A rare cancer patient spent months fighting insurance denials for the treatment and transplant his physicians believed offered his best chance at survival.
Medicare for all, but ditch Medicare Advantage and broaden coverage to things like dentistry and hearing aids. U.S. healthcare as it is now is a disgrace. Healthcare should not be run as a profit making opportunity but that's all it is in this country.
Prior approval is used as a denial of care. I thought the ACA and healthcare were supposed to cover anyone with preexisting conditions. So, you are healthy when you get health insurance, but if you should get sick, they will pull out the prior approval to deny your care.
It is time for our country to deny their approval to make billions off of us.
We need universal healthcare that covers all of us through a government funded program. We all pay into it and we can afford to have healthcare, period.
Yes, the private commercial for-profit health insurance industry profits more on sick care. With Passing the Medicare for ALL acts; so much is covered, including acupuncture.
Thank you for this story which points to the core issues for people facing challenging health issues. Unfortunately, health insurance companies are in the business of ensuring their profits, not the patients in need of life-saving treatment. The reality is, a single pair system. Structured for effective service and efficiency makes all the sense in the world. The way things are now, companies are always changing their policies which affects both the providers and the patients. You can't count on anything, and like this young man – who at least had experience in researching and confronting the system that was set against him, a huge proportion of time and energy with the existing system is consumed at every level with this bureaucracy that has nothing to do with efficiency, or quality healthcare. In fact, it is designed to maximize profits at the top and make the functioning of the system so chaotic and cumbersome that most people give up. If we're going to do better, we're going to have to come together, bringing lawmakers, healthcare providers, patients, and the best of the expertise in healthcare management to design a better system from the ground up.
You cite two examples of the usefulness of LLMs to help patients manage their health care journey. Why taint that with illustrations that are nothing more than LLM slop?
I lived in Europe for many years and experienced true universal health care, first hand in Germany but also seeing how it works in France, Italy, Luxembourg, Belgium, NL, etc. What we really need to do is to outlaw *corporate* "insurance" (the word is a dismal joke).
In Germany, Krankenkasse Versicherung means something more along the lines of 'sick fund' 'guarantee'... get it? Not a corporate for profit scam (USA) that murders or banktrupts millions of hard working citizens... but a true assurance, a social guarantee. We need to ditch all this corrupt corporate republican fox noise dishonesty and propaganda.. stop calling us (the majority, working people) communists and socialists (socialist is not a bad word)... rather, get some new leadership there in the toilet formerly known as White House... and let us turn this 18th century sewage tank (led by Donald Dump) into a 21st Century country on par with so many others. YES WE CAN!
Bring back Obama and other great leaders like him!
Do you honestly believe that M4A will solve this problem? The government will decide who will receive treatment based on the probability of recovery and life expectancy. The patient's doctor will have no say! Take the UK as a perfect example. They have the worst cancer survival rates, period!
M4A will promise and deliver coverage for everything. Then when the cost of running M4A becomes prohibitive and the government can't continue raisin taxes to pay for it, the they start paring down benefits, then rationing arrives, then producing members of society will receive priority care, while infants and the elderly with chronic and serious medical issues will be considered outside their usefulness.
I would much rather argue with a private insurer then no access to a faceless bureaucrat any day! From the government that brought you the PPACA, and Covid lockdowns, social distancing and masks. We were sold swamp land and you all think it's gong to be nirvana with M4A? Get real!
You should blame the poor design that is Health Reform, the Patient Protection and Affordable Care Act of 2010.
That law required removal of annual and lifetime benefit limits, which raised the cost of coverage and, given turnover among working Americans (and the ability of making a different Exchange coverage choice each year), made prior authorization of expensive treatment essential for both insured coverage and for employer-sponsored, self-insured plans.
The better design would have been something Senators Ted Kennedy, jack Reed, John Kerry, and Bill Frist once endorsed, coupled with a nod to Governor Phil Bredesen of Tennessee and his CoverTN initiative. They had design suggestions that might couple an individual mandate of everyday, basic health coverage with a lower annual dollar limit on benefits (say $25,000 a year), coupled with a mandatory, federal reinsurance/stop loss coverage for expenses incurred in excess of $25,000 a year (where stop loss would limit charges to either Medicare or Medicaid allowable limits). Would reduce the need for and impact of prior auth, whether the insurer/TPA approved or denied the treatment.
Stop blaming insurers - their profits are miniscule relative to total health care spending in the United States (only about 1%). Long past time to focus on the other 99%!
It is not too late to solve the affordability issue that PPACA 2010 NEVER addressed - affordability for everyone state and federal governments ignore - when they are busy buying votes for those enrolled in Medicare, Medicaid and the VA by fixing prices at levels below cost - shifting those costs and the full profit margin to folks with employer-sponsored, exchange or individual coverage!
Medicare for all, but ditch Medicare Advantage and broaden coverage to things like dentistry and hearing aids. U.S. healthcare as it is now is a disgrace. Healthcare should not be run as a profit making opportunity but that's all it is in this country.
Prior approval is used as a denial of care. I thought the ACA and healthcare were supposed to cover anyone with preexisting conditions. So, you are healthy when you get health insurance, but if you should get sick, they will pull out the prior approval to deny your care.
It is time for our country to deny their approval to make billions off of us.
We need universal healthcare that covers all of us through a government funded program. We all pay into it and we can afford to have healthcare, period.
Yes, the private commercial for-profit health insurance industry profits more on sick care. With Passing the Medicare for ALL acts; so much is covered, including acupuncture.
Thank you for this story which points to the core issues for people facing challenging health issues. Unfortunately, health insurance companies are in the business of ensuring their profits, not the patients in need of life-saving treatment. The reality is, a single pair system. Structured for effective service and efficiency makes all the sense in the world. The way things are now, companies are always changing their policies which affects both the providers and the patients. You can't count on anything, and like this young man – who at least had experience in researching and confronting the system that was set against him, a huge proportion of time and energy with the existing system is consumed at every level with this bureaucracy that has nothing to do with efficiency, or quality healthcare. In fact, it is designed to maximize profits at the top and make the functioning of the system so chaotic and cumbersome that most people give up. If we're going to do better, we're going to have to come together, bringing lawmakers, healthcare providers, patients, and the best of the expertise in healthcare management to design a better system from the ground up.
Private Doctors & Physicians Don’t Work for You They're Employees of the Insurance Companies: https://old.bitchute.com/video/Kt90pn6hYpcl [1min]
And please refer to Sunlightreportinsurance.com
We are all on the same side as far as comprehensive care. Capture this…Replacing private healthcare insurance industry spending with progressive taxes
Thank you for sharing this heart felt experience.
You cite two examples of the usefulness of LLMs to help patients manage their health care journey. Why taint that with illustrations that are nothing more than LLM slop?
Yes as the wiser of Oz is hiding behind the curtain called Ponzi for the for-profit commercial private health insurance industry.
I lived in Europe for many years and experienced true universal health care, first hand in Germany but also seeing how it works in France, Italy, Luxembourg, Belgium, NL, etc. What we really need to do is to outlaw *corporate* "insurance" (the word is a dismal joke).
In Germany, Krankenkasse Versicherung means something more along the lines of 'sick fund' 'guarantee'... get it? Not a corporate for profit scam (USA) that murders or banktrupts millions of hard working citizens... but a true assurance, a social guarantee. We need to ditch all this corrupt corporate republican fox noise dishonesty and propaganda.. stop calling us (the majority, working people) communists and socialists (socialist is not a bad word)... rather, get some new leadership there in the toilet formerly known as White House... and let us turn this 18th century sewage tank (led by Donald Dump) into a 21st Century country on par with so many others. YES WE CAN!
Bring back Obama and other great leaders like him!
JTC My Pensive Pen
John T. Cullen author, journalist
https://www.johntcullen.com
https://johntcullen.substack.com/
Nothing will ever change... How many years has this BS been going on? TOO DAMN MANY.
Do you honestly believe that M4A will solve this problem? The government will decide who will receive treatment based on the probability of recovery and life expectancy. The patient's doctor will have no say! Take the UK as a perfect example. They have the worst cancer survival rates, period!
M4A will promise and deliver coverage for everything. Then when the cost of running M4A becomes prohibitive and the government can't continue raisin taxes to pay for it, the they start paring down benefits, then rationing arrives, then producing members of society will receive priority care, while infants and the elderly with chronic and serious medical issues will be considered outside their usefulness.
I would much rather argue with a private insurer then no access to a faceless bureaucrat any day! From the government that brought you the PPACA, and Covid lockdowns, social distancing and masks. We were sold swamp land and you all think it's gong to be nirvana with M4A? Get real!
You should blame the poor design that is Health Reform, the Patient Protection and Affordable Care Act of 2010.
That law required removal of annual and lifetime benefit limits, which raised the cost of coverage and, given turnover among working Americans (and the ability of making a different Exchange coverage choice each year), made prior authorization of expensive treatment essential for both insured coverage and for employer-sponsored, self-insured plans.
The better design would have been something Senators Ted Kennedy, jack Reed, John Kerry, and Bill Frist once endorsed, coupled with a nod to Governor Phil Bredesen of Tennessee and his CoverTN initiative. They had design suggestions that might couple an individual mandate of everyday, basic health coverage with a lower annual dollar limit on benefits (say $25,000 a year), coupled with a mandatory, federal reinsurance/stop loss coverage for expenses incurred in excess of $25,000 a year (where stop loss would limit charges to either Medicare or Medicaid allowable limits). Would reduce the need for and impact of prior auth, whether the insurer/TPA approved or denied the treatment.
Stop blaming insurers - their profits are miniscule relative to total health care spending in the United States (only about 1%). Long past time to focus on the other 99%!
It is not too late to solve the affordability issue that PPACA 2010 NEVER addressed - affordability for everyone state and federal governments ignore - when they are busy buying votes for those enrolled in Medicare, Medicaid and the VA by fixing prices at levels below cost - shifting those costs and the full profit margin to folks with employer-sponsored, exchange or individual coverage!
Ultreia translated to beyond.