3w ago

Health Insurers Limit Coverage of Prosthetic Limbs, Questioning Their Medical Necessity

kffhealthnews.org Health Insurers Limit Coverage of Prosthetic Limbs, Questioning Their Medical Necessity - KFF Health News

Advocates say it is discrimination and are arguing for “insurance fairness” on the grounds that people who have joints surgically replaced typically don’t face the same kinds of coverage challenges.

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3w ago

Health Insurers Limit Coverage of Prosthetic Limbs, Questioning Their Medical Necessity

kffhealthnews.org /news/article/prosthetic-limbs-private-insurance-coverage-denials-amputees/

16 1

112 comments

Weird how we have to pay more money every single year, and insurance somehow provides us less and less for our greater and greater spend
- Or, with car insurance, you get punished for actually using the service you pay for.
  
  A service you are legally required to pay for, no less.
- Oh, but ~~if you're rich,~~ we have the best healthcare system in the world! ~~Rich~~ people from all over the globe come to America for medical care!
  
  And ironically, rich Americans travel the globe for the best healthcare.
- It is actually kinda incredible. I remember seeing a comic in Mad Magazine back in the 90s that satirized insurance companies by cutting 'expensive' healthcare and the cartoon showed an emaciated patient on IV and the insurance guy about to cut the tube with scissors.
- They're the ones practicing medicine now

I have a friend who has a prosthetic. Sure they could live their life in a wheelchair. But this guy goes hiking, and acts like a fully capable walking person. The quality of life is huge. It really gives back their life.
- Yep. It’s absolutely insane they wouldn’t cover it.
  It’s honestly unethical as shit.
  
  Unethical and counterproductive. Having a prosthetic limb would almost invariably lead to a less sedentary lifestyle, which is strongly correlated with better health. Paying for a prosthetic today has to be cheaper than paying for a heart attack or diabeties later.
  
  Won't somebody thinking about the profiteers?
  Those guys can go to hell
  
  It's absolutely insane that people should be expected to either buy insurance or pay for medical care out of their own pocket. And the insurance is never enough.
  
  I mean it’s not really. They don’t cover hearing aids or even implant surgery. “Not necessary” is what my sister gets told. Yeah, trying living deaf you asshats!
- They are saying it’s not “medically necessary” to have any quality of life. As long as you’re breathing, you’re A-okay in their book.
  This is what insurance in the US has come to mean.
  
  Like how they still consider dental care to be "cosmetic." They'll rip them out of your head free of charge, but putting new ones in? No sir... You can eat mush!
  But God forbid anyone mentions a solution that includes socialized healthcare...
- From a purely "medical necessity" viewpoint even, having a properly-functioning prosthetic helps him keep the rest of his body healthy! (Although I suppose they'd figure on denying claims for hospital treatment when his unhealthy heart caved in!)
  
  (Although I suppose they'd figure on denying claims for hospital treatment when his unhealthy heart caved in!)
  The long term goal of this type of policy is to not only reduce immediate cost, but to offload the cost of long term care onto a socialized network like social security.
  The majority of amputees are already diabetics, if you remove their ability to remain active and mobile, you substantially increase the chance of renal failure. Patients who require dialysis because of renal failure get enrolled for disability through social security.

Noooo heckin' killing CEOs is violent and bad
Then this fucking headline pops up.
They're basically crippling people, who could have at least some kind of limb use, by denying them limbs that THEY ALREADY PAID FOR AS PART OF INSURANCE PAYMENTS.
- This is exactly the type of shit that radicalizes people into violent action.
  
  It's almost like they're trying to force people to be violent. I don't get it.
  
  Violence is NEVER the answer! Can you imagine how horrible it would be if some degenerate insurance needer walked into a board meeting and pewpew'd all the poor shareholders? Who would make the hard decisions and demands that costs be dramatically cut and value dramatically increased? What if some horrible psychopath threw a maltov into an executive office? Or some villainous cloak and dagger type of scum rigged car bombs in some poor wealthy persons gated drive way? What would we do then! We'd live in terror of extracting value out of a system that is ment to provide service instead of just freely taking that value without consequences! Can't you even image how bad that would be! Think of the CEOs people!
- Maybe you're being a little unreasonable. Have you stopped to think about what the money might want? Maybe your money wants to be with the CEO without partaking in some nasty exchange of goods or services.
  
  The money wants to be with the CEOs and thus have the chance to be spent on private jet rentals and lavish vacations in exotic places with influential people. It wants the chance to be spent on expensive tuition at old-money, name-brand universities and third and fourth homes in the country and on post-apocalypse survival compounds in expensive, English-speaking island nations. If you were a dollar, wouldn't you want this too? Or would you want to spend your days going in and out of tills at Walmart and Dollar General or forked over to some prole delivery driver as a tip, a driver who'll just spend you on fuel or fries at some greasy drive-up. Money wants to be free, free to live the good life, and to live it with the people who care about it more than anything else under the sun.

This just feeds into my disillusionment with science and technology. What is the point of having developed these incredible things to then not go and use them. I just have to spell it out now. What. The. Fuck. You know I was born into a modern age but looks like im going to die in the dark ages.
- In capitalism, EVERYTHING only exists for profit. If there isn't money to be drained, it's tossed to the landfill
  
  Including science.
  We research profitable fields and defund unprofitable ones.
- It’s not a Sci/Tech issue.
  It’s a dystopian capitalism issue. When products that don’t have adequate profit margin and volume to make notable contributions to the bottom line, or worse yet, negativley affect the bottom line in a high per-unit cost, they are a liability. Profits direct research, too, unfortunately.
  Humanity, quality of life, and all that medical shit is secondary or even further down the priority list for the corporations thinking about their profits first and the “service” last.
  
  Capitalism is not the issue in this case. I'm certain that prostetics have adequate profit margins. It's a lucrative business.
  The issue here is that the insurance company just doesn't want to pay for it.
  It's the insurance company that doesn't have an adequate profit margin without screwing their customers over.
- I’m not clear on the issue, in this case, with science and technology. Seems to me to be a problem with societies not caring for all their people.
  
  It has to do with the motivation of folks to expand the limits of science and technology. Many folks who do that stuff genuinely are looking to improve life for all mankind.
  
  Science and technology become magic, accessible only by the Fair Folk while we toil away in the dirt.
  
  That's capitalism

Man, I wish I could serve on that Luigi jury.
- So say we all.

Let’s-a-go! - luigi
- It would be hilarious if this happened again and the guy was called Mario.
  
  Your comment to gods ears!

I wonder if someone cut off the CEO's limbs, would the medical necessity of prosthetic limbs would be questioned?
- You know, maybe we should force healthcare CEOs to be insured with the lowest tier of their own insurance.
  
  Kinda misses the point because they have their own money to pay for whatever treatments they want, even if their company regularly denies them to clients. Buying insurance is gambling against the house, just health insurance has that extra bit where the insurance companies somehow have a say in what treatments they'll cover.
  That's why the rich don't gaf about ruining public services. They can still just hire someone to do it for them and if the government isn't providing the service for everyone else, they'll also need to hire someone to do those things, meaning some capitalist can set up a business to profit from the need the government no longer meets.
  
  Like some kind of new saw movie lol
- It’s almost as if someone recently gave a heads up on how the public feels about health insurance companies… and they chose to implement this anyway 🤔
  
  Line must go up. They probably see themselves as brave by continuing to follow Friedman's shareholder logic in the face of these events.
- That's not how it works. The CEO is so wealthy that the insurance companies treat them for free because of all the business they bring in from enrolling their workers.
  We don't hear stories about the soft privileges of being in a position of power very often but they tend to be immense. We're just not in the club so we would never know.

Tbh I was expecting the first comment to contain the name Luigi...
- Up you go, and soon it will.

Wow. This means that now, someone can say that medical bills literally cost them an arm & a leg.

Lemmy Netizens Consider Offing Another Healthcare CEO, Questioning Their Industry Necessity - Fediverse News Network
^*not ^an ^actual ^news ^network. ^Yet.
- You'll need to get a Prior Authorization on that offing to show that it's Ethically Necessary. Fortunately you've come to the right place.

Someone needs to play super Mario bros again.

Someone needs some adjusting.

"I mean technically any medical service is not truly medically necessary, right? You could just die*"
*Funeral services are not covered under your current plan.

Burn it all to the ground

Denied: Can't you just lie there like a broken Crash Test Dummy until you stop being a burden?
- You do get the sense your continued existence is a problem for them.
  
  They dont give a fuck about you as long as you're not affecting their profits.
- Mmmmm mmmmmm mmmmmm

Why are US citzens not founding a health care co-op? Are there even viable solutions left over there?
- Between the regulatory capture and corporate/political bribery, it'll be tough to change anything from a grassroots perspective.
- Lots but a couple of note:
  Health insurance already has deals with pharmaceuticals and hospitals to charge a specific rate. The buy in on these deals is cost prohibitive to some degree. Think legal and administrative cost, especially when working between municipalities and States, let alone from hospital to hospital.
  Health sharing ministries are a form of this. They have tied the concept to religious roots which is often limiting e.g. women's and queer healthcare. They also have horror stories in the same abubdance as the big corps.
  There's nothing technically stopping a coop from forming short of startup capital and legal status. But those are insanely large hurdles.

Okay, I can spell out the "medical necessity" for you insurance companies in a way you'll understand: mental health is important for physical health. You do things to improve mental health and you also improve physical health. So if you improve someone's mental health now, you won't be paying out for all of the later physical problems brought on by the stress and the knowledge that their life would be better if only some more miserly than Scrooge insurance company would let them have a fucking leg.
- And having a prosthetic limb is important for physical health anyways. Helps you be more active, massively increases productivity (that’s what capitalists want right?), decreases wheelchair/caregiver costs, etc.
  It’s simply an all around win.
  
  Excellent points. The increased physical activity part would also save these idiot insurance companies money, but they would have to think beyond the next quarter.

Insurance companies push obvious lies to intentionally defraud the public. That's their entire business model. That's why your doctor had to fight through dozens of automatic rejections sent by the insurance company, they fully intend to lie in order to avoid making payments they agreed too when signing you up for insurance. A just society would be putting these people in federal prisons.

That doesn't seem like a smart response to one of you getting assassinated.
- Could be a punishment in the vein of "one of you defied, so you'll all be punished." Y'know, l everaging a person's individual fear of being the "cause" for things getting worse to prevent them from attempting to make any changes. It's a classic crackdown in authoritarian areas.
  Edit: not to say that's what's happening, but that is a methodology.

You can make a perfectly serviceable peg leg with an old broom handle. Ask your insurance company for a free how-to brochure!
- And then throw out your back or fall and break a hip because of the unnatural motion required to walk with said broomstick.
- That was good enough for Ahab, and he was able to captain a commercial ship using his! Back in the good old days nobody expected insurance to cover ordinary everyday whale attacks. Those were "acts of God" just like everything else.
- Your health insurance corporation would charge you $50 for that brochure.

For idiots who would like the UK to adopt American system instead:
"NHS covers the cost of prosthetic limbs for those who need them. In the UK, there are around 55,000 to 60,000 patients who require prosthetic limbs due to amputation or congenital limb deficiencies, and NHS England allocates about £60 million annually for these services."
- If you read the article though, it appears as though a more basic prosthetic would be covered, but the one with electronics to provide greatly enhanced stability will not be.
  I’m in no way siding with the insurance company, but they’re not flat out refusing to cover the prosthetic.

Looks like a clever ruse to encourage the next mario bros to shoot them in the leg instead of killing them outright
- They can afford the prosthetic out of pocket.

I think it's about time for an organized mass murder of all healthcare ceos.... Maybe then they'll learn? Or do we need to go after the shareholders too? What will it take? How can we make them quiver in their boots half as much as they fucked us out of paychecks only to tell us to get bent when we request the care we've paid for?

This leads me to question the social necessity of companies gatekeeping medical services
- But if it was socialized we would have death panels lol like this isn't already a death panel with less guardrails
  
  That "death panels" bullshit was such obvious propaganda.
  The answer should've been "death panels already exist, would you rather them be civil servants or for-profit insurance agency accountants?"

You think a CEO has ever been beaten near death with a broken prosthetic limb? Just asking maybe that's a thing.

I thought this was an Onion headline

Luigi was right all along

At an old job of mine, a co-worker with a congential heart condition told me that he had to provide papers to his insurance company to prove he needed heart medication. Then the company constantly pesters him to go back to the doctor to ask if his condition has improved.
It is congential... he was born with it. He CAN'T get rid of it. Even if medical technology advanced to the point where he could have it cured, they would still spend years delaying for it to be done because they need to know if it is medically necessary.

The grift has always been greater than the "service".

They're afraid of giving one-legged men the power to luck their asses.

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