UnitedHealth Group CEO Andrew Witty said in a leaked internal video that the insurance company plays an important role in guarding against "unnecessary" and "unsafe" care.
Yeah, "unnecessary" is the health insurance code word for "we can get away with not paying for it". Because it's executives and lawyers and not doctors that determine if something is "unnecessary". Sure they have doctors as scape goats, but they have specific instructions not written by medical professionals that they are required to follow. Unnecessary doesn't mean it won't save a person's suffering or life, it means it's more expensive than relieving the persons pain is worth or the person's life is worth (i.e. the likelihood that they would lose a lawsuit for significant damages if they die).
What if we just nationalized the claims process. Imagine that. A single guideline for what was necessary or not. And decided by people who don't profit by denying reasonable claims.
role is a critical role, and we make sure that care is safe, appropriate, and is delivered when people need it.
Pretty sure that is the role of my doctor who is the one actually seeing me and not some shithead two thousand miles away they pay to give a conflicting second opinion.
Look, if they can convict a concentration camp administrator for the people they ordered killed, I can call any insurance executive with decision making power a murderer.
"We guard against the pressures that exist for unsafe care or for unnecessary care to be delivered in a way which makes the whole system too complex and ultimately unsustainable," Witty said.
Frankly it's a miracle that so many countries around the world have functioning healthcare systems at all without these bastions of safety at the helm.
"We guard against the pressures that exist for unsafe care or for unnecessary care to be delivered in a way which makes the whole system too complex and ultimately unsustainable," Witty said.
Fuck you, leech. YOU do not get to decide what is and is not necessary for a patient. The doctor and patient decide.
We should have a law that if an insurance company denies a claim, and upon external appeal it is found to clearly be medically necessary and covered, the insurance company should have to both pay for the procedure AND hand the customer a check equal to the full value of the procedure. Wrongfully deny a claim? Be prepared to pay double.
And this is how you get a completely sociopathic system held up by seemingly "moral" or "good" people.
In a general sense it's hard to argue against unnecessary care. After all it's right in the name. It's unnecessary. And it's hard to argue against managing personnel based on performance. Trying to audit every decision could be time consuming and expensive. Just put in a KPI (Key Performance Indicator) with respect to cost to company. If you approve $X amount of claims and your coworker approved $Y, when they need to downsize or trim the fat, you just look at X and Y and let go the one that approved more claims.
Each step can be kinda argued and supported in a vacuum. And that's where these CEOs wilfully sit. They don't explicit tell employees to deny more claims. They just make it more lucrative at every step to do so.
It's a service for the public interest and should be run by local governments, like roads, parks, libraries, fire departments, etc. The end goal of a service isn't to make money but to be used by the community. This is also why running a country as a business doesn't make sense - countries aren't meant to generate profit. A nation is a safeguard for the people within against the unpredictable reality of everyday living.
This is also why running a country as a business doesn’t make sense - countries aren’t meant to generate profit.
Yes and no. Not profit, but surplus. Profit is something that is extracted- a surplus is available to be reinvested and improve the quality and quantity of services. Running a country like a "business" makes sense insofar as focus should be made on using generated surpluses to improve citizen's lives. But we of course know thats not their target with said surpluses.
I learned this random factoid a while back while looking into some medical claims with UHC from an insurance contract manager as a random example of how the industry sucks. Apparently ultrasounds can be used in place of mammograms for women so they don't have to have a titsquish and are just as effective at detecting cancer. Unfortunately, insurance only pays for the titsquish.
I had my prostate imaged with an ultrasound while traveling abroad. I went for a full medical check, and I was fully preparing myself for my first butthole-fingering. When they did the ultrasound I was like "holy shit has that been an option all along??"
It's almost like a healthcare system that creates an arms race between health insurance companies denying care vs healthcare providers overcharging leaves us paying huge amounts of $$ while not receiving adequate coverage.
Yeah, they're kind of right that "unnecessary care" happens, but they're conveniently ignoring that they are a large contributor to the problem. Without insurance companies leaving hospitals and patients on the hook for thousands at a time, you might not see $20 bandaids, $2000 ambulance rides, and expensive tests that didn't really need to be done.
And also important is that more people might be inclined to get preemptive care, and physicals/checkups, if it didn't require they jump through so many hoops (or go bankrupt if Dr. finds/treats something).
I'm positive that my co-pay is the actual price or even over the actual price. The insurance company negotiates their own prices and hospitals charge more for out of pocket payers. Insurance just fights you so they never have to pay anything once you have an actual expensive issue.
I'm sure you mean it's unnecessary for the average Joe. But if it were any of his immediate family with the same issue, it would be absolutely necessary.
Yeah not like anthem Blue Cross reversed their decision not to cover anesthesia during surgery because the UHC CEO was killed, they were absolutely going to do that anyway.