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Posted on 5/6/24 at 7:19 am to Dixie2023
quote:Insurance should cover whatever they have contractually agreed to cover, assuming you have fulfilled your end of the contract by paying your premiums.
Insurance should cover whatever a physician or allied health professional recommends. Period. They should have no right to deny. But it’s not medical insurance anymore, it’s managed care.
This post was edited on 5/6/24 at 7:21 am
Posted on 5/6/24 at 7:19 am to TexasTiger89
quote:
For many it is the only way to get treatment. Not everyone can pay.
“Should have worked harder to afford better insurance.”
“Should have started an HSA at 19 to prepare for these situations.”
“Should be more concerned that the medical insurance guys can make money. They’re just trying to feed their families.”
“Should move to a socialist country if they want free shite. We have enough freeloaders around here!”
Posted on 5/6/24 at 7:21 am to Eurocat
quote:
reviewing cases that nurses had flagged for denial or were unsure about
Problem number 1 here.
Posted on 5/6/24 at 7:21 am to StringedInstruments
quote:What's your solution?
“Should have worked harder to afford better insurance.”
“Should have started an HSA at 19 to prepare for these situations.”
“Should be more concerned that the medical insurance guys can make money. They’re just trying to feed their families.”
“Should move to a socialist country if they want free shite. We have enough freeloaders around here!”
Posted on 5/6/24 at 7:22 am to Gravitiger
quote:
Insurance should cover whatever they have contractually agreed to cover, assuming you have fulfilled your end of the contract by paying your premiums.
Imagine getting in a car wreck and while the car is in the shop they suggest that updated after market rims and tires would increase gas mileage and add life to the car.
Posted on 5/6/24 at 7:23 am to LSUfan4444
quote:
It's not denying treatment, only coverage. A patient always has the option to receive and pay for treatment that insurance doesnt cover.
Are you a ‘medical director’ for BCBS? I’ve heard that boilerplate response hundreds of times.
Posted on 5/6/24 at 7:23 am to LSUfan4444
quote:
It's not denying treatment, only coverage. A patient always has the option to receive and pay for treatment that insurance doesnt cover.
If my doc orders a test or procedure that he/she feels is warranted, and I pay my premiums, the insurance company should STFU and pay.
Posted on 5/6/24 at 7:23 am to Eurocat
Can’t speak for other areas but while insurances can be a real pain in the arse, Cigna might be one of the worst. Their reimbursement rates are so low in our area that a ton of providers don’t even bother credentialing with them.
ETA: Unfortunately they’re going to merge with Humana. That’s going to be a shitshow.
ETA: Unfortunately they’re going to merge with Humana. That’s going to be a shitshow.
This post was edited on 5/6/24 at 7:26 am
Posted on 5/6/24 at 7:27 am to Gravitiger
quote:
What's your solution?
Insurance companies should follow the recommendation of the board certified doctors actually treating the patient.
Posted on 5/6/24 at 7:28 am to LSUfan4444
quote:
Imagine getting in a car wreck and while the car is in the shop they suggest that updated after market rims and tires would increase gas mileage and add life to the car.
Simple Jack energy.
Posted on 5/6/24 at 7:29 am to Flavius Belisarius
quote:
I’ve heard that boilerplate response hundreds of times.
Thats because it's true. The US doesnt just have the most expensive healthcare system in the world, we have the worst outcomes of any high income nation at the highest cost.
This is like blaming failures for the NY Yankees on a lack of spending.
People in this country already don't have enough vested stake in their healthcare or conditions but continually point the finger at other people and expect someone else to pay for things that don't actually improve their condition.
Posted on 5/6/24 at 7:32 am to Pikes Peak Tiger
quote:
If my doc orders a test or procedure that he/she feels is warranted,
So, if your doctor orders something that he profits from, then someone else pays for regardless of effectiveness, that should be enough?
People are so much more fiscally liberal than they realize.
Just gimme shite someone else pays for and I am good.
Posted on 5/6/24 at 7:33 am to LSUfan4444
Probably what we ought to do is continue to throw hundreds of billions of government dollars into the health care industry. That ought to bring costs under control...
Posted on 5/6/24 at 7:34 am to Eurocat
This article actually makes it seem nurses and doctors review every claim was is completely untrue.
They hire kids off the street to check claims and send denials. A nurse/DR probably doesn’t see it til the decision is appealed.
Like stated already some insurances are reverting to AI and programs to auto deny. Insurances are not your friend
They hire kids off the street to check claims and send denials. A nurse/DR probably doesn’t see it til the decision is appealed.
Like stated already some insurances are reverting to AI and programs to auto deny. Insurances are not your friend
Posted on 5/6/24 at 7:34 am to Eurocat
This is why I tell all my patients to make insurance give multiple refusals before giving up
Posted on 5/6/24 at 7:35 am to LSUfan4444
quote:Car shops recommend unnecessary shite all the time, just like doctors. Imagine being able to say, "No thanks."
Imagine getting in a car wreck and while the car is in the shop they suggest that updated after market rims and tires would increase gas mileage and add life to the car.
This post was edited on 5/6/24 at 7:42 am
Posted on 5/6/24 at 7:36 am to TigerMan327
quote:
This article actually makes it seem nurses and doctors review every claim was is completely untrue.
I don't think the article is referring to claims, it's referring to prior authorization for services.
Posted on 5/6/24 at 7:36 am to StringedInstruments
quote:Even if the policy that the person paid for explicitly doesn't cover that treatment?
Insurance companies should follow the recommendation of the board certified doctors actually treating the patient.
What if two reasonable board certified doctors actually treating the patient disagree?
This post was edited on 5/6/24 at 7:56 am
Posted on 5/6/24 at 7:37 am to LSUfan4444
quote:
People in this country already don't have enough vested stake in their healthcare or conditions but continually point the finger at other people and expect someone else to pay for things that don't actually improve their condition.
This isn’t a loaded question because I’m one of those that are pretty ignorant about it. I agree with the posters here that say if it’s meets the criteria of a partnered doc, it should be covered.
What’s your solution?
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