I can’t imagine receiving this diagnosis on a child or grandchild and the Dr. being forced to tell the parents “The bad news is that your child has MLD and will die without treatment. The good news is that there is a treatment that will cure your child. The worst news is that the treatment will cost $4.25m. “
American Healthcare continues to go backward
- Thread starter steross
- Start date
Yeah. As a parent, I don't know how you say "no" to any treatment saving your child. But at the same time how is any normal person supposed to pay that? Does insurance pay it and negotiate their cost down to like $100 like they do with most costs? The ridiculous charge is generally only for anyone that's not an insurance company. Watch insurance companies refuse to cover it though.
Likely a combination of insurance discounts, advocacy groups paying a portion, and them extracting what money they can from the family. I have a family member on a medication that while not $4.5 million it is $11K a month which is far beyond her means. It was denied by insurance but an advocacy group has covered most of the bill. But that only occurred after they attempted to get as much money from her as the could.
Medical providers by and large do not set what you pay. The insurance companies do.
If you look at the cost of services that run without insurance (LASIK, some plastic surgery) the prices are not as outrageous.
A Doctor at Cigna Said Her Bosses Pressured Her to Review Patients’ Cases Too Quickly. Cigna Threatened to Fire Her.
Cigna tracks every minute that its staff doctors spend deciding whether to pay for health care. Dr. Debby Day said her bosses cared more about being fast than being right: “Deny, deny, deny. That’s how you hit your numbers,” Day said.
She had been working at Cigna for nearly 15 years, reviewing cases that nurses had flagged for denial or were unsure about. At Cigna and other insurers, nurses can greenlight payments, but denials have such serious repercussions for patients that many states require that doctors make the final call. In more recent years, though, Day said that the Cigna nurses’ work was getting sloppy. Patient files that nurses working in the Philippines sent to her, she said, increasingly had errors that could lead to wrongful denials if they were not corrected.
Day was, in her own words, persnickety. If a nurse recommended denying coverage for a cancer patient or a sick baby, she wanted to be certain it was the right thing to do. So Day said she researched guidelines, read medical studies and scrutinized patient medical records to come to the best decision. This took time. She was clearing fewer cases than many of her peers.
Some of her colleagues quickly denied requests to keep pace, she said. All a Cigna doctor had to do was cut and paste the denial language that the nurse had prepared and quickly move on to the next case, Day said. This was so common, she and another former medical director said, that people inside Cigna had a term for these kinds of speedy decisions: “click and close.”
A Doctor at Cigna Said Her Bosses Pressured Her to Review Patients’ Cases Too Quickly. Cigna Threatened to Fire Her.
Cigna tracks every minute that its staff doctors spend deciding whether to pay for health care. Dr. Debby Day said her bosses cared more about being fast than being right: “Deny, deny, deny. That’s how you hit your numbers,” Day said.
Stillwater Townie
Deputy
I'm still for Medicare For All. The only thing that seems worth debating is should it go further by being Medicare Advantage For All so as to allow private insurance companies to participate in it.
HacklemanPoke
Deputy
I think we should have Medicare for all. Allow companies and individuals to purchase a private Advantage Plan, Supplemental policy or a private plan as they can now even utilize the exchange.
Give companies the choice to pay into Medicare for All or pay into a private plan.
I’m sure we could even get red states like Oklahoma to give individuals up to 7500 per person tax credit to purchase private Advantage or individual plans. I mean those are my tax dollars right? I should be able to use them for school … I mean insurance choice.
We just need some Christian insurance companies...........
We've allowed companies to screw the medical/insurance field up so badly that Medicare For All seems to be the only option.
And the government would screw that up. In other words, WE SCREWED!
That's what I keep hearing. The government screws up everything so we don't want them running Healthcare. Why are we so bad at running things like this?
Most of wealthy countries do government run Healthcare with good service and lower cost to the population that market run... why can't we find any kind of solution to this problem?
Sometimes I feel like they are doing the husband/dad thing where you intentionally mess up at certain things you don't want to do so the family stops asking.
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See above
Maybe people that don’t think the government works should stop trying to be part of the government.
A lot of government agencies operate to increase their workload to justify hiring more people. Empire builders abound in every niche of government. Change my mind.
I can’t change your mind you won’t be open to it. All type of jobs have their leaches. You act like it’s only government. The private sector is just as bad. But when people like Ted Cruz get into government while saying it doesn’t work then actively try to make it not work it’s a self fulfilling prophesy.
Stillwater Townie
Deputy
I suspect the main reason why American health care is in the state that it is in is because most people are in excellent health while requiring no costly care due to chronic ailments. If you disagree, try electing somebody who is in a wheelchair for better national health care for everybody. Of course, Gov. Abbot, a Republican who is in a wheelchair, would love to shoot down my suggestion.
I never said anything about the private sector. We all know it is just greedy.
