United healthcare is notorious. It's 32% claim rejection rate is legendary. It's an unbelievable frustration for physicians trying to get coverage for care for their patients. You spend hours on the phone with them. You pour man-hours into the prior authorization paper work. You document. You explain. You cajole. Then they reject the claim and meanwhile while you're dicking around with this bureaucratic nonsense, your patient is not getting treatment. The patient gets the shaft while they post record profits for their shareholders.
I totally understand the emotions swirling about the CEO's murder. It's reprehensible to try and hold one person's life as punishment for an entire organization like this, or to call for his death at all. That's not moral, but I understand.
Insurance as a for-profit enterprise is a major drain on the US healthcare system. You need a profit motive to get people to be willing to take on the financial risk the business entails. That's Econ 101, but these guys have too many laws and policies that allow them too much safety from paying claims they should be paying.
Fixing it is not simple however. A scalpel is needed. Maybe one of those monstrously large scalpels they use for autopsies, but a scalpel, and not a chainsaw.
I've been on disability since 2008, had Humana. I was determined disabled bc I'd had 3 lumbar surgeries with accompanied nerve damage before I was 30. In 2023, I had a 4th multi level lumbar fusion. 4 months later, cardio wanted to do a stress test. Did the auth for a nuclear stress test cuz I can't run - on a treadmill or anywhere else. Those idiots DENIED the nuclear stress test because there was NO PROOF I COULDNT RUN ON A TREADMILL!!! Yes, I lost my shit. Not only that, but if they hadn't denied it, my co pay would have been $350. So, they weren't going to be carrying the entire payment due. It's a crock. And I'm at a loss how they expect anyone on disability or Soc Sec to pay an out the blue $350 bill. You don't get to save or really invest money when you become disabled at 38 and have 2 kids to care for. Seems to me, they should only be allowed a certain % of profit. They deny care or charge such an exorbitant co pay that you can't afford it anyway while pocketing billions in profit.
Humana's no better. I had the misfortune to require their services for a few years now. The copays are ridiculous, even on their "good" plans, and of course, just like anyone else, they like denying claims. Every time I needed a new medication, we went through several rounds of denials before the doc got on the phone and chewed their consultant doctor's ass until he approved it. They create these protocols in the way they do to make it easy to deny expensive therapies.
I think your last line is key. They bleed their patients dry while positing billions in profit. Morally, we think of healthcare as a non-profit concept. We need the business acumen to keep the system running efficiently. We need the brain in the system, but we also need the heart - and it's tough to design a system that relies on people choosing to be decent and moral people. You can't legislate that, and it's very tough to run a business like that.
United healthcare is notorious. It's 32% claim rejection rate is legendary. It's an unbelievable frustration for physicians trying to get coverage for care for their patients. You spend hours on the phone with them. You pour man-hours into the prior authorization paper work. You document. You explain. You cajole. Then they reject the claim and meanwhile while you're dicking around with this bureaucratic nonsense, your patient is not getting treatment. The patient gets the shaft while they post record profits for their shareholders.
I totally understand the emotions swirling about the CEO's murder. It's reprehensible to try and hold one person's life as punishment for an entire organization like this, or to call for his death at all. That's not moral, but I understand.
Insurance as a for-profit enterprise is a major drain on the US healthcare system. You need a profit motive to get people to be willing to take on the financial risk the business entails. That's Econ 101, but these guys have too many laws and policies that allow them too much safety from paying claims they should be paying.
Fixing it is not simple however. A scalpel is needed. Maybe one of those monstrously large scalpels they use for autopsies, but a scalpel, and not a chainsaw.
I've been on disability since 2008, had Humana. I was determined disabled bc I'd had 3 lumbar surgeries with accompanied nerve damage before I was 30. In 2023, I had a 4th multi level lumbar fusion. 4 months later, cardio wanted to do a stress test. Did the auth for a nuclear stress test cuz I can't run - on a treadmill or anywhere else. Those idiots DENIED the nuclear stress test because there was NO PROOF I COULDNT RUN ON A TREADMILL!!! Yes, I lost my shit. Not only that, but if they hadn't denied it, my co pay would have been $350. So, they weren't going to be carrying the entire payment due. It's a crock. And I'm at a loss how they expect anyone on disability or Soc Sec to pay an out the blue $350 bill. You don't get to save or really invest money when you become disabled at 38 and have 2 kids to care for. Seems to me, they should only be allowed a certain % of profit. They deny care or charge such an exorbitant co pay that you can't afford it anyway while pocketing billions in profit.
Humana's no better. I had the misfortune to require their services for a few years now. The copays are ridiculous, even on their "good" plans, and of course, just like anyone else, they like denying claims. Every time I needed a new medication, we went through several rounds of denials before the doc got on the phone and chewed their consultant doctor's ass until he approved it. They create these protocols in the way they do to make it easy to deny expensive therapies.
I think your last line is key. They bleed their patients dry while positing billions in profit. Morally, we think of healthcare as a non-profit concept. We need the business acumen to keep the system running efficiently. We need the brain in the system, but we also need the heart - and it's tough to design a system that relies on people choosing to be decent and moral people. You can't legislate that, and it's very tough to run a business like that.