Another tragedy in medical care

[imported_Shivetya]

Jennifer Bell, 22, had been told she was suffering from stress but after months of illness had finally been referred to a neurologist. She then faced a 13-week wait before a 'relatively urgent' MRI scan could be carried out.

13 weeks for a MRI.

Why? Because its RATIONED.

Like about any other high tech treatment your private insurance in the US pays for and yet people bitch about the costs. Sorry, you have a choice, pay for access to high tech when you need it or go through government bureacracy that could care less.

 

[ayabe]

Compare this to the thousands or perhaps millions of people in this country who go bankrupt or forgo food to buy medicine.

FYI insurance companies deny claims for life and death procedures all the time.

 

[dmcowen674]

Originally posted by: Shivetya
Topic Title: Another tragedy in medical care
Topic Summary: brought to you by socialized medicine...

You should be thrilled, you guys are always saying how you don't like the sick and old.

 

[senseamp]

You don't think this happens in America? I know I waited 2 months for BCBS to approve my CT. First they declined it 2 times, then they changed their mind and decided to "certify it." Of course later they also dragged out the payment for months too.

BTW, her case is an issue of an initial misdiagnosis and the doctor putting incorrect/confusing priority on her MRI. A failure in the system. Denials of needed care in the US are not considered a failure in the system but are there by design. There is no other reason why a BCBS "doctor" who has never seen me would be allowed to overrule a university hospital professor specialist who was treating me and ordered a CT.

 

[Hacp]

Wait, so the doctor misdiagnosed her? The illness is rare, there are plenty of doctors who misdiagnose their patients.

 

[Moonbeam]

And of course with the billions we would save in private insurance costs and paying fat fees for the owners of for profit hospitals we could put an MRI unit in every garage.

 

[alchemize]

Originally posted by: ayabe
Compare this to the thousands or perhaps millions of people in this country who go bankrupt or forgo food to buy medicine.

FYI insurance companies deny claims for life and death procedures all the time.

:roll: I've been in in the insurance industry for over 10 years now and never once seen or heard of a single "life or death procedure" denied. This might have happened in the unregulated insurance markets of the 80's and 90's, but it just doesn't happen anymore. Your comment is completely untrue and I'd like to see you back it up with anything beyond a "Michael Moore anecdote".

 

[kedlav]

Originally posted by: Shivetya
Jennifer Bell, 22, had been told she was suffering from stress but after months of illness had finally been referred to a neurologist. She then faced a 13-week wait before a 'relatively urgent' MRI scan could be carried out.

13 weeks for a MRI.

Why? Because its RATIONED.

Like about any other high tech treatment your private insurance in the US pays for and yet people bitch about the costs. Sorry, you have a choice, pay for access to high tech when you need it or go through government bureacracy that could care less.

Woman dumped on Skid Row because she doesn't have the money to pay for treatment. The simple facts are any system will not help everyone and people will fall through the cracks. The debate is whether more people will be helped by which system, and the bottom line is, more people get screwed by HMO's than by socialized medicine. Grabbing extreme cases and citing them as examples of systematic failures is sheer idiocy!

 

[senseamp]

Originally posted by: alchemize

Originally posted by: ayabe
Compare this to the thousands or perhaps millions of people in this country who go bankrupt or forgo food to buy medicine.

FYI insurance companies deny claims for life and death procedures all the time.

:roll: I've been in in the insurance industry for over 10 years now and never once seen or heard of a single "life or death procedure" denied. This might have happened in the unregulated insurance markets of the 80's and 90's, but it just doesn't happen anymore. Your comment is completely untrue and I'd like to see you back it up with anything beyond a "Michael Moore anecdote".

You've never seen a life or death procedure denied? Doesn't mean it hasn't happened. Did you follow up with all the denials to make sure they didn't die from something that could have been detected by a test that was denied? Do you believe an insurance company "doctor" who has never seen the patient and has a vested interest to deny claims is a better judge of what is "life and death" procedure than the doctor ordering it?

 

[alchemize]

Originally posted by: senseamp

Originally posted by: alchemize

Originally posted by: ayabe
Compare this to the thousands or perhaps millions of people in this country who go bankrupt or forgo food to buy medicine.

FYI insurance companies deny claims for life and death procedures all the time.

:roll: I've been in in the insurance industry for over 10 years now and never once seen or heard of a single "life or death procedure" denied. This might have happened in the unregulated insurance markets of the 80's and 90's, but it just doesn't happen anymore. Your comment is completely untrue and I'd like to see you back it up with anything beyond a "Michael Moore anecdote".

You've never seen a life or death procedure denied? Doesn't mean it hasn't happened. Did you follow up with all the denials to make sure they didn't die from something that could have been detected by a test that was denied? Do you believe an insurance company "doctor" who has never seen the patient and has a vested interest to deny claims is a better judge of what is "life and death" procedure than the doctor ordering it?

Well, since I've been privy to literally millions of processed claims, as well as seen the appeals results, YES is the answer. I have never seen a legitimate life or death procedure denied, not once. Your turn - produce a study or some good examples.

As far as your second question, many times yes. Utilization management is what managed care is all about. It's quite shocking the degree that doctors will go to to often times outright defraud insurance companies. And if you think "so what, the insurance companies are making oodles of money", well over-utilization is a primary factor in what drives higher health insurance premiums/higher healthcare costs.

Socialized medicine is basically a giant HMO run by the government.

 

[senseamp]

Originally posted by: alchemize

Originally posted by: senseamp

Originally posted by: alchemize

Originally posted by: ayabe
Compare this to the thousands or perhaps millions of people in this country who go bankrupt or forgo food to buy medicine.

FYI insurance companies deny claims for life and death procedures all the time.

:roll: I've been in in the insurance industry for over 10 years now and never once seen or heard of a single "life or death procedure" denied. This might have happened in the unregulated insurance markets of the 80's and 90's, but it just doesn't happen anymore. Your comment is completely untrue and I'd like to see you back it up with anything beyond a "Michael Moore anecdote".

You've never seen a life or death procedure denied? Doesn't mean it hasn't happened. Did you follow up with all the denials to make sure they didn't die from something that could have been detected by a test that was denied? Do you believe an insurance company "doctor" who has never seen the patient and has a vested interest to deny claims is a better judge of what is "life and death" procedure than the doctor ordering it?

Well, since I've been privy to literally millions of processed claims, as well as seen the appeals results, YES is the answer. I have never seen a legitimate life or death procedure denied, not once. Your turn - produce a study or some good examples.

As far as your second question, many times yes. Utilization management is what managed care is all about. It's quite shocking the degree that doctors will go to to often times outright defraud insurance companies. And if you think "so what, the insurance companies are making oodles of money", well over-utilization is a primary factor in what drives higher health insurance premiums/higher healthcare costs.

Socialized medicine is basically a giant HMO run by the government.

You have seen the appeals results, not the medical outcomes of those appeal results. Just because the denial was upheld on appeal (by the insurance company themselves) doesn't mean it did not have negative impact on care. If you are claiming that these insurance company "doctors" who review claims are perfect, and never make a bad call on a life and death claim, then maybe we should all just get treated by mail. Hell, if out of millions of cases, they don't get one wrong, then why waste time actually seeing a doctor? Insurance company's job is to pay for claims, not determine what care is necessary and what isn't. That's the treating doctor's job.

 

[ayabe]

Originally posted by: alchemize

Originally posted by: ayabe
Compare this to the thousands or perhaps millions of people in this country who go bankrupt or forgo food to buy medicine.

FYI insurance companies deny claims for life and death procedures all the time.

:roll: I've been in in the insurance industry for over 10 years now and never once seen or heard of a single "life or death procedure" denied. This might have happened in the unregulated insurance markets of the 80's and 90's, but it just doesn't happen anymore. Your comment is completely untrue and I'd like to see you back it up with anything beyond a "Michael Moore anecdote".

YouTube

Its a Michael Moore clip from The Awful Truth, not sure if this was the anecdote you seem to dismiss as fiction. It's amazing that someone who works in the industry like yourself seems to deny that you're in the business to make money. You are always looking to deny claims because that's how you make your money.

This isn't an isolated incident and is inexcusable.

 

[alchemize]

Originally posted by: senseamp

Originally posted by: alchemize

Originally posted by: senseamp

Originally posted by: alchemize

Originally posted by: ayabe
Compare this to the thousands or perhaps millions of people in this country who go bankrupt or forgo food to buy medicine.

FYI insurance companies deny claims for life and death procedures all the time.

:roll: I've been in in the insurance industry for over 10 years now and never once seen or heard of a single "life or death procedure" denied. This might have happened in the unregulated insurance markets of the 80's and 90's, but it just doesn't happen anymore. Your comment is completely untrue and I'd like to see you back it up with anything beyond a "Michael Moore anecdote".

You've never seen a life or death procedure denied? Doesn't mean it hasn't happened. Did you follow up with all the denials to make sure they didn't die from something that could have been detected by a test that was denied? Do you believe an insurance company "doctor" who has never seen the patient and has a vested interest to deny claims is a better judge of what is "life and death" procedure than the doctor ordering it?

Well, since I've been privy to literally millions of processed claims, as well as seen the appeals results, YES is the answer. I have never seen a legitimate life or death procedure denied, not once. Your turn - produce a study or some good examples.

As far as your second question, many times yes. Utilization management is what managed care is all about. It's quite shocking the degree that doctors will go to to often times outright defraud insurance companies. And if you think "so what, the insurance companies are making oodles of money", well over-utilization is a primary factor in what drives higher health insurance premiums/higher healthcare costs.

Socialized medicine is basically a giant HMO run by the government.

You have seen the appeals results, not the medical outcomes of those appeal results. Just because the denial was upheld on appeal (by the insurance company themselves) doesn't mean it did not have negative impact on care. If you are claiming that these insurance company "doctors" who review claims are perfect, and never make a bad call on a life and death claim, then maybe we should all just get treated by mail. Hell, if out of millions of cases, they don't get one wrong, then why waste time actually seeing a doctor? Insurance company's job is to pay for claims, not determine what care is necessary and what isn't. That's the treating doctor's job.

Do you always just blab on about whatever your feelings are on a subject you obviously know nothing about?

If you want a pure indemnity program, feel free to enroll in one allows that. There are still some out there (though very rare). Be prepared to pay substantially higher insurance premiums.

As for most other employee funded and ALL government funded insurance programs, good luck with that. You will be under some form of managed care.

 

[Hacp]

So the US is ranked just above cuba in health care. We need to tar and feather all the greedy insurance companies.

 

[alchemize]

Did summer school get out early today? Is the short bus broken down?

Originally posted by: alchemize
Your comment is completely untrue and I'd like to see you back it up with anything beyond a "Michael Moore anecdote".

Originally posted by: ayabe


Its a Michael Moore clip from The Awful Truth

 

[alchemize]

Just as a personal exercise, I decided to see what percentage insurance company profit represented of total healthcare spending. Based on that, if we recouped all of that money, how much could we save on healthcare.

I took the top 6 payers in the US and took their 2006 net income (in millions):

United 4159
WellPoint 3094
Aetna 1701
Cigna 1155
Coventry 560
Hum 487
Total 11156


So let's assume they dominate 1/2 the healthcare insurance market (it's probably much higher, but let's be conservative). So I roughly doubled the number - call it 20 $billion.

2005 Healthcare costs were estimated to be roughly $2 trillion. Probably low for 2006, but again being conservative.

That gives us a whopping 1.12% decrease in expenses.

 

[alchemize]

And for the record, before all you trolls want to start accusing me of this and that, I personally support some very serious healthcare/managed care reform in the US. Personally I think some combination of public and private insurance should be made available to all (need-based) US Citizens. Medicare is a reasonably effective program when the idiots in Washington aren't jacking around with handouts. We need to stop using the emergency room to treat the flu. We need to dramatically change sedentary obese lifestyles. We need to have an effective strategy to deal with over-utilization and an increasingly aging population. And I think the government has to be involved with it, but also private industry. We need to find the strengths of all our systems and use those strengths to get ahead of the problem before we are buried by these costs.

 

[senseamp]

Originally posted by: alchemize

Originally posted by: senseamp

Originally posted by: alchemize

Originally posted by: senseamp

Originally posted by: alchemize

Originally posted by: ayabe
Compare this to the thousands or perhaps millions of people in this country who go bankrupt or forgo food to buy medicine.

FYI insurance companies deny claims for life and death procedures all the time.

:roll: I've been in in the insurance industry for over 10 years now and never once seen or heard of a single "life or death procedure" denied. This might have happened in the unregulated insurance markets of the 80's and 90's, but it just doesn't happen anymore. Your comment is completely untrue and I'd like to see you back it up with anything beyond a "Michael Moore anecdote".

You've never seen a life or death procedure denied? Doesn't mean it hasn't happened. Did you follow up with all the denials to make sure they didn't die from something that could have been detected by a test that was denied? Do you believe an insurance company "doctor" who has never seen the patient and has a vested interest to deny claims is a better judge of what is "life and death" procedure than the doctor ordering it?

Well, since I've been privy to literally millions of processed claims, as well as seen the appeals results, YES is the answer. I have never seen a legitimate life or death procedure denied, not once. Your turn - produce a study or some good examples.

As far as your second question, many times yes. Utilization management is what managed care is all about. It's quite shocking the degree that doctors will go to to often times outright defraud insurance companies. And if you think "so what, the insurance companies are making oodles of money", well over-utilization is a primary factor in what drives higher health insurance premiums/higher healthcare costs.

Socialized medicine is basically a giant HMO run by the government.

You have seen the appeals results, not the medical outcomes of those appeal results. Just because the denial was upheld on appeal (by the insurance company themselves) doesn't mean it did not have negative impact on care. If you are claiming that these insurance company "doctors" who review claims are perfect, and never make a bad call on a life and death claim, then maybe we should all just get treated by mail. Hell, if out of millions of cases, they don't get one wrong, then why waste time actually seeing a doctor? Insurance company's job is to pay for claims, not determine what care is necessary and what isn't. That's the treating doctor's job.

Do you always just blab on about whatever your feelings are on a subject you obviously know nothing about?

If you want a pure indemnity program, feel free to enroll in one allows that. There are still some out there (though very rare). Be prepared to pay substantially higher insurance premiums.

As for most other employee funded and ALL government funded insurance programs, good luck with that. You will be under some form of managed care.

You work for the health insurance industry, so your obvious bias doesn't surprise me. And yes, I think we need to get rid of the health insurance industry in its entirety. Why do we need a system like that? You already admitted it's still managed care, just like socialized medicine. Except socialized medicine will pay for preexisting conditions and cover everyone, not pretend that health is just another kind of financial asset where a total loss is a perfectly acceptable outcome if the client cannot afford to insure it, which is what the insurance industry is by definition. I don't blame the insurers for acting the way they do, I blame us and the government for allowing them to take control of our health care.

 

[alchemize]

Please re-read my last post.
I do agree, "bankruptcy via illness" is unacceptable. I do agree, everyone should have access to needs-based medical coverage (as a safety net, and with limitations). But where I disagree is that government is the best administrator. Medicare is what everyone points to as a successful socialized system. But most of Medicare administration is "outsourced" and that's where it is successfully administered at a low cost. Why do we need private health insurance industry? Simple - it's the most effective and efficient way of managing healthcare costs. Government should dictate the strategy, the regulations and laws, and let private industry do what it does best - compete.

Frankly my bias isn't because of any fear of losing my job, and I don't own any stock or options. With socialized medicine I'd be in even higher demand than I am now. My bias is because I work inside the belly of the beast, and I work with the government, and I see what the reality is.

 

[fskimospy]

Originally posted by: alchemize
Just as a personal exercise, I decided to see what percentage insurance company profit represented of total healthcare spending. Based on that, if we recouped all of that money, how much could we save on healthcare.

I took the top 6 payers in the US and took their 2006 net income (in millions):

United 4159
WellPoint 3094
Aetna 1701
Cigna 1155
Coventry 560
Hum 487
Total 11156


So let's assume they dominate 1/2 the healthcare insurance market (it's probably much higher, but let's be conservative). So I roughly doubled the number - call it 20 $billion.

2005 Healthcare costs were estimated to be roughly $2 trillion. Probably low for 2006, but again being conservative.

That gives us a whopping 1.12% decrease in expenses.

They are also spectacularly inefficient. Their overhead costs are huge compared to socialized systems, I think it was somewhere over 25% which is nearly twice what people pay in other systems... and THAT is a lot of money.

 

[alchemize]

Originally posted by: eskimospy

Originally posted by: alchemize
Just as a personal exercise, I decided to see what percentage insurance company profit represented of total healthcare spending. Based on that, if we recouped all of that money, how much could we save on healthcare.

I took the top 6 payers in the US and took their 2006 net income (in millions):

United 4159
WellPoint 3094
Aetna 1701
Cigna 1155
Coventry 560
Hum 487
Total 11156


So let's assume they dominate 1/2 the healthcare insurance market (it's probably much higher, but let's be conservative). So I roughly doubled the number - call it 20 $billion.

2005 Healthcare costs were estimated to be roughly $2 trillion. Probably low for 2006, but again being conservative.

That gives us a whopping 1.12% decrease in expenses.

They are also spectacularly inefficient. Their overhead costs are huge compared to socialized systems, I think it was somewhere over 25% which is nearly twice what people pay in other systems... and THAT is a lot of money.

So post a reputable link...because frankly that doesn't pass the smell test. These are companies competing against each other, and more overhead means loss of competitive advantage (and loss of profit, lower stock price, go out of business). The only example I've ever seen posted was Medicare, and of course Medicare outsources it's administration to - you guessed it - health insurance companies!

 

[senseamp]

How can you claim with the straight face that the insurance industry is "the most effective and efficient way of managing healthcare costs." Our healthcare costs have escalated out of control since we turned our healthcare over to the HMOs. We are spending way more than any other country on healthcare while achieving completely mediocre results. A large percentage of our population treating flu and cold in the emergency room, because the current system refuses to pay for care that is not an emergency, is an indicator of the most efficient way of managing healthcare costs? The patients that the insurance industry wants to cover are those who wouldn't cost the government much to insure anyways. Young and healthy with no preexisting conditions. The health insurance industry still leaves the big problems to the government, and in many ways politically it stands in the way of the government providing care because then it would have to compete with the government and lose most of its business. So basically what they are doing is not covering a huge group of people, and also doing everything they can to prevent the government from creating programs to cover them because their more profitable subscribers would also take advantage of these programs and dump the HMO.

 

[alchemize]

Originally posted by: senseamp
How can you claim with the straight face that the insurance industry is "the most effective and efficient way of managing healthcare costs." Our healthcare costs have escalated out of control since we turned our healthcare over to the HMOs. We are spending way more than any other country on healthcare while achieving completely mediocre results. A large percentage of our population treating flu and cold in the emergency room, because the current system refuses to pay for care that is not an emergency, is an indicator of the most efficient way of managing healthcare costs? The patients that the insurance industry wants to cover are those who wouldn't cost the government much to insure anyways. Young and healthy with no preexisting conditions. The health insurance industry still leaves the big problems to the government, and in many ways politically it stands in the way of the government providing care because then it would have to compete with the government and lose most of its business. So basically what they are doing is not covering a huge group of people, and also doing everything they can to prevent the government from creating programs to cover them because their more profitable subscribers would also take advantage of these programs and dump the HMO.

Correlation does not equal causation.

We're spending more on healthcare because of the following factors (in roughly descending order):
- An increasingly overweight, unhealthy, and aging population
- Over-utilization of increasingly expensive technologies and over-utilization of healthcare in general
- Over reliance on treatment instead of preventative medicine (lump that with prescriptions)
- Greatly increased immigrant population
- Lawsuits


If you are interested in a good read about a private/public combination, read about France:
http://www.pubmedcentral.nih.g...der.fcgi?artid=1447687

It's funny that Michael Moore never mentions that France has private insurers as an integral part of their system

And I promise you - no private business is afraid of competing with the government on a level playing field

 

[senseamp]

Originally posted by: alchemize

Originally posted by: senseamp
How can you claim with the straight face that the insurance industry is "the most effective and efficient way of managing healthcare costs." Our healthcare costs have escalated out of control since we turned our healthcare over to the HMOs. We are spending way more than any other country on healthcare while achieving completely mediocre results. A large percentage of our population treating flu and cold in the emergency room, because the current system refuses to pay for care that is not an emergency, is an indicator of the most efficient way of managing healthcare costs? The patients that the insurance industry wants to cover are those who wouldn't cost the government much to insure anyways. Young and healthy with no preexisting conditions. The health insurance industry still leaves the big problems to the government, and in many ways politically it stands in the way of the government providing care because then it would have to compete with the government and lose most of its business. So basically what they are doing is not covering a huge group of people, and also doing everything they can to prevent the government from creating programs to cover them because their more profitable subscribers would also take advantage of these programs and dump the HMO.

Correlation does not equal causation.

We're spending more on healthcare because of the following factors (in roughly descending order):
- An increasingly overweight, unhealthy, and aging population
- Over-utilization of increasingly expensive technologies and over-utilization of healthcare in general
- Over reliance on treatment instead of preventative medicine (lump that with prescriptions)
- Greatly increased immigrant population
- Lawsuits


If you are interested in a good read about a private/public combination, read about France:
http://www.pubmedcentral.nih.g...der.fcgi?artid=1447687

It's funny that Michael Moore never mentions that France has private insurers as an integral part of their system

And I promise you - no private business is afraid of competing with the government on a level playing field

Other countries have aging populations too, have a lot of immigrants, and have access to the same fast food that we do, and often times drink and smoke more than we do as well. I don't think our lack of universal healthcare is unrelated to the general unhealthiness of our population. It is no coincidence that the most unhealthy populations are those with the least access to care. Doctors help shape our decision making when it comes to our habits as well. If an uninsured person does not see a doctor until he's really sick, he may often not be aware of how unhealthy his habits are or have any feed back on his decisions. He may say, hey, I am chunky, but I feel fine. What's the big deal? A doctor would be able to tell him his cholesterol or blood pressure or whatever other warning signs there are well before the problem develops.
Plus our reliance on treatment over prevention is by design in the current system. If you are uninsured, there is no coverage except for the most expensive late stage emergency treatment where the hospital is required by law to treat you. Otherwise, no pay, no care.
The end result speaks for itself. The system is the most expensive by far and downright mediocre in the end result. A patchwork of insurance companies and some government programs that we have now is not working efficiently at all, and is certainly not the most efficient way.

 

[OutHouse]

Originally posted by: ayabe

Originally posted by: alchemize

Originally posted by: ayabe
Compare this to the thousands or perhaps millions of people in this country who go bankrupt or forgo food to buy medicine.

FYI insurance companies deny claims for life and death procedures all the time.

:roll: I've been in in the insurance industry for over 10 years now and never once seen or heard of a single "life or death procedure" denied. This might have happened in the unregulated insurance markets of the 80's and 90's, but it just doesn't happen anymore. Your comment is completely untrue and I'd like to see you back it up with anything beyond a "Michael Moore anecdote".

YouTube

Its a Michael Moore clip from The Awful Truth, not sure if this was the anecdote you seem to dismiss as fiction. It's amazing that someone who works in the industry like yourself seems to deny that you're in the business to make money. You are always looking to deny claims because that's how you make your money.

This isn't an isolated incident and is inexcusable.

UnitedHealth, PUT ALLEGRA-D BACK ON THE LIST OF DRUGS YOU COVER!! :|