I’ve worked in healthcare for over 20 years, and the fact is that licensed, well trained, and caring individuals are forced to waste hours a day getting ‘approval’ from non-licensed high school educated insurance reps to try and justify their treatments. There can be entire departments dedicated to just dealing with insurance companies at pretty much every hospital, but often times insurance companies will only talk with the actual clinicians that care for patients.
The entire practice is fucked. First of all non-licensed non-medical people should not be dictating the treatment of care. Whether it’s directly or by means of denying coverage. Second of all there should be absolutely no way that they should even be allowed to look at your private medical records. And finally when it comes to something like auto insurance there are laws that insurance companies cannot steer customers to certain repair shops or dealerships. And yet when it comes to our health, health insurance companies are able to set up elaborate networks that essentially do the exact same thing they steer customers to certain institutions and prohibit them from going to others.
The entire setup of our health care industry seems like it would be at odds with most of our well-established laws regarding insurance, PHI Access, and delivery of medical care.
This is going to become more and more of a problem since the working conditions are burning out clinicians at alarming rates
I commiserate with my medical professionals literally every time I have to see them. The worst part is that it isn’t even the GED holder on the other end of the request. It is the actuarial table and risk analysis software they punch everything in to. Or an AI trained on the exact same tables and algorithms.
I have contemplated training an AI to look at medical records and score the standard of care given to patients. Would be nice to be able to weaponize the tech against them.
