurance system does not work in the medical field, it would never work because insurance is for managing risks that are unknown, like a house flooding or your car getting hit in an intersection.

      In medical “insurance” it is often dealing with known issues, and the insurance system is just not set up to deal with preventative care, annual check ups, mammograms, blood tests, or pre-existing conditions. It would be like trying to use car insurance to pay for an oil change, which is just as ridiculous as it sounds in your head.

      That’s exactly why the term “insurance” should be used when discussing a single payer system, it’s not really insurance, it should be a collective action group that works together with the medical community to find a middle ground where hospitals can still exist and pay wages to their staff, the people can get the medical care they need without getting thrown into poverty for daring to get sick, and the government benefits from having a healthier population as a whole.

      Too bad theres way too much money in the short term in keeping this all private, and having a sicker population, so we have decades of insurance company propaganda to work against, and a huge population of people that don’t understand that by doing single payer health care your taxes would go up, but you also wouldn’t be paying out the nose for medical insurance & medical care (because they don’t cover anything). Also think of a world where your health care isn’t beholden to your employment, all the different choices you’d make in your life.

    • rhombus@sh.itjust.works
      link
      fedilink
      English
      arrow-up
      15
      ·
      1 month ago

      I have a chronic condition that requires expensive medication. Every. Single. Year. I have to fight insurance to renew the prescription. I went without for months the first time and ended up needing a far more expensive surgery to fix the damage it caused. I was already pretty left-leaning before my diagnosis, but now I don’t believe there is any justification for private anything in healthcare. It’s a completely morally bankrupt business to be making money off of people’s unavoidable suffering.

    • TheFrirish@jlai.lu
      link
      fedilink
      English
      arrow-up
      1
      arrow-down
      1
      ·
      1 month ago

      I don’t get it why americans still put up with this if I suffered from that in France I would just leave my country.

  • TommySalami@lemmy.world
    link
    fedilink
    English
    arrow-up
    137
    ·
    1 month ago

    I work for a neurologist practice, and the amount I have to argue with insurance (and inevitably have to get the neurologist on the phone to directly request something for many) is insane. A good chunk of my job isn’t providing care, but arguing with insurance that the care is necessary. These companies are actively delaying patient care, and try to blame the physician whenever possible.

    Wildly infuriating, especially when the denials are worded along the lines of “we reviewed this, and don’t consider it medically necessary”. Motherfucker, a doctor said it was necessary and listed the clinical reasons why this test or procedure would be beneficial. Nothing has radicalized me for universal healthcare more than working in healthcare.

    • BorgDrone@lemmy.one
      link
      fedilink
      English
      arrow-up
      40
      ·
      1 month ago

      How is that even legal? How is someone who hasn’t examined the patient and isn’t their physician allowed to make treatment decisions? If they even have the necessary qualifications.

      • skulblaka@sh.itjust.works
        link
        fedilink
        English
        arrow-up
        41
        ·
        1 month ago

        Because of money!

        Every time you see something that feels illegal but isn’t, or that makes no sense in general, look for the money trail. There’s always one, and it always leads to the explanation.

        In this case, insurance companies have made such an absolute ass ton of money by killing off their customers that they have become a political entity. They now use their deep pockets to lobby politicians to keep their scam legal.

      • WoahWoah@lemmy.world
        link
        fedilink
        English
        arrow-up
        5
        arrow-down
        1
        ·
        1 month ago

        They’re technically not making treatment decisions, they’re making payment decisions about treatment decisions. Effectively it’s a distinction without a difference though. And it’s usually a “doctor” working for the healthcare company rubber stamping the denials. It’s a thoroughly shitty system.

        • frezik@midwest.social
          link
          fedilink
          English
          arrow-up
          3
          ·
          1 month ago

          Specifically, it’s the doctors who technically passed med school, but only just. They’re not going to practice medicine anywhere else, but they can make good money writing up legally protected reports that say “in my professional opinion, this patient’s lack of arms does not prevent him from going back to his roofing job”.

    • givesomefucks@lemmy.world
      link
      fedilink
      English
      arrow-up
      26
      ·
      1 month ago

      People love to shit on the VA, because they’re the largest American healthcare provider in the country so there’s a lot of bad stories

      But my last MRI went like this:

      Doctor: you need an MRI, let me check if it’s open. (Less than a minute on laptop). Ok, go down to room ____ and they can get you in now.

      There’s a huge up front cost for that machine, so for profit hospitals went everyone to use it to make the money back, and insurance wants no one to use it so they don’t have to pay.

      Take insurance out of the picture, take the hospital trying to make money out of the picture. And it’s really that easy. No one pushes for unnecessary tests, no one tries to prevent necessary tests. And there’s a huge push towards preventive medicine, because it’s cheaper to catch shit early.

      We already pay more than what it would cost, it’s just the healthcare industry donates to both parties, so as long as both standards are “at least they’re not the other team” shits never going to get fixed.

      If we hold higher standards than that, it won’t take many election cycles to get change to actually happen

      • Landless2029@lemmy.world
        link
        fedilink
        English
        arrow-up
        6
        ·
        1 month ago

        It’s cheaper to catch shit early.

        This is a huge takeaway. Insurance doesn’t care about your longevity, health, quality of life or even long term costs.

        People hop insurance providers all the time so the companies are literally focused on profits quarter by quarter.

    • pancakes@sh.itjust.works
      link
      fedilink
      English
      arrow-up
      24
      ·
      1 month ago

      On the flip side, I can’t imagine being the person arguing for the insurance companies makes them a better or happy person in the long term. Being a devil’s henchman, over time it must destroy important parts of them like empathy, trust in people, and their basic human decency. Virtues that are needed now more than ever in society.

      • AA5B@lemmy.world
        link
        fedilink
        English
        arrow-up
        5
        ·
        1 month ago

        I expect it’s like any call center - the computer spits out a result and they have a script to follow, and are not allowed to stray from the script

      • Rekorse@sh.itjust.works
        link
        fedilink
        English
        arrow-up
        2
        ·
        edit-2
        1 month ago

        This part isnt brought up enough. You can take more severe examples, folks working in slaughter houses, military translators marking targets based on vague phrasing, and they have well documented negative effects on people who work those jobs in general.

        Theres no reason to think someone working an insurance claims job might not develop the same type of problems if they feel they are helping cause harm, even if to a lesser degree.

    • JaggedRobotPubes@lemmy.world
      link
      fedilink
      English
      arrow-up
      10
      ·
      1 month ago

      And some doctors themselves will be hesitant to give care that might not be provably required beyond all doubt but is objectively prudent.

    • USNWoodwork@lemmy.world
      link
      fedilink
      English
      arrow-up
      2
      ·
      1 month ago

      I feel like we’re getting to the point that this needs to be an election deciding issue. It won’t be this upcoming election, but probably the one after where the presidency isn’t on the line. We need to ignore republican/democrat talking points and elect based on a will to completely revamp the system. Obama tried but it didn’t go far enough. Once its bad enough that people are willing to cross party lines to fix it, then you’ll see change, and I (probably too optimistically) think we’re almost there.

    • Schmoo@slrpnk.net
      link
      fedilink
      English
      arrow-up
      2
      ·
      1 month ago

      Hospitals should unionize and sue the the ever-loving shit out of insurance companies for lost time. Not like our neoliberal politicians are going to do anything about it.

  • ByteOnBikes@slrpnk.net
    link
    fedilink
    English
    arrow-up
    81
    arrow-down
    1
    ·
    edit-2
    1 month ago

    Had my buddy over who brought over his incredibly questionable 30yo brother who shared some real incel levels of talk. He used my bathroom and asked if I wore tampons since a pack was visible. Like bro, I have a wife and a daughter.

    Anyways, that guy works in health insurance!

    I don’t know how much decisions he can actually make. But that dude has a middle-school level education about sex ed and struggled to explain what a period is. And he is one of the barriers to approving/rejecting your health care.

    • ramble81@lemm.ee
      link
      fedilink
      English
      arrow-up
      26
      arrow-down
      3
      ·
      1 month ago

      “You want me to whip out my dick and slap you with it since that was the stupidest question I’ve heard?”

    • Bongles@lemm.ee
      link
      fedilink
      English
      arrow-up
      2
      ·
      1 month ago

      There’s different teams doing different types of work.

      Like the claim system might have it setup so X codes in Y situations can’t be automated. Then someone looks at the claim, determines based on their written guidelines that this one needs to be reviewed so they look to see if there are notes attached. If there aren’t they request the notes, maybe by sending a letter. If there are, they send it to the team that reviews notes and makes these decisions. Those people probably also have written guidelines on what is allowed or not and if it’s more complicated they (should) have someone qualified that can review it. Then the claim is probably sent back to the other team saying “Hey, deny that code and allow this code”, where they then just do whatever that says.

      They probably also have situations where X code in Y situation is “never” allowed and the first people reviewing it just always deny it. Then, as mentioned elsewhere here, the provider has to resubmit it and then it’s allowed on “appeal” by another team. This brother you mentioned is probably doing very little decision making beyond applying already decided guidelines to each claim, if he even processes them.

  • Phoenixz@lemmy.ca
    link
    fedilink
    English
    arrow-up
    67
    ·
    1 month ago

    So here is a question:

    A medical professional examined the person IN PERSON and has a requirement.

    In comes the insurance to tell you your doctor is wrong and that you’re perfectly fine, your doctor is basically lying to you.

    Question: how the fuck did any of this ever become legal?

    • overcast5348@lemmy.world
      link
      fedilink
      English
      arrow-up
      19
      arrow-down
      4
      ·
      edit-2
      1 month ago

      You do need some checks and balances because what’s to stop a hospital from profiting off the insurance companies by asking for a CT scan/whatever of every single patient just because they can.

      I suppose we could have the government run the hospitals too. But noooooo, that’s never going to work out because communism or something.

      Maybe we should try effective altruism and accelerationism instead? Let’s just hand over all our money to a few tech bros and then we can go beg them to pay for the scans. And if they don’t pay for it, surely someone will come up with a cheaper technology to do the same. Yes, that’ll definitely work.

      • Echo Dot@feddit.uk
        link
        fedilink
        English
        arrow-up
        12
        ·
        1 month ago

        You could just get rid of the for-profit medical industry entirely and then there would be no incentive to over treat patients.

      • merc@sh.itjust.works
        link
        fedilink
        English
        arrow-up
        8
        arrow-down
        2
        ·
        1 month ago

        Yes, it’s clear why it’s legal and necessary to some extent. In a for-profit system, a doctor’s office or hospital, every procedure or test the doctor can order (and have the patient pay for) will generate profit. Doctors have an incentive to order as many tests as possible. I assume that most doctors are somewhat honorable and won’t abuse this too much, but they’ll probably still err on the side of ordering as many tests as possible not necessarily because of profits, but because more tests gives them more information.

        Meanwhile, in a for-profit system, an insurance company will generate the most profit by agreeing to as few tests and procedures as possible. So, they will have an adversarial relationship with doctors and will try to arrange as few tests and procedures as possible. My guess is that the average insurance company is less ethical than the average doctor, so they’re probably more likely to refuse to allow tests that are actually medically necessary.

        In a sane system, there would be a neutral referee, the government, who would resolve disputes and severely punish any actor in the system that was behaving badly. But, AFAIK that only rarely happens in the US, where the idea is that the “invisible hand of the free market” will magically make it all work.

        • JovialMicrobial@lemm.ee
          link
          fedilink
          English
          arrow-up
          11
          arrow-down
          1
          ·
          edit-2
          1 month ago

          Doctors do not directly profit from ordering tests. They get paid whether they order a test or not.

          You want to know who profits from over testing? Quest Diagnostics.

          https://bergermontague.com/quest-diagnostics-pay-1-79-million-settle-false-claims

          These guys literally defrauded the government, but everyone points their fingers at poor people, doctors, liberals, ethnic minorities, lgtbq people, ect. The problem is corrupt businesses and their CEO’s hoovering up as much money as they can so they can shove it up their ass.

        • intensely_human@lemm.ee
          link
          fedilink
          English
          arrow-up
          1
          arrow-down
          3
          ·
          1 month ago

          Doctors have an incentive to order as many tests as possible

          This would conceivably be true for car repair as well. A mechanic is incentivized to order as many repairs as possible for a car.

          So why don’t they?

          The answer is many-faceted, but the main ones are (a) professional ethics, (b) reputation, and © second opinions which kinda feed into b.

          Any provider whether doctor/mechanic/wedding photographer/whatever is also incentivized to serve their customers well by selling them only things that truly benefit them.

          We don’t need insurance companies in all those other industries to prevent providers from using an infinite-billing hack to generate infinite money.

          • merc@sh.itjust.works
            link
            fedilink
            English
            arrow-up
            1
            ·
            1 month ago

            This would conceivably be true for car repair as well. A mechanic is incentivized to order as many repairs as possible for a car.

            So why don’t they?

            They do. Car mechanics have a notorious reputation for doing repairs that aren’t necessary, or for breaking something so that the owner has to come in again soon.

            is also incentivized to serve their customers well by selling them only things that truly benefit them.

            Yeah, there’s a natural counterbalance that means they don’t want to be seen as dishonest. Similarly, an insurance company is counterbalanced against trying to prevent every test or procedure by also wanting to be seen as honest.

            We don’t need insurance companies in all those other industries

            You’re aware that car insurance is a thing right? Any industry where the charges are going to be extremely high is going to involve insurance. Cars are fairly expensive devices, and so there’s car insurance, and if you’re in a big accident your car insurance will pay for the repairs. But, the car insurance will keep an eye on you to make sure you’re not committing insurance fraud, and also limit how much the car repair shops are allowed to spend to repair your car.

      • Phoenixz@lemmy.ca
        link
        fedilink
        English
        arrow-up
        1
        ·
        1 month ago

        If a hospital is found to push doctors to prescribe unneeded medicine or tests, the entire top staff should be questioned and jailed for fraud where applicable.

        If an individual doctor does this, same treatment

        We’re not just talking money here were talking human lives. If you risk health for money, off yo jail you go

      • intensely_human@lemm.ee
        link
        fedilink
        English
        arrow-up
        1
        arrow-down
        4
        ·
        1 month ago

        what’s to stop a hospital from profiting off the insurance companies by asking for a CT scan/whatever of every single patient just because they can

        The patient saying no. Also a system where the patient isn’t forced to use insurance.

        We could have markets run the hospitals but heaven forbid people would consent to their economic interactions.

        • overcast5348@lemmy.world
          link
          fedilink
          English
          arrow-up
          2
          ·
          edit-2
          1 month ago

          We could have markets run the hospitals but heaven forbid people would consent to their economic interactions.

          “Hello! My mother is clutching her chest. She may be having a heart attack. Could you please email me an estimate for the treatment? I’m talking to two other car dealers, and I’ve read all the posts about the 4 square method online, I’m on to your tricks.”

    • intensely_human@lemm.ee
      link
      fedilink
      English
      arrow-up
      1
      arrow-down
      8
      ·
      1 month ago

      It became legal when we decided medicine was too important to be handled by a free market, and we created a labyrinth of laws governing how medicine must be administered.

      • rhandyrhoads@lemmy.world
        link
        fedilink
        English
        arrow-up
        2
        ·
        1 month ago

        Medicine in the US is the closest we have to a free market. (Newly developed pharmaceuticals being a bit of exception due to the nature of our patent system) In a free market you work on principles of supply and demand. An important concept here is that of inelastic demand. For certain goods, up to a certain point demand will remain constant regardless of price as they are essential to life or addictive. Think gasoline, water, cigarettes, etc…

        With medicine people will generally spend whatever it takes often even going into debt if necessary because they value continuing to live very highly. As a result, hospitals are able to charge as much as they think people are willing to pay before they decide that dying is a better financial decision.

        You could argue that in a free market, hospitals which charge less will see more business pushing costs down. For certain areas like elective plastic surgery the whole free market model actually works out fairly well since people have the option to shop around. However, let’s say you get in a life threatening car crash. In that moment you don’t have the time to shop around for the cheapest ambulance provider and run a cost benefit analysis on which one has the closest ambulance. After that you can’t shop around local hospitals to see which can offer the cheapest solution for your procedure because first off you don’t know exactly what’s wrong until you get to the hospital. Second, you’re currently suffering from serious injuries and need to get to the closest hospital. This is why just about the entire developed world apart from the US has nationalised healthcare. Is it completely free of issues? No. Are there some markets where private healthcare can offer better service? Yes. However, you don’t have people going into financial ruin because they needed emergency medical care.

      • Phoenixz@lemmy.ca
        link
        fedilink
        English
        arrow-up
        1
        ·
        edit-2
        10 days ago

        You literally take the wrong takeaway from all this.

        A free market for healthcare is a disaster. A few big companies will form that will squeeze every last cent out of dying people, you get the US system. US healthcare and it’s free market literally is the worst. Be healthy and bankrupt or die

  • barsquid@lemmy.world
    link
    fedilink
    English
    arrow-up
    59
    ·
    1 month ago

    Sometimes the Frank is an AI that is wrong 90% of the time. That’s fine, because reasons.

    • TranscendentalEmpire@lemm.ee
      link
      fedilink
      English
      arrow-up
      14
      ·
      1 month ago

      I fucking wish. At least then I wouldn’t have to be put on hold for 30 min just to have to eventually explain to a person who was hired 3 weeks ago how to do their job.

      Private insurance always has you speak to an actual adjuster for authorization, mainly because they know any sort of automated system would be more accurate and faster than having you talk to their undertrained and understaffed employees.

      Private insurance’s goal is to erect as many barriers between the provider and the patients as possible, and then blame the provider for all the barriers. It works every time.

      “I have the best insurance, they told me it would be covered”. Nope, Medicare is the best insurance and you traded that away for a privatized Medicare supplemental that lies to you about your coverage.

    • jballs@sh.itjust.works
      link
      fedilink
      English
      arrow-up
      7
      ·
      1 month ago

      Sometimes the Frank is an AI that is wrong 90% of the time. That’s fine, because reasons $$$.

  • sevan@lemmy.ca
    link
    fedilink
    English
    arrow-up
    51
    ·
    edit-2
    1 month ago

    Also, there’s this common “feature”:

    Dr: “You need this procedure.”

    Me: “How much will it cost me?”

    Office Manager: “I won’t know until I bill your insurance and find out if it is covered.”

    Me: “What is the cash price I would pay you if it isn’t covered by insurance.”

    Office Manager: “I have no idea.”

    • gallopingsnail@lemmy.sdf.org
      link
      fedilink
      English
      arrow-up
      9
      ·
      edit-2
      1 month ago

      Actually, since January 2022, you have the right to request a good faith estimate for services from healthcare providers if you’re not billing insurance.

      source

      • Bytemeister@lemmy.world
        link
        fedilink
        English
        arrow-up
        8
        ·
        1 month ago

        I’d like to see a law that says you get a complete and correct bill in 3 months or less as well. I avoid getting healthcare because even though I have insurance, every single time I’ve gone, the billing gets fucked up and I don’t find out about it until 6 months, or even up to 2 years later, and I’m on the hook for that. It ought to be law, that if your office is so fucked up that you can’t produce a correct bill for services in 3 months and deliver it to your customer, then you should have to nullify it.

      • sevan@lemmy.ca
        link
        fedilink
        English
        arrow-up
        3
        ·
        1 month ago

        This is great information, thanks! In several cases it wouldn’t have helped us because of the 3 day advance request requirement, but at least its an improvement. Still not as good as what auto mechanics are required to provide, but its a step in the right direction.

    • TexMexBazooka@lemm.ee
      link
      fedilink
      English
      arrow-up
      2
      arrow-down
      3
      ·
      1 month ago

      I’m actually ok with this system, but only because I throw the bills away after

  • chiliedogg@lemmy.world
    link
    fedilink
    English
    arrow-up
    46
    arrow-down
    1
    ·
    1 month ago

    Prior authorization should 100% be outlawed. It’s either insurance adjusters practicing medicine without a license, or insurance doctors making diagnoses without examining a patient, both of which are unethical or illegal.

    Though I think the real solution is a system where every time a prior authorization denial is overruled by the DOO or a court, the insurance company has to pay punitive damages of at least $200,000 to the patient.

  • FuzzyRedPanda@lemm.ee
    link
    fedilink
    English
    arrow-up
    45
    arrow-down
    1
    ·
    1 month ago

    The cruelty of the US American for-profit health system is what should be uniting all US Americans in protest, riot, and violent overthrow of the current system.

  • WoahWoah@lemmy.world
    link
    fedilink
    English
    arrow-up
    44
    ·
    1 month ago

    Last time my doctor had to bill my insurance he said he would just run it immediately, because apparently “routine denial” is a thing where they just automatically deny it because if you really need it the doctor will then have his office try again with more justifications. He hated this a lot, because it basically meant he had to just assume first denial for no real reason and then his staff had to take the time to almost always go back and resubmit. He said sometimes he would submit it with the info, it would be denied, and then he would resubmit it two more times and suddenly it would be approved.

    Like seriously, what the fuck. But only does that hold up necessary care, it also makes doctors do more bureaucratic work and hire more staff, which, of course, makes medicine more expensive. Brilliant.

    • The Picard Maneuver@lemmy.worldOP
      link
      fedilink
      English
      arrow-up
      22
      ·
      1 month ago

      The sad thing is they do hire some licensed healthcare professionals to fall back on when appealed. They just look for the least compassionate MDs to rubber stamp denials.

      • ✺roguetrick✺@lemmy.world
        link
        fedilink
        English
        arrow-up
        4
        ·
        edit-2
        1 month ago

        Eh, generally a peer to peer won’t get denied but requiring a peer to peer is a good way to waste the doctors time in the hopes they’ll give up on the request. The instance company isn’t paying the doctor extra time to perform the peer to peer after all. Now if that time was billable, you’d see it go away real fast.

      • theneverfox@pawb.social
        link
        fedilink
        English
        arrow-up
        2
        ·
        1 month ago

        While I think the job selects for doctors with less compassion, but I believe some of them are there for genuine harm reduction

        The system they’re installed in is just insidious. They are given extremely short amounts of time each request, they face basically no consequences for a bad rejection, but they do face them for a bad acceptance. Their main metrics boil down to “rejections per hour”

        A “bad acceptance” often means “improper paperwork”. If the doc fills in a form wrong, you send it back. If the doctor files in a way that doesn’t link relevant history correctly in their system, send it back. If the doctor fails to state a required prerequisite for the procedure, send it back (even if it was previously stated, or stated differently)

        It’s a pure lawful evil system, it’s designed to slow things down and delay, hoping the problem will go away. It requires doctors to navigate a complex hostile bureaucracy perfectly, and often blindly. We’re at a point where each patient is seen for an average 15 minutes before 45 minutes of paperwork to get insurance to pay for it

        Then the requests are read feverishly to meet metrics. They can’t think they’re doing good, but I buy that some of them are doing their best to reduce harm in a broken system

  • cordlessmodem@lemmy.world
    link
    fedilink
    English
    arrow-up
    33
    ·
    1 month ago

    The private for profit health insurance industry - because what could make number go up better than a (LEGALLY MANDATED) do nothing middle man who’s only purpose is to take your money and ensure as little as possible is spent on healthcare sitting between you and not dying?

  • Death@lemmy.world
    link
    fedilink
    English
    arrow-up
    27
    ·
    1 month ago

    And when the patient turned out to be fine after the scan, the insurance company will try to blame that the doctors are lying so that the insurance company has to pay the hospital more It’s like they thought that the doctors must be able to see through the patients’ body as if they forgot that the reason for these equipments to exist in the first place is that because the doctors can’t really be 100% sure about what’s actual situation inside human body

    • UnderpantsWeevil@lemmy.world
      link
      fedilink
      English
      arrow-up
      13
      arrow-down
      6
      ·
      edit-2
      1 month ago

      There’s two sides to this coin. On the one end, you have insurance companies refusing to pay for anything because the modern industry is just six scams in a trench coat.

      But on the other, you have doctor’s offices where the physician literally leases an MRI machine to the tune of several million dollars and then has to run a certain number of patients through the scanner every year or lose money. That’s because the MRI patent is held by GE and they can charge 10-100x markups on hardware that is fundamental to modern medicine.

      Its the same with diabetes treatments. Insurance companies will try and refuse service or kick people off their policies if they are at risk. But then pharmacy companies will sell $3 of insulin for $75, then kickback a chunk of the balance to judicial/congressional bribes in order to guarantee the cash flow.

      At some level, the only insurance companies that can survive in such a market are the ones that say “No!” to everything. The even-remotely-ethical firms just get fleeced by the for-profit industry until they get bought out or go bankrupt. That, or you’re Medicare/Medicaid and you have an infinite wallet backstopped by the US Treasury. You don’t care if you’re paying multiples of whatever any other clinic anywhere else in the world would charge on an enormous population of poor and elderly patients, because you have an unlimited money cannon to mow it all down with.

      • piecat@lemmy.world
        link
        fedilink
        English
        arrow-up
        12
        ·
        1 month ago

        Very uninformed take, its almost laughable.

        GE isn’t the only one who makes MRIs. The other big players are Siemens, Philips, United, and to some extent Canon, Fujifoto, and Hitachi.

        No, that’s really how much it costs. The margin on MRI machines is terrible. I’d like to see you do it cheaper… “Just” build then supercool magnet for superconduction for 3T of homogenius magnetic field, build coils that handle KW of RF/gradients that can fit a human comfortably without artifacts, build the high power and precision circuitry to transmit and receive said RF, then control that equipment accurately and safely.

        Super easy, off-the-shelf stuff.

        Oh, and you can’t use any ferrous parts, nor can your power supplies generate any noise.

        That’s like, senior design level stuff amirite

        • piecat@lemmy.world
          link
          fedilink
          English
          arrow-up
          5
          ·
          1 month ago

          The other big factor in cost is supply chain. Everything has to be tracable. So the supply chains have to do a lot of paperwork, inspection audits, since a defective part can kill someone.

      • bitwaba@lemmy.world
        link
        fedilink
        English
        arrow-up
        4
        ·
        edit-2
        1 month ago

        *cough* single payer fixes all this *cough*

        Sorry, cough has been acting up. I should go see a doctor with a MRI about that…

        • UnderpantsWeevil@lemmy.world
          link
          fedilink
          English
          arrow-up
          6
          ·
          1 month ago

          cough single payer fixes all this cough

          I’d go one further and say a National Health System fixes all this. Rather than paying a guy to pay a guy, you just have publicly financed clinics and hospitals. This is the traditional way of building up medical infrastructure, btw. City hospitals used to be the norm. We only entered the era of corporate consolidation when we sold off our public infrastructure for a song during the neoliberal turn of the 70s and 80s.

      • intensely_human@lemm.ee
        link
        fedilink
        English
        arrow-up
        3
        arrow-down
        2
        ·
        1 month ago

        Shouldn’t that patent have expired by now?

        This kind of thing is why it bothers me when people complain about “free market medicine”.

        A market where only one entity is allowed to build MRI machines, or license the tech to others to build, is not a free market. That’s a government-enforced monopoly.

        Even the fact that a patient can’t just go get their own MRI at Scans-R-Us, but needs to get a doctor’s referral first, is a huge departure from what an actually free market for medicine would look like.

        • UnderpantsWeevil@lemmy.world
          link
          fedilink
          English
          arrow-up
          3
          arrow-down
          2
          ·
          1 month ago

          Shouldn’t that patent have expired by now?

          It’s an evolving technology. We get new patents with every iteration.

          A market where only one entity is allowed to build MRI machines, or license the tech to others to build, is not a free market.

          If you spend a few years in Business School getting your MBA, you get an earful about how and why patent law exists. The core argument is that private investment is predicated on returns and we can’t have nice things unless we have men with guns come for the property and freedom of anyone who “steals an idea”.

          But more practically, this shit is just a racket. Lots of lobbyist money changes hands to make sure the decks at the casino are properly stacked. Medical treatment is just another opportunity to apply leverage through debt to control other people.

          • intensely_human@lemm.ee
            link
            fedilink
            English
            arrow-up
            3
            arrow-down
            1
            ·
            1 month ago

            I understand the value of a patent system, but patents should expire.

            Is there some reason why previous-generation technology, like the tech being used for MRIs in the 90s, can’t be used to manufacture more competitively-priced machines?

            Like, is there a law specifying that the new technology must be used for an MRI to be usable as a diagnostic tool?

            • UnderpantsWeevil@lemmy.world
              link
              fedilink
              English
              arrow-up
              2
              ·
              1 month ago

              patents should expire

              They do. It’s just that they can be renewed under various circumstances, typically as an incentive to increase production.

              Is there some reason why previous-generation technology, like the tech being used for MRIs in the 90s, can’t be used to manufacture more competitively-priced machines?

              You need a certain amount of industrial capital geared towards making these machines and GE is the only one that really does (excepting manufacturers overseas). A big part of the problem is that we don’t have a good mechanism for introducing new small businesses to the market. You really need to know someone that needs a steady number of MRI machines on a regular basis to make a new MRI factory worth it, and unless you have that business connection you have no buyers.

              • intensely_human@lemm.ee
                link
                fedilink
                English
                arrow-up
                1
                arrow-down
                1
                ·
                1 month ago

                So you’d need to have a single integrated business, just to get all that information in-house.

                The same company could build the machines, and sell the MRI scanning service.

                Then you’d need a lot of conversations with various doctor’s offices.

                But there are probably lots of places who’d rather be able to provide patients with a lower-cost, lower-quality MRI, so it should be possible to collect a number of providers saying “if such a service exists, I’ll use it”.

                My guess is there’s gonna be a lot of government money available soon for people who want to build new manufacturing capability in the US

    • Snowclone@lemmy.world
      link
      fedilink
      English
      arrow-up
      7
      ·
      edit-2
      1 month ago

      IThey can’t even be sure after the MRI. Which again, proves your point. It took one MRI battery and one alert and skilled MRI tech to catch my brain cyst, THEN another whole set, I straight up spend a whole 8hr shift in an MRI machine, Then a TEAM of neurologists studied my custom hand made brain for MONTHS. THEN they had a really good set of educated guesses. Then they did the surgery, and only after they opened up my brain case did the actually see what in the hell was going on. Even after all that, my neurologists was like ‘‘This is what we think is happening’’, I asked what it would take to really know factually, he said an autopsy. He didn’t recommend it. The point is, Doctors save lives with these scans, and nothing is certain. That’s not a barrier to treatment, but no scans Is a barrier to treatment.

      • intensely_human@lemm.ee
        link
        fedilink
        English
        arrow-up
        1
        arrow-down
        2
        ·
        1 month ago

        This is why we need transporter tech from star trek.

        Beam yourself into the copy buffer, kill the copy, and do an autopsy.