906
$25 million UnitedHealth CEO whines about social media trashing his industry
(www.thedailybeast.com)
this post was submitted on 08 Dec 2024
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The doctor thinks its necessary. Claims handler and insurance company suddenly become medical professionals and give a second opinion of “its not necessary”.
Why even bother with the doctor? Just ask the insurance company instead.
Whats funny too - whenever the alternative is brought up (socialised healthcare), at least the conservative side of america starts seething over it, falling over themselves defending private insurance companies
100% this. If they know what's best for us they should open a hospital.
Do the people making these refusals have medical degrees? Those people without medical degrees actually think they know better than a doctor?
"Necessary" is a really telling word there. Is it necessary that I have pain meds? No. It's possible to go through my life in pain. It would fucking suck, but those pain meds aren't strictly necessary. Just fuck anybody and any corporation who would want you to go through life in pain.
Same with teeth.
Sure, I can live without them but everything becomes harder and worse and there's an awful period where you could probably die from the infections as many people used to.
But those are luxury bones covered by other, separate insurance, as though it is not related to my health.
100%. The majority of my health concerns at the moment are my teeth, and because dental is separate, I’m spending a lot more out of pocket because the maximum coverage is so much lower.
It's also a fucking rip off. I supposedly have "good" insurance options and the premiums for a family of 3 are almost $1k a year, only cover up to $2k yearly of work, and requires 40 - 65% coinsurance depending on the type of work.
So if I spend less than $2k on dental work, I lose money buying dental. The max benefit I get is from $4k of dental, and any work beyond that just makes the situation even less attractive.
Every dental plan I've ever had (and they are considered good) was just my money pretax. No actual insurance. So, use it or lose it. I've already paid for it.
And eyes. If eyes aren't necessary they should prove it by gouging out their own.
Dentist stuff being covered separately is more due to a historical division between MDs and dds that is unrelated to profit motive per se.
I mean those do exist, see Kaiser Permanente. Even they have a much lower denial rate than United.
I know! Kaiser is my favorite, but they have a very limited coverage area and a few years ago I moved outside of it.
Isn't that a closed ecosystem though?
It is, though rarely they'll reimburse you for out of network stuff as well. I got a COVID vaccine from rite aid and because Kaiser wasn't fully stocking it at the time they reimbursed me.
They also only provide coverage in certain regions, so if you're completely out of their regions and network they reimburse there too. They do this through a "travel card".
Part of it might be trying to guard against upselling.
We had two kids. One at a corporate hospital that specializes in pre- and post-natal care, and another at a non-profit independent hospital.
In retrospect, the first kid felt an awful lot like buying a car. Or getting married. Literally felt like they were trying to tack on all the things. "Oh you need to take first aid and CPR classes, they are covered by your insurance if you're pregnant". "Oh you should take this breastfeeding class". "Have you seen our Alternative Birthing Center?". "Babies looking a little big. Let's schedule extra ultrasounds to track it". Followed by scaring us into a planned c-section.
Kids first night he's got a little wheeze. Head nurse during the day knew her shit, she said it was fine and noted it in the chart. Night nurse ain't having that. Sent him right down to the NICU. Spent the night. Nothing wrong with him, he just didn't really cry a lot so he never got to get all the fluid out of his lungs.
And then the bottle shaming after the fact. La leche League, et al....all a bunch of titnazis. But lactation counseling is covered by insurance. So...
Second kid, hospital looked and felt a lot more rundown, but the kid was even bigger, and they were less concerned about his size and even encouraged my wife when she said she wanted a VBAC. Staff was way more personal. Totally different experience.
I partway expect to start getting calls about my first kids extended warranty soon.
My sleep doctor has talked about going to appeal hearings for medicine with insurance companies, and talked about how they brought doctors, but not sleep doctors. So, when the arbitrator or whatever asked a question about sleep practices or medicine to the insurance doctor, they would defer the question to her because they didn’t know the answer.
But Obama and FEMA are running the death panels.
Just being Devil's Advocate here: Medicare fraud is a thing - docs who prescribe, or claim to have performed, unnecessary treatments, which may be as much as $60B (out of $900B spending, so...7-ish%). Maybe not enough to justify UHC's 32% denial rate. And nobody seems to source their $60B or $100B fraud estimates - I can only find case evidence for a few hundred million, and those are cases spanning years.
That's not a reason to deny claims for cancer treatment. If fraud is their worry, have a fraud team to investigate, don't cut off coverage when your life saving operation runs an hour past the allotted time.
Sounds like it would be easier to have a single government entity focused on fraud and Healthcare outcomes though.
The main arguement for private health insurance is that it will help better optimize how healthcare is distributed, but in a capatilistic society it seems unlikely we'd get anything other than means based optimization. However, Healthcare shouldn't be optimized for financial status, but most likely should be optimized for optimal coverage.