Universal health care? I don't want government making my health care decisions! We have for-profit companies for that.
Death panels?
Believe it or not, that's also Frank.
Fun fact, he was named after the health insurance industry’s inspiration, 1789 France.
Frank is a busy man. Denying medical treatments, sitting on death panels. Is there nothing Frank can do?
Oh yeah, Frank can't approve medical treatment.
i have a friend who's a transplant patient and has been taking the same meds for over 10 years post transplant-- every year it's a furious battle with insurance who, every year, decides the meds are no longer "medically necessary" and drops coverage for it. fucking helloooo these are anti-rejection pills, the textbook definition of "medically necessary."
it's not that insurance companies are stupid, it's that they're saving money on people dying when those people don't get what they needed to live.
insurance is the biggest fucking scam of all time
The insurance system does not work in the medical field, it would never work because insurance is for managing risks that are unknown, like a house flooding or your car getting hit in an intersection.
In medical "insurance" it is often dealing with known issues, and the insurance system is just not set up to deal with preventative care, annual check ups, mammograms, blood tests, or pre-existing conditions. It would be like trying to use car insurance to pay for an oil change, which is just as ridiculous as it sounds in your head.
That's exactly why the term "insurance" should be used when discussing a single payer system, it's not really insurance, it should be a collective action group that works together with the medical community to find a middle ground where hospitals can still exist and pay wages to their staff, the people can get the medical care they need without getting thrown into poverty for daring to get sick, and the government benefits from having a healthier population as a whole.
Too bad theres way too much money in the short term in keeping this all private, and having a sicker population, so we have decades of insurance company propaganda to work against, and a huge population of people that don't understand that by doing single payer health care your taxes would go up, but you also wouldn't be paying out the nose for medical insurance & medical care (because they don't cover anything). Also think of a world where your health care isn't beholden to your employment, all the different choices you'd make in your life.
I have a chronic condition that requires expensive medication. Every. Single. Year. I have to fight insurance to renew the prescription. I went without for months the first time and ended up needing a far more expensive surgery to fix the damage it caused. I was already pretty left-leaning before my diagnosis, but now I don’t believe there is any justification for private anything in healthcare. It’s a completely morally bankrupt business to be making money off of people’s unavoidable suffering.
Frank didn't even look at it. He just fed your claim into their computer and it spat out a rejection.
Bold to assume he bothered to feed it to a computer when you can just reject without having to do that. Feeding something to a computer takes time, and time is money y'know.
Frank bought a self-inking stamp that says "REJECTED" and saw a 70% productivity increase.
Everything is filed electronically, having a person step in will always be more work and money dude…
And leaves a nasty paper trail!
I work for a neurologist practice, and the amount I have to argue with insurance (and inevitably have to get the neurologist on the phone to directly request something for many) is insane. A good chunk of my job isn't providing care, but arguing with insurance that the care is necessary. These companies are actively delaying patient care, and try to blame the physician whenever possible.
Wildly infuriating, especially when the denials are worded along the lines of "we reviewed this, and don't consider it medically necessary". Motherfucker, a doctor said it was necessary and listed the clinical reasons why this test or procedure would be beneficial. Nothing has radicalized me for universal healthcare more than working in healthcare.
How is that even legal? How is someone who hasn’t examined the patient and isn’t their physician allowed to make treatment decisions? If they even have the necessary qualifications.
Because of money!
Every time you see something that feels illegal but isn't, or that makes no sense in general, look for the money trail. There's always one, and it always leads to the explanation.
In this case, insurance companies have made such an absolute ass ton of money by killing off their customers that they have become a political entity. They now use their deep pockets to lobby politicians to keep their scam legal.
On the flip side, I can't imagine being the person arguing for the insurance companies makes them a better or happy person in the long term. Being a devil's henchman, over time it must destroy important parts of them like empathy, trust in people, and their basic human decency. Virtues that are needed now more than ever in society.
Well yeah that's why they keep doing it
People love to shit on the VA, because they're the largest American healthcare provider in the country so there's a lot of bad stories
But my last MRI went like this:
Doctor: you need an MRI, let me check if it's open. (Less than a minute on laptop). Ok, go down to room ____ and they can get you in now.
There's a huge up front cost for that machine, so for profit hospitals went everyone to use it to make the money back, and insurance wants no one to use it so they don't have to pay.
Take insurance out of the picture, take the hospital trying to make money out of the picture. And it's really that easy. No one pushes for unnecessary tests, no one tries to prevent necessary tests. And there's a huge push towards preventive medicine, because it's cheaper to catch shit early.
We already pay more than what it would cost, it's just the healthcare industry donates to both parties, so as long as both standards are "at least they're not the other team" shits never going to get fixed.
If we hold higher standards than that, it won't take many election cycles to get change to actually happen
And some doctors themselves will be hesitant to give care that might not be provably required beyond all doubt but is objectively prudent.
Had my buddy over who brought over his incredibly questionable 30yo brother who shared some real incel levels of talk. He used my bathroom and asked if I wore tampons since a pack was visible. Like bro, I have a wife and a daughter.
Anyways, that guy works in health insurance!
I don't know how much decisions he can actually make. But that dude has a middle-school level education about sex ed and struggled to explain what a period is. And he is one of the barriers to approving/rejecting your health care.
“You want me to whip out my dick and slap you with it since that was the stupidest question I’ve heard?”
You should see what @pancakes@sh.itjust.works wrote in this very thread. You basically just answered their question about what this industry must do to a person's ability to empathize and be a decent person to others. Or in this case, maybe lack thereof is a job requirement?
Sometimes the Frank is an AI that is wrong 90% of the time. That's fine, because reasons.
I fucking wish. At least then I wouldn't have to be put on hold for 30 min just to have to eventually explain to a person who was hired 3 weeks ago how to do their job.
Private insurance always has you speak to an actual adjuster for authorization, mainly because they know any sort of automated system would be more accurate and faster than having you talk to their undertrained and understaffed employees.
Private insurance's goal is to erect as many barriers between the provider and the patients as possible, and then blame the provider for all the barriers. It works every time.
"I have the best insurance, they told me it would be covered". Nope, Medicare is the best insurance and you traded that away for a privatized Medicare supplemental that lies to you about your coverage.
Sometimes the Frank is an AI that is wrong 90% of the time. That's fine, because ~~reasons~~ $$$.
Also, there's this common "feature":
Dr: "You need this procedure."
Me: "How much will it cost me?"
Office Manager: "I won't know until I bill your insurance and find out if it is covered."
Me: "What is the cash price I would pay you if it isn't covered by insurance."
Office Manager: "I have no idea."
Actually, since January 2022, you have the right to request a good faith estimate for services from healthcare providers if you're not billing insurance.
I'd like to see a law that says you get a complete and correct bill in 3 months or less as well. I avoid getting healthcare because even though I have insurance, every single time I've gone, the billing gets fucked up and I don't find out about it until 6 months, or even up to 2 years later, and I'm on the hook for that. It ought to be law, that if your office is so fucked up that you can't produce a correct bill for services in 3 months and deliver it to your customer, then you should have to nullify it.
Prior authorization should 100% be outlawed. It's either insurance adjusters practicing medicine without a license, or insurance doctors making diagnoses without examining a patient, both of which are unethical or illegal.
Though I think the real solution is a system where every time a prior authorization denial is overruled by the DOO or a court, the insurance company has to pay punitive damages of at least $200,000 to the patient.
Last time my doctor had to bill my insurance he said he would just run it immediately, because apparently "routine denial" is a thing where they just automatically deny it because if you really need it the doctor will then have his office try again with more justifications. He hated this a lot, because it basically meant he had to just assume first denial for no real reason and then his staff had to take the time to almost always go back and resubmit. He said sometimes he would submit it with the info, it would be denied, and then he would resubmit it two more times and suddenly it would be approved.
Like seriously, what the fuck. But only does that hold up necessary care, it also makes doctors do more bureaucratic work and hire more staff, which, of course, makes medicine more expensive. Brilliant.
The cruelty of the US American for-profit health system is what should be uniting all US Americans in protest, riot, and violent overthrow of the current system.
I love how the insurance company, the party that has no medical expertise whatsoever, gets to unilaterally decide how much that MRI will cost you today.
The sad thing is they do hire some licensed healthcare professionals to fall back on when appealed. They just look for the least compassionate MDs to rubber stamp denials.
The private for profit health insurance industry - because what could make number go up better than a (LEGALLY MANDATED) do nothing middle man who's only purpose is to take your money and ensure as little as possible is spent on healthcare sitting between you and not dying?
American health insurance in a nutshell: https://youtu.be/llx-SaGq4Fs?si=eDIny0fqcGYFkB2a
And before non-Americans ask, yes, that's actually how it is. The humor in this video isn't from exaggeration, the comedy derives from the unexpectedly clear way the absurdity of the system is explained.
And when the patient turned out to be fine after the scan, the insurance company will try to blame that the doctors are lying so that the insurance company has to pay the hospital more It's like they thought that the doctors must be able to see through the patients' body as if they forgot that the reason for these equipments to exist in the first place is that because the doctors can't really be 100% sure about what's actual situation inside human body
There's two sides to this coin. On the one end, you have insurance companies refusing to pay for anything because the modern industry is just six scams in a trench coat.
But on the other, you have doctor's offices where the physician literally leases an MRI machine to the tune of several million dollars and then has to run a certain number of patients through the scanner every year or lose money. That's because the MRI patent is held by GE and they can charge 10-100x markups on hardware that is fundamental to modern medicine.
Its the same with diabetes treatments. Insurance companies will try and refuse service or kick people off their policies if they are at risk. But then pharmacy companies will sell $3 of insulin for $75, then kickback a chunk of the balance to judicial/congressional bribes in order to guarantee the cash flow.
At some level, the only insurance companies that can survive in such a market are the ones that say "No!" to everything. The even-remotely-ethical firms just get fleeced by the for-profit industry until they get bought out or go bankrupt. That, or you're Medicare/Medicaid and you have an infinite wallet backstopped by the US Treasury. You don't care if you're paying multiples of whatever any other clinic anywhere else in the world would charge on an enormous population of poor and elderly patients, because you have an unlimited money cannon to mow it all down with.
Very uninformed take, its almost laughable.
GE isn't the only one who makes MRIs. The other big players are Siemens, Philips, United, and to some extent Canon, Fujifoto, and Hitachi.
No, that's really how much it costs. The margin on MRI machines is terrible. I'd like to see you do it cheaper... "Just" build then supercool magnet for superconduction for 3T of homogenius magnetic field, build coils that handle KW of RF/gradients that can fit a human comfortably without artifacts, build the high power and precision circuitry to transmit and receive said RF, then control that equipment accurately and safely.
Super easy, off-the-shelf stuff.
Oh, and you can't use any ferrous parts, nor can your power supplies generate any noise.
That's like, senior design level stuff amirite
IThey can't even be sure after the MRI. Which again, proves your point. It took one MRI battery and one alert and skilled MRI tech to catch my brain cyst, THEN another whole set, I straight up spend a whole 8hr shift in an MRI machine, Then a TEAM of neurologists studied my custom hand made brain for MONTHS. THEN they had a really good set of educated guesses. Then they did the surgery, and only after they opened up my brain case did the actually see what in the hell was going on. Even after all that, my neurologists was like ''This is what we think is happening'', I asked what it would take to really know factually, he said an autopsy. He didn't recommend it. The point is, Doctors save lives with these scans, and nothing is certain. That's not a barrier to treatment, but no scans Is a barrier to treatment.
I had a friend who needed a CT head, chest and abdomen. The insurance company decided she could have the head and abdomen, but not the chest, and couldn't really explain why when asked. American health care is a joke.
I recently went in because I had a thunderclap headache, thought it was about to die from a brain aneurysm. No insurance. They did 1 CT scan and billed me for a Head CT, Neck CT and a Cervical Spine CT, each costing over $3K. After months of calling their billing department I ended up having to setup a payment plan before they sent it to collections. Not a single person in the billing department, up to and including the head of billing, could tell me the difference between a neck CT and a cervical spine CT. Still on the hook for over $11K. Probably going to have to file for bankruptcy soon. My life is effectively over.
Your life isn't over. Discharge the debt through bankruptcy and move on. I honestly mean no offense, but if you were already uninsured and an 11K debt would effectively end your life, you're not going to be much further back than where you were before bankruptcy. Maybe even a little ahead.
Bankruptcy isn't just for rich people and corporations, although it sure is treated that way sometimes. Do it now, don't keep letting debt holders guilt you into "bootstrapping" it. They're just squeezing as much money out of you as possible while they can.
tl;dr: It doesn't.
Maybe if you can't afford to pay premiums that allow you to have an IRM, just ~~don't indulge in expensive illnesses~~ die already.
My $7000/mo medication has a bunch of "cost relief" programs so they can pretend that they give a shit about affordability, then when you actually try to use them they make you do like 20 phone calls over the span of several months until they finally let you enroll and when you do it only lasts for a short amount of time before they kick you off and you have to start the process all over again. I've had to miss multiple doses of the medication which is dangerous for my physical health because I don't have the money to pay for it and this process takes so fucking long.
Recently, they signed me up for some super shady thing where I pay for the medication upfront and then they pay me back after showing me the receipt. What they didn't tell me is that it has a limit for how much it will pay for, so I pay for the medication, and what a surprise, they rejected my claim and now I lost $5000 to the medication, which could have paid for a car or a semester of community college. Our healthcare system does a great job at making dying sound like a decent alternative to healthcare.
Yes I would like to change this, too. Who do I vote for to make this happen? Just kidding I don't have access to $10B of "free speech."
Had surgery to correct an underbite a few years ago after prepping for it with braces for years. For context, I was still young enough to be on my parents' insurance. The surgery involved moving my upper jaw forward and my lower jaw back because the underbite was so severe. The insurance denied the claim. My parents (I love them so much for this) decided beforehand that, if the claim and the appeal were denied, they would instead "gift" me the money out of their own retirement savings and have me pay for it. The procedure alone cost, I believe, $16k out of pocket. (I don't remember the specific reason why they gifted me the money instead of paying for it outright.)
Sure we could save lives by listening to doctors! But who will save our dollars, huh? The REAL value!
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