Doctors should determine treatment and care. Insurance companies should never determine medical care.
Insurance companies currently determine type of care and deny care with out any training in medicine, all doctors, including alternative care, chiropractic, functional medicine doctors and nurse practitioners should determine appropriate medical treatment along with patients. that should include all natural forms of medicine, and treatment not just synthetic drugs and surgery.
Patients are currently denied treatments doctors prescribe. Insurance companies should not be in the business of determining individual treatment for patients.
Currently insurance companies dictate treatments even when they are the most costly. A less expensive natural therapy will be denied with a chemical or surgical treatment costing hundred of thousand to millions will be allowed.
Agreed that healthcare providers should determine what appropriate treatments their patients get, not insurance companies. I believe there has to be some mechanism in place to prevent abuse, but that should be a rarity, not the rule.
I suspect that for-profit health insurance is an unsolvable ethical dilemma. Health insurance companies should be forced to be TRULY non-profit, with explicit limits on all compensation for ALL employees. Limits should also exist for how much in reserve assets these companies are allowed to possess (to pay out benefits during a particularly rough year), and the rest of the money they hold MUST be paid to subscribers as either a benefit or dividend.
There are mechanism to prevent abuse. Providers who commit fraud get arrested. There are also rules and regulations in place.
In addition, things like Stark laws prevent self referral.
Patients can go for second and third opinions.
In addition to the uneducated and harmful denials etc Insurance Corporations are also guilty of approving claims then coming back later and taking the money back from the Healthcare Provider. They don’t just take $100. They come back and take $25,000 or $50,000. Where do you think a Provider is going to get that money after it is already used for the business? It puts stand alone clinics out of business. It’s just another dirty trick to keep more money to invest in the stock market. The abuse is largely on the Insurance Industry end.
It definitely should not be the Insurance Industry determining if their is abuse since it is in their self interest to claim abuse so they can deny claims and keep that money invested in the stock market.
We also have to change the education preparing medical students to be doctors. They are trained to use health insurance parameters as their guide to treatment rather than the root cause of the health issue.
Over 2 years ago I had a simple out patient procedure that went fully septic and caused Osteomyelitis (Its severe Bone Infection where bone actually swells). Fast forward two years and the bones continue to get worse and when they say ok we have to fuse this insurance says oh do another 10 visits of PT, even when the last MRI clearly showed End Plate changes as a focal point for pain.
I do not know the exact number of denied claims but it is a lot. I have been waiting since June to get the MRI, it is December and I need another 5 visits to PT before they can maybe approve it, that is 10 weeks and $150.00.
Maybe it is time to go make changes to help, the people, the ones they make a profit on.
Yes and no. I guess many people are dependent on their health insurance to pay for their care? Personally, I don’t give and f what somebody at a desk at an insurance company says. If my doctor and I want to do something, I’ll pay for it. My health is more important to me than what Cigna/BCBS )or insert name of corrupt insurance agency here) thinks is deemed appropriate care. The entire system needs an overhaul. I don’t have an exact solution, only complaints lol. Sorry! Maybe more money put into health savings accounts than towards insurance by employers? People themselves need to accept responsibility for their own health before a decent system will work. Too many are not active participants in their own health. Doctors are also at fault. The corruption is so embedded.
Sooo true! As long as there is profit in health insurance, nothing will change. I realize we can’t all the sudden go to non-profit but what if a non-profit like UNOS would be created (instead of organ donation health care) and anyone who would want to opt into non-profit could. The for profit would have to change their business model and actually provide top notch service for being higher priced. I guess that’s utopia and will never happen.
Why can’t HHS look at countries that get it right and adopt their processes. Look at France, Germany and Switzerland etc. As for Canada and the UK, I hear horror stories, I don’t think it’s a system we should transition to I think they are both single payer) but I might be wrong.
What definitely needs to happen is that no one becomes bankrupt from health issues. Western Europeans are shocked at how much we pay, that you can become bankrupt while having health insurance. I better stop, just thinking about how messes up US healthcare is makes me angry
As the arhitect of the only Medicare4All prototype system for the Clinton Task Force in 1991 can only somewhat agree. It opens the door to considerable fraud & over consumption especially in Medicare. Insurers do not make $ by denying claims but rather protect policy holders from unnecessary spending. They operate on standards of usual, reasonable & customary care for the given circumstances & further employ knowledgeable, professional case managers to make these determinations when things deviate from the norm. IMO what is needed is a better defined system for determining what is “medically necessary” for every situation and would assume that to be complex. Primary Care Drs. are responsible for much overspending. Premium dollars are not unlimited. When claims exceed the given corridor, premiums go up. The country is looking for ways to Reduce costs and this is not a blueprint for that although morally it would seem logical. There are many sides to this issue.
You bring up some good points. There are no true NFP’s. 7 of 10 most profitable health systems are NFP’s. However NFP’s are mandated to provide services that FP’s don’t have to comply with in order to retain NFP status. In return they receive benefits that FP’s don’t receive. Insurers don’t set premiums. State insurance dept’s do in the manner you suggest. Excess premium, if any IS returned to policyholders. What you are seeking is CASE MANAGEMENT. Case Mgrs. interface directly with providers on your behalf and explain why certain things are being denied on one hand as well as advocate for other avenues or services that hadn;t been considered on the other. HC is VERY Complicated. Best wishes.
www.unitedstatesuniversalsystem.wordpress.com agrees with your suggestion. Single payer is not the answer, That would be government insurance, fraught with problems like Canada and Americans won’t go for it. There are literally 1,000 issues to be considered in HC reform.
NFPs often masquerade as being NFP but really act as FPs. Every single NFP I interviewed at would now allow me to earn additional income by working anywhere else after hours or starting a private practice to provide care on weekends. Those that did would have a non-compete clause prohibiting me from providing care in an overly cumbersome radius, ie: 50 miles effectively making it not possible.
These places do not want any competition. They could care less about access to care. Ironically, the few FPs I interviewed at, didn’t care what I did during my free time.
I’m not sure where you get this information, it’s not true but I do sympathize with your message. Doctors are trained on what to do, but they must adjust their recommendations based on the insurance companies which dictate how they practice. For example, they know patient needs drug X. But the insurance won’t pay for it until they have tried and failed drug Y and drug Z first. So unless the patient is rich, they aren’t going to prescribe drug X first because it’s pointless.
TLDR, doctors do try to treat the root cause and provide the best care, it’s insurance companies that block it.
Also, the root cause of most health issues is poor diet and lack of exercise. Everyone knows this, you don’t need to be a doctor. Problem is no one wants to eat healthy or exercise so the doctor is forced to treat the symptoms and the after effects.
I’m self employed. We do not have medical insurance due to the high costs if it and we dont go to the doctor enough to justify paying a monthly premium. I have had insurance in the past and yes I’ve had them deny treatments i needed. It is frustrating and dangerous especially if they deny a treatment that could be live saving. The whole medical system needs reform including the insurance companies, hospitals, doctors offices, pharmaceutical industry, the whole nine yards. They need to get back to practicing medicine not being greedy and chasing a dollar at our expense.
I don’t think enough emphasis is placed on diet, physical activity and sleep. There is also too much priority given to pharmaceutical interventions rather than natural remedies. They are not taught what herbal medicines are most effective because something one can grow and use at home isn’t patentable. Doctors aren’t taught how to use what God created, only what man made. There’s also a lack of knowledge on Gods design of the human body and how it works.
Depending on what you mean by natural remedies, there aren’t enough quality studies on it. Insurance companies won’t pay for it so people on a large scale do not have access and therefore can’t be studied.
Maybe you’ll prefer to see an osteopathic physician. Their approach, in principle (as they’re taught; it does not mean they practice this way), is to promote the body to heal on its own. They still use medications though. It’s the DO degree instead of the MD degree.
