I work for a neurologist practice, and the amount I have to argue with insurance (and inevitably have to get the neurologist on the phone to directly request something for many) is insane. A good chunk of my job isn’t providing care, but arguing with insurance that the care is necessary. These companies are actively delaying patient care, and try to blame the physician whenever possible.
Wildly infuriating, especially when the denials are worded along the lines of “we reviewed this, and don’t consider it medically necessary”. Motherfucker, a doctor said it was necessary and listed the clinical reasons why this test or procedure would be beneficial. Nothing has radicalized me for universal healthcare more than working in healthcare.
People love to shit on the VA, because they’re the largest American healthcare provider in the country so there’s a lot of bad stories
But my last MRI went like this:
Doctor: you need an MRI, let me check if it’s open. (Less than a minute on laptop). Ok, go down to room ____ and they can get you in now.
There’s a huge up front cost for that machine, so for profit hospitals went everyone to use it to make the money back, and insurance wants no one to use it so they don’t have to pay.
Take insurance out of the picture, take the hospital trying to make money out of the picture. And it’s really that easy. No one pushes for unnecessary tests, no one tries to prevent necessary tests. And there’s a huge push towards preventive medicine, because it’s cheaper to catch shit early.
We already pay more than what it would cost, it’s just the healthcare industry donates to both parties, so as long as both standards are “at least they’re not the other team” shits never going to get fixed.
If we hold higher standards than that, it won’t take many election cycles to get change to actually happen
How is that even legal? How is someone who hasn’t examined the patient and isn’t their physician allowed to make treatment decisions? If they even have the necessary qualifications.
Every time you see something that feels illegal but isn’t, or that makes no sense in general, look for the money trail. There’s always one, and it always leads to the explanation.
In this case, insurance companies have made such an absolute ass ton of money by killing off their customers that they have become a political entity. They now use their deep pockets to lobby politicians to keep their scam legal.
They’re technically not making treatment decisions, they’re making payment decisions about treatment decisions. Effectively it’s a distinction without a difference though. And it’s usually a “doctor” working for the healthcare company rubber stamping the denials. It’s a thoroughly shitty system.
Specifically, it’s the doctors who technically passed med school, but only just. They’re not going to practice medicine anywhere else, but they can make good money writing up legally protected reports that say “in my professional opinion, this patient’s lack of arms does not prevent him from going back to his roofing job”.
I work for a neurologist practice, and the amount I have to argue with insurance (and inevitably have to get the neurologist on the phone to directly request something for many) is insane. A good chunk of my job isn’t providing care, but arguing with insurance that the care is necessary. These companies are actively delaying patient care, and try to blame the physician whenever possible.
Wildly infuriating, especially when the denials are worded along the lines of “we reviewed this, and don’t consider it medically necessary”. Motherfucker, a doctor said it was necessary and listed the clinical reasons why this test or procedure would be beneficial. Nothing has radicalized me for universal healthcare more than working in healthcare.
People love to shit on the VA, because they’re the largest American healthcare provider in the country so there’s a lot of bad stories
But my last MRI went like this:
Doctor: you need an MRI, let me check if it’s open. (Less than a minute on laptop). Ok, go down to room ____ and they can get you in now.
There’s a huge up front cost for that machine, so for profit hospitals went everyone to use it to make the money back, and insurance wants no one to use it so they don’t have to pay.
Take insurance out of the picture, take the hospital trying to make money out of the picture. And it’s really that easy. No one pushes for unnecessary tests, no one tries to prevent necessary tests. And there’s a huge push towards preventive medicine, because it’s cheaper to catch shit early.
We already pay more than what it would cost, it’s just the healthcare industry donates to both parties, so as long as both standards are “at least they’re not the other team” shits never going to get fixed.
If we hold higher standards than that, it won’t take many election cycles to get change to actually happen
How is that even legal? How is someone who hasn’t examined the patient and isn’t their physician allowed to make treatment decisions? If they even have the necessary qualifications.
Because of money!
Every time you see something that feels illegal but isn’t, or that makes no sense in general, look for the money trail. There’s always one, and it always leads to the explanation.
In this case, insurance companies have made such an absolute ass ton of money by killing off their customers that they have become a political entity. They now use their deep pockets to lobby politicians to keep their scam legal.
They’re technically not making treatment decisions, they’re making payment decisions about treatment decisions. Effectively it’s a distinction without a difference though. And it’s usually a “doctor” working for the healthcare company rubber stamping the denials. It’s a thoroughly shitty system.
Specifically, it’s the doctors who technically passed med school, but only just. They’re not going to practice medicine anywhere else, but they can make good money writing up legally protected reports that say “in my professional opinion, this patient’s lack of arms does not prevent him from going back to his roofing job”.