https://mas.to/@MikeBeas/113666556469008087
EDIT: I think you should get the service you pay for, just so that’s clear.
Not a meme.
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’.
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.
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.
The customers of insurance companies are shareholders.
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.
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.
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.
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.”