https://mas.to/@MikeBeas/113666556469008087
EDIT: I think you should get the service you pay for, just so that’s clear.
I don’t care what that guy thinks.
UnitedHealth Group is so vertically integrated that, in fact they do own doctors, hospitals and pharmacies under the Optum brand. So yes, they do have a duty to take care of people even if they act like they don’t.
Worse than that they staff doctors in name only. The type of quacks who couldn’t make it in the real medical world. I really don’t understand how they can’t be sued for malpractice when they argue a diagnosis with your doctor. At that point they are acting as your doctor.
That’s why you have to request the documentation and proof of specialty to confirm whether they’re acting out of scope.
From personal experience, the vast majority are practicing out of scope. It would cost them a ton of money in overhead to have a cardiologist deny a claim for cardiology related testing or treatment so they just wing it. In some cases it’s not even a physician, it’s a nurse, NP or PA.
This is where government needs to step and regulate but we all know that isn’t going to happen.
The regulation is there, it’s the enforcement that’s the problem. We don’t need lawmakers, we need cops.
Yup, thank you for sharing the link!
The very concept of paying for health care through insurance is evil.
Why do we even allow a profit motive to deny health care? Should be straight up illegal.
… This dude needs to understand how other types of insurance work
Beasley kind of has a point that it’s a stretch to call monetary debt as murder, but I really hope more people start voting for politicians who will end privatized healthcare.
Even if a claim gets denied the fact that it was submitted means you already got the treatment.
Denied treatment is murder. Social murder. Stop simping for these companies they don’t give a fuck about you.
Insurance companies deny payments for treatments. Hospitals deny treatment.
Insurance companies shouldn’t exist, I would never simp for them, but as a personal policy I always call out lies. The lie in this case being “insurance companies are murderers.”
You’re being pedantic and ridiculous.
Pedantic or a liar, I guess we get to pick our class.
Even if a claim gets denied the fact that it was submitted means you already got the treatment.
That’s quite often not true. There are tons of procedures/tests/etc that don’t get run until a “prior authorization” has been granted by the insurance company. Also medications and durable medical equipment are not dispensed until insurance has been approved. If the prior auth is not granted or the medication is not covered, they usually will not be performed/provided unless the patient pays up front, and without the negotiating power of the insurance company, the patient will be paying 5 to 10 times what the insurance company would have paid.
I’ve personally been dealing with medical issues the past 3 months and the amount of prior auths I’ve seen go by is astounding. Tomorrow I actually go in for some more tests that they couldn’t do a few weeks ago because these ones in particular needed some prior auths that are harder to get.
Generally speaking, uninsured medical costs and medication are cheaper than what the insurance company pays. SOURCE
Hospitals and Insurance companies do this because it’s a write-off for the insurance company and it makes the patients feel better about their coverage plan.
You likely could get the treatment without the authorizations if you pressed, I sincerely doubt the hospital would try to stop you, but that would put you into debt so obviously don’t do that.
To make it easier to understand for our short term minds, let’s sketch a different scenario.
You hire a bodyguard. They’re a 7"2 giant bodybuilder with armor. Then someone walks towards you with a knife, raising it up and staring you in the eyes with a frantic expression.
Your giant bodyguard steps aside, and watches are you slowly get tortured to death. Little by little, while you scream for help. The bodyguard tells you Venezuelan blood torture is not covered.
I think someone might rightfully be upset with this bodyguard company. Perhaps as much as the health insurance company that forces people to go into a year long legal battle to get cancer treatment.
At least, that’s what I’ve been hearing about the healthcare system in the usa as of recent.
You know… that kinda vow would be a great idea! Doctors take an oath like thing too, right?
Any company that promises goods and/or services in exchange for money that takes your money in exchange said goods and/or services and then doesn’t deliver services or goods is a scam
Not a fan of the smug liberal aura this post has.
You can point out someone is wrong but still agree with the spirit of what they’re saying…
It rarely goes over well, but I do it all the time. And I’m pretty fucking progressive.
Like, if people honestly thinks their insurance took a vow to protect them, it needs to be corrected. They’re not saying it shouldn’t be changed, but the first step to fixing it is understanding where we’re at.
To be honest, I hadn’t interpreted the quoted toot (man I do hate that they are called toots) as trying to educate people on how insurance works. In that light I do agree with what you are saying, people should be aware of how these systems actually work.
Apologies if this post is coming off as overly ‘smug liberal’.
Like this guy has a point they dont have a duty of care, they didnt take an oath, they are a private for profit company with shareholders. They will absolutely take as much as they can, give you as little as they can and be as cunty about it as they can get away with.
Its fucking WRONG but its not surprising.
I feel like every time someone uses the word “liberal” on lemmy, the meaning of the word shifts slightly to the right.
Liberals are right wing. They’re comparatively further left than conservatives but both ideologies favour capitalism as the economic system which is inherently on the right – in opposition to a more controlled market.
Conservatism is just far right liberalism as a pit stop on the path to fascism.
Liberals are right wing.
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The customers of insurance companies are shareholders.
That’s not what a share holder is
You misunderstand. The service that insurance companies provide is one that is for shareholders. It’s a way of allocating and rationing medical care while also keeping business going.
Poor people don’t own hospitals. Poor people can’t develop medicines and medical equipment. Can’t train and hire doctors. That stuff is extremely expensive. The capital class owns that stuff, right?
They aren’t just going give it away are they? But they do need a labor force that, though desperate, isn’t too sickly that their labor can’t be exploited.
The service that health insurers provide to their actual customers, the capital class, is to reallocate the aforementioned expenses back onto workers by way of premiums and limiting care to the bare minimum.
This is why health insurance is tied to employment in America. You (most likely) didn’t hire your health insurer and negotiate your insurance contract, your employer did. It’s not for you, it’s for them, and really, for their owners, who extract the value of your healthy labor from your employer.
And this isn’t come an-cap or communist hot take, this is just the economics of how healthcare works in America. You’re getting the care, sure, and if you’re covered hopefully you’re in the road to recovery and won’t become insolvent due to medical debts, but this system is not for your benefit. It’s not out to save you money. You are at best an afterthought, a concept of a customer. More of a number.
The OOP described is, in different terms, as if health insurer was nothing more than a risk pool cooperative.
Here are the customers of UNH:
They also own the hospital groups, the device makers, and the pharmaceuticals.
If that’s the tack he wants to take with his argument, than in fact that opposite is true.
They’re a business. You provide them money and they provide a service. So in that respect, there should be no such thing as denial of service for ANYTHING because you’ve already paid for it.
What about the contract?
Well, what about the contract? Traditionally, contracts have three main elements: Offer, acceptance, and consideration. That is, one party offers something, the counter-party accepts the offer, and there’s an exchange of something of value between them. It ought to be obvious to even the most casual observer that there’s a lot to unpack about acceptance. Clearly, the party accepting the offer should understand the offer in order for the contract to be valid.
If I offer the neighborhood cats treats in exchange for not digging up my plants, and they accept, that doesn’t give me a cause of action to sue them (or their owners) for breach of contact when they still dig up my plants. A cat cannot lacks the understanding of the offer, and cannot accept, and therefore no contact exists.
Similarly, if a human lacks the mental capacity to understand an offer—say, a person deep in dementia agrees to a reverse mortgage without knowledge of their legal guardian—a court can rule that no contract existed, because the person did not understand the offer.
Health insurance contracts are anything but clear. In fact, the Byzantine details surpass the ability of most people to understand. (Part of my job in the past was getting paid to read and interpret health benefit statements for other people. Quick— what’s ERISA, and what are the legal implications of health insurance vs. health benefit plans?) Is it really a valid contract, if people can’t even begin to understand the offer?
One might say that people should get an attorney to look it over. Yeah, and then what? Counter-offer? We don’t have much leverage to do so, because the terms of all of the offers are bad, and opting out of health coverage entirely is not a good option. (Even the healthiest person could get hit by a car and be financially ruined for life.)
That’s the source of the anger. We can understand how insurance is supposed to work: Pay premiums to mitigate risk. Instead, these companies hide all manner of gotchas in contract terms we have no hope of understanding. Traditionally, that would not be a valid contract, but the legal system seems to exist to serve the powerful, so it enforces them anyway. (Even then, the insurance companies try to avoid fulfilling what seem like their clear obligations because sick people lack the wherewithal to fight them.)
Maybe you missed the post I replied to which said “there should be no denials at all.” You’re right that it’s all rigged against the insureds that wasn’t really the point though. Obviously it doesn’t cover every single thing.
The worst part is, they actually hire doctors to analyze claims and they’re the ones making the decisions whether the claims are accepted or not.
Edit: clarification
I’m sure the doctors stick with reviewing claims for which they have a lot of experience, spend the time to actually review the patient’s specific scenario better than the doctor who saw the patient, and aren’t financially incentivized to deny as many claims as possible.
Yeah that’s what I was getting at. For some reason I’m being downvoted for saying how things actually work?
The person you’re responding to was being sarcastic. They’re bottom of the barrel doctors practicing outside their specialty and have a financial incentive to deny claims.
Yes I know! That’s what I’m trying to say.
Text saying how it actualy works without any indication that you think it is bad sounds like approval of the existing system by default.
If you said ‘the crazy part is…’ or ‘they hired the doctors to give themselves the appearance of medical doctors making qualified decisions’ then maybe it wouldn’t have come off that way. Instead, it comes across as ‘yeah, but they have doctors making the decisions so it is fine’.
Ah ok I see. It’s a misunderstanding.
Well, we were responding to the words that were there and not the unsaid context. Even with your edit you are missing something making it clear why the worst part is that they are hiring doctors to deny the claim.
I included the parts you seem to be in agreement with and included the ‘better than the doctor who saw the patient’ both to make it clear it was sarcasm and why having doctors deny claims is not in the best interest of the patients.
😓
It’s all good!
Took me a long time to figure out how much detail should be included and sometimes I still screw up and ride the down vote train into oblivion. The other thing I learned is that clarifying rarely helps, most people see that as making excuses because people in general are terrible judges of other people’s intent.
Shouldnt a doctor be “reviewing” the patient before making decisions?
Like wtf is is this middle manning. You go see doctor, then another insurance doctor is checking his homework but only based on paper work and with a financial incentive to deny as many claims as possible.
Also, I bet they explicitly state they are not rendering care when they review a claim, CYA legal shit. So are they even acting in their capacity as medical professional or just paper pusher with an MD. I don’t think it even requires a licese.
Exactly.
Insurance is defined at its core as a transfer of risk. Its that simple. If insurance denies everything I send their way while I am paying them, its no longer a transfer of risk, I am simply paying someone to tell me ‘no’.
That out of the way, the whole health insurance industry does not follow the concept of transfer of risk. The insurance companies rather follow the concept of transfer of action. Basically I am not going to spend all day negotiating with a hospital. That said, them denying is because they do not want to do the work still, so in other words, I am still paying someone to tell me ‘no’.
In both concepts, the insurance companies are not doing what they ascribed to. Along with the laws that congress stripped away affordable care to its basics that we all are required to have it - read an extra tax but to corporations who give kick backs to their congressional lackeys - and the fact that insurance companies basically are price fixing all the rates and such, it becomes a lose (you)/lose (you)/lose (hospitals)/only ones who win are the companies.
Late stage capitalism hard at work.
That why insurance should not be for profit.
