Healthcare Insurance Corruption (in detail)

[Phenomenally Frantastic]

“Want to know how corrupt some health insurance companies are? Read on.

I once had a health insurance employee admit to me that they would randomly pull prior-authorizations submitted by a doctor’s office for a particular treatment or study and simply deny it without looking at the chart or details. A prior authorization is a process of getting a treatment plan approved by your insurance company.

When asked why, she said that statistically a certain number of doctor’s offices will stop there and simply tell the patient it was denied and rather than take the time to do what’s called a peer review.

A peer review is when your doctor sets up a call with the insurance company’s “doctor” and reviews the treatment plan to see if it is truly necessary. The majority of times, in my experience, it was authorized after a peer review.

Insurance companies have become wiser about peer reviews as well. Your doctor used to be able to simply call a number and get a peer review almost immediately.

This was too convenient so many insurance companies now schedule an appointment for a peer review during regular office hours knowing a busy doctor’s office would not block patient time to take the call. Therefore, if/when the doctor misses the appointment then they can claim it was not their fault but the doctor’s instead and that’s why it was denied.

After hearing all of this it is easy to say it is the doctor’s laziness or lack of care that leads to not taking the time to do a peer review. However, when insurance companies begin denying so many treatments and studies, it becomes impossible for a physician to do a peer review for so many patients. He or she would be on the phone all day.

Insurance company’s know all of this and this is why the strategy of randomly pulling charts and denying them works by saving them money while denying care to patients.”

 

[IIowaFarmBoy]

What is funny is how many of you swear by your medical system, doctors, and Fauci.

 

[RagnarLothbrok]

View embedded media

“Want to know how corrupt some health insurance companies are? Read on.

I once had a health insurance employee admit to me that they would randomly pull prior-authorizations submitted by a doctor’s office for a particular treatment or study and simply deny it without looking at the chart or details. A prior authorization is a process of getting a treatment plan approved by your insurance company.

When asked why, she said that statistically a certain number of doctor’s offices will stop there and simply tell the patient it was denied and rather than take the time to do what’s called a peer review.

A peer review is when your doctor sets up a call with the insurance company’s “doctor” and reviews the treatment plan to see if it is truly necessary. The majority of times, in my experience, it was authorized after a peer review.

Insurance companies have become wiser about peer reviews as well. Your doctor used to be able to simply call a number and get a peer review almost immediately.

This was too convenient so many insurance companies now schedule an appointment for a peer review during regular office hours knowing a busy doctor’s office would not block patient time to take the call. Therefore, if/when the doctor misses the appointment then they can claim it was not their fault but the doctor’s instead and that’s why it was denied.

After hearing all of this it is easy to say it is the doctor’s laziness or lack of care that leads to not taking the time to do a peer review. However, when insurance companies begin denying so many treatments and studies, it becomes impossible for a physician to do a peer review for so many patients. He or she would be on the phone all day.

Insurance company’s know all of this and this is why the strategy of randomly pulling charts and denying them works by saving them money while denying care to patients.”

What do you think should be done? I agree private insurance is a scam. So, what’s the solution? Instead of allowing private insurance companies to rake in billions, should we all just be taxed more so government can run healthcare without the profit motive? Is that the solution to you?

I pay $148.53 a month for my private insurance as a government employee. That adds up to almost $2,000/year. If the government eliminated the need for private insurance and raised my taxes $2,000 a year, I would be fine with it. Frankly, we are already paying more in taxes because of Obamacare, Medicaid, etc. Unless something has changed that I am unaware of, people on Medicaid pay nothing—meaning nothing for insurance, nothing for prescriptions, nothing for medical care, literally nothing. That’s Bernie Sanders socialism—free shit that ain’t free.

So, since we already half-ass have socialism for healthcare, should we just go all the way and tax everyone for government-run healthcare? I’m asking for opinions. To me, since several million people are on Medicaid paying nothing, why not have those people have a little skin in the game and pay a little more in taxes? I think most of us agree that the United States has the best healthcare providers in the world but the must inefficient and dumbest way of paying for it.

So, again, what’s the solution?

 

[RagnarLothbrok]

What is funny is how many of you swear by your medical system, doctors, and Fauci.

I don’t think it’s so much that as it is a recognition that modern medicine is generally a good thing despite its flaws. On top of that, its a vast improvement from severely limited knowledge of medicine compounded by ridiculous superstitions of the past in which people viewed sickness and disease as punishment from god.

Praying disease away is about as effective as praying the gay away. At some point, regardless of how vigorously con artists like Kenneth Copeland “execute judgment on COVID-19,” people need to wake up and realize science, despite its flaws and constant evolution, is not a conspiracy and a pretty good alternative to fairytales and fables.

Maybe that’s just me.

 

[Scruddy]

Maybe we should overhaul and simplify healthcare. Remove the bloated administration sector and government involvement which has made everything leaps and bounds worse since Obama care was introduced. It doesn't take a 10,000 IQ idea, we just need to simplify the process drastically.

 

[Hoosierhawkeye]

What do you think should be done? I agree private insurance is a scam. So, what’s the solution? Instead of allowing private insurance companies to rake in billions, should we all just be taxed more so government can run healthcare without the profit motive? Is that the solution to you?

I pay $148.53 a month for my private insurance as a government employee. That adds up to almost $2,000/year. If the government eliminated the need for private insurance and raised my taxes $2,000 a year, I would be fine with it. Frankly, we are already paying more in taxes because of Obamacare, Medicaid, etc. Unless something has changed that I am unaware of, people on Medicaid pay nothing—meaning nothing for insurance, nothing for prescriptions, nothing for medical care, literally nothing. That’s Bernie Sanders socialism—free shit that ain’t free.

So, since we already half-ass have socialism for healthcare, should we just go all the way and tax everyone for government-run healthcare? I’m asking for opinions. To me, since several million people are on Medicaid paying nothing, why not have those people have a little skin in the game and pay a little more in taxes? I think most of us agree that the United States has the best healthcare providers in the world but the must inefficient and dumbest way of paying for it.

So, again, what’s the solution?

Look at Germany's system, it would be the easiest thing to transition to from where we are at, has universal coverage and has more capacity per capita than our system.

It's not single payer healthcare but it is universal healthcare.

But even single payer healthcare, even the UK's system where the government owns all of the hospitals and clinics would be superior to our own. Only the very wealthy in these countries want our system.

 

[Hoosierhawkeye]

What is funny is how many of you swear by your medical system, doctors, and Fauci.

The system sucks. The doctors are good.

They are entirely different things.

 

[joelbc1]

What is funny is how many of you swear by your medical system, doctors, and Fauci.

I believe the alternative is sold sort of “universal health care”…that would change how things are being run and how claims are feint avoided. It would fundamentally change the insurance business as we know it in the US today… and the “insurance crisis” is by no means limited to health care…home owners and car insurances are in crisis too…Some action will be needed before Congress “arranges” a bailout… for their campaign contributors. Imagine the “largess” and the generosity that will cost us taxpayers!

 

[Dr. Phil Seuss]

The system sucks. The doctors are good.

They are entirely different things.

We have the best specialty system in the world. We have the best trained doctors and conduct the most bleeding edge research. The only deficiency in the delivery model is relative to their digitization and technological modernization. They’ve been a massive laggard, but it is coming around.

If you polled America, I bet over 95% of people that use the system would tell you that their only issues pertain to insurance and billing. Meanwhile, these awful companies that everyone hates do nothing except extract record profits from the transaction and make it harder for the doctors to treat people.

 

[dgordo]

Doctors and hospitals should be able to earn a profit, for profit health insurance should be eliminated.

 

[Dr. Phil Seuss]

Doctors and hospitals should be able to earn a profit, for profit health insurance should be eliminated.

Are we really going to get better experiences as patients if the executives running our payer source aren’t being driven in a Rolls Royce Phantom and living in a $22M house? I doubt it.

 

[Hoosierhawkeye]

Are we really going to get better experiences as patients if the executives running our payer source aren’t being driven in a Rolls Royce Phantom and living in a $22M house? I doubt it.

You will if the executives are not worried about reporting a profit to investors in order to keep their awesome jobs or to get a nice fat bonus check. Especially if said executives are investors themselves.

 

[Dr. Phil Seuss]

You will if the executives are not worried about reporting a profit to investors in order to keep their awesome jobs or to get a nice fat bonus check. Especially if said executives are investors themselves.

hey, markfromj—you’re in the wrong account

 

[IIowaFarmBoy]

The system sucks. The doctors are good.

They are entirely different things.

No they arent. Some are, especially functional med. Cancer, no. Emergency generally ok, but still are driven by insurance. You need to be smart. Hell we used mercyry for dental when it was known how bad it was...and still do. Mercury is still in flu vaxes.

Think man...

 

[goldmom]

Look at Germany's system, it would be the easiest thing to transition to from where we are at, has universal coverage and has more capacity per capita than our system.

It's not single payer healthcare but it is universal healthcare.

But even single payer healthcare, even the UK's system where the government owns all of the hospitals and clinics would be superior to our own. Only the very wealthy in these countries want our system.

And maybe if the US pulled back from providing Germany with military protection the Germans would need to allocate their own taxpayer dollars to their own defense and their healthcare system might look more like ours?

 

[goldmom]

Are we really going to get better experiences as patients if the executives running our payer source aren’t being driven in a Rolls Royce Phantom and living in a $22M house? I doubt it.

Who is that? Is this a real person?

 

[onlyTheObvious]

I fail to understand why hospitals and clinics need to be architectural marvels with round walls, and multi story glass atriums. Seems like a waste. Half of all medical donations should go into an endowment for the purpose of decreasing medical costs. Don’t need the Elon Musk entrance atrium with fine art and a Starbucks.

A Big Mac cost the same amount of money at 3am and 1pm. Why does the ER get to charge Monopoly money? I doubt the doctors and nurses are getting Monopoly money for night shift.

 

[onlyTheObvious]

And maybe if the US pulled back from providing Germany with military protection the Germans would need to allocate their own taxpayer dollars to their own defense and their healthcare system might look more like ours?

That’s a solid point. Western countries have gotten protection from the US military and they put the money into social services.

 

[Dr. Phil Seuss]

I fail to understand why hospitals and clinics need to be architectural marvels with round walls, and multi story glass atriums. Seems like a waste. Half of all medical donations should go into an endowment for the purpose of decreasing medical costs. Don’t need the Elon Musk entrance atrium with fine art and a Starbucks.

A Big Mac cost the same amount of money at 3am and 1pm. Why does the ER get to charge Monopoly money? I doubt the doctors and nurses are getting Monopoly money for night shift.

Building things that look nice > building brutalist junk like we did in times past.

A hospital should be nice. If you’re there, it isn’t for a good reason, and being in a nice comfortable setting puts you in a much better mental state, so you can focus on the matter at hand.

 

[Hoosierhawkeye]

And maybe if the US pulled back from providing Germany with military protection the Germans would need to allocate their own taxpayer dollars to their own defense and their healthcare system might look more like ours?

They don't necessarily want us having military basis in Germany. That's sort of a thing WE or I should say our politicians have wanted and they have allowed to keep good relations.

Ultimately they don't even care if we downsize our military.

The only thing they are concerned about is if we will abide by our treaty obligations to fight along side of them if they are attacked.

The choice to spend so much money on our military is an American choice, not a German one. We could drop back to the 2% of GDP target for peacetime and our military can be ramped up quite quickly in the eventuality of war. That's how every freaking American generation did things until after WW2. We always kept a small military during peace time and politically a large military was frowned upon.
And honestly the fact that we have nukes means we don't need a very big force at all. Just keep our nukes on alert for anyone who dares to attack us or NATO.

 

[Hoosierhawkeye]

Building things that look nice > building brutalist junk like we did in times past.

A hospital should be nice. If you’re there, it isn’t for a good reason, and being in a nice comfortable setting puts you in a much better mental state, so you can focus on the matter at hand.

There is also the psychological fact that people are going to inherently trust a hospital that looks nicer architecturally.

 

[IIowaFarmBoy]

And maybe if the US pulled back from providing Germany with military protection the Germans would need to allocate their own taxpayer dollars to their own defense and their healthcare system might look more like ours?

No, its about lobby in US.

 

[onlyTheObvious]

Building things that look nice > building brutalist junk like we did in times past.

A hospital should be nice. If you’re there, it isn’t for a good reason, and being in a nice comfortable setting puts you in a much better mental state, so you can focus on the matter at hand.

Curved glass? And the piping issues in the Children’s hospital shows the line has been crossed by a mile. Millions and millions and millions wasted on complexities, legal fees, and repairs.

Maybe AI can create drawings that loo impressive with cost savings. Doesn’t have to be “either or” type of thing.

 

[IIowaFarmBoy]

There is also the psychological fact that people are going to inherently trust a hospital that looks nicer architecturally.

While they feed trash for patient meals.

 

[Dr. Phil Seuss]

Curved glass? And the piping issues in the Children’s hospital shows the line has been crossed by a mile. Millions and millions and millions wasted on complexities, legal fees, and repairs.

Nothing in the developed world is built without significant waste; anywhere, ever.

 

[RagnarLothbrok]

Look at Germany's system, it would be the easiest thing to transition to from where we are at, has universal coverage and has more capacity per capita than our system.

It's not single payer healthcare but it is universal healthcare.

But even single payer healthcare, even the UK's system where the government owns all of the hospitals and clinics would be superior to our own. Only the very wealthy in these countries want our system.

I agree. It’s a crummy system and frankly highway robbery.

 

[Hoosierhawkeye]

Curved glass? And the piping issues in the Children’s hospital shows the line has been crossed by a mile. Millions and millions and millions wasted on complexities, legal fees, and repairs.

Maybe AI can create drawings that loo impressive with cost savings. Doesn’t have to be “either or” type of thing.

AI is not ready for primetime. Not by a long shot.

 

[IIowaFarmBoy]

MY wife took a clinic job where the covered mold smells with glade type products which are harmful.

Thats how the system works. Deal with symptoms and ignore the xauses

 

[franklinman]

Now the pricks are using A1, which is garbage to deny coverage for many policy holders. Sorry but i can't feel sorry for anything that happens to any insurance company. I think this shooter has opened up a huge can of worms, er snakes.

 

[ft254]

What do you think should be done? I agree private insurance is a scam. So, what’s the solution? Instead of allowing private insurance companies to rake in billions, should we all just be taxed more so government can run healthcare without the profit motive? Is that the solution to you?

I pay $148.53 a month for my private insurance as a government employee. That adds up to almost $2,000/year. If the government eliminated the need for private insurance and raised my taxes $2,000 a year, I would be fine with it. Frankly, we are already paying more in taxes because of Obamacare, Medicaid, etc. Unless something has changed that I am unaware of, people on Medicaid pay nothing—meaning nothing for insurance, nothing for prescriptions, nothing for medical care, literally nothing. That’s Bernie Sanders socialism—free shit that ain’t free.

So, since we already half-ass have socialism for healthcare, should we just go all the way and tax everyone for government-run healthcare? I’m asking for opinions. To me, since several million people are on Medicaid paying nothing, why not have those people have a little skin in the game and pay a little more in taxes? I think most of us agree that the United States has the best healthcare providers in the world but the must inefficient and dumbest way of paying for it.

So, again, what’s the solution?

The medical profession/industry seems totally out of whack. Extravagant facilities, monumental fees and compensation.

Of course, compensation is commensurate with the difficulty in attaining expertise, and the ongoing cost and the expenses of R&D to develop new techniques, procedures and processes. Much of this new design and development has come through and from our systems, thus financed as such.

Health care costs money. It is not sane or reasonable to expect an individual to cover the cost of his/her health care when the public can contribute. The United States is the only industrialized country free market country without universal health care. The wealthiest country in the world. The greediest country in the world.

 

[IIowaFarmBoy]

I don’t think it’s so much that as it is a recognition that modern medicine is generally a good thing despite its flaws. On top of that, its a vast improvement from severely limited knowledge of medicine compounded by ridiculous superstitions of the past in which people viewed sickness and disease as punishment from god.

Praying disease away is about as effective as praying the gay away. At some point, regardless of how vigorously con artists like Kenneth Copeland “execute judgment on COVID-19,” people need to wake up and realize science, despite its flaws and constant evolution, is not a conspiracy and a pretty good alternative to fairytales and fables.

Maybe that’s just me.

I agree but what kind of a system uses closed vents for covid or a treatment known to damage kidneys?

 

[goldmom]

Look at Germany's system, it would be the easiest thing to transition to from where we are at, has universal coverage and has more capacity per capita than our system.

It's not single payer healthcare but it is universal healthcare.

But even single payer healthcare, even the UK's system where the government owns all of the hospitals and clinics would be superior to our own. Only the very wealthy in these countries want our system.

Germany can afford the best healthcare. After all they don’t have to allocate monies to defense in their budget, since WE provide the vast majority of it for them. Maybe we finally start pulling back some of those freebies and see how the Germans deal with picking up that gap?
It’s only been 80 years…

 

[Dr. Phil Seuss]

Well, we did ask them to lay down arms and let us play goalie for them.

 

[hawkedoff]

Germany can afford the best healthcare. After all they don’t have to allocate monies to defense in their budget, since WE provide the vast majority of it for them. Maybe we finally start pulling back some of those freebies and see how the Germans deal with picking up that gap?
It’s only been 80 years…

They also rely 9n Americans to fund the vast majority of research. All these foreign systems negotiate the rates in things like drugs which is a polite way of saying the Americans will make up the costs. We fund the workds healthcare

 

[pjhawk]

Germany can afford the best healthcare. After all they don’t have to allocate monies to defense in their budget, since WE provide the vast majority of it for them. Maybe we finally start pulling back some of those freebies and see how the Germans deal with picking up that gap?
It’s only been 80 years…

You think the Germans pay more per capita when it comes to health care than the United States?

Just how ridiculously uninformed are you?

We have the worst of all possible worlds when it comes to health care. We pay by far the most comparative to the rest of the 1st world and get much worse results.

 

[93hawkeye]

Plenty of blame to go 'round, but lobbying Congress by all the special interest players in the system is screwing us.

 

[Sharky1203]

What do you think should be done? I agree private insurance is a scam. So, what’s the solution? Instead of allowing private insurance companies to rake in billions, should we all just be taxed more so government can run healthcare without the profit motive? Is that the solution to you?

I pay $148.53 a month for my private insurance as a government employee. That adds up to almost $2,000/year. If the government eliminated the need for private insurance and raised my taxes $2,000 a year, I would be fine with it. Frankly, we are already paying more in taxes because of Obamacare, Medicaid, etc. Unless something has changed that I am unaware of, people on Medicaid pay nothing—meaning nothing for insurance, nothing for prescriptions, nothing for medical care, literally nothing. That’s Bernie Sanders socialism—free shit that ain’t free.

So, since we already half-ass have socialism for healthcare, should we just go all the way and tax everyone for government-run healthcare? I’m asking for opinions. To me, since several million people are on Medicaid paying nothing, why not have those people have a little skin in the game and pay a little more in taxes? I think most of us agree that the United States has the best healthcare providers in the world but the must inefficient and dumbest way of paying for it.

So, again, what’s the solution?

IMO, I don't want the Gov. anywhere near my medical anything.

With that being said, it seems everyone involved has their hand in the cookie jar grabbing money. Dr. offices overcharge everything. Why should I get charged for a pack of gauzes when they use 1 or 2 (example). Insurance doesn't have competition. We are stuck with just a few so they can charge and do whatever they want. The Gov puts way too much red tape in the way. We need to address all three of these in order to make this work.

 

[hawkedoff]

You think the Germans pay more per capita when it comes to health care than the United States?

Just how ridiculously uninformed are you?

We have the worst of all possible worlds when it comes to health care. We pay by far the most comparative to the rest of the 1st world and get much worse results.

Moron. America subsidized the German system and every other system like it in the world.

 

[pjhawk]

Moron. America subsidized the German system and every other system like it in the world.

LOL's. You think that we pay far more per capita when it comes to health care than the Germans because of American subsidies to the "German system"? You're hopeless.

 

[pjhawk]

IMO, I don't want the Gov. anywhere near my medical anything.

OMFG how comprehensively stupid are these people?