https://mas.to/@MikeBeas/113666556469008087
EDIT: I think you should get the service you pay for, just so that’s clear.
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.
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.
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’.
I feel like every time someone uses the word “liberal” on lemmy, the meaning of the word shifts slightly to the right.
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Liberals are right wing.
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.
“It’s a business” is not a justification for evil, and yet that’s always how the phrase is used.
That why insurance should not be for profit.
Funny how life insurance always pays, no problem. Because if they get a bad rep, people will go elsewhere. We can’t do that with employer-covered healthcare!
These tricks are many, this is just the tip.
insurance is a fucking scam that preys on the most vulnerable segment of the population in order to enrich themselves and their shareholders. and the vast majority of people think that’s just the way things are in america, therefore it’s the best possible way for things to be. what’s not to understand?
The free market is excellent at producing, at a reasonable cost, myriad voluntary luxuries like large televisions and speedy cars. These prices are naturally constrained by the consumers’ willingness to do-without. When the consumer cannot rationally choose to do-without, the elegant self-regulation intrinsic to the free market evaporates.
So well worded. I struggle to get this concept out when discussing the concern about grocery prices and why homesteading / community gardens are the only protection we can reasonably have right now
Without realizing it, Mike Beasley makes a great argument for why private, for-profit health insurance shouldn’t exist.
As some who has no clue who Mike Beasley is, that seems like a perfectly legitimate Interpretation. A lot of people, like the one he is replying too, knowingly or not are defending the existing system and the existence of health insurances companies.
I mean, forget about health for a second: we all know insurance companies fucking suck, and they are essentially just a symptom of a shitty system. So why are we fighting/wishing/hoping for them to be run better/more empathetically instead of wanting a different system?
I think the his comment can be seen as a call-out of how some people are missing the root of the issue.
It’s like all the media that think they are defending Brian Thompson by saying he was less horrible than the average healthcare CEO. Sometimes I wonder if they are making an argument for resurrecting the guillotine industry.
It’s my understanding that health insurance companies hire doctors, who have taken the hypocritical oath, to review claims and deny them.
Are they practicing medicine here?
They are making medical decisions.
When the insurance company describes their functional area is the term “medical decision” listed anywhere?
Asking for a friend
If the insurance company declines a patient’s treatment, citing that they believe it to be unnecessary, against the recommendations of their healthcare provider, is that a non-medical decision, then?
Where is the medical board that licenses these physicians then?
Nice sea lioning just asking questions.
Health insurance companies specifically hire doctors often in unrelated specialties solely to deny claims as being not medically necessary.
Quit your gaslighting bullshit. I hope you’re being paid well for your simping.
Poor reading comprehension.
But yes:
companies specifically hire doctors often in unrelated specialties solely to deny claims as being not medically necessary
Has a doctor ever gotten in trouble with the board for this conduct?
Do you ever wonder why not?
Asking for a friend 🐸
I think a lot of doctors are gonna start getting their credentials threatened as more people learn how to use the system to their benefit. I for one had no idea one could get the info of whos denying care and then complain to the licensing board, until Luigi brought to light our shit ass medical system. People are waking up from the gaslighting.
Will there be any major changes? Probably not until more CEOs get killed.
My point being medical board will do nothing because from legal perspective it is not their jurisdiction.
I am not disputing that these whores are making medical decisions but that’s not how system views it.
They are essentially pleading to authority
we hired medical professionals to deny your claim, they know what they are doing
These people are not practicing medicine and they are not subject to any oversight beyond their corpo komissar
Probably not until more CEOs get killed.
The reverse of beatings will continue u til morale improves… Fuck them, nobody care if they die lol
PS. People should try to report their denoed claim to medical board within theIr state. Ot is a valid vector to attack these parasites. But both know medical board won’t do shit. But it would make a great propublica story
They are making financial decisions.
They are making medical decisions through a financial lense.
Report your denied claim to the medical board and please report back your results!
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?
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.
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.
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.
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!
… This dude needs to understand how other types of insurance work
We should stop calling it “insurance”, it doesn’t ensure anything. We should call it what it is - a protection racket. Either that, or we could refer to it as “medical loans” - of course, it’s all paid in advance, in many installments. Oh wait. That’s just defining a protection racket again, isn’t it?
It’s a protection racket similar to the mob, except the mob has scruples and will actually protect you if you pay up. If you don’t pay up, broken kneecaps.
Health insurance is just paying for broken kneecaps. If the mob ran healthcare we’d have better outcomes than we currently do, let’s be real.
Loans pay out.
Oh no, each claim is a new loan application. You pay in your premium to have the right to apply.
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.
You know… that kinda vow would be a great idea! Doctors take an oath like thing too, right?
Not a meme.
Oh, look, it’s the guy who doesn’t know what a meme is and insists on spamming it all the time
And the guy who proved that their bio:
I say unpopular things but never something I know to be untrue. Always open to hear good-faith counter arguments. My goal is to engage in dialogue that seeks truth rather than scoring points.
Was a lie yesterday.
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.
