Not a great day for Luigi

[The Sultan]

I don't think a lot of people have a great understanding of how difficult it is to navigate the health care system these days. IMO it has gotten significantly harder and more expensive the last decade or so.

https://www.newyorker.com/culture/2024-in-review/the-gilded-age-of-medicine-is-here

[warriorchick]

https://x.com/DudespostingWs/status/1867552667284713785?t=G2kFjlS_YJCcv7xG3M2SJg&s=19

[forgetful]

Totally the same. OJ admitted he cut Nicole and Ron Goldman's heads off but that is was in self defense. And there was proof that Nicole attacked the Juice with a skateboard and that Goldman had a Glock pointed at OJ's head. Lots of chaos in Brentwood that night.

What you are failing to acknowledge is that the people that look at this the same as those other cases, look at it in that way because these healthcare CEO's run companies that deny insurance claims for necessary treatments, without which, the individuals who need them may, or likely will die. Or are suffering from debilitating injuries/diseases which make them want to die.

So to them, it is the the same (or in some cases they would prefer) that they just were attacked with a skateboard. Or that it is the same as having a Glock to their head, because, they can choose bankruptcy or death.

[Billy Hoyle]

but then when BCBS tries to do something to keep costs down for patients the doctors go nuts (that Q7 payment and country club dues aren't going to pay themselves) and force a reversal and the public cheers:

https://www.vox.com/policy/390031/anthem-blue-cross-blue-shield-anesthesia-limits-insurance?utm_source=substack&utm_medium=email

[wadesworld]

but then when BCBS tries to do something to keep costs down for patients the doctors go nuts (that Q7 payment and country club dues aren't going to pay themselves) and force a reversal and the public cheers:

https://www.vox.com/policy/390031/anthem-blue-cross-blue-shield-anesthesia-limits-insurance?utm_source=substack&utm_medium=email

How'd your dad manage to pay for the country club dues? Big pharm reps just put those on the expense account for him?

[Billy Hoyle]

How'd your dad manage to pay for the country club dues? Big pharm reps just put those on the expense account for him?

my dad was just a small-town GP so I worked at the country club and we played at the public course. But the payments on his Chevy S10 with power nothing were low enough he didn't have to overcharge patients.

I do remember his group stopped taking Medicaid patients in the early 90s because the reimbursement process was so arduous and unreliable.

[Lennys Tap]

What you are failing to acknowledge is that the people that look at this the same as those other cases, look at it in that way because these healthcare CEO's run companies that deny insurance claims for necessary treatments, without which, the individuals who need them may, or likely will die. Or are suffering from debilitating injuries/diseases which make them want to die.

So to them, it is the the same (or in some cases they would prefer) that they just were attacked with a skateboard. Or that it is the same as having a Glock to their head, because, they can choose bankruptcy or death.

On the contrary, I totally acknowledge that to some people executing healthcare CEOs, abortion doctors, oil company executives, presidential candidates and others whom they consider bad people is a form of self defense or justifiable homicide. I just think they're way worse than the people the people they choose to murder. Evidently many here disagree.

[Hards Alumni]

On the contrary, I totally acknowledge that to some people executing healthcare CEOs, abortion doctors, oil company executives, presidential candidates and others whom they consider bad people is a form of self defense or justifiable homicide. I just think they're way worse than the people the people they choose to murder. Evidently many here disagree.

Peak

[Scoop Snoop]

my dad was just a small-town GP so I worked at the country club and we played at the public course. But the payments on his Chevy S10 with power nothing were low enough he didn't have to overcharge patients.

I do remember his group stopped taking Medicaid patients in the early 90s because the reimbursement process was so arduous and unreliable.

Unless things have changed, the "GP" physicians still earn far less than physicians in specialties. My guess is that your father got a lot of flak when he stopped taking Medicaid patients. The "reimbursement process" is faceless, so it can easily escape blame.

My brother, a grad from Marquette's last Medical School class and a Urologist, had a policy of waiving the office and treatment charges for kids if the family was unable to pay. If an adult was unable to pay, he would ask what they did for a living or what skills they had to offer. In hardship cases, he waived the charges. When I would visit him, there was sometimes an electrician, painter, or landscaper keeping his end of the bargain. I would joke "being a fine upstanding American citizen, I know that you are reporting the value of their services on your 1040." 

My Primary physician is almost always cheerful and he is very likable. But when he talks about Big Pharma? A darker side of his personality emerges.

[#UnleashSean]

https://bsky.app/profile/themorrancave.bsky.social/post/3ld6n72q2422v

Let's make this thread an example of the cruelty and disgrace that is the American healthcare system.

Heyoooooo ABA therapy in the news!

[#UnleashSean]

but then when BCBS tries to do something to keep costs down for patients the doctors go nuts (that Q7 payment and country club dues aren't going to pay themselves) and force a reversal and the public cheers:

https://www.vox.com/policy/390031/anthem-blue-cross-blue-shield-anesthesia-limits-insurance?utm_source=substack&utm_medium=email

Were not defending that awful position of arbitrary time lengths for surgeries are we? Because that was straight nonsense.

[Billy Hoyle]

Unless things have changed, the "GP" physicians still earn far less than physicians in specialties. My guess is that your father got a lot of flak when he stopped taking Medicaid patients. The "reimbursement process" is faceless, so it can easily escape blame.

My brother, a grad from Marquette's last Medical School class and a Urologist, had a policy of waiving the office and treatment charges for kids if the family was unable to pay. If an adult was unable to pay, he would ask what they did for a living or what skills they had to offer. In hardship cases, he waived the charges. When I would visit him, there was sometimes an electrician, painter, or landscaper keeping his end of the bargain. I would joke "being a fine upstanding American citizen, I know that you are reporting the value of their services on your 1040." 

My Primary physician is almost always cheerful and he is very likable. But when he talks about Big Pharma? A darker side of his personality emerges.

As a kid I asked my dad why he didn't drive a Porsche or Corvette like and orthopedic surgeons who parked next to him did. He responded "because I'm not an orthopedc

Unless things have changed, the "GP" physicians still earn far less than physicians in specialties. My guess is that your father got a lot of flak when he stopped taking Medicaid patients. The "reimbursement process" is faceless, so it can easily escape blame.

My brother, a grad from Marquette's last Medical School class and a Urologist, had a policy of waiving the office and treatment charges for kids if the family was unable to pay. If an adult was unable to pay, he would ask what they did for a living or what skills they had to offer. In hardship cases, he waived the charges. When I would visit him, there was sometimes an electrician, painter, or landscaper keeping his end of the bargain. I would joke "being a fine upstanding American citizen, I know that you are reporting the value of their services on your 1040." 

My Primary physician is almost always cheerful and he is very likable. But when he talks about Big Pharma? A darker side of his personality emerges.

My dad did something similar with a patient who was a hairstylist and her husband had lost his job when he had cancer; my family got haircuts in exchange for not being charged for medical care. I doubt he could do something similar today, but in the 80s it was a different era in medicine.

Yes, GPs are on the lower end of the pay scale, which is a major reason fewer medical students are entering specialties and that's contributing to patients having less access to general and preventative care. Patients are more frequently seeing PAs or NPs instead of physicians for routine appointments and wait times to get in are longer. GPs certainly aren't in the poor house but there is a large gap in both income and time spent working.

[Jockey]

I don't think a lot of people have a great understanding of how difficult it is to navigate the health care system these days. IMO it has gotten significantly harder and more expensive the last decade or so.

https://www.newyorker.com/culture/2024-in-review/the-gilded-age-of-medicine-is-here

Actually I think a lot of people do understand it - hence the lack of sympathy for the dead guy.

[Jockey]

my dad was just a small-town GP so I worked at the country club and we played at the public course. But the payments on his Chevy S10 with power nothing were low enough he didn't have to overcharge patients.

I do remember his group stopped taking Medicaid patients in the early 90s because the reimbursement process was so arduous and unreliable.

Are you saying he (and his group) were so adamant about the Hippocratic Oath that they jettisoned their most needy patients?

[real chili 83]

Reading this thread, you would think almost ALL medical insurance claims are denied.

The fact is, many, many plans are self funded by employers.  It's employers who dictate what is covered and what isn't, outside of what is legally required to be covered.  Health coverage is one of the largest costs employers face.  They are constantly balancing what they can afford to cover with offering a competitive benefit package.

You can debate that better coverage will allow for lower costs long term if you can get healthier  employees.  There is also the issue of lifestyle is a choice...

In self funded plans, the insurance company does not dictate what should be paid, it is the plan design.  Insurance companies get paid to process bills, and draw funds out of your account to cover them.

I have Anthem BCBS, and couldn't be happier with them.  I've had some ongoing stuff over the past few years, which includes a couple of surgeries.  They have been awesome.  Do I wish they would cover Wegovy so I could lean on that crutch to shed some extra pounds?  Heck yes, but I realize I own the root issue (too many Marquette specials with cheese and onions).

Sure, there are people with bad stories/experiences with their insurance.  Some are well founded, but many are not...those people usually aren't telling you the full story.  My point is that the generalizations going on here about ALL insurance companies being bad is just BS.

[The Sultan]

In self funded plans, the insurance company does not dictate what should be paid...

While in reality that is the case, the insurance companies have "pre-packaged" plans that an employer has to analyze to determine what their costs would be. Sure they can say "I will take your Choice Plan, but I want you to up the coverage for chronic pain," but they don't actually do that very often.

I have Anthem BCBS, and couldn't be happier with them.

And I've had United Health and have had no problems whatsoever.

[Uncle Rico]

Reading this thread, you would think almost ALL medical insurance claims are denied.

The fact is, many, many plans are self funded by employers.  It's employers who dictate what is covered and what isn't, outside of what is legally required to be covered.  Health coverage is one of the largest costs employers face.  They are constantly balancing what they can afford to cover with offering a competitive benefit package.

You can debate that better coverage will allow for lower costs long term if you can get healthier  employees.  There is also the issue of lifestyle is a choice...

In self funded plans, the insurance company does not dictate what should be paid, it is the plan design.  Insurance companies get paid to process bills, and draw funds out of your account to cover them.

I have Anthem BCBS, and couldn't be happier with them.  I've had some ongoing stuff over the past few years, which includes a couple of surgeries.  They have been awesome.  Do I wish they would cover Wegovy so I could lean on that crutch to shed some extra pounds?  Heck yes, but I realize I own the root issue (too many Marquette specials with cheese and onions).

Sure, there are people with bad stories/experiences with their insurance.  Some are well founded, but many are not...those people usually aren't telling you the full story.  My point is that the generalizations going on here about ALL insurance companies being bad is just BS.

No, they're all bad

[warriorchick]

As a kid I asked my dad why he didn't drive a Porsche or Corvette like and orthopedic surgeons who parked next to him did. He responded "because I'm not an orthopedc

My dad did something similar with a patient who was a hairstylist and her husband had lost his job when he had cancer; my family got haircuts in exchange for not being charged for medical care. I doubt he could do something similar today, but in the 80s it was a different era in medicine.

Yes, GPs are on the lower end of the pay scale, which is a major reason fewer medical students are entering specialties and that's contributing to patients having less access to general and preventative care. Patients are more frequently seeing PAs or NPs instead of physicians for routine appointments and wait times to get in are longer. GPs certainly aren't in the poor house but there is a large gap in both income and time spent working.

And that's why a lot of primary care is being shifted to NPs and PAs.

I have a nurse practitioner as my PVP and I couldn't be happier with my care. She takes plenty of time with me whenever I visit. She actually listens to me and doesn't hesitate to refer me to a specialist if needed.

[Hards Alumni]

Reading this thread, you would think almost ALL medical insurance claims are denied.

The fact is, many, many plans are self funded by employers.  It's employers who dictate what is covered and what isn't, outside of what is legally required to be covered.  Health coverage is one of the largest costs employers face.  They are constantly balancing what they can afford to cover with offering a competitive benefit package.

You can debate that better coverage will allow for lower costs long term if you can get healthier  employees.  There is also the issue of lifestyle is a choice...

In self funded plans, the insurance company does not dictate what should be paid, it is the plan design.  Insurance companies get paid to process bills, and draw funds out of your account to cover them.

I have Anthem BCBS, and couldn't be happier with them.  I've had some ongoing stuff over the past few years, which includes a couple of surgeries.  They have been awesome.  Do I wish they would cover Wegovy so I could lean on that crutch to shed some extra pounds?  Heck yes, but I realize I own the root issue (too many Marquette specials with cheese and onions).

Sure, there are people with bad stories/experiences with their insurance.  Some are well founded, but many are not...those people usually aren't telling you the full story.  My point is that the generalizations going on here about ALL insurance companies being bad is just BS.

Nonsense.  UnitedHealthcare denied one out of every three claims last year.  And in that same year they made $33 billion (!) in profits. 

https://www.forbes.com/sites/amyfeldman/2024/12/05/unitedhealthcare-denies-more-claims-than-other-insurers---angering-patients-and-health-systems/

Not to mention, small businesses employ 50% of Americans, and 75% of small businesses employ less than 50 people, and are therefore exempt from having to provide health insurance for their employees.

If you're not having problems with your health insurance that's great for you, but entirely anecdotal.

[#UnleashSean]

Reading this thread, you would think almost ALL medical insurance claims are denied.

The fact is, many, many plans are self funded by employers.  It's employers who dictate what is covered and what isn't, outside of what is legally required to be covered.  Health coverage is one of the largest costs employers face.  They are constantly balancing what they can afford to cover with offering a competitive benefit package.

You can debate that better coverage will allow for lower costs long term if you can get healthier  employees.  There is also the issue of lifestyle is a choice...

In self funded plans, the insurance company does not dictate what should be paid, it is the plan design.  Insurance companies get paid to process bills, and draw funds out of your account to cover them.

I have Anthem BCBS, and couldn't be happier with them.  I've had some ongoing stuff over the past few years, which includes a couple of surgeries.  They have been awesome.  Do I wish they would cover Wegovy so I could lean on that crutch to shed some extra pounds?  Heck yes, but I realize I own the root issue (too many Marquette specials with cheese and onions).

Sure, there are people with bad stories/experiences with their insurance.  Some are well founded, but many are not...those people usually aren't telling you the full story.  My point is that the generalizations going on here about ALL insurance companies being bad is just BS.

The same Anthem that wanted to arbitrarily dictate surgery times?

[real chili 83]

While in reality that is the case, the insurance companies have "pre-packaged" plans that an employer has to analyze to determine what their costs would be. Sure they can say "I will take your Choice Plan, but I want you to up the coverage for chronic pain," but they don't actually do that very often.


And I've had United Health and have had no problems whatsoever.

You are correct about the pre-packaged plans.  Those are fully funded and are used for employers who have typically under 100 employees or are uncomfortable with the potential variability of self funded plans.

[real chili 83]

Nonsense.  UnitedHealthcare denied one out of every three claims last year.  And in that same year they made $33 billion (!) in profits. 

https://www.forbes.com/sites/amyfeldman/2024/12/05/unitedhealthcare-denies-more-claims-than-other-insurers---angering-patients-and-health-systems/

Not to mention, small businesses employ 50% of Americans, and 75% of small businesses employ less than 50 people, and are therefore exempt from having to provide health insurance for their employees.

If you're not having problems with your health insurance that's great for you, but entirely anecdotal.

Mine is not anecdotal.  It just doesn't fit your narrative.

[Hards Alumni]

Mine is not anecdotal.  It just doesn't fit your narrative.

No, it literally is. 

I don't have a narrative.  Our health care system is broken and gets worse every year.  We outspend everyone else in the world (it isn't remotely close either) and get results similar to third world countries.

https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#Health%20expenditures%20per%20capita,%20U.S.%20dollars,%20PPP%20adjusted,%202022

I could go on about this for days.  Again, I'm happy for your outcomes, but the US health care system is the laughingstock of the world.

[tower912]

All of that.  And, through their denial of care, big insurance is now the death panels Sarah Palin warned us about.

This is the killer's motive. 

So, if the defense is able to hang a jury, does that mean this guy isn't a killer?

[real chili 83]

No, it literally is. 

I don't have a narrative.  Our health care system is broken and gets worse every year.  We outspend everyone else in the world (it isn't remotely close either) and get results similar to third world countries.

https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#Health%20expenditures%20per%20capita,%20U.S.%20dollars,%20PPP%20adjusted,%202022

I could go on about this for days.  Again, I'm happy for your outcomes, but the US health care system is the laughingstock of the world.

Agree that there is a ton of room for improvement.  Don't need the hyperbole, though. 

There are a ton of reasons for it, from waste to lifestyle, to the cost of medical research, to....