Insurance Companies: Why Do They Ration Care?

[natty dread]

Openly flaming? What's the alternative to open flaming? Secret flaming?

Yes.

It's when I post something to you which is kind of funny but in a weird way, that you don't quite understand - it kind of gives you this disturbing, haunting feeling that you can't quite place your finger on. Maybe you'll reply something irrelevant to it, maybe not, you don't think much of it and shrug it off...

Then, you read the next couple of responses from other people in the thread, and you start to get this weird, disturbing feeling again - like there's some very subtle hints in the tone of other people's posts, like they're all kind of hiding a smile behind their hand - are they making fun of you? Are they laughing at you?

Next, you go out for groceries, and the cashier girl gives you a weird look and a hint of a smile. Does she read CC forums? Is she in on the joke?

Then you'll spend the next 2 days, just staring at the monitor blankly. You occasionally look at the post, read it again, try to decipher it's hidden meaning - but to no avail. That funny feeling, that small, disturbing feeling at the back of your head won't go away. What is it? You have to know! But you can't just post about it - people might think you're slow or something! Or maybe you're just being paranoid. Maybe you're making a big deal out of nothing. But the haunting feeling won't go away... it tears your mind apart, it keeps you up at night, it won't leave your mind for a second - sometimes you cry a little.

Next thing you know, you will be wearing a tin foil hat because you haven't slept for 4 days and the paramedics will be coming for you.

[thegreekdog]

Openly flaming? What's the alternative to open flaming? Secret flaming?

Yes.

It's when I post something to you which is kind of funny but in a weird way, that you don't quite understand - it kind of gives you this disturbing, haunting feeling that you can't quite place your finger on. Maybe you'll reply something irrelevant to it, maybe not, you don't think much of it and shrug it off...

Then, you read the next couple of responses from other people in the thread, and you start to get this weird, disturbing feeling again - like there's some very subtle hints in the tone of other people's posts, like they're all kind of hiding a smile behind their hand - are they making fun of you? Are they laughing at you?

Next, you go out for groceries, and the cashier girl gives you a weird look and a hint of a smile. Does she read CC forums? Is she in on the joke?

Then you'll spend the next 2 days, just staring at the monitor blankly. You occasionally look at the post, read it again, try to decipher it's hidden meaning - but to no avail. That funny feeling, that small, disturbing feeling at the back of your head won't go away. What is it? You have to know! But you can't just post about it - people might think you're slow or something! Or maybe you're just being paranoid. Maybe you're making a big deal out of nothing. But the haunting feeling won't go away... it tears your mind apart, it keeps you up at night, it won't leave your mind for a second - sometimes you cry a little.

Next thing you know, you will be wearing a tin foil hat because you haven't slept for 4 days and the paramedics will be coming for you.

Post of the Year 2012.

[thegreekdog]

Malpractice lawsuits have little or no effect on the cost of American healthcare.

They don't? There is probably one set of data you're looking at and another set of data that I'm looking at.

Data Set 1 (I don't provide links so you don't complain about having to click links):

"Medical malpractice is actually a tiny percentage of healthcare costs, in part because medical malpractice claims are far less frequent than many people believe. In 2004, the CBO calculated malpractice costs amounted to 'less than 2 percent of overall health care spending. Thus, even a reduction of 25 percent to 30 percent in malpractice costs would lower health care costs by only about 0.4 percent to 0.5 percent, and the likely effect on health insurance premiums would be comparably small.'"

Data Set 2 (I don't provide links so you don't complain about having to click links):

"CTs and MRIs routintely change the course of medical care, often for the better. But their usehas become so routine that their lifesaving benefits are being increasingly overshadowed by the risk of overuse. Medical imaging is the fastest-growing source of cost inflation in the Medicare program. Meanwhile, the real value of so much testing has been widely questioned in scientific literature: imaging rates are going up, but docotrs are not diagnosing (or necessarily misdiagnosing) more diseases."

"Eighty-two percent of doctors order more tests and procedures than are medically necessary - and almost on a daily basis - in fear of potential law suits. According to a recent poll conducted by the Gallup organization, about 1 in 4 dollars spent in health care can be attributed to these tests and procedures that are clinically unnecessary. The problem has become so overwhelming that recently a group of nine medical specialty boards launched the 'Choose Wisely' initiative, asking doctors to cut back on 45 tests and procedures that provide little value to patients. The medical profession is to be commended for drawing attention to exuberant testing. But while the profession is starting to raise awareness about defensive medicine, it might not change the behavior of doctors until we change our medical tort system. Some doctors have told me they have no choice but to 'scan some patients until they glow' as long as they can be hauled into court for frivolous reasons. Doctors order up tests - in most cases - not because it was necessary to diagnose what was wrong but because if they didn't and something went very wrong, they believe they would not have been protected in a lawsuit. Patients for Fair Compensation, a nonprofit seeking to educate policymakers about defensive medicine, estimates that unnecessary tests and procedures cost about $650 billion a year. That is money spent on the unnecessary MRI the doctor ordered for a worker with a nagging backache, for example, and the EKG the physician ordered for an otherwise healthy 36-year-old patient with no history of heart disease. The $650 billion in lost revenue spent on unnecessary tests includes money coming out of the pockets of taxpayers. Up to $125 billion a year is paid by Medicare for unnecessary yetsts and procedures, and up to $96 billion is paid by Medicaid for unneeded tests and procedures."

"Defensive medicine is the practice of diagnostic or therapeutic measures conducted primarily not to ensure the health of the patient, but as a safeguard against possible malpractice liability. Fear of litigation has been cited as the driving force behind defensive medicine, however even critics of the litigation system have found that a more fundamental motive may be a deliberate increase of services to create revenue [thegreekdog is shocked... SHOCKED!]. Defensive medicine is especially common in the United States of America, with rates as high as 79% to 93%, particularly in emergency medicine, obstetrics [I can vouch for that personally], and other high-risk specialties."

[BigBallinStalin]

Sounds like a legal issue. inb4 pimpdave's 2nd "hurr durr helt cair teh guv'ment."

[pimpdave]

Openly flaming? What's the alternative to open flaming? Secret flaming?

As opposed to actively trying to get a user permanently banned, whether in the moderator super secret forum or by trying to convince people to report a user just for some petty grievance. See: Night Strike.

[thegreekdog]

Openly flaming? What's the alternative to open flaming? Secret flaming?

As opposed to actively trying to get a user permanently banned, whether in the moderator super secret forum or by trying to convince people to report a user just for some petty grievance. See: Night Strike.

What are you talking about?

[PLAYER57832]

Because if an insurance company says they will cover something and then don't, they can be sued or prosecuted criminally.

ONLY If you have the money to do so. And, in the meantime..everyone's rates go up to pay for the many attorneys, not to mention any settlement. The insurance company does not really lose even if they do technically lose a lawsuit. They just pass on the cost. A winp-win for them. A lose for the rest of us.

So a governmental system where you have no opportunity for recourse and no other options to buy from is a better system?

People HAVE recourse under the government. They can sue in court, but ALSO can vote to change policies through legislation and elected officials.

You have no contractual guarantees with the government and they can change their coverage daily if they so chose (without the ability to sue).

Baloney! Laws dictate what the government can and cannot do. The government is brought into court constantly. Also, people can and do vote to change laws so things change. The trouble of late is that too many people would rather believe all they have to do is lower taxes for the wealthy and businesses, along with an occasional toss back to the rest of us and things will somehow magically be fized, not even for free, but with a PROFIT!

Who else do tax cuts go to when it's only the rich(er) who actually pay taxes. It's impossible to give tax cuts to people who don't currently pay taxes. And laws don't govern the government (especially if the mandate stands) because they can change the laws anytime they want (and they can change the non-voted-on regulations daily if they choose to). Laws DO govern private businesses, which is where the safeguards for breach of contract comes in.

LOL... only the rich pay taxes????

If you are that far off the deep end, no wonder you think everything I say is nonsense.
As for the rest, exactly who are you saying can just change the mandates? Try COMPANIES. Our system has been designed to cater to insurance companies and some big supply corporations.

Now you are saying the answer is to just take the government out?

Plus, you can't shop around when the government system is the only one around, and they will make it prohibitively expensive for private companies to provide the basic care that they will claim to provide.

Only a few people who work fulltime in mostly salaried positions for larger companies OR the government get to have any choice at all. Contrary to your "fact" government sponsored Medicare plans provide a lot of choice. Most private employers, even if they provide insurance, offer only one choice.. and it can be VERY poor insurance, indeed.

How does Medicare give you a bunch of options when doctors are dropping those patients on a frequent basis because the government won't pay the full costs of the care (by the way, which forces insurance to pay the difference)? Is the government going to make doctors take those patients?

Hmm.. so Medicare is forcing doctors to drop patients? Interesting, because around here, its Blue Cross that dictates costs.... And the "insurance" most people have is so poor (deductibles of $1500-2000 per person). they cannot use it except for extreme issues.

By the way, you get more choice when you change to an individual-pay system, not a government-provided system.

Not necessarily, not necessarily at all. Further, we don't have an individual pay system. We have an employer pay system. Obama care is set to create more of an individual system, but you are quick to declare that illegal.

[AAFitz]

that a serious question dave? LOL

Care costs money, in case you didn't know. If there isn't any money, there isn't any care.

Hope I answered your brain busting question

Actually that's his point. But instead of spending the money on the care, they spend it on themselves.

Defending the actions of insurance companies that refuse care and find ways around providing the insurance they sell... is utterly ridiculous, uneducated, and really quite stupid.

Hell, my own insurance company tried to scam me out of money. After say paying them about $60000 and over the years them maybe paying out lets say $6000 (and that's high)....I sent in a receipt for an ER trip, and their response was that my coverage was not in effect.

Now, their explanation ...actually there wasn't one....no apology, no explanation....just absolute silence when the question was asked why they told the hospital there was no policy. I was meant to infer it was just a mistake, since Ive made every payment ever, but the real explanation is that they purposely do that, literally hoping I'm just stupid enough to take that on face value and pay the claim myself. And while I am luckily not in this case, many are, and simply aren't able to understand the insanely complicated legal document that an insurance policy is, cant afford to hire someone to explain to them, so don't receive the correct or timely care that they not only need, but even paid for, simply because of the pure greed and corruption of the insurance companies.

By all means, chalk this up to just a great marketing plan with an emphasis on increased revenue vs expenses, but again, that makes you ridiculous, uneducated, and really...quite stupid.

[thegreekdog]

that a serious question dave? LOL

Care costs money, in case you didn't know. If there isn't any money, there isn't any care.

Hope I answered your brain busting question

Actually that's his point. But instead of spending the money on the care, they spend it on themselves.

Defending the actions of insurance companies that refuse care and find ways around providing the insurance they sell... is utterly ridiculous, uneducated, and really quite stupid.

Hell, my own insurance company tried to scam me out of money. After say paying them about $60000 and over the years them maybe paying out lets say $6000 (and that's high)....I sent in a receipt for an ER trip, and their response was that my coverage was not in effect.

Now, their explanation ...actually there wasn't one....no apology, no explanation....just absolute silence when the question was asked why they told the hospital there was no policy. I was meant to infer it was just a mistake, since Ive made every payment ever, but the real explanation is that they purposely do that, literally hoping I'm just stupid enough to take that on face value and pay the claim myself. And while I am luckily not in this case, many are, and simply aren't able to understand the insanely complicated legal document that an insurance policy is, cant afford to hire someone to explain to them, so don't receive the correct or timely care that they not only need, but even paid for, simply because of the pure greed and corruption of the insurance companies.

By all means, chalk this up to just a great marketing plan with an emphasis on increased revenue vs expenses, but again, that makes you ridiculous, uneducated, and really...quite stupid.

I think I saw that in a movie (from the 90s) based on a John Grisham book. I'm not saying your story is untrue; rather, I'm wondering how it could possibly be true since it is not only illegal for the insurance company to deny coverage given your facts (for which arrests could be made), this kind of thing was wiped out long ago through legal action. My conclusion is that you must have a really shitty health insurance policy for which you're spending way too much money and that you should report the insurance company to the better business bureau or similar commercial institution and/or the state government. Immediately.

[Symmetry]

that a serious question dave? LOL

Care costs money, in case you didn't know. If there isn't any money, there isn't any care.

Hope I answered your brain busting question

Actually that's his point. But instead of spending the money on the care, they spend it on themselves.

Defending the actions of insurance companies that refuse care and find ways around providing the insurance they sell... is utterly ridiculous, uneducated, and really quite stupid.

Hell, my own insurance company tried to scam me out of money. After say paying them about $60000 and over the years them maybe paying out lets say $6000 (and that's high)....I sent in a receipt for an ER trip, and their response was that my coverage was not in effect.

Now, their explanation ...actually there wasn't one....no apology, no explanation....just absolute silence when the question was asked why they told the hospital there was no policy. I was meant to infer it was just a mistake, since Ive made every payment ever, but the real explanation is that they purposely do that, literally hoping I'm just stupid enough to take that on face value and pay the claim myself. And while I am luckily not in this case, many are, and simply aren't able to understand the insanely complicated legal document that an insurance policy is, cant afford to hire someone to explain to them, so don't receive the correct or timely care that they not only need, but even paid for, simply because of the pure greed and corruption of the insurance companies.

By all means, chalk this up to just a great marketing plan with an emphasis on increased revenue vs expenses, but again, that makes you ridiculous, uneducated, and really...quite stupid.

I think I saw that in a movie (from the 90s) based on a John Grisham book. I'm not saying your story is untrue; rather, I'm wondering how it could possibly be true since it is not only illegal for the insurance company to deny coverage given your facts (for which arrests could be made), this kind of thing was wiped out long ago through legal action. My conclusion is that you must have a really shitty health insurance policy for which you're spending way too much money and that you should report the insurance company to the better business bureau or similar commercial institution and/or the state government. Immediately.

My impression on the Grisham point was that he based it on a true story, but fair point that it got filtered through a fictionalised novel and then a screen-adaptation.

[PLAYER57832]

I'm not saying your story is untrue; rather, I'm wondering how it could possibly be true since it is not only illegal for the insurance company to deny coverage given your facts (for which arrests could be made), this kind of thing was wiped out long ago through legal action. .

Interesting how you decry government, but are quick to claim that all we have to do is sue to get things rectified.

No hospital in the US can deny emergency care, right now. However, once you get beyond the "life and death" emergency bit, its pretty amazing how many "misunderstandings" appear, particularly with Blue Cross/Blue Shield lower end policies (which are NOT treated at all the same as peopel with the better Blue Cross policies!!!!).

But, let's say we want to take the course you suggest, suing. Know any lawyers willing ot take these cases for free? Injury lawyers, sure, but not fighting insurance companies in what is considered civil action. Then are those attorneys of the same caliber as the one's hired by Blue Cross/Blue Shield? Probably not...

Etc.

[thegreekdog]

I'm not saying your story is untrue; rather, I'm wondering how it could possibly be true since it is not only illegal for the insurance company to deny coverage given your facts (for which arrests could be made), this kind of thing was wiped out long ago through legal action. .

Interesting how you decry government, but are quick to claim that all we have to do is sue to get things rectified.

No hospital in the US can deny emergency care, right now. However, once you get beyond the "life and death" emergency bit, its pretty amazing how many "misunderstandings" appear, particularly with Blue Cross/Blue Shield lower end policies (which are NOT treated at all the same as peopel with the better Blue Cross policies!!!!).

But, let's say we want to take the course you suggest, suing. Know any lawyers willing ot take these cases for free? Injury lawyers, sure, but not fighting insurance companies in what is considered civil action. Then are those attorneys of the same caliber as the one's hired by Blue Cross/Blue Shield? Probably not...

Etc.

I know literally hundreds of lawyers who would take that case. Literally. Hundreds.

[Symmetry]

I'm not saying your story is untrue; rather, I'm wondering how it could possibly be true since it is not only illegal for the insurance company to deny coverage given your facts (for which arrests could be made), this kind of thing was wiped out long ago through legal action. .

Interesting how you decry government, but are quick to claim that all we have to do is sue to get things rectified.

No hospital in the US can deny emergency care, right now. However, once you get beyond the "life and death" emergency bit, its pretty amazing how many "misunderstandings" appear, particularly with Blue Cross/Blue Shield lower end policies (which are NOT treated at all the same as peopel with the better Blue Cross policies!!!!).

But, let's say we want to take the course you suggest, suing. Know any lawyers willing ot take these cases for free? Injury lawyers, sure, but not fighting insurance companies in what is considered civil action. Then are those attorneys of the same caliber as the one's hired by Blue Cross/Blue Shield? Probably not...

Etc.

I know literally hundreds of lawyers who would take that case. Literally. Hundreds.

Hmm, my understanding is that Player is basically correct. The life and death part is basically the threshold of emergency room care. Whether lawyers will take a case on or not seems a little irrelevant.

[thegreekdog]

I'm not saying your story is untrue; rather, I'm wondering how it could possibly be true since it is not only illegal for the insurance company to deny coverage given your facts (for which arrests could be made), this kind of thing was wiped out long ago through legal action. .

Interesting how you decry government, but are quick to claim that all we have to do is sue to get things rectified.

No hospital in the US can deny emergency care, right now. However, once you get beyond the "life and death" emergency bit, its pretty amazing how many "misunderstandings" appear, particularly with Blue Cross/Blue Shield lower end policies (which are NOT treated at all the same as peopel with the better Blue Cross policies!!!!).

But, let's say we want to take the course you suggest, suing. Know any lawyers willing ot take these cases for free? Injury lawyers, sure, but not fighting insurance companies in what is considered civil action. Then are those attorneys of the same caliber as the one's hired by Blue Cross/Blue Shield? Probably not...

Etc.

I know literally hundreds of lawyers who would take that case. Literally. Hundreds.

Hmm, my understanding is that Player is basically correct. The life and death part is basically the threshold of emergency room care. Whether lawyers will take a case on or not seems a little irrelevant.

Well, yeah.

[Night Strike]

No hospital in the US can deny emergency care, right now. However, once you get beyond the "life and death" emergency bit, its pretty amazing how many "misunderstandings" appear, particularly with Blue Cross/Blue Shield lower end policies (which are NOT treated at all the same as peopel with the better Blue Cross policies!!!!).

If you don't like your insurance company, go find another one. And we'll ALL be getting that type of poor care if the government controls everything.

[natty dread]

What happens if I don't like your insurance company?

[Night Strike]

What happens if I don't like your insurance company?

You don't get to make my spending choices for me (although you and yours are loving to try to with governmental mandates).

[Symmetry]

What happens if I don't like your insurance company?

You don't get to make my spending choices for me (although you and yours are loving to try to with governmental mandates).

What if the hospital doesn't like your insurance company?

[Frigidus]

No hospital in the US can deny emergency care, right now. However, once you get beyond the "life and death" emergency bit, its pretty amazing how many "misunderstandings" appear, particularly with Blue Cross/Blue Shield lower end policies (which are NOT treated at all the same as peopel with the better Blue Cross policies!!!!).

If you don't like your insurance company, go find another one. And we'll ALL be getting that type of poor care if the government controls everything.

What if every single insurance company behaves the same way? What if the current situation involves way more price gouging and care denial than a government option would?

[saxitoxin]

What happens if I don't like your insurance company?

You don't get to make my spending choices for me (although you and yours are loving to try to with governmental mandates).

What if the hospital doesn't like your insurance company?

Go to a different hospital.

What if you don't like the waiting list at your hospital, Symmetry?

(A friend of mine in Wales just had his sinus infection corrected after ten days on antibiotics, following a 4 month wait to see an ENT. I was absolutely horrified.)

[natty dread]

What if I strap myself with C4 and march into the insurance company headquarters, loudly demanding everyone present to strip naked and slather themselves with cooking oil, or I'll blow up the entire building, and videotape the whole thing and send it to youtube?

What then, guys?

[Frigidus]

What if I strap myself with C4 and march into the insurance company headquarters, loudly demanding everyone present to strip naked and slather themselves with cooking oil, or I'll blow up the entire building, and videotape the whole thing and send it to youtube?

What then, guys?

If you do that I'll like the video.

[Symmetry]

What happens if I don't like your insurance company?

You don't get to make my spending choices for me (although you and yours are loving to try to with governmental mandates).

What if the hospital doesn't like your insurance company?

Go to a different hospital.

What if you don't like the waiting list at your hospital, Symmetry?

(A friend of mine in Wales just had his sinus infection corrected after ten days on antibiotics, following a 4 month wait to see an ENT. I was absolutely horrified.)

He's American, right? British folk would just go to their GP. Ear, Nose and Throat doctors are kind of an American thing. GP's can prescribe anti-biotics. Tell him to visit his local doctor next time, rather than wait four months to get a prescription from a hospital that he could have picked up by phoning for an appointment with a local surgery and received the next day.

[saxitoxin]

What happens if I don't like your insurance company?

You don't get to make my spending choices for me (although you and yours are loving to try to with governmental mandates).

What if the hospital doesn't like your insurance company?

Go to a different hospital.

What if you don't like the waiting list at your hospital, Symmetry?

(A friend of mine in Wales just had his sinus infection corrected after ten days on antibiotics, following a 4 month wait to see an ENT. I was absolutely horrified.)

He's American, right? British folk would just go to their GP. Ear, Nose and Throat doctors are kind of an American thing. GP's can prescribe anti-biotics. Tell him to visit his local doctor next time, rather than wait four months to get a prescription from a hospital that he could have picked up by phoning for an appointment with a local surgery and received the next day.

No, he's Swiss.

Specialists are not "an American thing" - practicing specialists have been common in most modern medical systems since the 1930s. (That said, I understand you personally may not have access to any so appreciate if it may seem more exotic to you in the way natives on Tuvalu once thought cameras might steal their soul.)

He attended the local country horse doctor as you suggest, who recommended he have tea and put a warm heat pack on his face three times each day (literally, I kid you not). I was absolutely horrified. It shouldn't take more than 1 or 2 days to see a specialist.

[AAFitz]

that a serious question dave? LOL

Care costs money, in case you didn't know. If there isn't any money, there isn't any care.

Hope I answered your brain busting question

Actually that's his point. But instead of spending the money on the care, they spend it on themselves.

Defending the actions of insurance companies that refuse care and find ways around providing the insurance they sell... is utterly ridiculous, uneducated, and really quite stupid.

Hell, my own insurance company tried to scam me out of money. After say paying them about $60000 and over the years them maybe paying out lets say $6000 (and that's high)....I sent in a receipt for an ER trip, and their response was that my coverage was not in effect.

Now, their explanation ...actually there wasn't one....no apology, no explanation....just absolute silence when the question was asked why they told the hospital there was no policy. I was meant to infer it was just a mistake, since Ive made every payment ever, but the real explanation is that they purposely do that, literally hoping I'm just stupid enough to take that on face value and pay the claim myself. And while I am luckily not in this case, many are, and simply aren't able to understand the insanely complicated legal document that an insurance policy is, cant afford to hire someone to explain to them, so don't receive the correct or timely care that they not only need, but even paid for, simply because of the pure greed and corruption of the insurance companies.

By all means, chalk this up to just a great marketing plan with an emphasis on increased revenue vs expenses, but again, that makes you ridiculous, uneducated, and really...quite stupid.

I think I saw that in a movie (from the 90s) based on a John Grisham book. I'm not saying your story is untrue; rather, I'm wondering how it could possibly be true since it is not only illegal for the insurance company to deny coverage given your facts (for which arrests could be made), this kind of thing was wiped out long ago through legal action. My conclusion is that you must have a really shitty health insurance policy for which you're spending way too much money and that you should report the insurance company to the better business bureau or similar commercial institution and/or the state government. Immediately.

Well, they did pay it after I called of course, and I can only speculate as to the reason for the initial denial of the claim, but I assure you, the reason given was that the policy was not in force, and it most certainly was at the time. I of course will be changing Insurance companies, but for me it was actually a great plan based on being self-employed. Maybe after I have another carrier, Ill be a little more loose with the information, and perhaps the info will make it to other places...but for now...they are my insurance company...so Ill hold off on messing with them for the time being.