Hard to say why, exactly, and it’s very hard to prove intentional fraud, like knowingly sending false bills to insurance.
I would guess it’s a combination of hiring low wage workers for the task and not providing effective process oversight.
IMO leveraging financial penalties big enough to hurt would go a long way towards keeping healthcare systems honest, or at least would help them keep mistakes low.
Interestingly, they often protect themselves against this with insurance. Specifically errors & omissions. So it gets confusing again.
No, though I’ve had patients talk about it. Whether it was user error or something else I couldn’t say, as I don’t delve into that side of things. I think what I see most often are what I think of as attempts to “shake the tree,” so to speak. Deny (whatever, sometimes government benefits), then approve if the person has the chops to appeal well enough. Many people don’t. They lack either the literacy or the confidence to fight with people on the phone who sound more certain than my people feel. Too, they need their docs to provide documentation and that’s a whole other hassle.
It’s (the entire medical industry) like a game played with Monopoly money, but that makes it a game we all have to participate in. I can’t afford to pay hundreds of thousands of dollars privately for care that does not seem reasonably valued at that amount, so I have to insure against catastrophic costs.
However, your unspoken point is correct: I am in robust health and covered probably very well by my carrier, all things considered. Should I have no complaint?
People chortle with glee over all sorts of things I find distasteful. It is very sad that a family lost a beloved member. However, there is reason to be pleased that these things are garnering attention. Perhaps concern/shame/wariness over one’s professional choices would not be a bad thing.
Thank you for this excellent article. It covered all the bases as to why what Mangione did was not only unjustified, but purely evil. Nonetheless, the fact that so many people supported Mangione in the first place demonstrates just how irrational and dangerous the collective psyche is. But I learned this lesson during the hysteria of the lockdowns.
And they figured out a certain percentage, I forget the number, of people who are denied won’t question it. And these are claims that should not have been denied.
The problem is defining these people in this way in order to avoid delving into why they feel this way. You’re playing the Hillary Clinton deplorables card.
So there is a lot to unpack here. Overall, the themes I’m picking up on are a stated inability to understand policy coverage and a belief that govt would solve this issue, plus an implication that healthcare is a right but not a right to be delivered by healthcare. I do appreciate your input and don’t want to minimize, however, so I’ll attempt addressing points individually.
Maybe. Lobbyists create a lot of power for sure, but they do not bypass regulations. I’m not surprised by the list you shared.
Regarding insurance specifically, a few lobby actions I am aware of (I am not a lobbyist but follow some industry news) are against the financial industry and, of course, the healthcare industry.
Lobbying against the financial industry is defensive in nature. Specific Insurance licensing covers some financial service products such as annuities or variable IULs with cash values invested in stocks and bonds. This is viewed as competition by financial advisors (who also often sell insurance products in the life insurance line), and for years they have lobbied hard to prevent insurance licensing from allowing the sale of said products so they can corner the market. Insurance fights back, of course, and usually via lobby action.
Lobbying against the healthcare industry tends to be proactive. Rising healthcare costs, and billing “mistakes” are expensive and directly impact health insurance bottom lines specifically. So they lobby for transparency and cost controls where possible, which I mentioned earlier is actually good for consumers. They can lobby and negotiate much harder than an individual actually stuck with medical costs. Most health systems will work out some sort of deal with uninsured individuals in hopes of receiving payment, but it will never be less than they could sell your debt to a collection agency for. Insurance companies can put a pretty big dick on the table to make them contend with, however. And they do.
I haven’t seen any corruption lobbies so to speak, and I’m not being sarcastic but if the idea is that looking out for profit is corruption then I disagree. I’m curious to hear what corruption you’ve seen successfully maintained with lobbying, above legal reproach.
You do have options though. And you listed them. Another option is self-insuring. This angle has been discussed above numerous times but I want to engage your thoughts directly.
Questions I have are:
Do you believe healthcare is a right, and if so, do you believe insurance is the entity to ride for access? Why not the providers themselves? How well do you understand insurance profit margins, mandated reserves and revenue? Are you willing to pay what it would take to have any and all health concerns, prescriptions or any healthcare interaction paid for by insurance, without question, and without looking at the cost of the care itself? If not where does the money come from? Tax propagated, single payer system as you mentioned government? Same question if so.
Should your employer do a better job detailing your benefits since they are brokering them to you? Should you call the insurance company and ask for a summary of benefits, and read it, before signing up? What do you suggest the insurance company does in this scenario, considering they will provide a summary of benefits and probably did so to your employer?
Are you at all concerned about the cost of care itself, necessitating the need for insurance to begin with? I understand your post is framing the burden of responsibility as belonging to insurance but why? If healthcare is a fundamental right, why do pharmaceutical companies get to sell pills they manufacture for literal pennies at hundreds or thousands of dollars each? Why do surgeons get to charge thousands if not tens of thousands of dollars per hour et cetera? How do you justify declaring healthcare a right without addressing the care itself? Insurance is not your access point, the hospital doors are.
I think it’s terrible health professionals charge so much for care that people can’t afford them as well. It’s really pretty sick. Never mind supply and demand, it’s more like pay or die, but somehow they pin the tail on a third party donkey (the psychology of which was also discussed earlier).
Again, whose responsibility is it to understand your coverage, or to make you understand it? Insurance will provide all policy information to you. Is your employer withholding?
And insurance is heavily regulated. This doesn’t solve for the problems you’re stating, however. Are you suggesting govt adds regulations, and if so in what way? Is the implication that there should be a single pay system? How will that solve anything? Cost will just shift to taxes. The only real “winners” in that scenario are people like Castoli, who confuse single pay healthcare with entitlement welfare programs. Everybody else just pays another way, and more as linked.
I understand the issues you’re raising but can you help me understand how you’re choosing where to place the onus of responsibility?
For context, the question you were responding to here was whether or not you’ve experienced a surprise denial.
It’s hard to reply to a surmised scenario. Statistics provided in this thread have shown something like 2% or less of the denials that do take place fall in to your scenario. While any percent is too much, it’s not the specter it’s being made out to be, and it’s not the reason healthcare is prohibitively expensive to begin with. I’m not in claims, but I’d be curious to see how many of those 2% were legitimate human error vs some sort of sinister plan to deny a minuscule amount of money in the grand scheme, which is the overriding implication of the thread. This reminds me of the scene in Austin Powers where Doctor Evil sinisterly asks for a tiny amount of money like it’s a huge deal and everybody is awkwardly stuck on it. Sharks with lasers.
This I agree with. I don’t know that we will ever have perfection in any system but imo addressing root cause is always the right path, for any analysis.
I don’t know. Claims and billing really aren’t my forte. My understanding is that AI is often wrong, and very assumptively wrong. It screws up complex ideas, but in a coding system I could see it as a tool to make sure numbers are correct, at least.
The issue as I understand it is converting doctor notes and directives in to numerical codes, however, and I think AI would struggle here.
But I’m not a tech expert either.
I’m as curious as the next guy about what AI will grow in to. Especially with Googles new gigachip.
That’s an interesting read and I agree with some of Cubans points.
For the record, he’s mislabeling “single-payer” in the application that it’s normally understood and is doing it a bit manipulatively.
What he’s really doing is self-insuring, while addressing medical costs directly, which I agree is the right way to frame the issue.
He is flippant in his dismissal of insurance companies, but in a nutshell he is acting as the insurance company and serving their role so it’s odd to see him poopoo them.
If he wants to do this for his employees I think it’s great, but I’d be curious to see what happens when costs begin to exceed the premium savings he’s most likely after but not discussing, or what he will do when an oddball treatment he didn’t contract pops up. Or if he fires people who get too expensive “at will”. You can’t play hot potato forever. You have to address the potato (cost).
He’s not really solving anything.
But he is on the right track.
TL:DR, all Cuban did was explain what insurance companies do, but he is doing it directly instead.
This is most likely an attempt to avoid paying millions in insurance premiums.
He will still encounter the same problems, like oddball treatments outside of his mentioned contractual agreements.
He will have to control costs. Negotiate harder, fire people, not give raises to cover costs which will never be mentioned et cetera.
First, what Mangione did was laudatory. Now he’s innocent until proven guilty. I’m glad you’re moving in the right direction.
The problem is defining these people in this way in order to avoid delving into why they feel this way. You’re playing the Hillary Clinton deplorables card.
When people celebrate the murder of an innocent man, they only have themselves to blame for why others focus on that rather than the origin of their grievances. That being said, nobody has avoided the issue on this thread or in the article itself. I have said that capitalism only works when companies are regulated to protect consumers, which may need to happen in the insurance industry. I have also said that healthcare is inherently expensive and the only foreseeable solution to the problem is further technological development that makes it cheaper. Others have tackled the issue from other perspectives, but the whole subject of this thread has been on the justifiability of Mangione’s actions.
You mean, it’s OK to question the system?
The lesson I learned during the lockdowns is that the mob is inherently unreasonable and prone to hysteria. History gives us the same lesson. People like me whole questioned the system were attacked by the mob.
I also think people are conveniently overreacting. Thompson is a symbol for an industry that has troubling issues with regard to ethics. His company in particular is known to be the worst offender in that regard. It denies at a significantly higher rate than the industry norm, by design and by his direction.
It’s very easy, or in this case convenient, to take internet blabbery as literal. Thompson is not the good guy and let’s keep in mind he was under investigation by the government. Whoever killed him is not the good guy either but Americans love the antihero.
It’s not some indictment on America that people fail to sympathize with someone in death who they could not find sympathetic in life. And it’s no surprise they can sympathize with whoever shot Thompson because they can understand the feelings of frustration and anger that Thompson and his company made them feel.
There is an issue that none of these Thompson apologists want to talk about. Why is it when a fat wealthy white man was murdered, every (not literally) law enforcement agency in the nation was involved in finding the killer? They posted a reward. The mayor of NYC felt he needed to confront the suspect, who was shackled and surrounded by heavily armed police, and let him know that NYC won’t put up with violent crime. They are even charging him with terrorism.
Meanwhile, truly innocent children of color are killed in cities across the nation, including New York, and there is no show of force by law enforcement and the mayor. If people want to claim the support for Mangione points to something rotten in the people of this country, fine, but prioritizing the life of a white millionaire over the lives of black children points to something that’s been rotten for a lot longer. People die from overdosing on drugs every day in America but I’m supposed to hang crepe for a man who profited off of other people’s pain and suffering? A man who was responsible for furthering their pain and suffering.
There is a lot of misinformation floating around about denial rates, along with everything else.
The linked video breaks it down a little.
It does sound like an apologist piece but statements are accurate.
The most egregious part is that the data being thrown around specifically relates to Medicare and Medicaid supplemental insurance policies, which are heavily restricted in what they can cover by federal law, and for consumer benefit.
You cannot supersede govt benefits with private insurance if participating in Medicare or Medicaid programs and claims doing so will be denied, because they have to be.
It’s important to understand information, not just blindly parrot it.
