What did you expect?
We’ve been told for years that herp derp the economy is doing amazing! If you don’t agree there’s something wrong with you! if you got laid off or your corpo landlord raised your rent and you’re now dying in the street well then… look everybody! An evil homeless person lowering your property values with their continued existence! Git em!
Luigi.
You know, at face value he’s absolutely right. We shouldn’t claim care that is unnecessary or maybe even harmful. But where we disagree is that I think that decision should be left to our medical professionals
Insurance claims are approved or denied by medical professionals. In the state of NY it’s even required for a specialist to approve or deny specialist care.
Some doctors are just absolute scum.
Medical professionals that spend an average of 6 seconds per case. And keep getting caught with revoked/expired licenses. And well outside their area of expertise (the classic example is failed dentists deciding on cancer treatments).
Except in this case, they used AI to help them make decisions. The lawsuit is still ongoing so I shouldn’t speak in definitive terms, but considering the circumstances and evidence I think it’s pretty clear than they have tried to automate some processes and didn’t audit them properly.
Did it not work as intended, though?
I mean I’m pretty sure it wasn’t meant to be a method of committing suicide
I don’t have a source. But i’ve read they are incentivized to go through as many claims as they can, and not to approve too many.
My insurance’s tactic to this sort of demand is to just completely ignore my requests/demands. They log an acknowledgement of my action, and then never do anything with it, ever.
That’s when you hope your state has a bureau of insurance or something similar that you can complain and appeal to, and then hope that the person assigned to your case isn’t prejudiced against the procedures in question, such as reproductive care or trans-related care, or isn’t prejudiced against you for being pretty much any minority.
What a mindfield to navigate when we’re at our most vulnerable.
Like, my life is already busy as fuck, without enough time to do everything I need to do. I have an ever present list of things that require my attention next. Ain’t nobody got time for this shit!
There is a lot of crap that they’re able to instantly deny through your plan’s terms and conditions.
It’s worth reading the plan summary of what won’t be covered, even if it’s prescribed treatment. Some of the shit that’s hidden in there is fucked up.
This year someone in my family started to have to pay out of pocket for their GLP1s because their diseases didn’t progress far enough for the treatment to be covered. They’d rather you hurry up and die than pay for expensive drugs that keep you alive for longer.
If they have cardiovascular disease or kidney disease, those are getting added as indications for the GLP-1’s so they might be able to resubmit the authorization/claim with those diagnosis codes added to get it covered.
Yeah, but the problem is, if tests / labs show the precursor indicators for those diseases, and you have a family history, they’ll still deny until you actually have the something like a heart attack or stroke.
GLP-1s are the hot new thing, but it’s pretty common for insurance companies to deny expensive preventative care, even after all other avenues have been thoroughly explored.
In my family medicine rotation a couple months ago, we got it approved for someone with pre-diabetes, high blood pressure, and stage 2/3 kidney disease (which is not very advanced. A lot of people over the age of 35-40 can technically fall into stage 1/2)
We just changed insurance and were able to get through with one provider that valued preventative care more, but our new insurance company is a complete pain in the ass. And the person in my family dealing with the insurance company actually works for the company and knows all the ins and outs.
They even give their own employees crap policies.
This is entirely unsurprising. Hopefully they can wrangle something functional out of the insurance at some point.
They are done by medical professionals who have no obligation or incentive to serve the best interests of the patient. If your doctor fucks up, he can be found liable. If the insurance doctor fucks up, there is no liability whatsoever. Cases have been brought to court and then immediately thrown out because there is no legal basis for holding them accountable.
Even if this were the case (it is not in any real sense, see your other replies), the fact that it is done by a for profit entity that will lose money by approving a claim all but ensures the process will not be neutral or correct.
Really what it should be is that if a doctor prescribes unnecessary care, they should go after the doctor, not the patient. Doctors have malpractice insurance. If the health insurance can’t win a case of malpractice, then they should pay the bill. Why are patients in the midfle here at all.
Patients usually have the least amount of power. That’s why.
Really what it should be is that if a doctor prescribes unnecessary care
That’s the core problem. The entity that defines unnecessary care is health insurance. And there are TONS of stories of them denying Diabetes medication for people with diabetes and anti-nausea meds to pediatric patients getting chemo.
If they were doing the right thing, no one would be pissed off. The “recent target” was the one to decided to run on AI driven denials that were denying 90% of care for months.
They are not fulfilling their duty to take the money from the subscribers and pay their righteous medical bills and instead using it as raw profit.
They are employing their own ‘doctors’ to prove stuff that is definitely necessary is labeled unnecessary.
It’s the conflict of interest in the “decision maker”
Not just meds. Patients with chronic pain are expected to take painkillers for treatment but omg if the doctor prescribes therapy deny that shit. Even though therapy helps faaaar better than medications for chronic pain sufferers.
Reminds me of the Tobacco Instrustry setting up the “Tobacco Institute”, to disprove any links between smoking being addictive, and lung cancer.
They were constantly gaslighting the public, even tried to discredit the Surgeon General for his report on second hand smoke.
This is still validating the profit incentive of private health insurance.
If the doctor prescribes unnecessary care, it should be none of these peoples’ business, because they shouldn’t be allowed any stake in the decision whatsoever.
My attitude is that if the doctor prescribes unnecessary care there’s a professional board for that.
Though let’s be real, the health insurance for profit industry is the problem and it’s not going to get better until we get rid of it
It’s the same trick as rebranding bank robberies to identity theft. It puts the blame on the consumer who can’t afford to defend themselves.
Huh, I hadn’t thought of that as a Crying Indian.
I miss Anonymous. Those fuckers would be figuratively burning down UHC right now.
they were taken down and then turned into a shell org of the NSA.
it’s a honeypot/scapegoat now.
What actually happened to them? Did key members get tracked down or something?
I don’t have sources, but I seem to recall reading somewhere that the OGs aged out or got caught, and the new gen that replaced them weren’t as ideologically driven or competent or something. I think they still technically exist but aren’t nearly as influential as they once were
Another thought this just popped into my head is that the next generation may not have been brought up with the same fundamental hacking skills that were somewhat inherent in being technical in the late 70s-mid 90s. Could you still learn them?…Of course, but having grown up with BBSs and LoD (Legion of Doom, and the like) and pre-WWW, some things were just more prevalent when it came to learning about the guts of systems and “cybersecurity” (that word didn’t really exist back then).
On the other hand, learning hacking itself is easier than ever. It’s turned legitimate under the guise of penetration testing.
It’s also not as easy to hack electronic systems anymore. It’s not that they are invulnerable, but the vulnerabilities are generally more complicated and difficult to exploit. Setting aside people still running Windows XP or something, vulnerabilities get patched pretty quickly today. State actors have the time and resources to still do straight up electronic hacking, but opportunities for individuals are sparse.
Of course there is still the human element. Most data breaches done by individuals nowadays rely, at least in part, on social engineering.
They all got arrested by the FBI.
I think they all just got jobs, honestly.
In this economy?!?! /s…kinda
Actually that makes sense, and saddens me a bit there wasn’t a contingent to pass the torch to.
It’s time for that green guy from that one video game that I can’t mention because the auto mods are erasing free speech
It’s WeeGee time.
Time to send another luigi fellas!
I see the mods are still being little bitches.
yup 😭
To be fair, I’ve had doctors pad the bill. I’m lucky enough to have decent insurance and I have a few stories about doctors taking advantage of that.
So what?
So it’s a good argument for single payer healthcare
Any examples?
A few. I had a primary care doctor who would talk my ear off. After we discussed whatever my problem was he would talk about religion and politics. He was pretty right wing, me having a catholic school education and have long paid attention to politics can hold my own. The odd thing, there was always a waiting room full of patients but he would gab on and on. Eventually I came in for an appointment and I said to his receptionist “the doctor sure doesn’t rush me out of there”. That’s when she said “yeah most insurance companies want you out in fifteen minutes”. At that moment it clicked. The doctor was always looking at his watch, if he went over fifteen minutes he could charge for another fifteen minutes. He also had a waiting room full of posters and pamphlets paid for by pharmaceutical companies. He suggested prescribing me medication for my anxiety, i just laughed. My doctor now has none of that propaganda in his waiting room. My last visit he pushed eating fresh fruit and vegetables. I told him that’s why I come to him, he tells me what I don’t want to hear. I had a dentist who was the same way. Also very religious and right wing.
so does that make it ok for healthcare providers to deny coverage for procedures or medication that has been prescribed due to an illness or ailment impacting a patients quality of life?
No it doesn’t but I can understand why they don’t greenlight everything. This all is a glaring example why we need single payer health care and doctors that earn a flat rate and not get paid per procedure (there is a name for this, i don’t know it).
It’s self fulfilling though. Doctors offices are at the whims of their agreements with the insurance companies to stay afloat. They pad the bill (charging maximum for everything) because the insurance company will only pay percentages on most procedures. Then they usually write off the rest (or close to it). Doctors are incentivized to prescribe certain drugs over others, and other such meddling.
Healthcare costs are as high as they are specifically because of private insurance. The evidence is in every single other developed country that has state-provided healthcare. It’s overall cheaper, and often better.
Insurance companies default to denying claims because they know, if the barrier is high enough (denial after denial), people will simply stop asking for the procedure (or whatever), so they don’t have to pay anything. Then their earnings go up, and they pad their pockets.
To say “insurance company bad” oversimplifies the problem. That’s why it’s foolish to base opinions on memes. Where there’s lots of money, greedy people will find a way to get at it or as I like to say “shit attracts flies”. In my work I deal with private companies that are paid with public dollars. What I see going on has jaded me hardcore. Publicly funding the health care system will be a disaster without overhauling the whole system.
I don’t disagree with you. We can’t simply replace insurance companies with a public version and expect everything to be okay. But Medicare and Medicaid seem to work really well for a lot of people. They can simply expand it, and then private insurance can still exist as a supplement if someone wants.
But what we really need is more regulation, everywhere, on almost all industries.
Gotta kill citizens United, and make superpacs illegal. When money gets out of politics, is when we’ll finally see some change.
So he’s suicidal?
More like, disconnected from reality.
Poh-tay-toh tuh-mah-toh
So many internet arguments revolve around binary choices that don’t need to be binary or appeals to authority or hypocrisy as the only leg they stand on.
Can we gamble on how long they have left?
That’d be some good old fashioned capitalism.
I think that would be hilarious but no gambling site would allow it.
the odds are too much in favor of the winners.
Doug Stanhope used to run a celebrity death betting pool where you could bet on which celebrity would be the next to die.
No idea if it was legal lol.
Luigi Time!
I win! Whoosanext?
That’s a cute email address
gonna put this dumb mother fucker on an airbrushed tee like he’s already dead
chalk yourself out ya big dumb bastard, show the sharks where that menstrual leak is bitch-made mf
Tune out the noise!
#BANG!
These dudes have their own dicks all the way down their throat.
I know right?
And you wish that’d prevent them from talking. Alas here we are.
Or at least develop chronic backpain.
Now I’m a bit jealous!
Did that guy just paint a big ol’ target on himself?
