Login required to started new threads

Login required to post replies

Prev Next
Aetna = Death panels
Quote | Reply
https://www.cnn.com/...stigation/index.html

So who should make healthcare decisions? A nameless faceless insurance company bureaucraft or a nameless faceless government bureaucrat?

Either way we are fucked.

Simple question. What is the solution?
Quote Reply
Re: Aetna = Death panels [davec] [ In reply to ]
Quote | Reply
Yep, S.Palin and Co. and all that drivel about "no one should come between you and your doctor". Right -- except the ins companies, which are profit driven.

I work in the dental industry. Who do you think is more qualified to determine a proper course of treatment... your Dr., or the ins co. hack who sits behind a desk and makes the yay-or-nay decision after (maybe) a cursory 20second "review".

At least Aetna is honest about not even reviewing cases before denying. We have ins co's who sit on cases, stone wall and request 'add'l info' even though it's already been sent, issue incorrect re-reimbursement, and best of all, send our reimbursement payments to incorrect addresses on the other side of the country.

Anyone who works in patient care can tell you ins co's are definitely not in it for the patient.
Quote Reply
Re: Aetna = Death panels [spookini] [ In reply to ]
Quote | Reply
spookini wrote:
Anyone who works in patient care can tell you ins co's are definitely not in it for the patient.

Oh they do, as patients are also shareholders who strive to maximize the return on their stock investments (such as in Aetna).

Funny how that turns out to bite one in the but, doesn't it?
Quote Reply
Re: Aetna = Death panels [davec] [ In reply to ]
Quote | Reply
davec wrote:
https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

So who should make healthcare decisions? A nameless faceless insurance company bureaucraft or a nameless faceless government bureaucrat?

Either way we are fucked.

Simple question. What is the solution?

The doctor treating the patient. How did we end up where a fucking insurance company gets to dictate how a patient is treated? It's absolutely disgusting that this type of thing has been allowed to happen.
Quote Reply
Re: Aetna = Death panels [davec] [ In reply to ]
Quote | Reply
I’m a doctor. l HATE dealing with insurance companies.

That said, “death panels” are a necessity if we want to keep costs down. Doctors will not be responsible stewards of health care resources. Neither will patients. They will do everything and anything more often than not. So whether it’s a private company or the government, someone will throttle the money being spent.

I’ll add, importantly, these aren’t decisions about healthCARE. This is a decisison about healthcare PAYMENT. Aetna cannot stop the treatment, only deny coverage of it. Due to cost, that’s often the same thing. In this specific case all the insurance company was asking was for the patient to update blood work he hadn’t had in 3 years before approving a $20k treatment. That seems reasonable. The patient didn’t comply initially. Once he did he got his treatment paid for. Again, reasonable.

Lastly, the answer in an ideal world, is either a centralized payer who covers basic stuff and a secondary insurance market for stuff not covered that way or a total free market where insurance companies and doctors compete for business by offering the best coverage and providing the best service at the lowest cost. Currently we have neither of those.
Quote Reply
Re: Aetna = Death panels [RZ] [ In reply to ]
Quote | Reply
Not the total solution either. Doc orders test procedures just to CYA. Patient insists on tests procedures that are not indicated and doc caves because he wants to be friends with patient. Costs then become unaffordable. Who pays?

Life is full of froth and trouble, two things stand in stone
Kindness in another's troubles, courage in one's own
Quote Reply
Re: Aetna = Death panels [RZ] [ In reply to ]
Quote | Reply
RZ wrote:
davec wrote:
https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

So who should make healthcare decisions? A nameless faceless insurance company bureaucraft or a nameless faceless government bureaucrat?

Either way we are fucked.

Simple question. What is the solution?


The doctor treating the patient. How did we end up where a fucking insurance company gets to dictate how a patient is treated?

When healthcare became expensive and the insurance companies had to figure out how to keep making money.
Quote Reply
Re: Aetna = Death panels [RZ] [ In reply to ]
Quote | Reply
RZ wrote:
davec wrote:
https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

So who should make healthcare decisions? A nameless faceless insurance company bureaucraft or a nameless faceless government bureaucrat?

Either way we are fucked.

Simple question. What is the solution?

The doctor treating the patient. How did we end up where a fucking insurance company gets to dictate how a patient is treated? It's absolutely disgusting that this type of thing has been allowed to happen.

It’s obviously not that simple. You can’t give doctors full range to prescribe any treatment or diagnostic option available. If you do, costs will go even higher. It’s not an either or scenario. We don’t have the money to pay for every treatment option for every patient. it’s unfortunate but it’s one of the reasons we have so many treatment options. People have invested tons in biotech finding unique and new treatments. The government couldn’t even get close to funding biotech in the way that it currently is funded.

-----------------------------------------------------------
De Soto Sport Athlete
Formerly Draketriathlon
Quote Reply
Re: Aetna = Death panels [RZ] [ In reply to ]
Quote | Reply
RZ wrote:
davec wrote:
https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

So who should make healthcare decisions? A nameless faceless insurance company bureaucraft or a nameless faceless government bureaucrat?

Either way we are fucked.

Simple question. What is the solution?


The doctor treating the patient. How did we end up where a fucking insurance company gets to dictate how a patient is treated? It's absolutely disgusting that this type of thing has been allowed to happen.

Can't you just pay for whatever treatment you want? Insurance is always going to have a limit to what it covers.
Quote Reply
Re: Aetna = Death panels [Nobbie] [ In reply to ]
Quote | Reply
Nobbie wrote:
RZ wrote:
davec wrote:
https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

So who should make healthcare decisions? A nameless faceless insurance company bureaucraft or a nameless faceless government bureaucrat?

Either way we are fucked.

Simple question. What is the solution?


The doctor treating the patient. How did we end up where a fucking insurance company gets to dictate how a patient is treated? It's absolutely disgusting that this type of thing has been allowed to happen.


Can't you just pay for whatever treatment you want? Insurance is always going to have a limit to what it covers.

Insurance of any kind wouldn't be necessary if most people could just pay for whatever.
Quote Reply
Re: Aetna = Death panels [Grant.Reuter] [ In reply to ]
Quote | Reply
Grant.Reuter wrote:
RZ wrote:
davec wrote:
https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

So who should make healthcare decisions? A nameless faceless insurance company bureaucraft or a nameless faceless government bureaucrat?

Either way we are fucked.

Simple question. What is the solution?


The doctor treating the patient. How did we end up where a fucking insurance company gets to dictate how a patient is treated? It's absolutely disgusting that this type of thing has been allowed to happen.


It’s obviously not that simple. You can’t give doctors full range to prescribe any treatment or diagnostic option available. If you do, costs will go even higher. It’s not an either or scenario. We don’t have the money to pay for every treatment option for every patient. it’s unfortunate but it’s one of the reasons we have so many treatment options. People have invested tons in biotech finding unique and new treatments. The government couldn’t even get close to funding biotech in the way that it currently is funded.

A lot of this. As much as people hate insurance companies giving prior-authorization to patients....doctors look at treatment but not always cost. I also don't expect them too, they have enough stuff to focus on.

I have a friend who injured her rotator-cuff. Insurance company made her go through multiple rounds of physical therapy before surgery. She complained but 4 rounds of PT is way cheaper than one round of surgery and very well may have fixed the issue. Doctor told her beforehand PT might fix it/might not, surgery 100% will, of course she wanted surgery right away.
Quote Reply
Re: Aetna = Death panels [Spiridon Louis] [ In reply to ]
Quote | Reply
Thanks for your informed viewpoint.

Quote:
Due to cost, that’s often the same thing. In this specific case all the insurance company was asking was for the patient to update blood work he hadn’t had in 3 years before approving a $20k treatment. That seems reasonable. The patient didn’t comply initially. Once he did he got his treatment paid for. Again, reasonable.

So typical CNN fake news.

Quote:
Lastly, the answer in an ideal world, is either a centralized payer who covers basic stuff and a secondary insurance market for stuff not covered that way or a total free market where insurance companies and doctors compete for business by offering the best coverage and providing the best service at the lowest cost. Currently we have neither of those.

I've historically been a "free market" and "less government" advocate. However, I'm to the point that if we had a vote on single payer today, I'd probably say yes.
Quote Reply
Re: Aetna = Death panels [Grant.Reuter] [ In reply to ]
Quote | Reply
Grant.Reuter wrote:
RZ wrote:
davec wrote:
https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

So who should make healthcare decisions? A nameless faceless insurance company bureaucraft or a nameless faceless government bureaucrat?

Either way we are fucked.

Simple question. What is the solution?


The doctor treating the patient. How did we end up where a fucking insurance company gets to dictate how a patient is treated? It's absolutely disgusting that this type of thing has been allowed to happen.


It’s obviously not that simple. You can’t give doctors full range to prescribe any treatment or diagnostic option available. If you do, costs will go even higher. It’s not an either or scenario. We don’t have the money to pay for every treatment option for every patient. it’s unfortunate but it’s one of the reasons we have so many treatment options. People have invested tons in biotech finding unique and new treatments. The government couldn’t even get close to funding biotech in the way that it currently is funded.

Nearly ALL the biotechs are spinoffs from federally funded research programs at academic institutions. The reason this happens is not because academic institutions do a poor job, it's because ultimately, the government wants research programs that prove successful to be self-sufficient instead of having to rely on one R01 after another. I just came back from a NCI funded project for folks with a current promising R01, that specifically addresses these questions and train researchers with business development, etc.

As for doctors, yes they can and should have all the possible options available, because they are the ones trained to do this. The question is whether it should be reimbursed or not. And in most cases, this question is addressed not by a single doctor, but comes from the scientific evidence, and the medical community. For instance, the USPSTF constantly revises what should or should not be covered as preventive care and for whom. These organizations are not governmental. They are non profit organizations with clinical, public health, public policy etc. experts.

So, in this specific case, it is obviously that simple.

-------------------------------------------

http://www.fmcoaching.com
Quote Reply
Re: Aetna = Death panels [AndysStrongAle] [ In reply to ]
Quote | Reply
AndysStrongAle wrote:
Grant.Reuter wrote:
RZ wrote:
davec wrote:
https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

So who should make healthcare decisions? A nameless faceless insurance company bureaucraft or a nameless faceless government bureaucrat?

Either way we are fucked.

Simple question. What is the solution?


The doctor treating the patient. How did we end up where a fucking insurance company gets to dictate how a patient is treated? It's absolutely disgusting that this type of thing has been allowed to happen.


It’s obviously not that simple. You can’t give doctors full range to prescribe any treatment or diagnostic option available. If you do, costs will go even higher. It’s not an either or scenario. We don’t have the money to pay for every treatment option for every patient. it’s unfortunate but it’s one of the reasons we have so many treatment options. People have invested tons in biotech finding unique and new treatments. The government couldn’t even get close to funding biotech in the way that it currently is funded.


A lot of this. As much as people hate insurance companies giving prior-authorization to patients....doctors look at treatment but not always cost. I also don't expect them too, they have enough stuff to focus on.

I have a friend who injured her rotator-cuff. Insurance company made her go through multiple rounds of physical therapy before surgery. She complained but 4 rounds of PT is way cheaper than one round of surgery and very well may have fixed the issue. Doctor told her beforehand PT might fix it/might not, surgery 100% will, of course she wanted surgery right away.

You also have the problem that sometimes what the patient wants and what the doctor wants are not what the evidence supports. There are number of conditions where conservative treatment (i.e. PT without surgery) has been shown to be just as effective or more effective than surgery. Obvious if the surgeon is the gate-keeper to PT well...
Quote Reply
Re: Aetna = Death panels [Spiridon Louis] [ In reply to ]
Quote | Reply
Spiridon Louis wrote:
a centralized payer who covers basic stuff and a secondary insurance market for stuff not covered.
+1, I vote for this. I guess that makes me a socialist who loves the idea of supplemental insurance for ppl who want it and can afford it.
Quote Reply
Re: Aetna = Death panels [spookini] [ In reply to ]
Quote | Reply
spookini wrote:
Spiridon Louis wrote:
a centralized payer who covers basic stuff and a secondary insurance market for stuff not covered.

+1, I vote for this. I guess that makes me a socialist who loves the idea of supplemental insurance for ppl who want it and can afford it.

Just curious as to what people think would fall into the non-basic stuff that wouldn't be covered, since it seems like to me insurance companies even now don't cover that stuff?
Quote Reply
Re: Aetna = Death panels [ThisIsIt] [ In reply to ]
Quote | Reply
ThisIsIt wrote:
spookini wrote:
Spiridon Louis wrote:
a centralized payer who covers basic stuff and a secondary insurance market for stuff not covered.

+1, I vote for this. I guess that makes me a socialist who loves the idea of supplemental insurance for ppl who want it and can afford it.


Just curious as to what people think would fall into the non-basic stuff that wouldn't be covered, since it seems like to me insurance companies even now don't cover that stuff?

Stuff that wouldn't give much of an increase in life/quality of life. In the UK socialised system, treatments are rated on the increase in life/quality of life per ÂŁ spent. If it doesn't reach a certain threshold, it's not considered effective and not funded. You are of course free to pay for supplementary insurance or pay directly for treatment if you wish.
Quote Reply
Re: Aetna = Death panels [ThisIsIt] [ In reply to ]
Quote | Reply
ThisIsIt wrote:
spookini wrote:
Spiridon Louis wrote:
a centralized payer who covers basic stuff and a secondary insurance market for stuff not covered.

+1, I vote for this. I guess that makes me a socialist who loves the idea of supplemental insurance for ppl who want it and can afford it.

Just curious as to what people think would fall into the non-basic stuff that wouldn't be covered, since it seems like to me insurance companies even now don't cover that stuff?

The devil’s in the details, huh? You’re right, it is. People will have to decide that and it will always be imperfect in ways, and there’ll still be room for abuse.

But a classic example l always use is the bed bound nursing home patient who falls and breaks her hip. Medicare will pay for a hip replacement and the doctor, who gets paid more to do that, tells the family she will hurt less if she gets that. So that’s what she gets. l think Medicare should only cover a pinning, supplemental insurance or cash would have to cover the hip replacement if that’s what they want.

But this system will never exist in our country because it will create tiers of care and that will be politically unpopular. Healthcare has become a “right” and everyone deserves the “best” care. It’s a ridiculous notion but it’s so accepted now that saying otherwise is a non-starter (watch people gasp that l even suggested that it’s not a “right” or that tiered care is ok).
Quote Reply
Re: Aetna = Death panels [Spiridon Louis] [ In reply to ]
Quote | Reply
Would I/my family be better off if you didn’t accept insurance but we could bargain for a cash discount?
Quote Reply
Re: Aetna = Death panels [ThisIsIt] [ In reply to ]
Quote | Reply
ThisIsIt wrote:
Nobbie wrote:
RZ wrote:
davec wrote:
https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

So who should make healthcare decisions? A nameless faceless insurance company bureaucraft or a nameless faceless government bureaucrat?

Either way we are fucked.

Simple question. What is the solution?


The doctor treating the patient. How did we end up where a fucking insurance company gets to dictate how a patient is treated? It's absolutely disgusting that this type of thing has been allowed to happen.


Can't you just pay for whatever treatment you want? Insurance is always going to have a limit to what it covers.

Insurance of any kind wouldn't be necessary if most people could just pay for whatever.

No insurance company is going to ok every treatment available because they would be bankrupt in no time unless they were allowed to keep increasing premiums, so they have to make those decisions on treatment. At any given premium rate there will be a limit on what they will pay for and as has already been said, this will be either the government or the insurance company to make the decision. If it's not your money paying for the treatment, you don't get to choose.
Quote Reply
Re: Aetna = Death panels [EndlessH2O] [ In reply to ]
Quote | Reply
EndlessH2O wrote:
Would I/my family be better off if you didn’t accept insurance but we could bargain for a cash discount?

One of our problems is that insurance isn’t “insurance” anymore. It’s a healthcare payment system. It’s like if your car insurance covered your oil changes. If insurance covered just “big stuff” and you paid for routine stuff out of your own pocket, yes, you’d be better off.
Quote Reply
Re: Aetna = Death panels [RZ] [ In reply to ]
Quote | Reply
RZ wrote:
davec wrote:
https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

So who should make healthcare decisions? A nameless faceless insurance company bureaucraft or a nameless faceless government bureaucrat?

Either way we are fucked.

Simple question. What is the solution?


The doctor treating the patient. How did we end up where a fucking insurance company gets to dictate how a patient is treated? It's absolutely disgusting that this type of thing has been allowed to happen.

Well, the insurance company is not dictating how a patient is treated; rather, whether the insurance company will pay for that treatment. Now, yes, I realize in practice that is a distinction without a difference. But, perhaps it points more to the issue of how health care is billed more than anything else.

If there are no dogs in Heaven, then when I die I want to go where they went. - Will Rogers

Emery's Third Coast Triathlon | Tri Wisconsin Triathlon Team | Push Endurance | GLWR
Quote Reply
Re: Aetna = Death panels [EndlessH2O] [ In reply to ]
Quote | Reply
EndlessH2O wrote:
Would I/my family be better off if you didn’t accept insurance but we could bargain for a cash discount?
You might be. In dentistry, the holy grail is to say, "You pay me in-full today -- and I'll have your ins. co mail the benefit check directly to you."
Some offices operate by that policy. You can absolutely try to negotiate a cash discount.. For example, payment by check saves the dentist the cost of credit card processing fees.

Don't know if it's possible to do that in the medical world. Medical seems orders-of-magnitude more byzantine...
Quote Reply
Re: Aetna = Death panels [JSA] [ In reply to ]
Quote | Reply
JSA wrote:
RZ wrote:
davec wrote:
https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

So who should make healthcare decisions? A nameless faceless insurance company bureaucraft or a nameless faceless government bureaucrat?

Either way we are fucked.

Simple question. What is the solution?


The doctor treating the patient. How did we end up where a fucking insurance company gets to dictate how a patient is treated? It's absolutely disgusting that this type of thing has been allowed to happen.


Well, the insurance company is not dictating how a patient is treated; rather, whether the insurance company will pay for that treatment. Now, yes, I realize in practice that is a distinction without a difference. But, perhaps it points more to the issue of how health care is billed more than anything else.

and in many cases when they are dictating whether they will pay for the treatment (and how much) they are dictating not to an individual doctor but to an equally large and for profit "fucking" organization that the doctor is employed by.
Quote Reply
Re: Aetna = Death panels [Spiridon Louis] [ In reply to ]
Quote | Reply
Seems to be the direction a lot of plans are going with now - high deductible. People complain but it does seem to make people actually think about necessity and options for treatment. I work at a large company which is self insured. Ever since we switched to high deductible, it's at least slowed the increase in costs though we have certain groups that are relatively sick and blow through the deductibles very quickly.

Spiridon Louis wrote:
EndlessH2O wrote:
Would I/my family be better off if you didn’t accept insurance but we could bargain for a cash discount?


One of our problems is that insurance isn’t “insurance” anymore. It’s a healthcare payment system. It’s like if your car insurance covered your oil changes. If insurance covered just “big stuff” and you paid for routine stuff out of your own pocket, yes, you’d be better off.
Quote Reply

Prev Next