"Deny, deny, deny. That’s how you hit your numbers."
April 30, 2024 6:41 AM Subscribe
A Doctor at Cigna Said Her Bosses Pressured Her to Review Patients’ Cases Too Quickly. Cigna Threatened to Fire Her. Nurses in the Phillipines are doing the initial reviews, and making major mistakes. Cigna wants their reviewing doctors to take about four minutes to check the reviews and decide if warranted, or if it should be approved, and penalizing doctors who do the work to know what's really going on.
The latest from ProPublica's series Uncovered: How the Insurance Industry Denies Coverage to Patients.
The latest from ProPublica's series Uncovered: How the Insurance Industry Denies Coverage to Patients.
You know, we could've had a public health insurance option by now. It was passed by the House of Representatives in 2009. By 2020 Joe Biden and other Democrats even supported it as a "reasonable" alternative to Bernie's Medicare-for-all (which just shows how important it is to shift the Overton window with demands for Medicare-for-all), and in the immediate aftermath of an unprecedented pandemic, it kind of seems like the thing that would get rolled into some sort of legislation to strengthen public infrastructure, doesn't it?
Wonder why it didn't happen....
posted by RonButNotStupid at 6:51 AM on April 30 [17 favorites]
Wonder why it didn't happen....
posted by RonButNotStupid at 6:51 AM on April 30 [17 favorites]
I'm in the middle of a search for a new primary care provider, and it is bringing home how much the current system sucks. Most providers in town aren't taking new patients at all, and those that are have months-long waiting lists for an initial appointment. (So good luck if you need a prescription refill in the meantime, unless you can talk an urgent care doctor into it.) The people I know with enough money have almost all switched to concierge doctors, where you pay X thousand dollars to get personalized care, same day appointments, and expedited referrals. I can't really afford that but I'm starting to consider it just given how paltry the other options are.
You know, we could've had a public health insurance option by now.
There's no practical barriers to this, it is all just political and profit-related barriers, given how many companies are benefiting from the current system. It is so incredibly frustrating.
posted by Dip Flash at 7:00 AM on April 30 [12 favorites]
You know, we could've had a public health insurance option by now.
There's no practical barriers to this, it is all just political and profit-related barriers, given how many companies are benefiting from the current system. It is so incredibly frustrating.
posted by Dip Flash at 7:00 AM on April 30 [12 favorites]
The only long fight I've ever had with an insurance company was with Cigna. They decided that a routine look-down-the-nose in an ENT's office was "outpatient surgery" because it was "an instrument entering the body," and therefore subject to deductible. My question of "What is a thermometer, then?" failed to gain any traction.
What followed was a good-cop bad-cop routine, where I'd call Cigna and ask for clarification and be told, we're so sorry, Sir, clearly this is a misunderstanding, I'll file this and have it reclassified and you will owe nothing. Then a couple of weeks would pass, I'd get a letter of denial, I'd get a bill from the doctor's office, and repeat.
I ended up going to a second ENT for reasons, and asked him up front before he did anything if his look-see would be charged as a procedure or if it would simply be part of the office visit, as it had always been before for me. "Far as I know, it's just part of the office visit," he replied, so I let him go ahead and do it.
The denial of coverage from Cigna and the second bill for "outpatient surgery" arrived a month later. It's the only medical bill I've ever simply refused to pay.
posted by delfin at 7:09 AM on April 30 [13 favorites]
What followed was a good-cop bad-cop routine, where I'd call Cigna and ask for clarification and be told, we're so sorry, Sir, clearly this is a misunderstanding, I'll file this and have it reclassified and you will owe nothing. Then a couple of weeks would pass, I'd get a letter of denial, I'd get a bill from the doctor's office, and repeat.
I ended up going to a second ENT for reasons, and asked him up front before he did anything if his look-see would be charged as a procedure or if it would simply be part of the office visit, as it had always been before for me. "Far as I know, it's just part of the office visit," he replied, so I let him go ahead and do it.
The denial of coverage from Cigna and the second bill for "outpatient surgery" arrived a month later. It's the only medical bill I've ever simply refused to pay.
posted by delfin at 7:09 AM on April 30 [13 favorites]
Between the MBA-ification / enshitification of medicine and the multiple grifts that exist at every level, the "medical industry" is so terribly broken that I've stopped even trying to find answers for my truly debilitating long COVID effects. The last pulmonologist that I saw for breathing issues literally spent 3 minutes with me, then told me that long COVID doesn't exist. He strongly implied that my issues were all in my head because the test that had been done didn't show anything out of the ordinary.
My current, about-to-retire PCP doc is telling us that we should look into concierge doctors because she can't find any new PCPs to take us. Even with great health insurance, we can't find any PCP docs willing to even schedule an appointment with us.
Which stage of enshitification is it when your customers stop bothering doing business with you because you suck so bad? Because we've been there in the US with medicine for a while, and I'm really not looking forward to the stage that comes after that.
posted by ensign_ricky at 7:13 AM on April 30 [11 favorites]
My current, about-to-retire PCP doc is telling us that we should look into concierge doctors because she can't find any new PCPs to take us. Even with great health insurance, we can't find any PCP docs willing to even schedule an appointment with us.
Which stage of enshitification is it when your customers stop bothering doing business with you because you suck so bad? Because we've been there in the US with medicine for a while, and I'm really not looking forward to the stage that comes after that.
posted by ensign_ricky at 7:13 AM on April 30 [11 favorites]
Which stage of enshitification is it when your customers stop bothering doing business with you because you suck so bad? Because we've been there in the US with medicine for a while, and I'm really not looking forward to the stage that comes after that.
My non-profit has switched insurance providers something like six times in 15 years. It's jarring each time, but it seems to be one of the only real organizational tools to address the healthcare needs of staff: pick up and move to another option). It's been unfortunate, though, because the options are all so same-y. We've ended up in a loop that feels like alternating among three providers.
The STI/toenail fungus example that's mentioned offhand in the article rings so loudly as an indicator for a system that functions poorly enough that it justifies regulatory intervention. I've been in public health and drug development since the late 90s and have long hoped that some instance like this—something small and nonconctroversial—would capture the public's attention in a way that would help carry this debate to a level of popular infamy that would be politically useful. The big crises seems, oddly enough, to almost directly achieve the opposite—they're juicy stories that are easy to manipulate to serve different political targets. I still hold out hope for something like this because if there's anything the modern internet is capable of doing it's blasting out meme-able information.
posted by late afternoon dreaming hotel at 7:29 AM on April 30 [3 favorites]
My non-profit has switched insurance providers something like six times in 15 years. It's jarring each time, but it seems to be one of the only real organizational tools to address the healthcare needs of staff: pick up and move to another option). It's been unfortunate, though, because the options are all so same-y. We've ended up in a loop that feels like alternating among three providers.
The STI/toenail fungus example that's mentioned offhand in the article rings so loudly as an indicator for a system that functions poorly enough that it justifies regulatory intervention. I've been in public health and drug development since the late 90s and have long hoped that some instance like this—something small and nonconctroversial—would capture the public's attention in a way that would help carry this debate to a level of popular infamy that would be politically useful. The big crises seems, oddly enough, to almost directly achieve the opposite—they're juicy stories that are easy to manipulate to serve different political targets. I still hold out hope for something like this because if there's anything the modern internet is capable of doing it's blasting out meme-able information.
posted by late afternoon dreaming hotel at 7:29 AM on April 30 [3 favorites]
There's no practical barriers to this, it is all just political and profit-related barriers, given how many companies are benefiting from the current system. It is so incredibly frustrating.
Is a public option too much of an ideological stretch? Fine. There are non-profit health insurers that are nominally better than the for-profit ones. No need to get into the whole should-government-provide-healthcare debate. Just ban/regulate-out-of-existence the for-profit ones. Instant, pragmatic, incremental progress!
But we can't even do that.
It's like how most everyone agrees that payday lenders are a scum upon the earth, but as long as there are a one or two elected officials who don't agree (because they profit directly or indirectly from them) nothing is ever going to get done.
posted by RonButNotStupid at 7:45 AM on April 30 [4 favorites]
Is a public option too much of an ideological stretch? Fine. There are non-profit health insurers that are nominally better than the for-profit ones. No need to get into the whole should-government-provide-healthcare debate. Just ban/regulate-out-of-existence the for-profit ones. Instant, pragmatic, incremental progress!
But we can't even do that.
It's like how most everyone agrees that payday lenders are a scum upon the earth, but as long as there are a one or two elected officials who don't agree (because they profit directly or indirectly from them) nothing is ever going to get done.
posted by RonButNotStupid at 7:45 AM on April 30 [4 favorites]
You know, we could've had a public health insurance option by now.
That's important, but it's not enough for it to exist; it needs to exist and be well-funded. Which means it's not a one-and-done thing: first some government has to create the system and allot initial funding, and then subsequent governments have to keep funding it, and funding it at a high enough level to provide service at a high quality. Fund it poorly enough, and you'll force even the best system to take frustrating, stupid, and truly harmful cost-cutting measures just like today's HMOs do (they do it out of greed, but that's not much help).
What's been happening to the NHS is a depressing case in point, and it's hard to imagine US Republicans being more willing to support public health than UK Tories.
Anyway, even though I'm a fan of public insurance it's not actually necessary in order to address the types of problems described in the article - Congress could regulate the behavior of the existing HMO system in all kinds of ways - but that doesn't seem to be happening either.
posted by trig at 7:48 AM on April 30 [12 favorites]
That's important, but it's not enough for it to exist; it needs to exist and be well-funded. Which means it's not a one-and-done thing: first some government has to create the system and allot initial funding, and then subsequent governments have to keep funding it, and funding it at a high enough level to provide service at a high quality. Fund it poorly enough, and you'll force even the best system to take frustrating, stupid, and truly harmful cost-cutting measures just like today's HMOs do (they do it out of greed, but that's not much help).
What's been happening to the NHS is a depressing case in point, and it's hard to imagine US Republicans being more willing to support public health than UK Tories.
Anyway, even though I'm a fan of public insurance it's not actually necessary in order to address the types of problems described in the article - Congress could regulate the behavior of the existing HMO system in all kinds of ways - but that doesn't seem to be happening either.
posted by trig at 7:48 AM on April 30 [12 favorites]
Good thing y'all didn't end up with death panels, eh?
posted by clawsoon at 7:50 AM on April 30 [16 favorites]
posted by clawsoon at 7:50 AM on April 30 [16 favorites]
...Bernie's Medicare-for-all (which just shows how important it is to shift the Overton window with demands for Medicare-for-all), and in the immediate aftermath of an unprecedented pandemic, it kind of seems like the thing that would get rolled into some sort of legislation to strengthen public infrastructure, doesn't it?
Wonder why it didn't happen....
Not to worry. You'll get Medicare-For-All just as soon as the insurance industry has sufficiently brainwashed americans into believing that Medicare Advantage plans are Honest! No-Foolin! real Medicare.
They aren't, of course. They're actually highly cynical steps toward privatizing Medicare, and killing-off the not-perfect-but-it-works-great Medicare system.
posted by Thorzdad at 7:51 AM on April 30 [8 favorites]
Wonder why it didn't happen....
Not to worry. You'll get Medicare-For-All just as soon as the insurance industry has sufficiently brainwashed americans into believing that Medicare Advantage plans are Honest! No-Foolin! real Medicare.
They aren't, of course. They're actually highly cynical steps toward privatizing Medicare, and killing-off the not-perfect-but-it-works-great Medicare system.
posted by Thorzdad at 7:51 AM on April 30 [8 favorites]
> Wonder why it didn't happen....
It's entirely the fault of a single senator - Joe Lieberman, who should forever be remembered solely for selling out his constituency in favor of his rich insurance industry donors.
posted by I-Write-Essays at 7:57 AM on April 30 [42 favorites]
It's entirely the fault of a single senator - Joe Lieberman, who should forever be remembered solely for selling out his constituency in favor of his rich insurance industry donors.
posted by I-Write-Essays at 7:57 AM on April 30 [42 favorites]
...over and over and over. Lieberman delenda est.
posted by wenestvedt at 8:11 AM on April 30 [2 favorites]
posted by wenestvedt at 8:11 AM on April 30 [2 favorites]
The stated purpose of one of our two main parties is "empower assholes." The other party listens to rich and powerful people too much, because they need money and power to succeed. The GOP has been smart in extending their mandate beyond rich powerful assholes to embrace poor and middle class assholes, but they have stumbled to a degree by excluding assholes of color, trans assholes, etc (though they seem to be inordinately successful with a portion of cis white gay assholes). We need a two-pronged approach to change: regulate business & tax the rich; and try not to be an asshole.
posted by rikschell at 8:37 AM on April 30 [3 favorites]
posted by rikschell at 8:37 AM on April 30 [3 favorites]
Primary care physician in rural America. We know. We've been screaming about this for the last two decades. Nobody gives a fuck what I, or any other family medicine physician thinks or want. Everyone in charge is a failson MBA. Physicians have been stripped of authority and removed from the leadership and executive roles across the board in clinics, physician groups, hospitals. All authority in patient care now lies solely with these unaccountable insurance corporations.
As more physicians leave due to disenfranchisement, more and more 22 year old freshly minted nurse practitioners graduate and immediately begin misrepresenting their training and credentialing, which is nonexistent. The flood of untrained NPs has only exponentially increased my workload and clogged referrals that were already having wait times of months. Family physician internal polling most recently was 99% of us would leave today and never look back if we could.
posted by hobo gitano de queretaro at 8:58 AM on April 30 [23 favorites]
As more physicians leave due to disenfranchisement, more and more 22 year old freshly minted nurse practitioners graduate and immediately begin misrepresenting their training and credentialing, which is nonexistent. The flood of untrained NPs has only exponentially increased my workload and clogged referrals that were already having wait times of months. Family physician internal polling most recently was 99% of us would leave today and never look back if we could.
posted by hobo gitano de queretaro at 8:58 AM on April 30 [23 favorites]
In software development there is the idea of subservient management - a product manager whose job isn't to manage workers, but to manage paperwork.
Can doctors unionize/organize and replace the mba-ment with project managers that report to the doctors? Like, a doctor coop, that hires a project manager to manage paperwork and the office etc, but the doctors are the the board.
posted by NotAYakk at 9:40 AM on April 30 [3 favorites]
Can doctors unionize/organize and replace the mba-ment with project managers that report to the doctors? Like, a doctor coop, that hires a project manager to manage paperwork and the office etc, but the doctors are the the board.
posted by NotAYakk at 9:40 AM on April 30 [3 favorites]
It's entirely the fault of a single senator - Joe Lieberman, who should forever be remembered solely for selling out his constituency in favor of his rich insurance industry donors.
I am going to say, reluctantly, what I have said about Manchin and Sinema over the last couple of years. Lieberman was the linchpin and proud flag-bearer of the blocking effort, but it may be a mistake to assume that 59 Dems were full-throated supporters right behind him. I strongly suspect that there were others who were willing to let Lieberman run his mouth and catch all the incoming fire, but who would've voted against it had they not been the deciding vote.
That said, Lieberman was a human cloaca and is where he belongs now. Lieberman delenda est indeed.
posted by delfin at 9:56 AM on April 30 [5 favorites]
I am going to say, reluctantly, what I have said about Manchin and Sinema over the last couple of years. Lieberman was the linchpin and proud flag-bearer of the blocking effort, but it may be a mistake to assume that 59 Dems were full-throated supporters right behind him. I strongly suspect that there were others who were willing to let Lieberman run his mouth and catch all the incoming fire, but who would've voted against it had they not been the deciding vote.
That said, Lieberman was a human cloaca and is where he belongs now. Lieberman delenda est indeed.
posted by delfin at 9:56 AM on April 30 [5 favorites]
I can't help but wonder why Dr. Day didn't just start issuing fast, half-assed *approvals* whenever she thought a denial didn't pass the sniff test.
Maybe it was in her nature to be methodical, or maybe Cigna also tracked and penalized "bad" approvals (but not bad denials), or maybe there is some other reason, but I would like to have seen that addressed.
posted by Reverend John at 10:00 AM on April 30 [1 favorite]
Maybe it was in her nature to be methodical, or maybe Cigna also tracked and penalized "bad" approvals (but not bad denials), or maybe there is some other reason, but I would like to have seen that addressed.
posted by Reverend John at 10:00 AM on April 30 [1 favorite]
Can doctors unionize/organize and replace the mba-ment with project managers that report to the doctors?
This is not unheard of. But as long the insurers deny everything they can, and Medicare reimburses for less than services cost to provide, it doesn't matter that much.
posted by paper chromatographologist at 10:02 AM on April 30 [3 favorites]
This is not unheard of. But as long the insurers deny everything they can, and Medicare reimburses for less than services cost to provide, it doesn't matter that much.
posted by paper chromatographologist at 10:02 AM on April 30 [3 favorites]
delfin: I am going to say, reluctantly, what I have said about Manchin and Sinema over the last couple of years. Lieberman was the linchpin and proud flag-bearer of the blocking effort, but it may be a mistake to assume that 59 Dems were full-throated supporters right behind him.
Yeah, it's kinda weird how often the Democrats would totally 100% do something if it weren't for just that one guy. Gee, we were all so close yet again.
posted by clawsoon at 10:03 AM on April 30 [12 favorites]
Yeah, it's kinda weird how often the Democrats would totally 100% do something if it weren't for just that one guy. Gee, we were all so close yet again.
posted by clawsoon at 10:03 AM on April 30 [12 favorites]
A comparatively small but consequential step we could take would be to simple disconnect health insurance from employment, and put everyone in the marketplace. If you're an employer, you're happy you don't have to think about that shit every year. If you're a fan of markets, you applaud the removal of a nonsensical, government-incentivized middleman in health insurance. If you're a fan of the public option (as I am), you've suddenly got millions more people of means who might choose it, who would actually consider if it would improve their own lives instead of some abstract poor person.
If you're an insurance company... git gud or get fucked, I guess.
posted by McBearclaw at 10:22 AM on April 30 [8 favorites]
If you're an insurance company... git gud or get fucked, I guess.
posted by McBearclaw at 10:22 AM on April 30 [8 favorites]
...but it may be a mistake to assume that 59 Dems were full-throated supporters right behind him.
Yeah, it's kinda weird how often the Democrats would totally 100% do something if it weren't for just that one guy. Gee, we were all so close yet again.
I think it's better to take this one guy thing at face value. Maybe there are other holdouts and the most obnoxious guy in the caucus graciously takes the heat so the others don't have to to, but I personally feel that level of cynicism is too much for productive debate.
Besides, the optics of one guy are just too damning. A dozen holdouts is a political reality that is hard to argue against, but one guy always keeping us from having nice things is WTF levels of outrage. If Democrats think they look better always being one guy short of delivering promises instead of showing a much larger lack of enthusiasm, then that's certainly a choice. But I'm going to take them for their word and be critical of their inability to stand up to assholes within their own party.
posted by RonButNotStupid at 10:37 AM on April 30 [5 favorites]
Yeah, it's kinda weird how often the Democrats would totally 100% do something if it weren't for just that one guy. Gee, we were all so close yet again.
I think it's better to take this one guy thing at face value. Maybe there are other holdouts and the most obnoxious guy in the caucus graciously takes the heat so the others don't have to to, but I personally feel that level of cynicism is too much for productive debate.
Besides, the optics of one guy are just too damning. A dozen holdouts is a political reality that is hard to argue against, but one guy always keeping us from having nice things is WTF levels of outrage. If Democrats think they look better always being one guy short of delivering promises instead of showing a much larger lack of enthusiasm, then that's certainly a choice. But I'm going to take them for their word and be critical of their inability to stand up to assholes within their own party.
posted by RonButNotStupid at 10:37 AM on April 30 [5 favorites]
I had to cancel my Cigna policy and scramble to find new insurance last year when they did the shittiest thing I've ever seen a major insurer do (at least, short of the outrageous denials that most of them will try whenever they think they can get away with it).
My policy with them was one that I had specifically selected in 2022 and was paying extra for because it included coverage at one of the best hospitals in the country, one that I lived half a dozen blocks away from. It was a significant premium but it was worth it to me, for the convenience of the hospital in my neighborhood and the quality of care. When I renewed the plan in 2023 they changed something minor in the name, the plan number I think, but it continued to be called "Cigna Plus something-something with [Major Hospital X] Medicine".
Right after the first of the year I went in for standard bloodwork. Shortly thereafter I received a bill for $973, for a blood draw and tests that would have been fully covered the previous year. After a series of calls with clueless reps assuring me there was a mistake and I should just resubmit the claim, I finally got someone who said, definitively, that the hospital was out of network for me. "How on earth is the hospital out of network," I asked, "when the NAME OF THE HOSPITAL IS SPECIFICALLY IN THE PLAN? And the entire reason for the plan and its premium price is the coverage at this specific hospital?"
Well, funny story! Turns out, Cigna apparently decided that they had spent too much in coverage for people in my neighborhood using this hospital's services in 2022, so they specifically removed us -- the people in the neighborhood -- from coverage. They didn't remove the hospital from the plan, though, because then they would have had to change the name of the plan. Instead, they snuck a disclaimer into the second or third page of policy details that said, services at Major Hospital X are in network for policy holders who live *outside of the county in which Major Hospital X is situated*. Residents who live *in the same county as Major Hospital X*, i.e., locals, people who had chosen the hospital because it was in their neighborhood, were now specifically excluded from the policy. If I had driven ten miles from the next county over to get service at the hospital, I would have still been covered, but because I could walk there from my house in the same county, I was no longer covered there.
Oh, and how was I supposed to have known that they made this change? "We sent a notice out to all affected policyholders last month," says the representative. But I was set up for paperless billing with Cigna, and everything I needed to see from them came to me digitally. They still cheerfully sent me several pieces of physical mail every month though, mostly promotional garbage that I confidently threw away because... I was supposed to get everything important by email, right? Why would I need to keep opening the spam mail they insisted on sending? But apparently the notice was buried in one of those spammy mailings, and it was my fault for missing it and naively assuming that the plan that said Major Hospital X would still cover my basic services at Major Hospital X.
I finally settled with the hospital months later for half the initial bill, still hundreds more than I would have paid if my insurance company had not specifically chosen to fuck me over. I'll never do business with Cigna again.
posted by Two unicycles and some duct tape at 10:39 AM on April 30 [39 favorites]
My policy with them was one that I had specifically selected in 2022 and was paying extra for because it included coverage at one of the best hospitals in the country, one that I lived half a dozen blocks away from. It was a significant premium but it was worth it to me, for the convenience of the hospital in my neighborhood and the quality of care. When I renewed the plan in 2023 they changed something minor in the name, the plan number I think, but it continued to be called "Cigna Plus something-something with [Major Hospital X] Medicine".
Right after the first of the year I went in for standard bloodwork. Shortly thereafter I received a bill for $973, for a blood draw and tests that would have been fully covered the previous year. After a series of calls with clueless reps assuring me there was a mistake and I should just resubmit the claim, I finally got someone who said, definitively, that the hospital was out of network for me. "How on earth is the hospital out of network," I asked, "when the NAME OF THE HOSPITAL IS SPECIFICALLY IN THE PLAN? And the entire reason for the plan and its premium price is the coverage at this specific hospital?"
Well, funny story! Turns out, Cigna apparently decided that they had spent too much in coverage for people in my neighborhood using this hospital's services in 2022, so they specifically removed us -- the people in the neighborhood -- from coverage. They didn't remove the hospital from the plan, though, because then they would have had to change the name of the plan. Instead, they snuck a disclaimer into the second or third page of policy details that said, services at Major Hospital X are in network for policy holders who live *outside of the county in which Major Hospital X is situated*. Residents who live *in the same county as Major Hospital X*, i.e., locals, people who had chosen the hospital because it was in their neighborhood, were now specifically excluded from the policy. If I had driven ten miles from the next county over to get service at the hospital, I would have still been covered, but because I could walk there from my house in the same county, I was no longer covered there.
Oh, and how was I supposed to have known that they made this change? "We sent a notice out to all affected policyholders last month," says the representative. But I was set up for paperless billing with Cigna, and everything I needed to see from them came to me digitally. They still cheerfully sent me several pieces of physical mail every month though, mostly promotional garbage that I confidently threw away because... I was supposed to get everything important by email, right? Why would I need to keep opening the spam mail they insisted on sending? But apparently the notice was buried in one of those spammy mailings, and it was my fault for missing it and naively assuming that the plan that said Major Hospital X would still cover my basic services at Major Hospital X.
I finally settled with the hospital months later for half the initial bill, still hundreds more than I would have paid if my insurance company had not specifically chosen to fuck me over. I'll never do business with Cigna again.
posted by Two unicycles and some duct tape at 10:39 AM on April 30 [39 favorites]
It's important with the Lieberman/single payer issue to remember that if you have a majority you can do fun things with the rules when you feel like it.
Sadly, what we actually had was 10+ dems (at least nine senators and the VP or 10+ senators) unwilling to touch the filibuster for the greatest public good that would likely be accomplished in my lifetime.
The bulk of dems did not want to fix healthcare then, didn't in 2020-2021, and presumably will continue to ignore the issue as best they can in the future.
posted by Slackermagee at 10:51 AM on April 30 [7 favorites]
Sadly, what we actually had was 10+ dems (at least nine senators and the VP or 10+ senators) unwilling to touch the filibuster for the greatest public good that would likely be accomplished in my lifetime.
The bulk of dems did not want to fix healthcare then, didn't in 2020-2021, and presumably will continue to ignore the issue as best they can in the future.
posted by Slackermagee at 10:51 AM on April 30 [7 favorites]
Oh, jeez, blood work.
My wife is dutiful and gets her blood drawn by an in-network facility every year for her family-doctor checkup. In the intervals in which I am insured, I do that, too. For many years, I used to get routine bloodwork done and pay something like $5-10 when the bill came in. One year, I opened the bill and my jaw dropped -- it was over $200, instead.
I paid it, then reported it to my family doctor on my next visit, and he looked shocked. "That's not supposed to be like that, based on what tests I ordered. Not at all," the doctor frowned.
I just got a bill for my wife's most recent blood work WITH insurance "coverage," for in-network services from an approved blood-draw facility. $610. That's because every bit of it was considered subject to the deductible on her current mid-range PPO.
It's one thing if what you need done is out of the ordinary. A coworker of my wife's, for instance, has a very expensive medical treatment that she needs regularly and she wrestles with the doctors and insurance regularly as to whether it'll be covered. But when you wring people dry over the routine stuff...
...that's when people start just doing without.
posted by delfin at 10:52 AM on April 30 [7 favorites]
My wife is dutiful and gets her blood drawn by an in-network facility every year for her family-doctor checkup. In the intervals in which I am insured, I do that, too. For many years, I used to get routine bloodwork done and pay something like $5-10 when the bill came in. One year, I opened the bill and my jaw dropped -- it was over $200, instead.
I paid it, then reported it to my family doctor on my next visit, and he looked shocked. "That's not supposed to be like that, based on what tests I ordered. Not at all," the doctor frowned.
I just got a bill for my wife's most recent blood work WITH insurance "coverage," for in-network services from an approved blood-draw facility. $610. That's because every bit of it was considered subject to the deductible on her current mid-range PPO.
It's one thing if what you need done is out of the ordinary. A coworker of my wife's, for instance, has a very expensive medical treatment that she needs regularly and she wrestles with the doctors and insurance regularly as to whether it'll be covered. But when you wring people dry over the routine stuff...
...that's when people start just doing without.
posted by delfin at 10:52 AM on April 30 [7 favorites]
...that's when people start just doing without.
The purpose of a system is what it does.
posted by notoriety public at 11:23 AM on April 30 [14 favorites]
The purpose of a system is what it does.
posted by notoriety public at 11:23 AM on April 30 [14 favorites]
Wendell Potter on Twitter. Potter describes himself as "Former VP, @cigna. Whistleblower and reformed insurance propagandist".
posted by neuron at 3:02 PM on April 30 [1 favorite]
posted by neuron at 3:02 PM on April 30 [1 favorite]
more and more 22 year old freshly minted nurse practitioners graduate and immediately begin misrepresenting their training and credentialing, which is nonexistent
I really want to highlight this. I'm in the middle of a mid-life career change from working in molecular biology to nursing. I was previously ambivalent about NPs before "oh that makes sense, they've been working in healthcare for years, a few more years of education probably makes them a pretty good." Now I won't allow my family to see them. I am IN NO WAY saying that there aren't good NPs out there, but the state boards of nursing have RUINED my trust in them by allowing absolutely bullshit education happen in NP schools. Not only is the NP education poor, but nursing education in general is poor. I don't understand it. I'm at a large state university with a supposedly top nursing program and (a year in) I haven't stopped being just dumbfounded by how its being run and what I'm being taught. My previous BS(s) are in psychology and molecular and cellular biology and if anything it's a hindrance, because anything relating to those topics in nursing school are 60 years out of date or just wrong. I am exaggerating only slightly for effect.
My local GP left, probably to the local VA, not sure. The only providers left at the office are NPs. It's been a struggle to find anyone with an MD/DO in town who is accepting patients. This is the future of primary care for anyone who can't afford concierge medicine.
posted by lizjohn at 4:16 PM on April 30 [6 favorites]
I really want to highlight this. I'm in the middle of a mid-life career change from working in molecular biology to nursing. I was previously ambivalent about NPs before "oh that makes sense, they've been working in healthcare for years, a few more years of education probably makes them a pretty good." Now I won't allow my family to see them. I am IN NO WAY saying that there aren't good NPs out there, but the state boards of nursing have RUINED my trust in them by allowing absolutely bullshit education happen in NP schools. Not only is the NP education poor, but nursing education in general is poor. I don't understand it. I'm at a large state university with a supposedly top nursing program and (a year in) I haven't stopped being just dumbfounded by how its being run and what I'm being taught. My previous BS(s) are in psychology and molecular and cellular biology and if anything it's a hindrance, because anything relating to those topics in nursing school are 60 years out of date or just wrong. I am exaggerating only slightly for effect.
My local GP left, probably to the local VA, not sure. The only providers left at the office are NPs. It's been a struggle to find anyone with an MD/DO in town who is accepting patients. This is the future of primary care for anyone who can't afford concierge medicine.
posted by lizjohn at 4:16 PM on April 30 [6 favorites]
I am currently being treated by an excellent nurse midwife for an ovary thing because the wait to see an OBGYN was 3 months. If folks are unhappy that we are increasingly being treated by NPs and PAs, blame the AMA, which lobbied for decades to limit the number of residency slots because of the fear of a "doctor surplus" (although it has recently reversed course on that) and still limits the ability of doctors trained in other countries to practice here without first completing one of those limited US residencies. The US population keeps increasing, the number of doctors doesn't.
I have many amazing students who would make excellent doctors, but they don't have the right pedigree and the right resume for medical school, so they become PAs and NPs instead. Increase the number of medical school and residency slots, admit people who don't have a 4.0 from Harvard with presidency of the debate team and captain of the lacrosse team, and this problem would go away.
(And of course, the availablity of OBGYNs in states like Georgia is limited by the disastrous post-Dobbs world where OBs are threatened with prosecution for doing their fucking jobs.)
...
Meanwhile, back to the actual topic at hand, insurance companies are fucking people over for profit every single day. For the decade that "CVS Pharmacy Benefits Management" controlled my prescriptions, I would regularly miss multiple doses of my biologic drug because of prior authorizations and other bullshit. It was clear that all those obstacles were put in place to save the company money by reducing the number of doses of my biologic drug I got each year. That is their entire plan. That is the point of prior authorizations. The system is working as designed.
A few years ago, after many calls to CVS PBM in one week, I finally got to talk to someone who was a supervisor who said she was a pharmacist whose job seemed to be like the one in the FPP--denying people's prior authorizations. I told her point blank, "You are hurting me. Did you go to pharmacy school to hurt people? Because that's what you're doing. Your job only hurts people. It does not help people." It fixed nothing, of course, but she did call to check on me a couple days later. I did not respond to her message. I hope she quit her terrible job. I doubt she did.
posted by hydropsyche at 5:05 PM on April 30 [12 favorites]
I have many amazing students who would make excellent doctors, but they don't have the right pedigree and the right resume for medical school, so they become PAs and NPs instead. Increase the number of medical school and residency slots, admit people who don't have a 4.0 from Harvard with presidency of the debate team and captain of the lacrosse team, and this problem would go away.
(And of course, the availablity of OBGYNs in states like Georgia is limited by the disastrous post-Dobbs world where OBs are threatened with prosecution for doing their fucking jobs.)
...
Meanwhile, back to the actual topic at hand, insurance companies are fucking people over for profit every single day. For the decade that "CVS Pharmacy Benefits Management" controlled my prescriptions, I would regularly miss multiple doses of my biologic drug because of prior authorizations and other bullshit. It was clear that all those obstacles were put in place to save the company money by reducing the number of doses of my biologic drug I got each year. That is their entire plan. That is the point of prior authorizations. The system is working as designed.
A few years ago, after many calls to CVS PBM in one week, I finally got to talk to someone who was a supervisor who said she was a pharmacist whose job seemed to be like the one in the FPP--denying people's prior authorizations. I told her point blank, "You are hurting me. Did you go to pharmacy school to hurt people? Because that's what you're doing. Your job only hurts people. It does not help people." It fixed nothing, of course, but she did call to check on me a couple days later. I did not respond to her message. I hope she quit her terrible job. I doubt she did.
posted by hydropsyche at 5:05 PM on April 30 [12 favorites]
Academic subspecialist weighing in. It's a disaster out here. I resigned earlier this year, in part because the aggravation of prior auth and paperwork is no longer worth the intrinsic or extrinsic value of clinical practice in an increasingly corporatized world. Cigna is the worst, except for Aetna, and oh United Healthcare and BC/BS and Anthem (oh God, Anthem, they been awful since I was a resident 10 years ago).
Spent 15 years learning my craft; the parasites broke me in 5. That's gotta be some kind of record.
I have a dream of buying a van and sticking a "doctor is in" sign on the front and just driving around like the horse-and-buggy docs of old. Direct Primary Care and Direct Specialty Care (different from concierge medicine, which is way too pricey and inequitable for my taste) may be what saves us.
posted by basalganglia at 5:54 PM on April 30 [10 favorites]
Spent 15 years learning my craft; the parasites broke me in 5. That's gotta be some kind of record.
I have a dream of buying a van and sticking a "doctor is in" sign on the front and just driving around like the horse-and-buggy docs of old. Direct Primary Care and Direct Specialty Care (different from concierge medicine, which is way too pricey and inequitable for my taste) may be what saves us.
posted by basalganglia at 5:54 PM on April 30 [10 favorites]
I have a dream of buying a van and sticking a "doctor is in"
... the lack of accessible, affordable healthcare is a reason we never moved back to the US. Along with the expense, it's deeply offensive, perverse, and vicious. As noted above "...but 'Death-Panels'!..." yeah, well, you got 'em anyway.
The worst is hearing family members suffering because of it. It's sad as hell.
posted by From Bklyn at 2:14 AM on May 1 [3 favorites]
... the lack of accessible, affordable healthcare is a reason we never moved back to the US. Along with the expense, it's deeply offensive, perverse, and vicious. As noted above "...but 'Death-Panels'!..." yeah, well, you got 'em anyway.
The worst is hearing family members suffering because of it. It's sad as hell.
posted by From Bklyn at 2:14 AM on May 1 [3 favorites]
I'm just chiming in that we're served by CVS Caremark for medications, and my PCP has been fighting with them on my behalf to get me the ADJD med that I need, because the psychiatric practice I went to for the screening refuses as a general thing to prescribe stimulants, and the only other medication they had does not go well with medications I am already taking. So that sucks.
posted by mephron at 4:30 AM on May 1 [2 favorites]
posted by mephron at 4:30 AM on May 1 [2 favorites]
Not only is the NP education poor, but nursing education in general is poor.
I worked at a university with a supposedly reputable nursing program, and from what I saw of the curriculum, a lot of it was focused on nurse-as-worker compliance and pacification (e.g., social-emotional learning and workplace communication frameworks that encouraged individualist perspectives and discouraged systemic frameworks that would facilitate the kind of critical analysis being made throughout this thread).
posted by audi alteram partem at 5:29 AM on May 1 [2 favorites]
I worked at a university with a supposedly reputable nursing program, and from what I saw of the curriculum, a lot of it was focused on nurse-as-worker compliance and pacification (e.g., social-emotional learning and workplace communication frameworks that encouraged individualist perspectives and discouraged systemic frameworks that would facilitate the kind of critical analysis being made throughout this thread).
posted by audi alteram partem at 5:29 AM on May 1 [2 favorites]
As noted above "...but 'Death-Panels'!..." yeah, well, you got 'em anyway.
Yes, but those are corporate death panels, so it's all good.
posted by Thorzdad at 11:01 AM on May 1 [2 favorites]
Yes, but those are corporate death panels, so it's all good.
posted by Thorzdad at 11:01 AM on May 1 [2 favorites]
I'm hoping for death panels for corporations.
posted by Dip Flash at 1:05 PM on May 1 [2 favorites]
posted by Dip Flash at 1:05 PM on May 1 [2 favorites]
I don't have health insurance. I can't afford it. I also can't qualify for Medicaid or Medicare for Reasons.
Rather, I could afford a policy whose deductable is larger than what it would cost for me to pay cash to my GP and buy my prescriptions using the pharmacy discounts (my pharmacist is great about finding me deals.). So that is what I do.
It helps, I think, that my GP is an Indian man who was sponsored into this country by a company doing workman's compensation claims. He was outside to deny as many as possible, and left the minute he could and still stay here.
Then he, his wife (also an MD, an OB/GYN) and a PA friend of theirs opened a clinic in a nearby city to me. They charge cash clients the exact amount they charge Medicare and Medicaid, and only that because the law will not allow them to charge less for cash patients. While that cost has risen over the 17 years they've been my doctors, it's still half of what any other GP or urgent care costs just to walk in the door.
They also tend to reach less often to expensive solutions. Several times they have declined to order extensive tests before trying less expensive and intrusive measures, and they have, in the experience of my family, always been right when they do so. Also always right when they've said this one is serious, meet me at the hospital.
They now have a clinic in my town and the one still in the nearby city. The one here is open until lunch, the other afterwards. And there are thousands of us here who can only get least care at all because of them.
I'm grateful.
posted by Vigilant at 4:47 PM on May 1 [13 favorites]
Rather, I could afford a policy whose deductable is larger than what it would cost for me to pay cash to my GP and buy my prescriptions using the pharmacy discounts (my pharmacist is great about finding me deals.). So that is what I do.
It helps, I think, that my GP is an Indian man who was sponsored into this country by a company doing workman's compensation claims. He was outside to deny as many as possible, and left the minute he could and still stay here.
Then he, his wife (also an MD, an OB/GYN) and a PA friend of theirs opened a clinic in a nearby city to me. They charge cash clients the exact amount they charge Medicare and Medicaid, and only that because the law will not allow them to charge less for cash patients. While that cost has risen over the 17 years they've been my doctors, it's still half of what any other GP or urgent care costs just to walk in the door.
They also tend to reach less often to expensive solutions. Several times they have declined to order extensive tests before trying less expensive and intrusive measures, and they have, in the experience of my family, always been right when they do so. Also always right when they've said this one is serious, meet me at the hospital.
They now have a clinic in my town and the one still in the nearby city. The one here is open until lunch, the other afterwards. And there are thousands of us here who can only get least care at all because of them.
I'm grateful.
posted by Vigilant at 4:47 PM on May 1 [13 favorites]
« Older Kiwi takes a nap in Far North woman's chicken coop | JZD Slušovice — A Socialist Miracle in... Newer »
I only hope that the greed is so out of control that it finally tips political will in favor of a system that actually serves its populace.
posted by mcstayinskool at 6:49 AM on April 30 [31 favorites]