re: UNH's UnitedHealth CEO shot and killed

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the industry has become a cash a cow.

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You’re Italian?

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ok bro but how will the insurance companies stay in business if they pay for everything your doctor says you WANT"

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"want" until an adverse event, then it's time to sue!

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"want" until an adverse event, then it's time to sue!

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Similar to adverse event during procedure that is approved, right?

It's not like approving and covering everything a provider or patient wants prevents adverse events. There is enough evidence showing costs vs outcomes to see that what we (as a system) currently cover and pay for produces horrible outcomes. It cannot be rationally assumed that the "fix" for that is to simply cover and pay for more. There has to be a turn to efficiency in medicine and right now, the payment model is designed that those in the delivery model profit from inefficiency.

Guy was separated from his “ estranged “ wife… now the real stuff starts.. shacked up with killers wife?? Wife hires hitman???

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Similar to adverse event during procedure that is approved, right?

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Not really. You're saying they "want" something. If a doctor diagnoses something and offers a treatment, it's no longer a "want". It's a "should" offer at that point if there's evidence that it prolongs life, etc. and now comes with medicolegal risk.

An adverse event during, let's say, a cancer surgery doesn't fall into that category. That's a risk of doing something that "should" be done. Not offering treatment for a potentially life threatening malignancy is the alternative there.

Also, cost efficiency is more of a cost problem than an approval problem. A cost problem created by insurance companies and hospital systems who have successfully obfuscated the real cost of healthcare for decades now.

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United is by far the worst offender for denying care under Medicare advantage , vastly outpacing bcbs and others. The OIG has documented this. United is getting our money to provide care under MA and then breaking their contractual obligations to do so. As others have said, it’s crony capitalism at its worst. When the congressional investigations come United will be first against the wall.

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No, you don't get it. You just don't "understand" this "complicated" industry. Don't worry, they have nothing but the best intentions for you and your healthcare.

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If a doctor diagnoses something and offers a treatment, it's no longer a "want". It's a "should" offer at that point if there's evidence that it prolongs life, etc. and now comes with medicolegal risk.

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Not to get caught up in semantics but that's what is referred to as "medically necessary" and yes, those should and are almost always approved.

That's not a want..that's a need. A want is a Dr ordering skilled nursing because a patient doesn't want to go back to her nursing home because she doesn't like the staff. A want is a Dr. ordering a motorized wheelchair so a patient can get groceries from the corner store.

There are different criteria to approve authorizations and pay claims but they all have a minimum criteria that payors MUST abide to. They can decide to approve and pay for more than just what the minimums are but there is always a minimum.

But, there are tons of treatments out there that someone (patient or provider) may want to try that MAY provide a healthier outcome. Platelet-rich plasma (PRP) is a great example. PRP has a success rate at it's highest around 90%. It's not medically necessary but it's a want from many and it's normally not covered by insurance. What about Botox for migraines. That has a much worse success rate than PRP and is mostly covered by insurance.

There are obviously tons and tons of examples but the discussion of wants, needs and medical necessity is a constant battle but almost everyone on the planet agrees that needs are and should be covered. It's the "wants" that cause friction, confusion and frustration.

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Not to get caught up in semantics but that's what is referred to as "medically necessary" and yes, those should and are almost always approved.

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almost everyone on the planet agrees that needs are and should be covered.

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You've covered yourself with the word "almost" everywhere. It almost seems like what you're saying almost may not be true.

I order medically necessary things for patients that get denied on an almost regular basis.

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These "peer to peers" in my field often are initiated by some nurse who doesn't read my note, then the MD to discuss the case isn't even in the same field and has no clue what is appropriate. Does it get approved? Mostly yes but we don't have time for that bullshite.

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My wife is a PA for an urology oncology clinic. I was talking with her about this earlier. She said for example that one of her patients had kidney cancer, insurance made her do a peer to peer deal and it was with an OBGYN for an MRI.

Just completely not even close.