You know, at face value he’s absolutely right. We shouldn’t claim care that is unnecessary or maybe even harmful. But where we disagree is that I think that decision should be left to our medical professionals
Insurance claims are approved or denied by medical professionals. In the state of NY it’s even required for a specialist to approve or deny specialist care.
Some doctors are just absolute scum.
Except in this case, they used AI to help them make decisions. The lawsuit is still ongoing so I shouldn’t speak in definitive terms, but considering the circumstances and evidence I think it’s pretty clear than they have tried to automate some processes and didn’t audit them properly.
My insurance’s tactic to this sort of demand is to just completely ignore my requests/demands. They log an acknowledgement of my action, and then never do anything with it, ever.
There is a lot of crap that they’re able to instantly deny through your plan’s terms and conditions.
It’s worth reading the plan summary of what won’t be covered, even if it’s prescribed treatment. Some of the shit that’s hidden in there is fucked up.
This year someone in my family started to have to pay out of pocket for their GLP1s because their diseases didn’t progress far enough for the treatment to be covered. They’d rather you hurry up and die than pay for expensive drugs that keep you alive for longer.
If they have cardiovascular disease or kidney disease, those are getting added as indications for the GLP-1’s so they might be able to resubmit the authorization/claim with those diagnosis codes added to get it covered.
They are done by medical professionals who have no obligation or incentive to serve the best interests of the patient. If your doctor fucks up, he can be found liable. If the insurance doctor fucks up, there is no liability whatsoever. Cases have been brought to court and then immediately thrown out because there is no legal basis for holding them accountable.
Really what it should be is that if a doctor prescribes unnecessary care, they should go after the doctor, not the patient. Doctors have malpractice insurance. If the health insurance can’t win a case of malpractice, then they should pay the bill. Why are patients in the midfle here at all.
It’s the same trick as rebranding bank robberies to identity theft. It puts the blame on the consumer who can’t afford to defend themselves.
Huh, I hadn’t thought of that as a Crying Indian.
Really what it should be is that if a doctor prescribes unnecessary care
That’s the core problem. The entity that defines unnecessary care is health insurance. And there are TONS of stories of them denying Diabetes medication for people with diabetes and anti-nausea meds to pediatric patients getting chemo.
If they were doing the right thing, no one would be pissed off. The “recent target” was the one to decided to run on AI driven denials that were denying 90% of care for months.
They are not fulfilling their duty to take the money from the subscribers and pay their righteous medical bills and instead using it as raw profit.
They are employing their own ‘doctors’ to prove stuff that is definitely necessary is labeled unnecessary.
My attitude is that if the doctor prescribes unnecessary care there’s a professional board for that.
Though let’s be real, the health insurance for profit industry is the problem and it’s not going to get better until we get rid of it
