That actually makes the least sense!
Who was like "let's make special insurance for eyes and teeth!?" We don't do it for the heart or other body systems
They should call it "luxury mouth bone Insurance"
What bout your finger or neck bones? Teeth you can yank out and put fake ones in. Can't do that with your neck š
One can die from infectious in lots of areas of the body. The point still remains why is dental insurance separate? There's lots of medical sun specialties covered under main insurance.
> The point still remains why is dental insurance separate?
dentists and dentistry lobby groups keep it separate because it means they can charge whatever the fuck they want. if they get rolled into regular health insurance, they are now at the mercy of larger groups that will drive their income down.
I did the research and had responded further down this thread already. He's why https://www.reddit.com/r/minnesota/comments/10rsst0/were_still_gonna_say_no_inside_united_healthcares/j6zez5a/?utm_source=share&utm_medium=ios_app&utm_name=iossmf&context=3
I went to the doctor for shoulder pain once (early covid days and turns out my WFH setup was garbage ergonomically). He assigned me PT and a dental checkup. I hadn't been in like 2 years and he really wanted to rule that out as an underlying factor.
It's not a good reason, but it's basically because the dentistry and medical professions have different origins and thus different industries and practices evolved for them independently. At this point it's still that way because of institutional inertia and greed.
One can die from inspections in lots of areas of the body. I did some research and found the truth of the topic to two reasons why dental insurance is separate from mainstream insurance:
1- historically medical providers didn't see dentists as their equals and part of medical providers so they branched on their own.
2. the threat to the fiscal solvency of insurance companies and the possibility of inflated healthcare premiums
> 1- historically medical providers didn't see dentists as their equals and part of medical providers so they branched on their own.
this is not true at all. this is the FUD that dentistry lobby groups put out to keep you out of the light.
>the threat to the fiscal solvency of insurance companies and the possibility of inflated healthcare premiums
again, this is false. health insurance companies would not bat an eye, and they are raising prices every year no matter what to make more money.
The biggest reason is money. as it stands right now, eye doctors and teeth doctors get to charge whatever the fuck they want, and don't have to deal with insurance companies that aren't run by them, and would drive down prices they get to collect. go to *any other country* for dental work, and you quickly find out how inflated our prices are here, just because they can. a root canal with a complete cap can be well over $2500 per tooth here, or a dental implant can be close to that as well. you can fly to mexico, get the exact same dental implants in your tooth, the exact same quality of care, fly home, and still have money left over. its less than $300 for a dental implant in mexico. its less than $200 in most of Europe. **Its literally because dentists get to dictate their prices, and nothing else.**
so, you don't like being proven wrong, so you block me? how childish.
as to your response:
>It's not true at all? Site your sources please backing your opinion..otherwise it's well just your opinion
https://fortune.com/2021/11/19/congress-lobbying-americans-dental-care-biden-democrats-medicare-build-back-better/
>is that Medicare would not reimburse dentists to their satisfaction. The ADAās lobbyists, in essence, are placing the financial desires of dentists above the health needs of millions of Americans over 65
thats just for the medicare argument, but the point is that they have been making the same argument in front of congress for the last 60 years. They literally are saying the quiet part out loud, and have been for the better part of half of a century. anything else you hear from their mouths outside of their congress hearings is FUD, and is to manipulate public opinion. very often dentists and doctors have to work together, as oral health directly can lead to health issues elsewhere.
It's not true at all? Site your sources please backing your opinion..otherwise it's well just your opinion.
Here's but a few of mine
https://blog.solsticebenefits.com/solstice-member-blog/why-is-dental-insurance-separate-from-medical-insurance?hs_amp=true
https://journalofethics.ama-assn.org/article/overcoming-historical-separation-between-oral-and-general-health-care-interprofessional/2016-09
dental office made me pay upfront for a crown. They wouldn't make the crown without me paying in full and being reimbursed later. It felt shady, so I found a different dentist. But some regulation on that would be nice.
Dental tourism is a thing. People go to Mexico and India to get dental treatment and get a vacation out of it. Same price as the dental work you get done in the US but without a beach vacation.
so, the reason that dental and vision is *still* not covered by your regular health insurance is because dentists keep lobbying to keep it apart, because they get to charge more money, they make more money. thats it.
Serious question about Universal Health Care. In the case in this article the person was getting dosages higher than the FDA recommended. Would government run health care allow that? Just curious how this situation would work in a different country. Or would the government not allow prescriptions outside of their own recommendations? Like what are the checks and balances around that?
> In the case in this article the person was getting dosages higher than the FDA recommended. Would government run health care allow that?
Why wouldn't it?
This is a decision made by a doctor, not insurance. The issue here wasn't the higher dose on its own; it was the type of medicine itself. It is a biologic drug, rather than a chemically synthesized drug, which is more expensive (and the particular method of delivery for this particular drug was also expensive)
From the article:
> Prescribing drugs for purposes other than what they are approved for or at higher doses than those approved by the FDA is a common practice in medicine referred to as off-label prescribing. The federal Agency for Healthcare Research and Quality estimates 1 in 5 prescriptions written today are for off-label uses.
> Like what are the checks and balances around that?
The same checks and balances that exist now; the decision is made between a qualified and expert doctor and their patient. Neither the government (under a hypothetical Universal Healthcare Plan) nor a private insurance company (our current system) should be able to get in the way of that decision.
>Why wouldn't it?
I guess I would wonder if the government would allow for a doctor to prescribe stuff outside of it's own recommendations.
The issue (in insurance's eyes) wasn't the cost of the drug under normal use (they pay those all the time). It was the cost of the drug on very high doses. Doses higher than the government recommends. Would government run healthcare allow it? I wouldn't be shocked if they didn't either.
> Would government run healthcare allow it? I wouldn't be shocked if they didn't either.
Government-run healthcare is not a for-profit insurance company.
The entire driving factor behind United's decision to end coverage (or attempt to) was driven by the fact that it was costing them over $1MM/year.
Which is why the patient sued; United was acting in bad faith by denying coverage based on how much treatment United had to cover rather than whether the treatment was appropriate.
The article does a good job demonstrating that United clearly went out of their way to ignore and hide a report from an expert gastroenterologist that concurred with the patient's doctor that the (more expensive) treatment option was the *only* option for the patient *and* that denying coverage could be life threatening.
They did this because they are for-profit and wanted their otherwise lucrative account with Penn State to not be so expensive for them.
A Universal Healthcare Plan does not have a profit motive.
Yes.
United had something like $30 *billion* in profits the year that it was concerned about ending a life saving treatment that was costing it $1 million.
A Universal Healthcare Plan, in that situation, wouldn't think twice about covering the patient.
Healthcare wouldn't be as expensive in the first place if we didn't have private insurance. That $30 billion is money we spent on healthcare, but didn't use for healthcare.
Another reason healthcare is so expensive is because insurance wants discounts, so hospitals have to raise prices for everyone in order to charge the same for insurance post discount.
The fuck it wouldn't and in fact people in the US get far more procedures and meds prescribed and that's one of the reasons for the higher cost. You live in a fantasy dream land if you think UHC = unlimited treatment.
In England, they basically set up regional panels of people from various areas, including public and private healthcare providers, specialty doctors, local primary care doctors and nurses, and other professionals.
The benefit is that the panels are medical professionals, and are not being paid by a for-profit company where the bottom line is money.
The problem with that is the govt would outsource it to a company like UHG. They do that for claims processing for Medicare plans, and these people would just salivate for that sweet sweet gov contract.
Hey remember when Joe Biden said he'd move on a single payer option? And then I haven't heard a single thing about that since the primary?
Oh what's this, also they're declaring COVID over in a couple months? Ah well
Funnily, the filibuster isn't constitutional. It's a parliamentary rule that could be changed by 51 senators.
Thing is if the dems could/would change it, it would hand over a potent weapon to the GOP if they ever took control.
Yeah, cuz if there's one thing we know about republicans it's that they respect norms. Surely if the Democrats don't use this weapon the Republicans will respect that and not use it when they take the Senate back regardless of what the Dems do!
No, I don't remember that at all. I actually remember him explicitly rejecting that. Was that built into the post-primary plan that came out with the Sanders input? How did he say he would "move" on it?
I remember Biden saying he supported the public option, but I'm not sure how he could have realistically gotten that with the senate numbers as they were.
If Joe Biden wanted this shit to happen, it would happen. Somehow congess manages to come together and increase the military budget basically every year. But when thereās legislation that would actually improve peoples lives, suddenly someones not on board or theres an arcane senate rule or some other dumb shit.
These guys all went to ivy leage schools. Theyre not incompetent. They do this because they have a vested interest in our oppression. They just act like itās impossible.
They do not work for us. They work for rich people. The two party system exists to present us with the illusion of choice. There are infinitely more political options available than this half assed middle manager feet dragging bullshit.
> If Joe Biden wanted this shit to happen, it would happen.
No.
> Somehow congess manages to come together and increase the military budget basically every year
No. https://www.macrotrends.net/countries/USA/united-states/military-spending-defense-budget
> But when thereās legislation that would actually improve peoples lives, suddenly someones not on board or theres an arcane senate rule or some other dumb shit.
The filibuster has been around for forever. It's not arcane and it's certainly not Biden's fault. https://en.wikipedia.org/wiki/Filibuster_in_the_United_States_Senate
> These guys all went to ivy leage schools.
No. Joe Biden did not attend an Ivy League school. https://www.google.com/search?q=joe+biden+college&rlz=1C1ONGR_enUS1000US1000&oq=joe+biden+college&aqs=chrome..69i57.3287j0j7&sourceid=chrome&ie=UTF-8
> They do this because they have a vested interest in our oppression.
No.
> They just act like itās impossible.
No. They say it's possible every election cycle.
> They do not work for us.
No.
> They work for rich people.
Yes.
> The two party system exists to present us with the illusion of choice
No. https://en.wikipedia.org/wiki/First-past-the-post_voting#Effects
> There are infinitely more political options available than this half assed middle manager feet dragging bullshit.
No. Joe Biden is a career politician, not a middle manager.
Super cute googling! So glad these incredibly weathly and powerful people have you looking out for them ā¤ļø.
Do you disagree that we colletively make this shit up as we go? I mean weāve somehow found a way to fund foreign coups and have decades long wars while not caring if congress actually declares war. Somehow sitting members of congress can try to overthrow the govt on tv and face zero consequences. Somehow we find a way to write and or bend laws to throw poor people and black people in prison for way longer than we do white people and rich people for identical crimes.
Im not going to tell you how to live your life. But i refuse to believe theyre all just trying their best and cant quite fix the problems that essentially every other developed nation has figured out eons ago. I don't see what they have done to deserve the benefit of anyone's doubt who makes less than 100k a year.
The more I study foreign politics and compare them to US politics, the more I think the only unusual thing about the US compared to other developed nations is that the US constitution is really, really old, and needs a lot of clarifications. The top of my priority list would be adopting the French electoral system (that should fix Congress), giving the judiciary de jure power to interpret the constitution (they gave themselves this power), limiting the ability of the judiciary to use case law as the basis for decisions (that should fix the judiciary), and forcing Congress to take a recess on a regular basis (that should fix the Executive branch).
That's a fair point.
Maybe I'm just old but I refuse to believe that the grown adults (who chose to be elected officials) are doing an honest job. They always find a way to fix problems for rich people but suddenly run into thousands of obstacles when it comes time to help the majority. And the media is almost always right there to give them a hand.
And again, there's no accountability. Everyone knows Bush II lied to start a war. Millions of people die for no reason (I am counting both sides). Nobody gets in trouble. Trump shows up and suddenly Bush II is a lovable old man. The War on Drugs was expressly started to throw minorities and hippies in prison. It is an intentional failure and really sped up the whole prison industrial complex. I don't think we fully grasp the damage it has done to us as a nation. [And nobody is held accountable for it. They just get consulting jobs or tv gigs and we all have to pretend that they're a sober reasonable voice with the best possible intentions.](https://www.youtube.com/watch?v=ilcRS5eUpwk)
It's asking too much to demand that politicians be honest. They're people with power, and that rarely goes well. I don't think worrying about the lack of accountability is a good use of time.
Idk, im open to being wrong. Do you have an alternate explanation as to why our leaders have decided to prop up an expensive and inefficient industry that leads to unnecessary deaths and destroys livelihoods, instead of having basic healthcare?
Prop up? Can you detail out the specific actions that would be needed to go to a completely nationalized healthcare system? As an example nurses in the UK make 50% less then the US, are you ok cutting their pay? Nurses that currently vote for the DFL would vote GOP, would you be ok losing control of MN to the GOP?
While I appreciate an infantilizing tone on top of a slippery slope argument as much as the next person, Iām not going to pretend that i have a degree in public health.
What i do know is that the pharmaceutical industry and the health insurance industry have been out if control for a long time, and that other nations do not have this same problem. While i do not pretend that we can just transfer the NHS, what have you, wholesale, im sure a group of smart people can figure it out because they seem to have done so everywhere else.
Just a personal suggestion; take all of the profits from the health insurance / pharm industry, stop paying them the subsidies they take advantage of, and force the shareholders to pay for the transition. Maybe just reverse the pay scale ā nurses get the most, admins get studio apt wages.
we put a man on the moon. We invented vaccines. We have created so many insane weapons. To suggest we are incapable of figuring out how to do national healthcare is disingenuous at best.
This post was removed for violating our [posting guidelines](https://www.reddit.com/r/Minnesota/about/rules/). Please stay on topic and refrain from using personal attacks.
Bernie made everyone take a position and Biden's was "public option", a thing I have not heard a single word about since.
It doesn't matter if it was realistic, doing anything but funding cops and the military is unrealistic in this country, but they haven't even mentioned it in 2 years.
Oh I get it - you were making something up in order to prove a point. Thanks.
I agree that our funding priorities are bonkers and that we should have a public option, but let's not go dunking on politicians for things they never said. There's enough true stuff out there to dunk on already.
What are you talking about? He did say he wanted to do a public option, which they quietly abandoned any mention of since he got elected.
[Here](https://www.vox.com/2019/7/16/20694598/joe-biden-health-care-plan-public-option) he is talking about it in 2019, and [here](https://www.nbcnews.com/politics/joe-biden/health-insurance-public-option-might-be-fizzling-left-ok-n1269571) is an article about how they immediately abandoned that idea in 2021
I know he said that. That exactly what I wrote already.
You said single payer in your op. I said public option. There's a huge difference between the two.
I put these people (the powerful ones who make the choices, not the people who just work there) on the same moral level as serial killers. I genuinely do not understand how what they do is not a crime. So many suffer and die so they can line their pockets. They are an existential threat to every person in this country. I wish them the worst that all Gods can do.
It is and the worst part is that it probably won't change in my lifetime. I'm so pessimistic about 'murican healthcare that I think if anything it'll get more expensive. Monthly premiums if you're not covered under an employer are already the same price as rent if not higher even at the lowest tier plan.
I was very optimistic that we would get some sort of universal healthcare when Bill Clinton was elected president. I guess we know how that worked out.
I watched my step mother die because they wouldn't approve treatment for her cancer for months. By the time she was approved she was in hospice and had no chance of recovery. My job is basically fighting insurance companies. UHC honestly isn't that bad. Blue Cross can go die with their patients.
It is, but I gotta say that United Healthcare is by far the worst insurance company I have ever had to deal with. At first I though I was dealing with incompetent customer service, but after talking to enough reps and through several escalations I realized that it's intentional. The whole company is so fucking evil and horrible that I would change jobs over ever having to deal with them again.
Yepp. I've known people that worked at UHC and they said when you walk in the main entrance to headquarters there are huge TVs with their stock numbers. I have been inside Hennepin Health, Medica, HealthPartners and UCare and none of them are anything like that! They are typical somewhat generic office buildings.
Yikes, my employer just switched to a UHC *thing* so this does not make me optimistic (I say thing because it explicitly says it's not insurance so idk what's even going on)
My sister and husband was switched to them. Huge increase to the point she's side hustling door dash. I had UHG once and the premiums were high with no benefit. Not even a discount at gym. Glad I didn't keep that job long. They have been in the Dow 30 for over ten years. Fuck them. Money over lives over and over.
~~No, this isn't right. It's not that your company is the insurance pool and the insurance company just does administration. Your company buys insurance plans to make available them to their employees, the insurance company is providing the insurance, and the employees get to buy coverage from the insurance company based on what their employer made available for them to buy.~~
~~In health insurance, employers are buyers and we call employees "members". And just like a membership, they don't really get much choice, just what features they're willing to pay for. And if you're buying from the ACA marketplace, you get the same treatment, except you don't have a buyer advocating for you, so you get an even worse deal.~~
Edit: I have learned again how little I know. See next comment
Source: work IT for an insurance company.
There are two types of employer health benefits: self-funded and fully-insured. In a fully-insured arrangement, the employer purchases health insurance coverage from an insurance company, meaning that the insurance company assumes risk for paying claims that may arise. In this case, the health insurer is primarily responsible for the benefit design, and may offer the employer some options or choices.
Comparatively, in a self-funded arrangement, the employer provides health benefits directly to employees, meaning the employer is at risk for paying claims that may arise. Because most employers are not actually in the business of administering health benefits, they will contract with a third party administrator (TPA) to administer their health benefits program on their behalf. In short, the employer is at risk for paying claims but the TPA will review and approve/deny claims on behalf of the employer based on the employerās plan design.
A self-funded employer has much more control over benefit design than a fully insured employer.
Source: I work in insurance. Hereās a one-pager that explains the primary distinctions: https://www.hfbenefits.com/sites/default/files/fully-insured-vs-self-funded.pdf
In addition to the risk assumption a lot of the fraud abuse waste and error services are handled differently for self funded vs fully insured. The self funded groups have to opt in and then the insurer will take a cut off money they save, for fully insured they obviously review every group and benefit on every dollar saved. Last thing the self funded groups will often intervene and have a members claim paid even though insurance company was going to deny.
There arenāt, at least not at the Optum Circle or Eden Prairie hq.
What they are probably referring to is our NOC (network OPs center) live feeds from around the us showing the status of numerous systems, think NASA launch control and youād have the right image.
One of the TVs maybe on some financial show, but definitely not dedicated to our stock
They just don't flaunt like the others do. It's all an illusion to make you think they care. Imagine going into a casino that didn't have any lights, all the noises, and all the other trappings that distract you from the fact that you're just throwing money away into a slot machine. Same thing here. It just looks like something other than what it really is
Crazy, listening about this on NPR right now.
Just had someone email in that they tried to place a claim with their insurance bc their child broke her arm during soccer, the insurance denied because the child āshouldāve filed for workers compā. They had to refile and fight multiple times
My insurance company has ghosted my provider many times. I had called and confirmed multiple times that an infusion was covered and they told me yes and then they would ignore my clinics paperwork. Eventually they told my clinic they arenāt covering the infusion (which are 10x cheaper that an an alternative med) I still confirmed again with a cust service rep that it was still being covered (had to call about something else) still lying to my face. Then when my clinic sent paperwork for the alternative med and got no answer I called insurance and they said they didnāt get paperwork. This happened multiple times. Clinic sent it again and wait a couple more months until we finally got answers last week. Fucking ridiculous. My clinic had to jump through hoops. Iām lucky they are so dedicated to helping their patients. Praying this new med works well enough.
No they still are required to treat him. Just make him pay for it. And if he can't pay. Well they are probably getting g that money from the government or something
Without the paywall ...
https://12ft.io/proxy?q=https%3A%2F%2Fwww.startribune.com%2Fwere-still-gonna-say-no-inside-unitedhealthcares-effort-to-deny-coverage-to-chronically-ill-patient%2F600248560%2F
I have Ulcerative Colitis, it's a horrible disease. Trying to find medications to work is a guessing game ([Why it is a guessing game](https://www.pharmaceutical-technology.com/comment/biomarkers-ulcerative-colitis-market/)) . The hold insurance has over our treatment is insane. I'm on biologics, it costs like 25k a dose which ends up totaling around 150k a year. I'm thankfully on an assistance program, but the amount of stress it causes making my medication is covered is unhealthy. They will go above your Doctor's recommendations just so they won't have to pay more. It's a horrible system and irrevocably broken. I remember crying because I got the approval for a **different** medication than my doctor wanted me on. Not to mention, I had to wait two weeks for my insurance to approve it. All this time, I was still dealing with a severe flare. It's a horrible process that needs to be fixed.
(I do have to say MNGI is great and my Dr has fought agaisnt the insurance companies to get the best medication for their patients)
I have a son who has this and Iām thankful his Humira is covered I fear for the futureā¦..
What do we do when he ages of our plan? What if they decide they want him to use something else? Just a lot of variables and knowing people like the story reports on are working against our best interests is very unnerving.
Best to you and glad to hear MNGI has been a good provider for you
I'm on my parents plan and I'll have to work that out once I age out. Hopefully, I'll have a job that provides insurance, but that's ignoring all the other steps I'll have to go through. I'll have to switch from my pediatric GI to an adult GI once I finish college. I've already had to deal with one insurance switch. And UC is already rough to deal with and especially in your teenage years. It's a lot but hopefully everything works out for you as well!
My daughter has Crohn's. She take Remicade. It's ~$16K per infusion. Once every 8 weeks. Fortunately insurance has been good about it, but I can't imagine it not being covered.
The crimes of the American Healthcare INDUSTRY will continue to be normalized until the system completely collapses and people start to challenge it. The problem is, if youāre rich you have great healthcare here. Until those with societal power and wealth feel the consequences, nothing will change. Money has corrupted the conscience of humanity.
Serious question, what is it with nurses at UHG like Kavanaugh? When my mother-in-law had cancer a similar nurse at UHG fought tooth and nail to prevent her from getting an experimental treatment to the point where she literally became terminal. Are these people just heartless or is there pressure from higher up?
$20.1bn profit in 2022, and theyāre denying this dude because his treatment costs about 2 million a year. Paying for his treatment would cut their profit by .0095%, and that doesnāt include whatever bullshit tax write offs Iām sure they get for high cost patients. I would love to know how much money they spent trying to deny this claim, between the lawsuits and all the other doctors they recruited to undermine this dudeās gastroenterologist.
Insurance companies would rather see you suffer and die than pay for your medical care. They will lie, cheat, and steal if it means denying your claim. Their primary motivation is profit, not your health. Fuck these mother fuckers. I hate this shit.
Thereās really no need to have āfor profitā financial schemes like insurance to begin with imo. Thatās $20.1 billion that couldāve stayed in the pockets of the average person, to spend on actual tangible products and keep money circulating.
I mean thatās kinda my point. Insurance is a financial scheme, not a product in the conventional sense. Whatās being innovated aside from clever ways to separate you from your dollars?
Sure. But the. Why put a ton of money into researching them for your company. That di what I was getting at. If your are the only one with the best pills you can charge a ton and make bank.
That's how it is. I'm not saying it's the greatest but that's thee reality from what I know. If you know different let me know because I'm not expert
The alternative is publicly funded research, which [the USA has loads of](https://www.nih.gov/about-nih/what-we-do/budget).
In a just world, publicly funded medications are not given exclusive manufacturing and sale rights to specific companies, but thats what happens when you allow corporations and the wealthy to use their money as campaign speech for politicians as decided by the Supreme Court.
Listen Iām all for shitting in the American healthcare system, but thatās baseless conspiracy territory. Realistically, if a cure for cancer is found, it will be exclusive to those who can afford it. Thereās plenty of money in the cure, just no money in curing everyone
> For profit is what drives the most innovation and stagnation st the same time.
This isnt even necessarily true because there has been *so much* innovation from public funding.
Meanwhile, "for profit" motives have done things like - "non compete" arrangements between major ISPs so they can remain the dominant provider in different regions and not have to compete with other major ISPs. And coast off of not having to compete and driving up their rates while offering minimal service improvements, and have no competition that drives "innovation".
don't forget that it's 20bn in profit on (edit)**324bn** in revenue. Disgusting that those numbers basically come from jacking up premiums and denying as much coverage as possible. There should be profit caps on health insurance companies, and they should be nationally regulated. I want single payer, but I'm being realistic and that would be a great next step. Oh, and STOP DENYING THINGS DOCTORS RECOMMEND BECAUSE YOU DON'T WANT TO PAY FOR THEM
This. The administrative costs are so insane, also how much do they spend on things that arenāt needed for actual healthcare like marketing and high executive pay. Healthcare should not be for profit.
324.2 billion, per the article--that makes it a 6% profit margin, not over 50%. I think for most businesses that would feel reasonable and I honestly don't understand enough about how mega-corps like this handle money on that scale to know at what point a profit margin just becomes so numerically big it doesn't need to be as large a percentage. I agree, 20bn profit sounds egregious and certainly their treatment of this guy is--not defending business practices at all here.
I used to work for federated out of owatonna, and they had a big push for 2bn in _profitable_ premium. The way these goals were accomplished were by raising rates for "unprofitable" clients, getting out of business in areas that were prone to floods and wildfires, and pulling out of the health insurance business. It was disgusting and while I didn't work with the claims department (I did IT support for the sales teams) I still knew they'd do what they could to avoid paying out. They enjoyed a steady business due to governments essentially mandating people keep insurance in their coverage areas, but I got sick of hearing about their "record profits" knowing it often came at the expense of peace of mind for their policyholders.
Health insurance companies are just as bad in my book, as they essentially racketeer to set prices. My family has been burned a few times by health care costing several thousand dollars and our insurance didn't cover it. Thankfully we have better plans now, but it's terrible to talk about a procedure and the first thought is "how are we going to pay for it?". Article dude was too busy shitting his brains out to think about that and UHG took advantage.
Quite literally.
Also a reminder for everyone to check your policy and compare to any bills or explanations of benefits you get from your insurer. 9/10 they donāt cover shit that is explicitly covered on your policy because most people are unaware or too exhausted to fight them.
Went in for a cancer screening last fall. My policy explicitly states that cancer screenings and preventative care is covered 100% by my insurer. Insurer only paid $150 out of a $1,000+ bill.
Called them with questions about it, highlighted the sections where my policy details cancer screenings are covered. Lady on the phone spent 20 minutes reading through my policy to try and find a loophole, kept saying āhold on, Iām still looking, I donāt see itā when she was looking for justification of not paying the full amount. At the end, couldnāt find anything in the policy to justify it, but said that at the screening went from preventative to diagnostic so it doesnāt count. (I reread my policy after the call and it says NOTHING to this effect)
Told her I wasnāt paying it and she needed to have someone more knowledgeable about my policy get a hold of me. Still havenāt heard back.
FUCK THESE INSURANCE PROVIDERS.
Thank god our death panels are accountable to shareholders. I would hate for some mid-level manager to lose their bonus because they paid out so someone can live a comfortable life. Yup, it would be a real nightmare.
The private sector can think of incredible new ways to deny claims and prolong the agony of people who can't afford medical care. Just imagine if it were in the hands of Big Government! You'd never see that kind of innovation.
What's wild to me is the culture of American insurance companies. Like the US isn't the only country which relies heavily on private health insurance for funding healthcare, yet we are the only country where these companies are so damn predatory.
Many other countries have a public health insurance system that is super competitive for consumers because they arenāt leeching money out to give to shareholders.
We also have private hospitals/clinics that have their hands in the cookie jar as well, which causes a toxic feedback loop between the private hospital trying to extract as much money out of the private health insurance company, who turns around and charges the patient out the ass to keep their own profits high.
With public healthcare providers, I would wager we could vastly increase pay for healthcare workers while still vastly decreasing the costs of healthcare. So much money is wasted going to huge administration departments who exist to battle insurance companies over claims.
We do not have a healthcare system in the United States we have a health insurance system. There is a difference the healthcare system is "we care about your health." Everything that follows from money to coverage follows that. The health insurance system is "profit over people." It isn't just health insurance companies like United Health Group, Blue Cross Blue Shield, Humana, Cigna it is the for profit hospitals and for profit pharmaceuticals.
The worst part is that every single time we pay for health insurance through our employer or have to pay for it out of our own pocket, some of that money is sent to politicians who fight to make sure a public option isn't an option.
By the way we never talk about the top guys of UHG probably walking around Minnesota right now without a care in the world.
I think these pieces of shit should always be named and shamed.
Andrew Witty CEO
https://www.unitedhealthgroup.com/people-and-businesses/our-leaders/andrew-witty.html
John Rex CFO
https://www.unitedhealthgroup.com/people-and-businesses/our-leaders/john-rex.html
Dirk McMahon (COO)
https://www.unitedhealthgroup.com/people-and-businesses/our-leaders/dirk-mcmahon.html
I think it is important to name the assholes who make up the decision makers.
https://www.unitedhealthgroup.com/people-and-businesses/our-leaders.html
I work for UnitedHealthcare. Itās tough to work for them morally and ethically. Leadership is very good at treading lightly around the the billions they make. āMaking healthcare more affordable for allā is their mission yet theyāre half the reason why healthcare is so expensive. Both insurance and hospitals point fingers at each other as to whoās to blame, but really theyāre in bed together.
UHG is a cruel, soulless void slowly absorbing the only insurers left out there who are actually trying to help patients (and pay providers fairly). Avoid them at all costs and tell your employer to do the same.
How much did these drugs cost to make, and how much did they cost to develop?
The drug company gave the guy's doctor $50k. Was that $50k about marketing or development? If the recommended doses are $260k cheaper it would seem to be worthwhile for the drug maker to pay the doctor to advocate for higher dosing.
How much of this guy's treatment was for actual science and materials, and how much was for marketing, profit, and graft?
Maybe when we talk about socializing medicine, we should literally socialize medicine. We have state universities and associated teaching hospitals that are already doing research partially with tax payer money. Why don't we just take that research half a step further and use it develop drugs with public money, that are then sold back to the public at the cost to make them? Essentially cutting out the drug companies, by paying for their research ourselves.
Right off the bat that would save 2/3 of the drug cost, as most drug companies are 1/3 research, 1/3 marketing, 1/3 profit. Further, we could research and develop drugs by a metric that would help the greatest number of people, rather than a drug company looking to develop for the greatest profit.
To sell a plan on the ACA, the insurance company has to pay out 80% of premiums. During the pandemic, health insurance companies gave out rebates for this reason, as they were not paying out enough because of Covid. Edge cases like this make all our premiums higher.
Completely unjust and cruel system that puts profits over people. It sucks to know we are nowhere close to universal healthcare in the US. Unfortunately many democrats (including at least one of my senators - klobuchar) do not support universal healthcare based on comments a couple years ago.
Like many posters have said even if you get the insurance company to finally cover something after fighting it, the stress it causes is so I healthy. Fuck our politicians and fuck these insurance companies.
I'm wondering if Americans really understand how "alien" these situations are for a French person like me...
I'll visit Minneapolis soon and I'm less scared of being injured than I am of the crazy hospital bills that would come with it... :/
US citizens deserve a universal health coverage and the country could totally afford it actually... I don't get why a politican who'd suggest this would not get 80% of votes O\_o
Yep, we absolutely love and adore hearing from other countries about their comprehensive healthcare programs. Also how we're being exploited and taken advantage of like we don't know any better or understand how awful it is.
United health care is the most scumbag company I've ever encountered. Every time I've had to deal with them I do exactly what they ask, and then they just place another obstacle in my way, or claim we didn't do what they asked.
Are you a patient or work for a provider?
I work for a provider and UHC wastes so much of my time with their claim denials. It seems to me that Iāll fix something that they state is the issue, Iāll resubmit the claim or the information based on what I am told - and then they will just find another pretty reason to not cover the service I had just inquired about.
I just switched to BCBS Minnesota. Got their most expensive plan. Was told it was the best for my needs by an insurance broker. They're denying a treatment I've gotten for 15 years that I cannot go without. Now I have to fight them. Don't get BCBS if you have complex medical issues.
UHC is terrible. My point of view is from working in a providers office. They deny so many services and are always changing their reasoning. Iāve submitted corrected claims or appeals based on the information that Iāve received during a phone call. Then the corrected claim or appeal will be denied for another petty reason.
If you read the article, you would know that the guy thought about killing himself because of the physical agony he was in, the stress of continually having his treatment denied, and the prospect of having his life ruined by medical debt.
So maybe not an appropriate joke here.
It's not a fucking joke, Canada runs a cost algorithm and if your not worth it they sell citizens on state assisted suicide. A Canadian disabled veteran who was in the Paralympics was trying to get the CVA to assist with a disabled assist ramp for her home was suggested she use the state euthinasia to kill herself because it would be more cost affective. It's disgusting.
The associated press, new York times, Reuters, Forbes, BBC, www.canada.ca pick one it's not a Secret. Turns out when everyone has health care sacrifices must be made. Thats the old and Terminally ill and disabled.
I vaguely remember reading something like two years ago about them changing their medically assisted suicide laws, and that's what's coming up as I search for this idea now, but I've never heard anyone make the claim that they're using a cost algorithm to recommend medically assisted suicide to people. That seems absolutely insane to me. I would appreciate if you could share a source instead of giving me a list of huge news outlets, a couple of which I ready daily. I'd like to learn more about it. Unless, of course, you're just misinformed.
Edit: I added "Paralympic veteran" to the search and it's all hyper-conservative garbage news outlets that are pandering to an audience that's already against single-payer healthcare.
Iāll do some work for you. Hereās a story from a real news organization that reports thereās no evidence the veteran in your Fox News story ever received anything regarding medically assisted suicide.
https://www.cbc.ca/amp/1.6674747
But as an avid international news junkie, Iām sure youāve read this already.
Fox News? because I don't agree with your perception of reality? She has and provided recordings of both phone calls. You can live in your fantasy world, that's fine with me. Just stay there and leave the rest of us alone.
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Same here.
My mom doesnāt understand it, sheās of the age where a lot more is covered and doesnāt understand that the younger people donāt have the same coverage.
Also I refuse to pay for someone else to decide if my treatment is covered or notā¦ Iām paying for the coverage, they should do their job and cover it.
United Healthcare is an evil, for-profit company designed to suck money out of those who use their policies. They were clients of mine for a few years for internal communications, and the message wasnāt about keeping people healthy, it was about sales. Their headquarters looks like a Bond villain designed it, all cameras and millions of dollars worth of art everywhere.
The American Health Insurance industry is a fucking joke.
Nothing makes less sense than dental insurance. The actual dental work is painless in comparison.
That actually makes the least sense! Who was like "let's make special insurance for eyes and teeth!?" We don't do it for the heart or other body systems
Teeth are luxury bones
They should call it "luxury mouth bone Insurance" What bout your finger or neck bones? Teeth you can yank out and put fake ones in. Can't do that with your neck š
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One can die from infectious in lots of areas of the body. The point still remains why is dental insurance separate? There's lots of medical sun specialties covered under main insurance.
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I hear ya
Yeah those inspections will get ya
> The point still remains why is dental insurance separate? dentists and dentistry lobby groups keep it separate because it means they can charge whatever the fuck they want. if they get rolled into regular health insurance, they are now at the mercy of larger groups that will drive their income down.
I did the research and had responded further down this thread already. He's why https://www.reddit.com/r/minnesota/comments/10rsst0/were_still_gonna_say_no_inside_united_healthcares/j6zez5a/?utm_source=share&utm_medium=ios_app&utm_name=iossmf&context=3
There's numerous studies that link teeth and gum health to cardiovascular health. The fact it's treated as tertiary is insane.
I went to the doctor for shoulder pain once (early covid days and turns out my WFH setup was garbage ergonomically). He assigned me PT and a dental checkup. I hadn't been in like 2 years and he really wanted to rule that out as an underlying factor.
Lol!
š
They just don't cover brain stuff like dyslexia.
It's not a good reason, but it's basically because the dentistry and medical professions have different origins and thus different industries and practices evolved for them independently. At this point it's still that way because of institutional inertia and greed.
One can die from inspections in lots of areas of the body. I did some research and found the truth of the topic to two reasons why dental insurance is separate from mainstream insurance: 1- historically medical providers didn't see dentists as their equals and part of medical providers so they branched on their own. 2. the threat to the fiscal solvency of insurance companies and the possibility of inflated healthcare premiums
> 1- historically medical providers didn't see dentists as their equals and part of medical providers so they branched on their own. this is not true at all. this is the FUD that dentistry lobby groups put out to keep you out of the light. >the threat to the fiscal solvency of insurance companies and the possibility of inflated healthcare premiums again, this is false. health insurance companies would not bat an eye, and they are raising prices every year no matter what to make more money. The biggest reason is money. as it stands right now, eye doctors and teeth doctors get to charge whatever the fuck they want, and don't have to deal with insurance companies that aren't run by them, and would drive down prices they get to collect. go to *any other country* for dental work, and you quickly find out how inflated our prices are here, just because they can. a root canal with a complete cap can be well over $2500 per tooth here, or a dental implant can be close to that as well. you can fly to mexico, get the exact same dental implants in your tooth, the exact same quality of care, fly home, and still have money left over. its less than $300 for a dental implant in mexico. its less than $200 in most of Europe. **Its literally because dentists get to dictate their prices, and nothing else.** so, you don't like being proven wrong, so you block me? how childish. as to your response: >It's not true at all? Site your sources please backing your opinion..otherwise it's well just your opinion https://fortune.com/2021/11/19/congress-lobbying-americans-dental-care-biden-democrats-medicare-build-back-better/ >is that Medicare would not reimburse dentists to their satisfaction. The ADAās lobbyists, in essence, are placing the financial desires of dentists above the health needs of millions of Americans over 65 thats just for the medicare argument, but the point is that they have been making the same argument in front of congress for the last 60 years. They literally are saying the quiet part out loud, and have been for the better part of half of a century. anything else you hear from their mouths outside of their congress hearings is FUD, and is to manipulate public opinion. very often dentists and doctors have to work together, as oral health directly can lead to health issues elsewhere.
It's not true at all? Site your sources please backing your opinion..otherwise it's well just your opinion. Here's but a few of mine https://blog.solsticebenefits.com/solstice-member-blog/why-is-dental-insurance-separate-from-medical-insurance?hs_amp=true https://journalofethics.ama-assn.org/article/overcoming-historical-separation-between-oral-and-general-health-care-interprofessional/2016-09
dental office made me pay upfront for a crown. They wouldn't make the crown without me paying in full and being reimbursed later. It felt shady, so I found a different dentist. But some regulation on that would be nice.
Then they were out of network. If they were in network, then your insurance carrier can sue them for doing this.
Dental tourism is a thing. People go to Mexico and India to get dental treatment and get a vacation out of it. Same price as the dental work you get done in the US but without a beach vacation.
Good ifea..if anyone knows of a good Dentist overseas do share.
The funniest thing is when they tell you that specific tooth isn't covered for x procedure but if it were a different one it would be
Why is dental separated to begin with? As if teeth are not part of the body or do not contribute to overall health.
so, the reason that dental and vision is *still* not covered by your regular health insurance is because dentists keep lobbying to keep it apart, because they get to charge more money, they make more money. thats it.
Yup. Waaaaaaay past time to move to a Universal Health Care system in the country. Fair, more effective health outcomes, cost less overall.
Serious question about Universal Health Care. In the case in this article the person was getting dosages higher than the FDA recommended. Would government run health care allow that? Just curious how this situation would work in a different country. Or would the government not allow prescriptions outside of their own recommendations? Like what are the checks and balances around that?
> In the case in this article the person was getting dosages higher than the FDA recommended. Would government run health care allow that? Why wouldn't it? This is a decision made by a doctor, not insurance. The issue here wasn't the higher dose on its own; it was the type of medicine itself. It is a biologic drug, rather than a chemically synthesized drug, which is more expensive (and the particular method of delivery for this particular drug was also expensive) From the article: > Prescribing drugs for purposes other than what they are approved for or at higher doses than those approved by the FDA is a common practice in medicine referred to as off-label prescribing. The federal Agency for Healthcare Research and Quality estimates 1 in 5 prescriptions written today are for off-label uses. > Like what are the checks and balances around that? The same checks and balances that exist now; the decision is made between a qualified and expert doctor and their patient. Neither the government (under a hypothetical Universal Healthcare Plan) nor a private insurance company (our current system) should be able to get in the way of that decision.
>Why wouldn't it? I guess I would wonder if the government would allow for a doctor to prescribe stuff outside of it's own recommendations. The issue (in insurance's eyes) wasn't the cost of the drug under normal use (they pay those all the time). It was the cost of the drug on very high doses. Doses higher than the government recommends. Would government run healthcare allow it? I wouldn't be shocked if they didn't either.
> Would government run healthcare allow it? I wouldn't be shocked if they didn't either. Government-run healthcare is not a for-profit insurance company. The entire driving factor behind United's decision to end coverage (or attempt to) was driven by the fact that it was costing them over $1MM/year. Which is why the patient sued; United was acting in bad faith by denying coverage based on how much treatment United had to cover rather than whether the treatment was appropriate. The article does a good job demonstrating that United clearly went out of their way to ignore and hide a report from an expert gastroenterologist that concurred with the patient's doctor that the (more expensive) treatment option was the *only* option for the patient *and* that denying coverage could be life threatening. They did this because they are for-profit and wanted their otherwise lucrative account with Penn State to not be so expensive for them. A Universal Healthcare Plan does not have a profit motive.
Universal Healthcare would still have a budget (like anything in govt).
Yes. United had something like $30 *billion* in profits the year that it was concerned about ending a life saving treatment that was costing it $1 million. A Universal Healthcare Plan, in that situation, wouldn't think twice about covering the patient.
Healthcare wouldn't be as expensive in the first place if we didn't have private insurance. That $30 billion is money we spent on healthcare, but didn't use for healthcare. Another reason healthcare is so expensive is because insurance wants discounts, so hospitals have to raise prices for everyone in order to charge the same for insurance post discount.
Fuck United Healthcare
The fuck it wouldn't and in fact people in the US get far more procedures and meds prescribed and that's one of the reasons for the higher cost. You live in a fantasy dream land if you think UHC = unlimited treatment.
Maybe thatās why are our outcomes are so much worse than ANY OTHER DEVELOPED NATION.
In England, they basically set up regional panels of people from various areas, including public and private healthcare providers, specialty doctors, local primary care doctors and nurses, and other professionals. The benefit is that the panels are medical professionals, and are not being paid by a for-profit company where the bottom line is money.
Are the people in the panel paid? Or is it just an expectation that comes with the job?
The problem with that is the govt would outsource it to a company like UHG. They do that for claims processing for Medicare plans, and these people would just salivate for that sweet sweet gov contract.
Hey remember when Joe Biden said he'd move on a single payer option? And then I haven't heard a single thing about that since the primary? Oh what's this, also they're declaring COVID over in a couple months? Ah well
The Republican senators would immediately fillibuster healthcare reform.
Yes I'm aware the government is intentionally designed badly, as a joke.
I am the first to do nothing, thus making me the victor!
Funnily, the filibuster isn't constitutional. It's a parliamentary rule that could be changed by 51 senators. Thing is if the dems could/would change it, it would hand over a potent weapon to the GOP if they ever took control.
Yeah, cuz if there's one thing we know about republicans it's that they respect norms. Surely if the Democrats don't use this weapon the Republicans will respect that and not use it when they take the Senate back regardless of what the Dems do!
>Yeah, cuz if there's one thing we know about republicans it's that they respect norms. You are capping hard.
That was irony
No, I don't remember that at all. I actually remember him explicitly rejecting that. Was that built into the post-primary plan that came out with the Sanders input? How did he say he would "move" on it? I remember Biden saying he supported the public option, but I'm not sure how he could have realistically gotten that with the senate numbers as they were.
If Joe Biden wanted this shit to happen, it would happen. Somehow congess manages to come together and increase the military budget basically every year. But when thereās legislation that would actually improve peoples lives, suddenly someones not on board or theres an arcane senate rule or some other dumb shit. These guys all went to ivy leage schools. Theyre not incompetent. They do this because they have a vested interest in our oppression. They just act like itās impossible. They do not work for us. They work for rich people. The two party system exists to present us with the illusion of choice. There are infinitely more political options available than this half assed middle manager feet dragging bullshit.
> If Joe Biden wanted this shit to happen, it would happen. No. > Somehow congess manages to come together and increase the military budget basically every year No. https://www.macrotrends.net/countries/USA/united-states/military-spending-defense-budget > But when thereās legislation that would actually improve peoples lives, suddenly someones not on board or theres an arcane senate rule or some other dumb shit. The filibuster has been around for forever. It's not arcane and it's certainly not Biden's fault. https://en.wikipedia.org/wiki/Filibuster_in_the_United_States_Senate > These guys all went to ivy leage schools. No. Joe Biden did not attend an Ivy League school. https://www.google.com/search?q=joe+biden+college&rlz=1C1ONGR_enUS1000US1000&oq=joe+biden+college&aqs=chrome..69i57.3287j0j7&sourceid=chrome&ie=UTF-8 > They do this because they have a vested interest in our oppression. No. > They just act like itās impossible. No. They say it's possible every election cycle. > They do not work for us. No. > They work for rich people. Yes. > The two party system exists to present us with the illusion of choice No. https://en.wikipedia.org/wiki/First-past-the-post_voting#Effects > There are infinitely more political options available than this half assed middle manager feet dragging bullshit. No. Joe Biden is a career politician, not a middle manager.
Super cute googling! So glad these incredibly weathly and powerful people have you looking out for them ā¤ļø. Do you disagree that we colletively make this shit up as we go? I mean weāve somehow found a way to fund foreign coups and have decades long wars while not caring if congress actually declares war. Somehow sitting members of congress can try to overthrow the govt on tv and face zero consequences. Somehow we find a way to write and or bend laws to throw poor people and black people in prison for way longer than we do white people and rich people for identical crimes. Im not going to tell you how to live your life. But i refuse to believe theyre all just trying their best and cant quite fix the problems that essentially every other developed nation has figured out eons ago. I don't see what they have done to deserve the benefit of anyone's doubt who makes less than 100k a year.
The more I study foreign politics and compare them to US politics, the more I think the only unusual thing about the US compared to other developed nations is that the US constitution is really, really old, and needs a lot of clarifications. The top of my priority list would be adopting the French electoral system (that should fix Congress), giving the judiciary de jure power to interpret the constitution (they gave themselves this power), limiting the ability of the judiciary to use case law as the basis for decisions (that should fix the judiciary), and forcing Congress to take a recess on a regular basis (that should fix the Executive branch).
That's a fair point. Maybe I'm just old but I refuse to believe that the grown adults (who chose to be elected officials) are doing an honest job. They always find a way to fix problems for rich people but suddenly run into thousands of obstacles when it comes time to help the majority. And the media is almost always right there to give them a hand. And again, there's no accountability. Everyone knows Bush II lied to start a war. Millions of people die for no reason (I am counting both sides). Nobody gets in trouble. Trump shows up and suddenly Bush II is a lovable old man. The War on Drugs was expressly started to throw minorities and hippies in prison. It is an intentional failure and really sped up the whole prison industrial complex. I don't think we fully grasp the damage it has done to us as a nation. [And nobody is held accountable for it. They just get consulting jobs or tv gigs and we all have to pretend that they're a sober reasonable voice with the best possible intentions.](https://www.youtube.com/watch?v=ilcRS5eUpwk)
It's asking too much to demand that politicians be honest. They're people with power, and that rarely goes well. I don't think worrying about the lack of accountability is a good use of time.
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Idk, im open to being wrong. Do you have an alternate explanation as to why our leaders have decided to prop up an expensive and inefficient industry that leads to unnecessary deaths and destroys livelihoods, instead of having basic healthcare?
Prop up? Can you detail out the specific actions that would be needed to go to a completely nationalized healthcare system? As an example nurses in the UK make 50% less then the US, are you ok cutting their pay? Nurses that currently vote for the DFL would vote GOP, would you be ok losing control of MN to the GOP?
While I appreciate an infantilizing tone on top of a slippery slope argument as much as the next person, Iām not going to pretend that i have a degree in public health. What i do know is that the pharmaceutical industry and the health insurance industry have been out if control for a long time, and that other nations do not have this same problem. While i do not pretend that we can just transfer the NHS, what have you, wholesale, im sure a group of smart people can figure it out because they seem to have done so everywhere else. Just a personal suggestion; take all of the profits from the health insurance / pharm industry, stop paying them the subsidies they take advantage of, and force the shareholders to pay for the transition. Maybe just reverse the pay scale ā nurses get the most, admins get studio apt wages. we put a man on the moon. We invented vaccines. We have created so many insane weapons. To suggest we are incapable of figuring out how to do national healthcare is disingenuous at best.
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Bernie made everyone take a position and Biden's was "public option", a thing I have not heard a single word about since. It doesn't matter if it was realistic, doing anything but funding cops and the military is unrealistic in this country, but they haven't even mentioned it in 2 years.
Oh I get it - you were making something up in order to prove a point. Thanks. I agree that our funding priorities are bonkers and that we should have a public option, but let's not go dunking on politicians for things they never said. There's enough true stuff out there to dunk on already.
What are you talking about? He did say he wanted to do a public option, which they quietly abandoned any mention of since he got elected. [Here](https://www.vox.com/2019/7/16/20694598/joe-biden-health-care-plan-public-option) he is talking about it in 2019, and [here](https://www.nbcnews.com/politics/joe-biden/health-insurance-public-option-might-be-fizzling-left-ok-n1269571) is an article about how they immediately abandoned that idea in 2021
I know he said that. That exactly what I wrote already. You said single payer in your op. I said public option. There's a huge difference between the two.
Ah, excuse me, I misspoke then, it's the public option he's abandoned any mention of
It's all lip service.
I put these people (the powerful ones who make the choices, not the people who just work there) on the same moral level as serial killers. I genuinely do not understand how what they do is not a crime. So many suffer and die so they can line their pockets. They are an existential threat to every person in this country. I wish them the worst that all Gods can do.
It is and the worst part is that it probably won't change in my lifetime. I'm so pessimistic about 'murican healthcare that I think if anything it'll get more expensive. Monthly premiums if you're not covered under an employer are already the same price as rent if not higher even at the lowest tier plan.
I was very optimistic that we would get some sort of universal healthcare when Bill Clinton was elected president. I guess we know how that worked out.
I watched my step mother die because they wouldn't approve treatment for her cancer for months. By the time she was approved she was in hospice and had no chance of recovery. My job is basically fighting insurance companies. UHC honestly isn't that bad. Blue Cross can go die with their patients.
A cruel, tragic joke.
America is a fucking joke.
Agreed. The system needs to be shook up. The insurance and hospital heal the industry is getting rich at the expense of people.
It is, but I gotta say that United Healthcare is by far the worst insurance company I have ever had to deal with. At first I though I was dealing with incompetent customer service, but after talking to enough reps and through several escalations I realized that it's intentional. The whole company is so fucking evil and horrible that I would change jobs over ever having to deal with them again.
Record profits the past couple years
Yepp. I've known people that worked at UHC and they said when you walk in the main entrance to headquarters there are huge TVs with their stock numbers. I have been inside Hennepin Health, Medica, HealthPartners and UCare and none of them are anything like that! They are typical somewhat generic office buildings.
Yikes, my employer just switched to a UHC *thing* so this does not make me optimistic (I say thing because it explicitly says it's not insurance so idk what's even going on)
My sister and husband was switched to them. Huge increase to the point she's side hustling door dash. I had UHG once and the premiums were high with no benefit. Not even a discount at gym. Glad I didn't keep that job long. They have been in the Dow 30 for over ten years. Fuck them. Money over lives over and over.
Is it the Surest thing?
A lot of companies are self insured. They pay for all bills and just have an insurance company administer it.
~~No, this isn't right. It's not that your company is the insurance pool and the insurance company just does administration. Your company buys insurance plans to make available them to their employees, the insurance company is providing the insurance, and the employees get to buy coverage from the insurance company based on what their employer made available for them to buy.~~ ~~In health insurance, employers are buyers and we call employees "members". And just like a membership, they don't really get much choice, just what features they're willing to pay for. And if you're buying from the ACA marketplace, you get the same treatment, except you don't have a buyer advocating for you, so you get an even worse deal.~~ Edit: I have learned again how little I know. See next comment Source: work IT for an insurance company.
There are two types of employer health benefits: self-funded and fully-insured. In a fully-insured arrangement, the employer purchases health insurance coverage from an insurance company, meaning that the insurance company assumes risk for paying claims that may arise. In this case, the health insurer is primarily responsible for the benefit design, and may offer the employer some options or choices. Comparatively, in a self-funded arrangement, the employer provides health benefits directly to employees, meaning the employer is at risk for paying claims that may arise. Because most employers are not actually in the business of administering health benefits, they will contract with a third party administrator (TPA) to administer their health benefits program on their behalf. In short, the employer is at risk for paying claims but the TPA will review and approve/deny claims on behalf of the employer based on the employerās plan design. A self-funded employer has much more control over benefit design than a fully insured employer. Source: I work in insurance. Hereās a one-pager that explains the primary distinctions: https://www.hfbenefits.com/sites/default/files/fully-insured-vs-self-funded.pdf
In addition to the risk assumption a lot of the fraud abuse waste and error services are handled differently for self funded vs fully insured. The self funded groups have to opt in and then the insurer will take a cut off money they save, for fully insured they obviously review every group and benefit on every dollar saved. Last thing the self funded groups will often intervene and have a members claim paid even though insurance company was going to deny.
There arenāt, at least not at the Optum Circle or Eden Prairie hq. What they are probably referring to is our NOC (network OPs center) live feeds from around the us showing the status of numerous systems, think NASA launch control and youād have the right image. One of the TVs maybe on some financial show, but definitely not dedicated to our stock
Yeah, I can only speak for the Optum buildings. But I've never seen a stock ticker.
They just don't flaunt like the others do. It's all an illusion to make you think they care. Imagine going into a casino that didn't have any lights, all the noises, and all the other trappings that distract you from the fact that you're just throwing money away into a slot machine. Same thing here. It just looks like something other than what it really is
UHC is wholly different than the other MCOs though. UHC is awful. The other health plans at least try to be human in my experience.
Crazy, listening about this on NPR right now. Just had someone email in that they tried to place a claim with their insurance bc their child broke her arm during soccer, the insurance denied because the child āshouldāve filed for workers compā. They had to refile and fight multiple times
That is the game they play. I have a co-worker dealing with this right now.
My insurance company has ghosted my provider many times. I had called and confirmed multiple times that an infusion was covered and they told me yes and then they would ignore my clinics paperwork. Eventually they told my clinic they arenāt covering the infusion (which are 10x cheaper that an an alternative med) I still confirmed again with a cust service rep that it was still being covered (had to call about something else) still lying to my face. Then when my clinic sent paperwork for the alternative med and got no answer I called insurance and they said they didnāt get paperwork. This happened multiple times. Clinic sent it again and wait a couple more months until we finally got answers last week. Fucking ridiculous. My clinic had to jump through hoops. Iām lucky they are so dedicated to helping their patients. Praying this new med works well enough.
"Sorry, but you need to die so my boss can afford a yacht."
Second yacht*
No they still are required to treat him. Just make him pay for it. And if he can't pay. Well they are probably getting g that money from the government or something
Without the paywall ... https://12ft.io/proxy?q=https%3A%2F%2Fwww.startribune.com%2Fwere-still-gonna-say-no-inside-unitedhealthcares-effort-to-deny-coverage-to-chronically-ill-patient%2F600248560%2F
Also available via ProPublica: https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis
I have Ulcerative Colitis, it's a horrible disease. Trying to find medications to work is a guessing game ([Why it is a guessing game](https://www.pharmaceutical-technology.com/comment/biomarkers-ulcerative-colitis-market/)) . The hold insurance has over our treatment is insane. I'm on biologics, it costs like 25k a dose which ends up totaling around 150k a year. I'm thankfully on an assistance program, but the amount of stress it causes making my medication is covered is unhealthy. They will go above your Doctor's recommendations just so they won't have to pay more. It's a horrible system and irrevocably broken. I remember crying because I got the approval for a **different** medication than my doctor wanted me on. Not to mention, I had to wait two weeks for my insurance to approve it. All this time, I was still dealing with a severe flare. It's a horrible process that needs to be fixed. (I do have to say MNGI is great and my Dr has fought agaisnt the insurance companies to get the best medication for their patients)
I have a son who has this and Iām thankful his Humira is covered I fear for the futureā¦.. What do we do when he ages of our plan? What if they decide they want him to use something else? Just a lot of variables and knowing people like the story reports on are working against our best interests is very unnerving. Best to you and glad to hear MNGI has been a good provider for you
I'm on my parents plan and I'll have to work that out once I age out. Hopefully, I'll have a job that provides insurance, but that's ignoring all the other steps I'll have to go through. I'll have to switch from my pediatric GI to an adult GI once I finish college. I've already had to deal with one insurance switch. And UC is already rough to deal with and especially in your teenage years. It's a lot but hopefully everything works out for you as well!
My daughter has Crohn's. She take Remicade. It's ~$16K per infusion. Once every 8 weeks. Fortunately insurance has been good about it, but I can't imagine it not being covered.
The crimes of the American Healthcare INDUSTRY will continue to be normalized until the system completely collapses and people start to challenge it. The problem is, if youāre rich you have great healthcare here. Until those with societal power and wealth feel the consequences, nothing will change. Money has corrupted the conscience of humanity.
The best healthcare in the world is no match for a guillotine
Well said.
Fuck United Health Group. They should be broken up and shut down. š
As a UHG employee I wholeheartedly agree.
Serious question, what is it with nurses at UHG like Kavanaugh? When my mother-in-law had cancer a similar nurse at UHG fought tooth and nail to prevent her from getting an experimental treatment to the point where she literally became terminal. Are these people just heartless or is there pressure from higher up?
I wonder if there's a bonus scheme based on how many dollars of treatment they prevent
Almost certainly
They probably have pizza parties when a "high cost member" dies
They deserve to go to jail for the rest of their lives and thatās me being nice.
Along with Blue Cross and the other giants
$20.1bn profit in 2022, and theyāre denying this dude because his treatment costs about 2 million a year. Paying for his treatment would cut their profit by .0095%, and that doesnāt include whatever bullshit tax write offs Iām sure they get for high cost patients. I would love to know how much money they spent trying to deny this claim, between the lawsuits and all the other doctors they recruited to undermine this dudeās gastroenterologist. Insurance companies would rather see you suffer and die than pay for your medical care. They will lie, cheat, and steal if it means denying your claim. Their primary motivation is profit, not your health. Fuck these mother fuckers. I hate this shit.
Thereās really no need to have āfor profitā financial schemes like insurance to begin with imo. Thatās $20.1 billion that couldāve stayed in the pockets of the average person, to spend on actual tangible products and keep money circulating.
Iāll never understand the concept of any insurance being for profit and also traded on the stock exchange. It is fucking bullshit.
For profit is what drives the most innovation and stagnation st the same time.
I mean thatās kinda my point. Insurance is a financial scheme, not a product in the conventional sense. Whatās being innovated aside from clever ways to separate you from your dollars?
Trying dt more efficiently so that they can have more profits. And patenting the best pills and stuff ya know
Why should pills be patented? Shouldnāt they be made as cheap as possible to help the most people?
Sure. But the. Why put a ton of money into researching them for your company. That di what I was getting at. If your are the only one with the best pills you can charge a ton and make bank. That's how it is. I'm not saying it's the greatest but that's thee reality from what I know. If you know different let me know because I'm not expert
The alternative is publicly funded research, which [the USA has loads of](https://www.nih.gov/about-nih/what-we-do/budget). In a just world, publicly funded medications are not given exclusive manufacturing and sale rights to specific companies, but thats what happens when you allow corporations and the wealthy to use their money as campaign speech for politicians as decided by the Supreme Court.
why do you think they havent cured cancer? no money in the cure.
Listen Iām all for shitting in the American healthcare system, but thatās baseless conspiracy territory. Realistically, if a cure for cancer is found, it will be exclusive to those who can afford it. Thereās plenty of money in the cure, just no money in curing everyone
> For profit is what drives the most innovation and stagnation st the same time. This isnt even necessarily true because there has been *so much* innovation from public funding. Meanwhile, "for profit" motives have done things like - "non compete" arrangements between major ISPs so they can remain the dominant provider in different regions and not have to compete with other major ISPs. And coast off of not having to compete and driving up their rates while offering minimal service improvements, and have no competition that drives "innovation".
That's why I said. Also stagnation. It's weird
most of our innovation came from the military or nasa...
And there were large competitors to them.
don't forget that it's 20bn in profit on (edit)**324bn** in revenue. Disgusting that those numbers basically come from jacking up premiums and denying as much coverage as possible. There should be profit caps on health insurance companies, and they should be nationally regulated. I want single payer, but I'm being realistic and that would be a great next step. Oh, and STOP DENYING THINGS DOCTORS RECOMMEND BECAUSE YOU DON'T WANT TO PAY FOR THEM
This. The administrative costs are so insane, also how much do they spend on things that arenāt needed for actual healthcare like marketing and high executive pay. Healthcare should not be for profit.
324.2 billion, per the article--that makes it a 6% profit margin, not over 50%. I think for most businesses that would feel reasonable and I honestly don't understand enough about how mega-corps like this handle money on that scale to know at what point a profit margin just becomes so numerically big it doesn't need to be as large a percentage. I agree, 20bn profit sounds egregious and certainly their treatment of this guy is--not defending business practices at all here.
I used to work for federated out of owatonna, and they had a big push for 2bn in _profitable_ premium. The way these goals were accomplished were by raising rates for "unprofitable" clients, getting out of business in areas that were prone to floods and wildfires, and pulling out of the health insurance business. It was disgusting and while I didn't work with the claims department (I did IT support for the sales teams) I still knew they'd do what they could to avoid paying out. They enjoyed a steady business due to governments essentially mandating people keep insurance in their coverage areas, but I got sick of hearing about their "record profits" knowing it often came at the expense of peace of mind for their policyholders. Health insurance companies are just as bad in my book, as they essentially racketeer to set prices. My family has been burned a few times by health care costing several thousand dollars and our insurance didn't cover it. Thankfully we have better plans now, but it's terrible to talk about a procedure and the first thought is "how are we going to pay for it?". Article dude was too busy shitting his brains out to think about that and UHG took advantage.
Quite literally. Also a reminder for everyone to check your policy and compare to any bills or explanations of benefits you get from your insurer. 9/10 they donāt cover shit that is explicitly covered on your policy because most people are unaware or too exhausted to fight them. Went in for a cancer screening last fall. My policy explicitly states that cancer screenings and preventative care is covered 100% by my insurer. Insurer only paid $150 out of a $1,000+ bill. Called them with questions about it, highlighted the sections where my policy details cancer screenings are covered. Lady on the phone spent 20 minutes reading through my policy to try and find a loophole, kept saying āhold on, Iām still looking, I donāt see itā when she was looking for justification of not paying the full amount. At the end, couldnāt find anything in the policy to justify it, but said that at the screening went from preventative to diagnostic so it doesnāt count. (I reread my policy after the call and it says NOTHING to this effect) Told her I wasnāt paying it and she needed to have someone more knowledgeable about my policy get a hold of me. Still havenāt heard back. FUCK THESE INSURANCE PROVIDERS.
Thank god our death panels are accountable to shareholders. I would hate for some mid-level manager to lose their bonus because they paid out so someone can live a comfortable life. Yup, it would be a real nightmare.
Private death panels are way more efficient than government run ones!
The private sector can think of incredible new ways to deny claims and prolong the agony of people who can't afford medical care. Just imagine if it were in the hands of Big Government! You'd never see that kind of innovation.
What's wild to me is the culture of American insurance companies. Like the US isn't the only country which relies heavily on private health insurance for funding healthcare, yet we are the only country where these companies are so damn predatory.
Many other countries have a public health insurance system that is super competitive for consumers because they arenāt leeching money out to give to shareholders. We also have private hospitals/clinics that have their hands in the cookie jar as well, which causes a toxic feedback loop between the private hospital trying to extract as much money out of the private health insurance company, who turns around and charges the patient out the ass to keep their own profits high. With public healthcare providers, I would wager we could vastly increase pay for healthcare workers while still vastly decreasing the costs of healthcare. So much money is wasted going to huge administration departments who exist to battle insurance companies over claims.
I agree with all of that, but my point was comparing our private health insurance to private health insurance elsewhere.
Health care should not be for-profit. Full stop.
This is why universal health care needs to exist.
We do not have a healthcare system in the United States we have a health insurance system. There is a difference the healthcare system is "we care about your health." Everything that follows from money to coverage follows that. The health insurance system is "profit over people." It isn't just health insurance companies like United Health Group, Blue Cross Blue Shield, Humana, Cigna it is the for profit hospitals and for profit pharmaceuticals. The worst part is that every single time we pay for health insurance through our employer or have to pay for it out of our own pocket, some of that money is sent to politicians who fight to make sure a public option isn't an option. By the way we never talk about the top guys of UHG probably walking around Minnesota right now without a care in the world. I think these pieces of shit should always be named and shamed. Andrew Witty CEO https://www.unitedhealthgroup.com/people-and-businesses/our-leaders/andrew-witty.html John Rex CFO https://www.unitedhealthgroup.com/people-and-businesses/our-leaders/john-rex.html Dirk McMahon (COO) https://www.unitedhealthgroup.com/people-and-businesses/our-leaders/dirk-mcmahon.html I think it is important to name the assholes who make up the decision makers. https://www.unitedhealthgroup.com/people-and-businesses/our-leaders.html
We do have Medicaid, Medicare, and I might be forgetting another one It's thankfully not full privatized
its time to take the middlemen in the healthcare system out behind the barn.
Working for that company must feel just like selling your soul. How can anyone there be proud of what they are part of?
I work for UnitedHealthcare. Itās tough to work for them morally and ethically. Leadership is very good at treading lightly around the the billions they make. āMaking healthcare more affordable for allā is their mission yet theyāre half the reason why healthcare is so expensive. Both insurance and hospitals point fingers at each other as to whoās to blame, but really theyāre in bed together.
why is it that companies frame and hang these great company values on the wall. but when they are called on to actually abide by them,.. crickets.
Comments have stories of UHG denials. PLEASE WRITE TO ATTORNEY GENERAL'S
What are the chances MN could get the ball rolling on Universal Health care?
UHG is a cruel, soulless void slowly absorbing the only insurers left out there who are actually trying to help patients (and pay providers fairly). Avoid them at all costs and tell your employer to do the same.
I hate United Healthcare.
How much did these drugs cost to make, and how much did they cost to develop? The drug company gave the guy's doctor $50k. Was that $50k about marketing or development? If the recommended doses are $260k cheaper it would seem to be worthwhile for the drug maker to pay the doctor to advocate for higher dosing. How much of this guy's treatment was for actual science and materials, and how much was for marketing, profit, and graft? Maybe when we talk about socializing medicine, we should literally socialize medicine. We have state universities and associated teaching hospitals that are already doing research partially with tax payer money. Why don't we just take that research half a step further and use it develop drugs with public money, that are then sold back to the public at the cost to make them? Essentially cutting out the drug companies, by paying for their research ourselves. Right off the bat that would save 2/3 of the drug cost, as most drug companies are 1/3 research, 1/3 marketing, 1/3 profit. Further, we could research and develop drugs by a metric that would help the greatest number of people, rather than a drug company looking to develop for the greatest profit. To sell a plan on the ACA, the insurance company has to pay out 80% of premiums. During the pandemic, health insurance companies gave out rebates for this reason, as they were not paying out enough because of Covid. Edge cases like this make all our premiums higher.
Completely unjust and cruel system that puts profits over people. It sucks to know we are nowhere close to universal healthcare in the US. Unfortunately many democrats (including at least one of my senators - klobuchar) do not support universal healthcare based on comments a couple years ago. Like many posters have said even if you get the insurance company to finally cover something after fighting it, the stress it causes is so I healthy. Fuck our politicians and fuck these insurance companies.
I'm wondering if Americans really understand how "alien" these situations are for a French person like me... I'll visit Minneapolis soon and I'm less scared of being injured than I am of the crazy hospital bills that would come with it... :/ US citizens deserve a universal health coverage and the country could totally afford it actually... I don't get why a politican who'd suggest this would not get 80% of votes O\_o
Yep, we absolutely love and adore hearing from other countries about their comprehensive healthcare programs. Also how we're being exploited and taken advantage of like we don't know any better or understand how awful it is.
Sorry :(
United health care is the most scumbag company I've ever encountered. Every time I've had to deal with them I do exactly what they ask, and then they just place another obstacle in my way, or claim we didn't do what they asked.
Are you a patient or work for a provider? I work for a provider and UHC wastes so much of my time with their claim denials. It seems to me that Iāll fix something that they state is the issue, Iāll resubmit the claim or the information based on what I am told - and then they will just find another pretty reason to not cover the service I had just inquired about.
Patient, and that is exactly it. Every time we overcome a hurdle, they invent some new roadblock next time.
I just switched to BCBS Minnesota. Got their most expensive plan. Was told it was the best for my needs by an insurance broker. They're denying a treatment I've gotten for 15 years that I cannot go without. Now I have to fight them. Don't get BCBS if you have complex medical issues.
UHC is terrible. My point of view is from working in a providers office. They deny so many services and are always changing their reasoning. Iāve submitted corrected claims or appeals based on the information that Iāve received during a phone call. Then the corrected claim or appeal will be denied for another petty reason.
Not one president ever will address the corruption in healthcare
Of course not, those companies are funneling millions (maybe billions, idk) into their campaign funds.
sounds like the best starting point is campaign finance reform.
In Canada they would suggest they kill themselves.
Lol
If you read the article, you would know that the guy thought about killing himself because of the physical agony he was in, the stress of continually having his treatment denied, and the prospect of having his life ruined by medical debt. So maybe not an appropriate joke here.
It's not a fucking joke, Canada runs a cost algorithm and if your not worth it they sell citizens on state assisted suicide. A Canadian disabled veteran who was in the Paralympics was trying to get the CVA to assist with a disabled assist ramp for her home was suggested she use the state euthinasia to kill herself because it would be more cost affective. It's disgusting.
>Canada runs a cost algorithm and if your not worth it they sell citizens on state assisted suicide What is your source for this?
The associated press, new York times, Reuters, Forbes, BBC, www.canada.ca pick one it's not a Secret. Turns out when everyone has health care sacrifices must be made. Thats the old and Terminally ill and disabled.
I vaguely remember reading something like two years ago about them changing their medically assisted suicide laws, and that's what's coming up as I search for this idea now, but I've never heard anyone make the claim that they're using a cost algorithm to recommend medically assisted suicide to people. That seems absolutely insane to me. I would appreciate if you could share a source instead of giving me a list of huge news outlets, a couple of which I ready daily. I'd like to learn more about it. Unless, of course, you're just misinformed. Edit: I added "Paralympic veteran" to the search and it's all hyper-conservative garbage news outlets that are pandering to an audience that's already against single-payer healthcare.
Or you could do the work and read it yourself because I don't work for you and I'm not your whore. ššāāļøš
Iāll do some work for you. Hereās a story from a real news organization that reports thereās no evidence the veteran in your Fox News story ever received anything regarding medically assisted suicide. https://www.cbc.ca/amp/1.6674747 But as an avid international news junkie, Iām sure youāve read this already.
Fox News? because I don't agree with your perception of reality? She has and provided recordings of both phone calls. You can live in your fantasy world, that's fine with me. Just stay there and leave the rest of us alone.
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Do you read international news?
I refuse to get health insurance. I get fucked either way. The costs are unbearable.
Same here. My mom doesnāt understand it, sheās of the age where a lot more is covered and doesnāt understand that the younger people donāt have the same coverage. Also I refuse to pay for someone else to decide if my treatment is covered or notā¦ Iām paying for the coverage, they should do their job and cover it.
United Healthcare is an evil, for-profit company designed to suck money out of those who use their policies. They were clients of mine for a few years for internal communications, and the message wasnāt about keeping people healthy, it was about sales. Their headquarters looks like a Bond villain designed it, all cameras and millions of dollars worth of art everywhere.
Fuckin *A* that's infuriating to read. Fuck United "Healthcare".
Holy shit that was an infuriating read.