My wife is a clinical psychologist who used to take insurance. She got tired of not being paid for months for patients she saw. Legally they have 90 days to pay you, but in practice it’s closer to 4-5 months. Every January they claim to have “computer problems related to the new year” and simply lose huge numbers of claims, requiring you to resubmit — oh that claim is more than 90 days old even though it was their system that “lost” it? Sorry, can’t submit! Guess you just worked for free!
She takes cash now. It was an abusive system and I’m not surprised it’s falling apart.
Up and down the board this is the game insurance companies are playing.
For example, I had need for a medical device. My doctors office submitted the claim for that device with documentation of it's necessity 5 times over 6 months before it was finally approved. The prior 4 times it was "You didn't include all the required information" even though each submission was identical.
There's simply far too little oversight on insurance agencies. They are perversely incentivized to give the worst outcomes for everyone which being to command high premiums because of the relatively low amount of competition or threat of "switching" (After all, you are using your employer's insurance. You didn't get to pick it, HR did. And they picked it based on who's cheapest. How did they become the cheapest? A race to the bottom in terms of service).
All of this burdens the whole system with cost and delay.
I'm all for universal healthcare, but if we can't get that can we at least get stronger regulations and punitive measure against insurance companies for playing these games? It's crazy that everyone has stories, regardless of agency, of illegitimate claim denials.
And to be clear, they do this because it saves them money and costs them nothing. By denying by default, a certain percentage of the population and doctors offices will ultimately just go away because of the headache it takes to convince the agency to provide the product you pay for.
I think this is the most infuriating thing about US healthcare. Your doctor thinks you need a diagnostic test to make sure you don’t have cancer?
Sorry bud, random bureaucrat at Premera thinks not! But you’re welcome to spend hours of your time filing and following-up on an appeal with absolutely zero chance of a different outcome!
Craziest thing is if you tried to institute the rules of health insurance on credit card fraud (where banks have full liability) heads would roll. However no one bats an eye when it’s for something as crucial as people living or dying.
On that note, why do I have to pay $200 to see a specialist who misdiagnoses me? Any other field, they’d be fired, sued, or at least not get paid for the service.
I would love, love for it to become a thing for Employers to put your money in a special type of account (similar to a Roth 401k) where the only thing you can do with it is buy insurance on the open market.
Heck, even have a list of 2-3 'preferred' plans that employees can choose from, if they don't want to do all the research. But seeing all that money go into their pay-stub, and then right back out for insurance is going to be very, very eye opening to people who currently just have their employer pay it, and they ever see it in their check.
It might not be if health insurance companies actually had to compete to consumers directly rather than only to CFO/CHROs, who in turn provide 2 or 3 "choices" from a single carrier.
That's exactly what my current job does. I buy a policy on the government marketplace, submit my premium statements, and I get reimbursed every month.
My allowance is quite generous, and it pays for 100% of the cost of the most comprehensive insurance I could find for both me and my husband. The platform is called PeopleKeep.
It's really, really nice to pick my own policy. Now I never, ever have to deal with CVS Caremark ever again.
Yep, I've submitted for prescription reimbursement for compounded medication. I submitted photocopies with just the dates and signatures changed - the formula and everything was the same. One time they gave me the full $45 in reimbursement. The next time it was $17 (cost of the prescription med without the other ingredients or compounding). The third time they gave me $1. I tried asking why each was different. They had no explaination but were emphatic that they paid the correct amounts.
> My doctors office submitted the claim for that device with documentation of it's necessity 5 times over 6 months before it was finally approved
I have had a profoundly deviated septum since childhood. A couple of years ago I went to an ENT to get it fixed. "Yup, 90% deviated on the right side." "Great, when do we schedule surgery?"
"Well, first, I prescribe you these two nasal sprays so that you can come back in four weeks and tell me they didn't fix your breathing, so I can tell the insurer that so they can approve surgery."
The CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P) may solve some of those problems starting in 2026.
Also a practicing clinician and this is such a terrible problem that goes well beyond what you’ve described
Someone comes in and has insurance “x”. “Am I in network?” I don’t know. Probably. I take those plans most of the time. I check Navinet, or provider express, or one of the many other insurance benefits verification websites because the various insurers can’t agree on one centralized platform for this.
It says you’re good and I’m in network, great! Or you checked the provider directory online and I’m listed. Most of the time we’re okay. Sometimes this is out of date though (the “computer issues” you mentioned). The only way to truly be sure is to call the insurance company and have them check their systems which I simply don’t have time to do, sorry, or submit billing. This is why I and basically every healthcare practitioner have the policy that you are ultimately responsible to verify your benefits.
So we meet and it’s fine and I collect your copay. Then I submit billing. Then we meet again weekly. Then the insurance takes four fucking months to process your intake session only to come back and say “hey wait, this actually isn’t covered because it’s technically out of network so neither are the 15 sessions that happened afterward”. Now you suddenly owe me 2-3 grand out of pocket and I either have to collect that, probably worsening your mental health by adding a signicant sudden expense, or write it off and basically say goodbye to any renumeration for the 16 hours of work I did. I will ask you to appeal of course.
This isn’t even a “rare exception” situation. It comes up like once a month and I run an independent solo outpatient practice. Low volume.
It’s a fucking nightmare. I get why your wife went to out of pocket. I don’t blame her. but then it’s the conflict of making services less accessible. My patients often have no clue how to submit for reimbursement and insurers seem to purposely make this a difficult process. It really just sucks. I tend to work with lower income populations that really rely on insurance coverage so it’s not an option to go cash only for me but I definitely understand those who do. the system we have is deeply flawed, maybe irreparably.
The only setting that alleviated this was larger settings. Major healthcare networks/hospitals, large agencies, etc. it still came up but less often and when it did there was an army of billing staff to appeal. But the downside is that imo care was inherently compromised in these settings due to demands placed on staff. There were benefits of having teams, training resources, increased supervision, etc. but all of these were outweighed by significant overhead costs and productivity demands. For perspective moving to private work allowed me to earn 35% more while working 20% less within the first year. I’m not struggling to make ends meet and I’m not constantly flirting with burnout anymore. So imo those institutions aren’t the solution unless they can make real systemic changes
Even beyond insurance, the system is fucked. My wife finished her master's program and started working under supervision. But, of course, the only places which offer supervision are (generally) community mental health centers. So my wife was fresh out of school, with a client load of 55 people, getting paid $20/hr -- and those 55 people were generally the people with the least resources and support, thus some of the most challenging non-inpatient clients you'll find in mental health.
Beyond that, she learned that these community mental health centers, despite being nonprofits, are still aiming to constantly reduce costs; in her first six months, she saw many support structures for both clients and clinicians cut. This included laying off most of the case management staff, expecting the counselors to pick up the slack. She rarely even had time to keep her (legally-required) notes.
She lasted less than a year before quitting. She's not sure she'll ever go back.
Counselors are being squeezed from both sides here: They either burn out early, or the insurance companies fuck them over in perpetuity.
When I was a student the rule was you had to do a year in community mental health type setting during school as an internship prior to graduation. I forget the exact hours requirement. It was supposed to be a learning experience but almost all of us were just put to work with a full caseload from day 1, paid $0 and hour, and the agency billed on our behalf. It was very burnout inducing to be making nothing working in the setting you describe. Then you’d graduate and get to have the honor of making $15-25/hour, the low end of which was offered over at target.
It’s also why I don’t understand how those programs struggle so much. AFAIK the practice continues to this day and it means they have a sea of interns providing free labor. The interns don’t get the same session rate as a fully licensed therapist but at the same time they literally cost $0/hour, they are slave labor. Medicaid and the community mental health system is built on it. It’s why low SES individuals are by default used to never having the same therapist for more than a few months or so; the turnover is crazy
> Then the insurance takes four fucking months to process your intake session only to come back and say “hey wait, this actually isn’t covered because it’s technically out of network so neither are the 15 sessions that happened afterward”. Now you suddenly owe me 2-3 grand out of pocket and I either have to collect that, probably worsening your mental health by adding a signicant sudden expense, or write it off and basically say goodbye to any renumeration for the 16 hours of work I did. I will ask you to appeal of course.
Not a clinician but did (previously) work in software developing claims benefit management software.
One of the parts of the recent Surprise Billing reforms was that if a patient "could reasonably believe" that they were in network (and in particular, the prominent example of note being the insurer's website or a provider they use lists the provider as being in-network, because they ostensibly have control or input thereinto), then the insurer was obligated to remunerate the claim as being in-network.
i.e. if insurance's directory says "sure, provider X is in-network", they don't get to turn around after you use their service and say "You know what, they're not, so this is uncovered/out-of-network".
My billing subcontractor has mentioned this as well but in practice it hasn’t worked extremely for us. Sometimes we resubmit and it gets paid, sometimes not. That’s where I often have to get the patient to directly appeal to their insurer. But I’m not sure if the subcontractor is necessarily following necessary procedures.
That’s a whole different issue though; I’ve had to change subcontractors twice in my career because after auditing I found they were dropping the ball on stuff like this and just billing clients when there was a path to insurance reimbursement that could be pursued. To insurance companies credit this is an issue at least a part of the time; billing departments and subcontractors that flake on their own work. Far less common but a non zero part of the issue.
Thankfully as things transfer to software solutions this becomes less of an issue; I’ve moved a portion of my billing to a software based billing solution rather than a human one and while it still has issues it has less. Sucks for job creation but better for my patients I guess
In my experience, this isn't anything special about therapists.
Going through the listings for any kind of doctor in your health plan is a nightmare. When I needed to see a primary care physician, it took two hours of calling 10+ listed offices to find one that was actually a primary care physician, was still practicing in the geographic area, was accepting new patients, and still accepted my health insurance (apparently dropping plans is common?). And the earliest they could see me was in 6 weeks.
It was the exact same type of experience when I needed to see a particular type of specialist, except the earliest appointment I could find was in 3 months.
The insurance companies just don't update their lists for any type of doctor, as far as I can tell. Whether this is due to sheer incompetence or deliberate deception or some combination of the two, I couldn't tell you.
Why in the world is the whole network thing even legal? It’s seems like a way to guarantee certain doctors and insurance companies a steady stream of cash flow without having to compete with one another. It is a hilariously corrupt system, but that’s par for the course with the medical industry. One of the only professions where you can charge people to have provided no solutions to their problems. Image a mechanic who tells you your misfiring engine and squeaky breaks are nothing and then charges you a few grand for the pleasure of them being obviously wrong.
Aside from such a scheme dominating a particular region and being a potential playground for other anticompetitive practices, nothing about the idea in general strikes me as inherently anticompetitive.
Insurance cos can still compete on the merits of their networks and, in theory but sadly I think not in practice, these schemes could work in favor of the patients if the insurance company uses their network to balance cost with service quality.
A very dominant one could effectively rule a region as a cartel, though.
> Why in the world is the whole network thing even legal?
The answer is on some of the other comments on this page. Insurance companies make reimbursement so difficult that some doctors do not want to accept the insurance.
most professions that bill by the hour work this way? squeaky brakes isn't a plausible example, but this isn't uncommon for electrical issues in luxury cars. the mechanic spends days/weeks chasing it down and eventually asks you if you want to keep paying them to look. if you say no, you still have to pay for the time they already spent. if you say yes, there's no guarantee they eventually fix it. or they come up with a root cause and give an estimate to fix. you still pay if they're "obviously wrong".
Honestly this is why I really like having Kaiser as my insurance provider (for those who don't know, Kaiser is an HMO that is both the insurance provider AND the hospital/doctors office/pharmacy. You get all your care from them).
Some people don't like not having choices for doctors, but I would much rather just have one system to deal with. I don't have to print out medical records like I have to for my wife and kids (they are on a different plan), or call a bunch of different providers to find care, or go back and forth as two different providers say the other side is the one that has to do anything. I never have to argue with my insurance provider about paying for something, I never have to wonder if something will be covered.
What do you do if you don't like your doctor? Or your doctor just gets it wrong? Are you just screwed?
For example, a therapist is a very personal thing and I'd imagine you might have to try many to get it right. Psychiatry is as much an art as a science, so it's not like they're fungible.
Or what if, say, your internist dismisses your heart problems as anxiety, but you'd like to see a specialist because you know the difference and it's not just anxiety. That's it? Not allowed?
You can request to change your primary care doctor. There is an online list of Kaiser doctors who have capacity and you can choose to change to them... the list is accurate and you can do it online, though, unlike those described in the article. You can also make appointments with other Kaiser primary care doctors, either because you want to see someone else or your doctor doesn't have availability.
You don't always have a choice to see a different specialist if you live in a smaller town, but in larger cities you can request a different one.
In general you can't make direct appointments with specialists on your own, you need to be referred by your primary care doc. Once you have seen a specialist, though, you can make direct appointments with them.
You can also call and tell them why you think you need to bypass the normal system. They have staff who are there to help navigate those situations. I have never had to do it personally, so I can't vouch for how accommodating they are.
I will say, though, that in my experience I have a lot more say over my care than my wife does with her traditional insurance provider. She has had to fight to get things paid for and been rejected way too many times.
Sure, she could make an appointment with any specialist she wants... but will insurance pay for it? In your example, if you have another doctor who has said the problem is just anxiety, will insurance pay for your second opinion?
If insurance isn't going to pay for it anyway, it doesn't really matter if you have Kaiser or a traditional insurance provider. Both of us can make any appointment we want if you are going to pay it yourself.
Why do I get the impression that the economy in 2023 is based on primarily fake things? So many things are either illusions, legal grifts, and outright ripoffs. This isn't anything new per se, but I think we may have gone beyond a critical threshold. Will the chickens come home to roost, or have things become so simulated that too many people believe ambiguously in the system for it to fail?
It’s basically the guaranteed end state of a society that both highly values individualism and has been kneecapping regulations/regulators/rule of law for decades.
You don’t need a very high proportion of the population to poison the well with bad behavior enough that everyone just accepts that as regular behavior and then even the ethical portion of your society starts engaging in the bad acts.
One of the main benefits for having a government is to go in and regulate bad behavior away that would never occur organically because each individual actor in society loses far too much trying to fix the situation on their own to rationally try.
The chickens won't come home to roost in anything like a dramatic moment of reconing. The USA will just slowly become more and more like many Latin American countries that should be prosperous in theory, and for some of their people there is incredible prosperity, but for most people it just appears like the only way to get ahead is to join some kind of thinly veiled racket masquerading as "business" or whatever.
History teaches us things can change fast. Think USSR in 1984. At some point things are going to give.
We have the technical means to provide a decent life for everyone. And I mean everyone, including illegal immigrants sneaking across the border. And we could do all that while everyone struggles less.
So yea. Most jobs are fake and stupid and don't need to be done. The ones that need doing could be given more support, distributed more evenly.
This was a mainstream economic viewpoint less than a century ago. What happened?
It is a good thing that we have an economy where there are jobs for people to do things that 'don't need to be done'. This is the only way that a highly specialized capitalist society can provide income and purpose for everyone, and drive further innovation. People need income and jobs, even as we add more automation. As long as our society produces enough basic needs to actually support people, it is better that people are doing 'unnecessary' jobs rather than being unemployed as the result of automation.
Everyone is worried that automation is going to steal people's jobs, and jobs won't exist anymore, but that has already been happening in full swing for 100+ years. 'Useless' jobs are and will continue to be the solution to that problem.
(And I am using 'useless' rather tongue-in-cheek. The jobs do have real functional value, even if they're in higher parts of Maslow's hierarchy)
Your rejoinder is valid, but I don't think the problem at this point is jobs that don't need to be done. I think the problem is jobs that do things that should not be done.
Doctors' offices employ people whose only purpose is to be experts at navigating the byzantine insurance system. Arguing that these jobs should be preserved is the broken window fallacy. These jobs do not have real functional value. They are compensating for something that is destroying value.
Even worse is when it's not even someone's job, as in the case of individual people fighting with their insurance company to get paid what they're owed.
I agree 100%. Not all BS jobs are good BS jobs. The ideal BS jobs are ones that do something productive that has a positive influence. The worst kind are the ones that are rent-seeking.
I wish that people in this country could get over the idea that 'jobs programs' are a bad thing. Some of the best BS jobs are artificially created, the ones that capitalism produces naturally tend to be of the rent-seeking variety.
I didn't mean "innovation" as in "novel and groundbreaking technical innovation". Innovation that is meaningful and valuable to society can be as simple as generating art, music, ideas, cultural contributions, etc.
> As for "purpose"...wow. Ask the next GrubHub employee that comes to your door if it gives them purpose.
I bet they have enough purpose in their life that they aren't committing violent crimes for shits and giggles.
>It is a good thing that we have an economy where there are jobs for people to do things that 'don't need to be done'. This is the only way that a highly specialized capitalist society can provide income and purpose for everyone, and drive further innovation. People need income and jobs, even as we add more automation.
For most families with two parents who work, it would be better for one to stay home and tend to life and children. It's inefficient, alienating and demoralizing to have both parents forced into specialized wage labor that amounts to a useless make work.
Well yes, the optimum number of full time jobs in a household is >=1 and <2. This isn't really a function of useless jobs existing or not, but more of a function of CoL and income distribution.
COL is itself a function of the prevalence of useless jobs. They increase the cost of everything, they increase the need for infrastructure, they create friction for real work, etc.
Put another way, if society allocates more resources to people who work outside the home doing useless things, then fewer resources are available to people staying in the home doing useful things. One way this manifests is inflation, ie, higher COL.
Romans had the technical means to integrate all the Barbarians crossing their borders, but they didn't. A lot of American Politicians who are waving Mexican Flags today would be welcoming in their new Barbarian constituency as Roman politicians.
After all Barbarians were Rome's strength, they just wanted to work jobs regular Romans didn't want to do. They are just moving for a better quality of life. Economic Migration into Rome.
It won't fall over (there are still lots of real things out there), but it's pretty much just basic economics. If you can make a fake thing instead of a real thing for significantly less cost, but could sell it for a similar price, why would you make the real thing?
We'll never be rid of it. It's politically impossible to get rid of. And I don't mean "political" as in D vs R.
The amount of money we spend on healthcare in excess of the OECD average is more than we spend on the military. 10% ish of that is the entire yearly profit of the healthcare industry. The other 90% is raw inefficiency. And where does that 90% go? Mostly to salaries. Eliminate our inefficient system, and you eliminate millions of middle class jobs.
No politician will do it. They may talk about it and campaign on it knowing it won't happen. But they will never pull the trigger because it would be political suicide.
This is such a crazy take. "Because the waste is so huge, it's impossible to do anything".
It's not like any individual reform is going to suddenly end all that waste and put everyone involved out of a job. Iterative small improvements make a real difference in people's lives, and won't provoke an immediate giant supply-side shock.
I don't pretend to have the answers to the question of "what reforms should we do?" but throwing our hands up and saying "nothing!" is not the answer.
How do you reduce inefficiencies and cut costs without compromising care?
You cut jobs that are redundant. America spends an insane amount of money on administrative overhead. 4x the average of other wealthy nations [1]. This is largely in part because our fragmented insurance system leads to excessive redundancy in administrative roles
So meaningful reform means cutting jobs. Or you do the shitty political move and preserve these useless jobs for the sake of keeping people employed because our social safety net is a joke and the cost cutting you do make is at the expense of compromising care and vulnerable populations (eg cutting Medicare and Medicaid benefits). Then you get more clinician burn out and struggle to fill key clinical roles/staffing issues, scheduling issues and longer appointment waiting periods, more deaths and complications from a lack of preventative care, more mental health issues and drug abuse in communities, etc. all of which is happening in the USA.
While I agree with you on this bleak outcome, it's more that it's a progressive vs conservative issue. Progressives make up a minority of the democrat party and 0 of the republican party.
The only way to really change this is voting for progressives when possible, though it's hard to convince others that this is what you need to do.
If you are in a blue state, vote in the primaries for the progressive candidates. If you are in red states, that's voting for democrats in general and the most centrist republicans in the primary.
The absolute worst thing to do is to not vote and let the most conservative candidates run wild.
This is not a D vs R / lib vs con issue. It is not a progressive vs centrist Democrat issue either. It's a healthcare industrial complex issue. The US spends 16.6% of GDP on healthcare. The OECD average is 9.7%. (https://stats.oecd.org/Index.aspx?DataSetCode=SHA). That 6.9% difference is $1.5 trillion! That's 2x defense spending!
That 6.9% of GP is supporting millions of jobs, and to remove an inefficiency like that would put them all out of work. It is not possible to do that in a democracy.
Solid take. It'd be much more fine if that 90% could convert over to something useful in times of crisis. But recent public health events have suggested otherwise.
I think the government could make progress by focusing on just cutting costs or just reducing inefficiencies. When the two are conflated and attempted at the same time, the incentives don't actually line up so nothing happens.
I've lived with Swedish, German and now Czech healthcare in addition to American (with very good health insurance). I'd choose any of them over the American system. I find other Americans' fear of change to such a terrible and expensive system very confusing.
Imagine any single one of those companies being the single payer insurance you are forced into. They (government included) become far worse. Rationing care, deciding who lives or does, underpaying doctors and nurses till the best ones quit and the remaining have any care burned out of them. That’s what’s happened in other countries and regions and every time there is a surge or a more complicated care you and loved ones are left to die or deprived of care options.
Yet we have examples of nationalized health care across the world that isn't this system you are describing. The US stands alone in it's terrible health care (and the price we pay for it).
We already ration care, it's based on what you can afford. We already underpay doctors and nurses like crazy, just go talk to one. We already drive them to burn out, because the current health care system is prioritizing admin pay over quality care.
The hellscape you imagine is the american system. It literally could not be done worse if we tried.
Compare the cost of living of Spain to the US (food, rent, public transit) my friend. What makes the cost of CARE cheaper is less administrative agents/overhead.
Hypothetically then places with high concentration of beneficiaries covered by a single-payer system (Medicare) should have markedly cheaper medical care, lower overhead costs and all.
1. Medicare only covers the most expensive in terms of health care costs demographic. Knowing nothing else I’d expect having more people on Medicare to correspond with higher costs per capita. We make 25 year old men who statistically have nearly no healthcare costs buy insurance while providing it to their 90 year old grand parent.
2. Medicare was not allowed to negotiate drug prices until this year. Drug comonies basically got to wr8te themselves checks. In some ways the Us taxpayer subsidizes drug development for the whole world.
I suspect demographics are part of why Florida hospital costs are so high.
The youngest state in the USA is Utah. The state has a median age of just 31. They have some of the least expensive hospitals in the country.
And type of nurse. Big difference in pay between an rn, Lpn, msn, crnp, but one might colloquially refer to all as a “nurse” (except maybe the crnp). Position matters too. A travel er nurse is going to make significantly more than an outpatient primary care office nurse
Exactly why the entire system should be nationalized instead of outsourced. Further, nationalized healthcare promotes political engagement on a basis of material necessities that politicians must be accountable for.
The dumpster fire is happening because the conservative government there is running it into the ground by cutting funding at every turn possible and closing down hospitals.
And even then, I've experienced NHS care and it's 1000% better than the experience I've had with american care. It's not perfect by any means, but it's insane how much better it is than what we have here.
They aren't necessarily cutting funding. They are cutting the amount of funding for nationalized services while increasing the amount of funding for outsourcing contracts.
I've heard this narrative over and over again yet every time I look at it the NHS budget has been consistently increasing year over year for a long time.
And proportionally even more of that budget goes to the pockets of politicians' donors who own the companies that displace the nationalized NHS. Again, the argument is for nationalization, which is the opposite of the direction the NHS has been heading in.
My argument is for nationalized healthcare. The NHS is increasingly not nationalized, so you're only proving my point if anything. Outsourcing the NHS has ruined it.
>Rationing care, deciding who lives or dies, underpaying doctors and nurses till the best ones quit and the remaining have any care burned out of them
This is literally happening under the current system now. My cancer treatment plan, should I ever get it while I'm living in America, is to blow all my cash and buy an exit bag on credit.
A lot of countries have both nationalized care and the fast track. Many people buy private insurance to cover what the national system does not.
Maybe it's not the best of both worlds, but it's at least a far better safety net than the US provides, and that's the most critical piece. Both for the most affected individuals, and society as a whole (even in terms of cost! An ounce of prevention is worth a pound of cure, and all that.)
There are medical company systems in the US that operate similarly to a nationalized system (insurer and provider bundled, I’m not mentioning the name) and have similar downsides - cancer care or any advanced care is sub-par and mental health is hard to impossible to get. The funding to physicians within is distributed on political instead of performance grounds so best ones leave. I’ve lost several friends who used that insurance.
In Bulgaria where I have many friends and family, the system has always been nationalized, barely funded by the government. I don’t know a single Cancer survivor there.
With USDA captured by agricultural interests, and FDA by pharmaceutical lobby, what’s to prevent the regulatory capture of this new single-payer agency?
So the answer to "rent seeking vampire insurance companies" is a rent seeking vampire government agency?
No thank you.
The answer to government created problems isn't a government created department.
All you have to do is look at all of history to see the results of increased government power. Look at the lies of the unaffordable care act. look at the fact that things the government promises as "free" become unaffordable and worse.
I'm very anti government / anti bureaucracy. But in this case it is hard to argue with results. The European system is simply more efficient at delivering healthcare. Here's a really long and detailed report showing why I'm right: https://www.mckinsey.com/~/media/mckinsey/industries/healthc...
But you don't need to worry, it's politically impossible to get rid of the healthcare industrial complex which is 5x the size of the more frequently cited military industrial complex.
Free market options with reasonable government regulations.
What we had when this country had great healthcare options.
You know... the stuff that was replaced with "Keep your Doctor", "keep your plan", "save $2500 a year" and other lies used to pass the unaffordable care act (and similar).
There's a reason "Free Healthcare" can only pass with lies - and it's because government options/UHC/etc are lies for those who don't look at... well... history.
I wouldn't necessary blame the insurance. My primary care doc gave me 10 referrals to psychiatric nurse practitioners but zero were taking new patients. I asked someone who'd written review articles on my condition to do the same and he said he would but I think he did some looking and came up short and ghosted me.
Why not? They're the ones who are gatekeeping the product (their network) at the same time as they're selling access to their network (this is considered one of the "features" on which insurance companies compete and sell their product).
Not to mention that, as mentioned in the article, insurers are legally required to maintain a sufficiently large network to enable their patients to receive care in a timely manner.
If insurance companies want to restrict patients and limit them to seeking care from providers within a preapproved, artificially limited network, then it's totally fair to criticize them for not ensuring that their network is sufficiently large and accessible to be practically usable by patients.
Even if the insurance had everybody in the network, psychiatric help is still scarce in 2023.
Some people still think it is like One Flew out of the Cuckoo's Nest but really you can be suicidal and still spend 48 hours in the emergency room before getting to spend another 96 hours in the psych ward, get a depot injection of Haloperidol decanoate and get discharged.
The US should just stop playing these games. Networks should be banned. Their purpose is to restrict choice not to increase it. It doesn't serve a rational economic purpose (other than enriching a parasitic minority).
Yes. All the time. First you have to find a therapist that actually exists. Then you need to find one who returns a simple email or phone call. Then one who is willing to take you on as a client, and finally one who actually has the tools to help. And each step is hell for someone with any of several conditions that might have been why they were seeking a therapist in the first place. It's no wonder we have a crisis - if that's even the word for something that has been going on so long.
As others have pointed out, this is the experience with other healthcare providers.
Insurers are incentivized for you to not seek out healthcare, but not die. Or seek care, but pay out of pocket. They need those premiums.
I had bad insurance once (Unicare), and an office lady I worked with who used to work there shared many horrifying stories of things like employees putting claims in plastic bags and hiding them above the ceiling tiles.
> this is the experience with other healthcare providers
I'd say there is still a difference in how the ghosting is likely to affect the person seeking care. Somebody seeking help with plantar fasciitis or urinary troubles might not appreciate being ghosted, but it could be a major roadblock to someone with executive dysfunction, or devastating to someone with social anxiety. There's probably also a bit of a difference in terms of finding someone actually good. Do you know whether you might be better served by a different dermatologist? Your sense of that is probably much less strong than that of someone currently seeing a therapist with the wrong approach for them. I agree that this does happen in all medical specialties and that it's bad everywhere, but it's even worse for therapists to do it.
Speaking from the clinician side insurance cos often make joining the network difficult and slow. It can take months. They very rarely reach out to get new providers to joint their networks when their subscribers are struggling to find clinicians. I’m pretty sure they just don’t tbh but I don’t know that definitively
Additionally certain insurers may pay terribly. Most insurers in my area pay about the same but one pays about 65% less than the average. It works out to less than minimum wage after I pay my overhead. No thanks, not joining that network.
I went to zoomcare recently, which is a clinic that does cash and/or insurance. They claim that without insurance the max for a simple visit is $200. With insurance they charged me over $300, a hundred more than people without coverage. When I asked how that was possible they laughed and said. “You know how insurance companies are.”
No the fuck I don’t. How can they get away with charging more for someone with coverage than without? What exactly is the point of my insurance if that’s the case?
I imagine the actual amount insurance pays out to the practice some amount less than 200$ per visit. Then there’s the overhead for staff having to submit claims and waiting 90+ days to get payed.
Hospitals are now required to publish prices for standard procedures. I was looking at differences in prices for insured vs uninsured, and in one case, it was like 25x difference.
Insurance companies insist they need to pay some smaller portion of the charges. They expect that getting paid through them you will give them a discount. Raising the insurance charge until insurers pay the same amount as the direct pay clients makes sense as a business. After all, dealing with insurance companies increased costs through increased overhead.
I haven't been able to verify, but I was once told at an optometrist or dentist office that they were prohibited from having a different rate for private pay than insurance. Not sure if it was a contractual obligation with insurance companies, a law on the books, or a misunderstanding by the employee.
Eliminating insurance would certainly help at this point - UHC alone is a wonderful proof of just how horrible that road is... but fee-for-service care directly paid for by customers needs to go. A reasonable level of healthcare is important and should be accessible to everyone.
So we should eliminate insurance but replace it with insurance? I pay directly for my services when I can, have a subscription to a local “concierge doctor” or direct patient care.
No I am not a Silicon Valley bro, with the amount of kids I have I’m practically 200% above poverty line. I have “great” insurance and still do this. It can be done.
I know insurance intimately and it’s a terrible deal with poorly aligned incentives (for patients). I think removing any and all possible middle men will significantly decrease the corruption factor and waste factor. I don’t need 3 levels of coding reviewer bosses, support staff, adjusters,
Blah blah blah to check my visit codes when I am the one responsible for ensuring what I ordered is what is delivered.
I also participate in an HSA and have been appreciating this idea and if anything think it should be increased, more tax breaks and more money directly to people.
I don't think the parent is correct in dismissing healthcare as a right, but to be fair, the rights they listed are 'passive' rights. They only require the state to not get in your way. e.g. you don't have a right to arms, you have a right to bear arms. If you can't get the weapons themselves there's absolutely no requirement for the government to give you some.
Who said anything about rights? We just want health care to be free at the site of service and funded by taxes. Just like fire fighters, police, etc. Every other western country does it that way, and none of them are clamoring to build a system like the USA currently has.
What about the right to bear arms. Do you want guns to be free at the site of service and funded by taxes? Just like a Militia giving away uniforms and long arms?
I hate the health insurance system in the USA so much. It's just horrendously bad. I had a kid enter this world at right about the same time I changed jobs. That resulted in changing health insurance. On paper, this should have been a little expensive but fine because I paid extra money for Cobra to extend my coverage until the new plan kicked in. But it was such a mess.
I was making phonecalls and sending emails and logging in to weird web portals with two different insurance companies, Cobra (which was managed by some mysterious other entity??), two different HR departments, and the finance people at the hospital for months trying to deal with this stuff. The hospital we were at was in-network for both insurance companies, but no one was communicating with each other (and apparently one doctor involved was not in-network, so there were extra charges, which is such bullshit).
Why is my employer involved with my healthcare costs anyway? It's genuinely a Kafka-esque nightmare.
Anyway, any presidential or congressional candidate that opposes universal healthcare doesn't get my vote, ever. Sorry Biden, but you don't automatically get my vote just because I disagree with the republican platform.
Even better, they refuse to remove therapists who no longer take insurance even after multiple attempts and letters requesting removal. It's a fun scam.
It’s unlikely this is as interesting as the headline suggests.
Maintaining a list of professionals is challenging. There are very simple input problems with this kind of data.
The professional, in this case a therapist, but it really doesn’t matter what they do, just isn’t going to keep their portal updated on the insurance network aggregator.
The insurance companies can’t make the anyone update their listing, and the professionals don’t have incentives. They’re full up on work so there’s no real need for them to do anything to get clients.
https://archive.ph/Nl7gj