How many news stories have you seen about someone denied a claim

[edhopper]

and dying, compared to a single CEO who got shot!

Just checking on the Media's priorities.

[OAITW r.2.0]

1. How many times does it happen to the people that can least afford it?

top of the iceberg, I think.

[vapor2]

2. Last week I posted a statement on how Medicare is much better than Advantage

Got tons of replies and only 2 were happy with their Advantage Medicare. Several (maybe 20 or more) were denied and/or unsatisfied

[rich7862]

3. The list of complaints to any medical insurance company except Medicare is monumental.

Even electronically it will takes months to review that many complaints. Teeeee Heeeel
It will probably the first time they were even read.

[rich7862]

4. Denied Medical Claims

are so common place, they are never reported to the public. It might hurt the medical insurance companies profit.
That's why it is never reported. In fact, Mary Lou Retton, was not even insurable because of so many injuries from Gymnastic.

These Insurance companies, literally, have the power over life and death. And that should only be in God’s hands. Not some maggot Insurance CEO Oligarch.

[thebigidea]

7. so why was Mary Lou Retton's story reported fairly extensively?

Didn't it threaten medical insurance profits? Did she have a special hall pass since she's a huge Trump supporter?

[Klarkashton]

5. It's a man bites dog thing. Almost literally.

[thebigidea]

6. how many clicks do you think such stories get vs a story like this?

Gee it's almost as if this sort of thing is what the audience fucking eats up with a spoon.

[Omnipresent]

8. Trying to find that shooters denied claim at UHC...

Is probably like trying to find a needle in a haystack.

[moonscape]

23. Or on Mars ...

[dalton99a]

9. I'd say a majority of Americans have had negative or extremely negative experiences with health insurance companies

[LeftInTX]

10. Yes

[Silent Type]

13. True. I've had negative experiences with just about every company that impacts my life, utilities, internet

providers, banks, phones, property insurance, auto dealers, doctors, hospitals, Medicare, builders, police, college, grocery stores, restaurants, heating and air, etc.

Admittedly, my life was not at stake.

[Silent Type]

11. I post on some health care sites on Reddit. Numerous people post about their denial. Some are legitimate, others are

like my health insurer won't cover XYZ drugs and my doctor has appealed.

Usually what I do in these cases is look up whether Medicare covers it, then at big insurance company coverage policies. Most of the time I post back something like, "Even Medicare does not cover it because it's considered experimental because it's not approved by the FDA for that purpose. You're going to have to talk to your doctor about alternatives that are covered by Medicare and major insurers. Good luck."

Over 80% of initial denials by health insurers are overturned when the doctor provides additional information like, "Oh, chit, we forgot to mention that the patient developed pneumonia just before the typical discharge date, please allow the additional days."

Many of the denials are partial denials, Doctor asked for 14 days of therapy, but insurer is only approving 10 days at this point and will reconsider additional days if patient is making progress. Original Medicare's payment policy might also deny claims after the typical, standard of care, period. If you read, UHC, Aetna, Cigna, etc., coverage policies, they mostly follow CMS/Medicare policies word for word. Whether those policies are applied correctly is another matter, but that's true under original Medicare too.

Believe it or not, doctors do cheat.

I've seen cases where a doctor might order an expensive test 1 time for every 100 patients when the patient has to be referred to another facility for the test (facility bills and profits in that case). Then, when the doc buys similar testing equipment for their office, thus being able to profit from it personally, the utilization rate jumps 400%. What that tells me is that the test wasn't needed that often, until the doc could profit off it.

I've asked doctors who billed a high paying code -- when they only performed a lower paying code -- why they chose the higher paying code? The answer from a supposedly intelligent doctor was, "Because I looked down the list of codes and the code I billed paid the most." Well, yeah doc, that is why Medicare is putting you on pre-payment review and fining you.

Admittedly, insurance rules are confusing, but that’s true under original Medicare too. But those are as much responsible for denials as anything.

Medicare audits doctors, hospitals, etc. They deny claims up front, but they also audit high utilizers several years after the fact.

In any event, it's time for Congress to get off their asses. They've had over 60 years to give us a rational healthcare system. Until they deliver, we are stuck with what we have.

[Sparkly]

14. This might be ONE way Kaiser is better as an HMO for Medicare Part C.

I know it can be AWFUL for a lot of things, including routine care and specialists. The surgery I needed for a highly aggressive, fast-growing cancer was delayed and referred out for lack of Kaiser surgeons in my center. A hospital that specializes in my cancer is 5 minutes away from me, had early availability, and I begged for approval, but was denied. Who knows whether that might have staged my cancer at a less lethal level, and given me years to live.

However, if you're diagnosed and on a plan, the coordination is excellent. The chemo center is great, they can schedule me for my CT-scans, MRIs, echo-cardios, blood tests, consults, etc. at various centers. Unfortunately, I'm equidistant from 3 centers, none of which are very convenient; and the "urgent care" is absolutely useless, at least where I live.

It has its ups and its downs. I've thought of going off of the Medicare Advantage to a regular Medicare plan, but given my condition, the cost would be prohibitive now, and the coordination would likely be insane.

Best to you.

[Silent Type]

15. I had Kaiser when I worked for one company. I liked it. They really pushed preventive care, colonoscopies, etc.

They would not approve one med that cost $100+ a month, but would approve the version that was 2 a day, rather than 1. Got ticked a first, but when they explained cost differential I tried the generic 2 a day. It works great and I have stayed on it.

I honestly am not into doctor shopping and liked being assigned practitioners. Liked all of them. They were young and looked like Doogie Howser, but seemed to care.

Hope you are doing well, considering.

[cliffside]

17. We the people decide those who advocate for a national system, the Dems have shunned those who have run on that platform

we need to win, but we need to advance the cause without rewarding for profit companies.

[ck4829]

21. When did we as a country become so pathetic?

When and how did we go fall from the Revolutionary War, the Underground Railroad, the suffrage movement, the labor rights movement, the civil rights movement, the moon landing, and the gay rights movement to "Until they deliver, we are stuck with what we have," when and how?
"

[Silent Type]

22. Have you called your reps and told them to get it done, even if it ain't perfect?

[ck4829]

24. "When and how?"

I'm not asking about contacting representatives, I'm asking when did we fall so hard and became this helpless.

[malaise]

27. All the reps have

full coverage

[Silent Type]

28. Good point. Sounds like we should vote them out in mid-terms if they won't cooperate.

[questionseverything]

25. So it's your job to defend the crap advantage insurance?

You usually end by blaming Congress and while I agree we do need strong healthcare guaranteed by law, I want to say, in my business I don’t need anyone holding an anvil over my head so i do what I said I would do, I do what I promised because I am not an evil liar or thief

[Meowmee]

31. Believe it or not insurers do deny valid claims

And those often do not get overturned on appeal…some doctors cheat, the vast majority don’t.

Example- my ins which I pay a fortune for was allowed to deny a HUGE hospital stay bill. The hospital appealed it which was denied. In the end because I had a potential lawsuit against them the h didn’t bill me and they absorbed the cost.

I told them that I would have to sue if they tried to bill me so they absorbed it but now I wish I had sued them anyway, because there was gross negligence that caused me permanent damage.

The insurance got away with it, that could easily have bankrupted me and caused serious financial harm if the hospital had not absorbed it.

At the time I was recovering from life-threatening events, which never should’ve happened, all due to negligence on the part of my doctors and the hospital, and I was too exhausted to deal with it.

Insurers make medical decisions every day, based not on any knowledge they have of medicine, but on protecting their assets and higher profits.

[question everything]

12. Here. Not dying. Running for their lives

https://www.democraticunderground.com/100219742598

The Sickest Patients Are Fleeing Private Medicare Plans--Costing Taxpayers Billions

Yes, it was about UnitedHealth. I had to snip the first paragraphs

[questionseverything]

26. That's the problem, advantage sucks up their premiums

When they are younger and fairly healthy but when they get really sick, after being denied they go back to regular medicare plus Medicaid probably so taxpayers are stuck with the cost w/o the benefit of the premiums during the early healthy years

[cliffside]

16. From experience with UNH ...

my husband went through two bone marrow transplants for acute myeloid leukemia, after a diagnosis of MDS. Each transplant included one round of induction chemo prior to transplant and another for transplant, both lasting a month at Sloan in NYC. Each hospital stay, four months in total for induction and transplant, was covered, they paid for everything. Our insurance policy had an 11K maximum out of pocket annual deductible, luckily we had enough in a retirement account to cover that.

Our HC system needs a major overhaul and have been in favor of a national system since I started posted here in 2004 and my daughter was in med school and thought of her salary reduction under a national system and all that med school debt. We need to look at that as well, her debt is paid, but someone who borrows for college plus med school is looking at taking on significant debt. We need more docs who do not begin with high a debt debt and a less salary ...lots of moving parts.

As side note, American Cancer society runs several Hope Lodges throughout the country where you can stay for free while undergoing treatment, the social worker at Sloan put us in touch with them. We stayed in the NYC Hope Lodge for 3 months x 2 free of charge. There are services available if needed, hopefully no one will ever need their services, but good to know.

But I agree, the attention being paid to the CEO vs those denied care is totally unbalanced ... that is our system. That being said those who try and bring attention to and disrupt the system are dismissed by many in our party.

[Meowmee]

18. Very few

[Mike 03]

19. Exceedingly few

Kicking.

[uponit7771]

20. Leave the health insurance CEOs alloooone !!!/ sarc

[lostnfound]

29. Lots of them on old Twitter, and in real life;, relatively few in media

[tenderfoot]

30. I've noticed the media's tone-deafness in regard to the universal reaction and the reason's behind it

I have stated many times and will continue to state that our media's primary objective is to protect the ruling class and here they are doing it again.