- cross-posted to:
- news@lemmy.world
- cross-posted to:
- news@lemmy.world
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At the risk of you all putting a literal hit out on me, I’m going to proclaim the hot take that this is not the best example of insurance company abuse. I am in complete agreement that insurance greed and frankly insurance company power over the entire US Healthcare system is way out of balance. I argue the walls need to come down and things need to be rebuilt in aore socialized model. But as far as refusing claims go, be it socialized or the insurance Co mess we have now, Healthcare resources are inevitably limited. Someone with a brain hemorrhage, in a coma, ventilated, in heart failure is going to be massively expensive to support and will have a low likelihood of functional outcome. Rather than denying dozens of chemotherapy meds, or MRIs for suspected brain lesions, I could see the ugly job of denying this claim as justifiable.
I agree with the insurance company too and most doctors would. I’m not sure who this doctor is but most people in healthcare industry that actually work ICU will agree. I also challenge commenters here to speak to your (hospital) healthcare friends about it too, especially if they work ICU.
ICU beds are very limited and honestly not designed to house pts who are intubated or comatose indefinitely. They are designed to be short term with active treatment. Otherwise, if they need to live somewhere as a comatose pt, they need to go to a subacute facility, forever on a vent. That’s the real reason why United Healthcare denied. “Not medically necessary” (‘for hospitals’ is what they left out).
If hospitals kept every uninduced comatose pt, they wouldn’t be able to treat anyone else (think stroke, cardiac, trauma, severe pulmonary, etc). Pts with TBI for example, 50% will never have consciousness returned and just have to live in this vegetative state. . Not only that but hospital staff isn’t trained to provide long term care. They aren’t educated or specialized in doing so. Some hospitals only have let’s say 20 ICU beds. Larger ones maybe 40. But even without people living in them, they are near 100% capacity every day.
Subacute facilities are also really difficult. They have trouble staying afloat because the care they provide is so expensive and most are reimbursed at a loss (Medi-Cal).
Theres lots of things wrong with the healthcare system but like this poster said, its not a good example. There are honestly literally millions of other examples that are absolutely egregious.
I’m not sure who this doctor is
This doctor is someone who knows a hell of a lot more about the situation than you do or the friends that I might ask that are in healthcare. Maybe, just maybe, he knows some information where it makes sense to continue treatment. You seem to be under the assumption that he did not share that information with the insurance.
I know in the 10 years ive worked in a hospital ive never had a patient denied care in ICU unless the reason listed above. I also know A LOT about insurance, much more than most healthcare professionals. I also connect my doctors to insurance when we do need to appeal decisions and ask for a peer to peer.
Im not saying insurance never denies care. They do. Anecdotally though, never had incorrect denial with ICU. Its too easy to prove insurance definition of "medical necessity’ there. I am still very doubtful of this specific example. Downvote all you want but the scanario I gave above is almost 100% probably what happened. I’m just explaining the process and likely what happened. Its okay if I’m not believed. I know what’s true and how healthcare works. Its bittersweet that I have my job because I know how to navigate the healthcare system and get my patients what they need for their healthcare goals.
Edit: Also, with the scanario above, almost 100% of ICU professionals would agree with insurance for the reasons listed above. We know how it feels to want to bring someone up from the ED but can’t because we have beds already full… There are a very few select patients occasionally that want to live in the hospital. I’m aware we are encountering some people at their most vulnerable, traumatic times. It sucks. But they can’t live there.
Y’all are making a lot of assumptions about this person’s life, as if you yourself were on the death panel. Maybe it’s, true, maybe it’s not, but the doctor knows more about the case and the patients prognosis than any of us
I know in the 10 years ive worked in a hospital ive never had a patient denied care in ICU unless the reason listed above. I also know A LOT about insurance, much more than most healthcare professionals. I also connect my doctors to insurance when we do need to appeal decisions and ask for a peer to peer.
Im not saying insurance never denies care. They do. Anecdotally though, never had incorrect denial with ICU. Its too easy to prove insurance definition of "medical necessity’ there. I am still very doubtful of this specific example. Downvote all you want but the scanario I gave above is almost 100% probably what happened. I’m just explaining the process and likely what happened. Its okay if I’m not believed. I know what’s true and how healthcare works. Its bittersweet that I have my job because I know how to navigate the healthcare system and get my patients what they need for their healthcare goals.
The fact that you have to be there and know the tricks to getting care is part of the problem. We have people who paid a crap load for medical insurance and doctors taking care of their treatment: why does there also need to be someone to deal with getting paid?
The reason for denial given was that the doctor didn’t prove the treatment was medically necessary, not that it costs too much.
That’s nitpicking. Is it medically necessary to support someone in a coma that likely won’t have a good outcome? It’s always about the money with insurance. That has to be assumed.
It’s not nitpicking, it was the literal denial reason. You are explaining why you think it was okay for them to do, but that’s not the reason given for a denial. They need to be able to defend what their denial actually says, not what you think it means, in the event of a lawsuit or appeal.
“Medically necessary” has a legal meaning, and it’s not dependent on whether you consider them a ‘useless eater.’
Medically unnecessary = we don’t support the decision making and don’t want to pay for it. It’s the only language they will ever use. This is just the wording insurance companies use to deny claims.
I get what you’re saying. Every denial reason is just a code for this is too expensive. The reason itself might be grounds to argue, but they are just going to try to deny it again with a different reason code.
To your original point, I agree that we should ask ourselves if it’s worth hundreds of thousands of dollars just to keep a vegetable breathing for a few more days. Frankly if I were in that shape, I know death would be a kindness.
But I will say it seems immoral to leave the decision in the hands of the profit-makers.
I’ll go with the opinion of the patient’s doctor, rather than some internet rando, thank you very much
The patient’s doctor isn’t the one that denied it. I’m not really sure what you’re saying. I think you just agreed with me.
Medically necessarily to have a chance to live, YES. You are confusing medically necessary with profitable, which is the whole point behind the outrage and the reason why the insurance “industry” is monstrous and dispicable.
Super Mario Bros 2025
Bing, Bing, Wah-gunshots
deleted by creator
Deny, Delay, Defend… may I add: Dispose?
It was delay, deny, depose iirc
Ai: “It is safe and profitable to deny this claim as she is unlikely to seek vengeance.”
AI forgot all the people who will seek vengeance for her, however…
Wait! They got a new CEO?
GO! They got a new CEO!
Yeah, every story like this plants a seed in someone’s mind to be the next Luigi. UHC executives are cultivating their own demise.
Dr. Levi better be careful, United may try to claim he’s violating HIPAA by publishing these details (even though it’s legal).
Not a violation unless he has identified the patient
HIPAA can be violated without giving a name, if certain details are disclosed; eg the only 6 year old in the state with rickettsiapox who was admitted on December 21.
But no, this tweet did not violate HIPAA.
Right that’s why was careful to say ”identified” and not “named”. If you give someone enough information to infer with certainty a patient’s identity without express permission from that patient, you’re cooked.
I bet their CEO is not the only one who bleeds.
they have infinite ceos
Funny. I’m pretty sure by that logic there are also infinite something else.
Wow careful there bubba. This can be construed as a call for violence and that’s illegal under 18 USC § 373.
I like how property is the first thing listed.
Tell me you didn’t go to law school without telling me you didn’t go to law school.
Edit - As American prisons are a form of institutional violence, your warning that posting Wikipedia links “could be in violation of Federal law” is in itself a call for violence against the original poster. You can self report to the gulags.
Stephen Helmsley:
He was managing partner and chief financial officer at Arthur Andersen.
Super shocking that he was doing insider trading at UHC. They hired a known crook and paid him tens of millions a year.
You’d think UHC would strive to behave impeccably with all the publicity around them lately. But no: they’re so shameless and so greedy they even behave rotten when everybody is busy dissecting their every moves. Amazing…
They had their underwriters run the numbers and they determined it’s more profitable to continue business as usual and just invest in private security for executives.
It is more profitable that the beatings continue.
They’re not scared enough yet.
they know that the publicity is temporary and does not matter because a corporation is not a democracy
The simplest explanation is they literally can’t change, they’ve built this level of callousness into their DNA. It’s useful confirmation that for-profit health insurance is beyond saving.
Of course they wouldn’t try to behave well. Remember that the bosses in this organization are all incredibly selfish. They are rich, they want to get richer, and f*** everybody else. Although the company itself might benefit from a positive PR campaign, none of these people individually would, so they’re not going to push for one.
It’s a strange kind of honesty about bad behavior. Everyone is so selfish that they can’t even pretend as an organization that they would like to do the right thing.
What incentivize do they have? The vast majority of their customers have no choice but to be their customers. They just need to keep the companies that companies contract with to set up benefits happy. That’s a very small pool and most aren’t customers of theirs. And especially with the anti-regulation party coming into power, there’s no reason to fear government intervention. But even before that, it wasnt really a threat.
My employer had to hire a lawyer to get their insurance company to cover us and stop denying claims. It’s beyond fucked up out there.
Because doing otherwise wouldn’t maximize profits. There’s no actual competition in the market for consumers to choose. Nearly all Americans get insurance through their work, and have absolutely no say in what companies those options are from, and those options might only change at the end of the year if the company changes their insurance partner (which I’m sure takes months to negotiate). UHC has no reason to change unless they are forced to. Customer Satisfaction in the industry is abysmal because there’s no incentive for the companies to actually be good.
“But free market and competition!!!”
🖕
I don’t think you can pivot a 465 billion dollar company. Especially one where being unethical is a profit making feature.
They won’t fix themselves, hell why even reign it in if the system rewards bad behavior?
CEO’s come and go and one just went
The ingredients you got bake the cake you get
So, if you get sick, cross your fingers for luck
‘Cause old Richard T. Burke ain’t givin’ a fuck
- Jesse Wells, United Health
Why? “Line must go up”
If that were the case, they’d have off’d the CEO themselves. That’s multi-millions that could go back to other higher-ups. Then we have a Highlander situation.
The CEO serves a very important role in that they get all the fallout for what the board probably wants, and then if there’s enough bad publicity, they can fire the CEO and pretend that the CEO acted entirely out of their own volition.
I mean that’s not to say they’re not greedy bloodsuckers, but they’re greedy bloodsuckers that the board needs. Because the board are even bigger greedy bloodsuckers and want to stay out of the news.
If course, the board can also play innocent in any bad decisions, because they can just say “It’s what the shareholders want!” or “It’s what the consultants told us!”
One less golden parachute. More for the rest.
In Corey Doctorow’s short story (Radicalized, in the collection Radicalized) the health fund attackers typically used explosives against the entire board and their support staff
I wonder if that would be more effective
I bet the new United Healthcare CEO (or whomever is in currently in charge) is le pooping their pants right about now.
And cleaning it up with hundred dollar bills.
Fuck these rich assholes
It’s “whoever”.
who’m’st’ve’er
who’m’st’ve’er’nt
M’who’m’st’ve’er’nt’lady?
Hey hey let’s leave the Welsh out of it
Dial L for Luigi
I wonder how Mario feels about this while Luigi is on lockdown
