this post was submitted on 27 Dec 2024
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Summary

Health insurance companies are increasingly denying cancer treatments and screenings recommended by physicians, leading to delays and potential harm for patients.

These denials, often based on internal rules lacking transparency, can result in serious adverse events, disease progression, and even death.

While prior authorization is intended to save money, physicians argue that the current system is inefficient and detrimental to patient care.

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[–] FlowVoid@lemmy.world 62 points 1 day ago (2 children)

Blue Cross and Blue Shield of Illinois, Pike’s health insurer through his employer, had declined to cover the roughly $40,000 treatment.

Blue Cross and Blue Shield of Illinois is a nonprofit, so it turns out nonprofits deny care too.

[–] FlyingSquid@lemmy.world 65 points 1 day ago (2 children)

There's no such thing as "nonprofit" insurance in a for-profit healthcare system. If they aren't making money for themselves, they've been created to make money for everyone else.

[–] Nougat@fedia.io 19 points 1 day ago (1 children)

The difference between a for profit and a non profit is just in the way they do accounting for where the money goes.

[–] FlowVoid@lemmy.world 11 points 1 day ago

The bigger difference is that NPOs don't have shareholders who demand profits.

[–] FlowVoid@lemmy.world 6 points 1 day ago* (last edited 1 day ago)

The hospital in this story, MD Anderson, is also a nonprofit. In fact it's part of the University of Texas, a state-run school. So nobody profited from what happened here.

And in general, insurance companies have an antagonistic relationship with health care providers. Because when insurance companies deny care, health care providers lose money.

oh yeah. been on blue cross most of my life. Its like you see with so many things now. Denial is standard to see if they can shake out anyone who won't go through the appeals process. The more expensive the more they fight the appeals and repeat the denials. If you fight and live long enough you might get the needed care.