- 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.
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.
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.
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?
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.
PLAYER 2 START
Player 2 has been trapped by Bowser inside the Koopa Dungeons, it’s Player 1’s turn.
Ready, Player 1?
They could put out a story like this every minute of every day and never run out. Burn it all down indeed
And I’m here for it.
Deny, Delay, Defend… may I add: Dispose?
It was delay, deny, depose iirc
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.
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.
Brb loading my gun
Respect to the doctor for publicly shaming United Healthcare.
Proof that Luigi was right! 2025 is the year we the people start denying their existence. Medicare for all and the doctors that get paid the most do so by having healthy patients. No more pill popping to keep making these insurers rich!
Given who is about to be sworn into office, I’m not sure too much progress will happen, but people will certainly get an idea of how much they’re getting fucked.
Maybe after the next election?
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…
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”
One less golden parachute. More for the rest.
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!”
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!!!”
🖕
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.
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.
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
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.
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?
they know that the publicity is temporary and does not matter because a corporation is not a democracy
They’re not scared enough yet.
united healthcare looked at bob kelso and was like this guy is the hero of the series.
Was Bob actually denying the claims, or just passing the buck to the lawyer character? Can’t remember his name.
Edit: Ted! No wonder I didn’t remember that. They barely ever actually said his name.
Bob wasn’t denying anything.
He just wanted the people who were getting treatment to have insurance so the hospital can get paid.
In this context, I’m sure if someone was denied coverage, his attitude on it would be the same as his attitude on people who are not insured.
AFAIK he would have had no say on whether someone was denied coverage. He did however, have a say on whether they were denied care. His professional attitude about that was “show them the door” but that policy was rarely ever actually enforced, and the few times it was, he complained that everyone did what he was telling them to.
Bob actually tried to milk the insurance companies for money, IIRC. He wasn’t entirely a monster, but definitely had no chill.
Dr. Bob Kelso: What the hell people? I saw Maggie Kent in the park. Why didn't we treat her? Nurse Carla Espinosa: She has no insurance. Dr. Bob Kelso: Well, why didn't we do what we always do? Why didn't you fix it while I turned my back and pretend not to notice? You know the dance.he definitely mellowed out as the series went on though in the first episode he did come up with
Dr. Dorian, do you not realize that you’re nothing but a large pair of scrubs to me? For God’s sake, the only reason I carry this chart around is so I can pretend to remember your damn names! Now look, if the patient has insurance, you treat them; if they don’t, you show them the door.
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.
Funny way to spell murders
Question -:why is there no website that lists and complicates these issues?
Is it shutdown by their legal?
Maybe someone could start a database distributed as torrent. So many people can host it and spin up as needed?
Be the change you want to see in the world
I’m a us citizen, but naturalized. Meaning they can accuse me of terrorism and deport me, whereas for Americans born here - they can’t really do that. Has to be someone born in us.
Doesn’t matter if you were born here or not, you just need to look like you would fit white in with their idea of normal.
Whereas a born American can just be accused of terrorism and be thrown in jail for god knows how many years?
If you’re not willing to be the change then it doesn’t need changing.
