Yeah, "unnecessary" is the health insurance code word for "we can get away with not paying for it". Because it's executives and lawyers and not doctors that determine if something is "unnecessary". Sure they have doctors as scape goats, but they have specific instructions not written by medical professionals that they are required to follow. Unnecessary doesn't mean it won't save a person's suffering or life, it means it's more expensive than relieving the persons pain is worth or the person's life is worth (i.e. the likelihood that they would lose a lawsuit for significant damages if they die).
this post was submitted on 11 Dec 2024
344 points (97.8% liked)
News
23600 readers
3466 users here now
Welcome to the News community!
Rules:
1. Be civil
Attack the argument, not the person. No racism/sexism/bigotry. Good faith argumentation only. This includes accusing another user of being a bot or paid actor. Trolling is uncivil and is grounds for removal and/or a community ban. Do not respond to rule-breaking content; report it and move on.
2. All posts should contain a source (url) that is as reliable and unbiased as possible and must only contain one link.
Obvious right or left wing sources will be removed at the mods discretion. We have an actively updated blocklist, which you can see here: https://lemmy.world/post/2246130 if you feel like any website is missing, contact the mods. Supporting links can be added in comments or posted seperately but not to the post body.
3. No bots, spam or self-promotion.
Only approved bots, which follow the guidelines for bots set by the instance, are allowed.
4. Post titles should be the same as the article used as source.
Posts which titles don’t match the source won’t be removed, but the autoMod will notify you, and if your title misrepresents the original article, the post will be deleted. If the site changed their headline, the bot might still contact you, just ignore it, we won’t delete your post.
5. Only recent news is allowed.
Posts must be news from the most recent 30 days.
6. All posts must be news articles.
No opinion pieces, Listicles, editorials or celebrity gossip is allowed. All posts will be judged on a case-by-case basis.
7. No duplicate posts.
If a source you used was already posted by someone else, the autoMod will leave a message. Please remove your post if the autoMod is correct. If the post that matches your post is very old, we refer you to rule 5.
8. Misinformation is prohibited.
Misinformation / propaganda is strictly prohibited. Any comment or post containing or linking to misinformation will be removed. If you feel that your post has been removed in error, credible sources must be provided.
9. No link shorteners.
The auto mod will contact you if a link shortener is detected, please delete your post if they are right.
10. Don't copy entire article in your post body
For copyright reasons, you are not allowed to copy an entire article into your post body. This is an instance wide rule, that is strictly enforced in this community.
founded 2 years ago
MODERATORS
What if we just nationalized the claims process. Imagine that. A single guideline for what was necessary or not. And decided by people who don't profit by denying reasonable claims.
"We guard against the pressures that exist for unsafe care or for unnecessary care to be delivered in a way which makes the whole system too complex and ultimately unsustainable," Witty said.
Frankly it's a miracle that so many countries around the world have functioning healthcare systems at all without these bastions of safety at the helm.
They're saying that less red tape makes the system more complex?
They will say anything besides the truth!
Scum. Health insurance should not be for-profit or publically traded. In reality, it shouldn't exist.
It's a service for the public interest and should be run by local governments, like roads, parks, libraries, fire departments, etc. The end goal of a service isn't to make money but to be used by the community. This is also why running a country as a business doesn't make sense - countries aren't meant to generate profit. A nation is a safeguard for the people within against the unpredictable reality of everyday living.
This is also why running a country as a business doesn’t make sense - countries aren’t meant to generate profit.
Yes and no. Not profit, but surplus. Profit is something that is extracted- a surplus is available to be reinvested and improve the quality and quantity of services. Running a country like a "business" makes sense insofar as focus should be made on using generated surpluses to improve citizen's lives. But we of course know thats not their target with said surpluses.
"We are going to make sure that we not only acknowledge and honor that legacy of Brian, but we'll continue it."
I hope they continue his legacy of getting gunned down in the street.
We need doctors. We don't need the rich.
They always act like their ownership is somehow benefiting everyone lol
Delusional parasites.
"We guard against the pressures that exist for unsafe care or for unnecessary care to be delivered in a way which makes the whole system too complex and ultimately unsustainable," Witty said.
Fuck you, leech. YOU do not get to decide what is and is not necessary for a patient. The doctor and patient decide.
We should have a law that if an insurance company denies a claim, and upon external appeal it is found to clearly be medically necessary and covered, the insurance company should have to both pay for the procedure AND hand the customer a check equal to the full value of the procedure. Wrongfully deny a claim? Be prepared to pay double.
And this is how you get a completely sociopathic system held up by seemingly "moral" or "good" people.
In a general sense it's hard to argue against unnecessary care. After all it's right in the name. It's unnecessary. And it's hard to argue against managing personnel based on performance. Trying to audit every decision could be time consuming and expensive. Just put in a KPI (Key Performance Indicator) with respect to cost to company. If you approve $X amount of claims and your coworker approved $Y, when they need to downsize or trim the fat, you just look at X and Y and let go the one that approved more claims.
Each step can be kinda argued and supported in a vacuum. And that's where these CEOs wilfully sit. They don't explicit tell employees to deny more claims. They just make it more lucrative at every step to do so.
role is a critical role, and we make sure that care is safe, appropriate, and is delivered when people need it.
Pretty sure that is the role of my doctor who is the one actually seeing me and not some shithead two thousand miles away they pay to give a conflicting second opinion.
I'm sure you mean it's unnecessary for the average Joe. But if it were any of his immediate family with the same issue, it would be absolutely necessary.
Look, if they can convict a concentration camp administrator for the people they ordered killed, I can call any insurance executive with decision making power a murderer.
One murderer took care of a mass murderer.
unnecessary care
Whew. That's kind of a doozy.
It's almost like a healthcare system that creates an arms race between health insurance companies denying care vs healthcare providers overcharging leaves us paying huge amounts of $$ while not receiving adequate coverage.
Yeah, they're kind of right that "unnecessary care" happens, but they're conveniently ignoring that they are a large contributor to the problem. Without insurance companies leaving hospitals and patients on the hook for thousands at a time, you might not see $20 bandaids, $2000 ambulance rides, and expensive tests that didn't really need to be done.
And also important is that more people might be inclined to get preemptive care, and physicals/checkups, if it didn't require they jump through so many hoops (or go bankrupt if Dr. finds/treats something).
Which would actually save money!
I suspect that dead saves more money. Biopsies are expensive and United Health does not like to pay for them.
I learned this random factoid a while back while looking into some medical claims with UHC from an insurance contract manager as a random example of how the industry sucks. Apparently ultrasounds can be used in place of mammograms for women so they don't have to have a titsquish and are just as effective at detecting cancer. Unfortunately, insurance only pays for the titsquish.
I had my prostate imaged with an ultrasound while traveling abroad. I went for a full medical check, and I was fully preparing myself for my first butthole-fingering. When they did the ultrasound I was like "holy shit has that been an option all along??"
This is an important message for America. He should stand up and say it publicly. And publish his itinerary in advance.
Good thing the actual Adjustor is still out there, these CEOs are still filing claims...
It’s past annual enrollment, but you better believe I’ll be ditching UHC next year.
...you... Get a choice in insurance providers?
UHC is better than some other providers... Just keep that in mind. Blue Cross, Blue Shield for example notorious and even worse.