American Healthcare continues to go backward

[mugatu]

I work with someone who was having mini strokes for the last year or so. Originally thought it was seizures but when the meds didnt work they did an MRI and found something that looked like it might be a clot in her neck just below the brainstem. Doc wanted a bunch of images to determine if surgery was required. Insurance was only letting them do one MRI at a time and them request each additional image individually. So it took her weeks of visits to get all the images the doc wanted instead of a single appointment... not to mention the delays in treating a serious condition.

I tore a labrum last winter. Went through orthopedic appointment, and imaging and determined that after the initial treatment I needed physical therapy. After 2 months of therapy, insurance denied my claims for every visit after my 3rd appointment even though I'm covered up to 26... because I didn't fill put a form they hadn't asked for explaining why I needed PT. Finally after 9 months they finally paid up. Why, why waste my and everyone else's time for something we all knew was covered. They had the treatments that had already been done, they had the imaging showing the tear...

Insurance companies suck.

 

[steross]

I work with someone who was having mini strokes for the last year or so. Originally thought it was seizures but when the meds didnt work they did an MRI and found something that looked like it might be a clot in her neck just below the brainstem. Doc wanted a bunch of images to determine if surgery was required. Insurance was only letting them do one MRI at a time and them request each additional image individually. So it took her weeks of visits to get all the images the doc wanted instead of a single appointment... not to mention the delays in treating a serious condition.

I tore a labrum last winter. Went through orthopedic appointment, and imaging and determined that after the initial treatment I needed physical therapy. After 2 months of therapy, insurance denied my claims for every visit after my 3rd appointment even though I'm covered up to 26... because I didn't fill put a form they hadn't asked for explaining why I needed PT. Finally after 9 months they finally paid up. Why, why waste my and everyone else's time for something we all knew was covered. They had the treatments that had already been done, they had the imaging showing the tear...

Insurance companies suck.

If we are going to keep this idiotic system of insurance companies negotiating with medical providers and deciding when they will pay and when they will not then they need to be able to be sued for the equivalent of malpractice when they make horrible recommendations.
Right now, they hide behind "we don't recommend not to do it, we just won't pay for it."

Well, that was fine before insurance was a requirement and the insurance companies force you to go to their network etc etc.

Fact is, very few Americans can afford health care without insurance now and they are making billions to show for it. So, they need to be on the hook and stop acting like the are just a side player when they deny. Their denials are clearly harming people.

 

[steross]

This may get some boos as I'm sure that there are people out there who have friends or family that are Nurse Practitinoers. I am not "against" nurse practitioners. I am against what has happened to them backed by corporate medicine.
In the past, you had to be a nurse (typically ICU or ED) for quite a long time to be selected to NP school. Then you actually went to a real school and were trained.

Now, anyone with an RN degree can go to online NP school. Then they set up their own "clinical rotations" by finding some preceptor doc willing to teach them. And for this, they send the school $25-45K.

The training quality has hit rock bottom. But, there is a flood of nurses doing this because it is a pay raise for them. Meanwhile they can be hired relatively cheaply so corps hire them and get rid of docs. To avoid liability, they force the doc to "sign off" on their charts, which also allows them to bill more.

https://twitter.com/x/status/1763842280006521176

https://twitter.com/x/status/1764143599493828939

 

[steross]

https://twitter.com/x/status/1764800868203786689

 

[steross]

https://twitter.com/x/status/1764780836996403293

This Change Healthcare thing is interesting, and scary. Basically, the company that processes most healthcare payments (owned by UNH of course) was hacked. I mean, even the VA is affected.

There are rumors that they did this on purpose so that more small clinics/pharmacies etc will go under and they can pick them up on the cheap. Probably not but I would not put it past them.

Amazing how big of a deal this is but hardly any reporting.

 

[Stillwater Townie]

Yet, I wonder why we don't hear of many unusual news stories is because they weren't verified as true. Yet, I'm afraid too many are true.

 

[steross]

https://twitter.com/x/status/1765006663264702534

 

[steross]

https://twitter.com/x/status/1764705369710899715

 

[steross]

https://twitter.com/x/status/1765589324756885651

 

[PJ-OSU]

Glad to see some guys advocating for this that you would not typically think about in this role. While I didn't know about this movement, I was aware of the ridiculous lack of consistency across the medical world being it is a specific burr for the people I personally know in medicine. Saw that Fat Joe, in particular, was invited as a guest to attend the State of the Union this evening. Another point to add to your post @steross

Rick Ross, Chuck D, Fat Joe Team for PSA Demanding Healthcare Transparency

Rick Ross, Chuck D, Busta Rhymes, Method Man, and Fat Joe have teamed up for a new PSA demanding that lawmakers pass healthcare transparency bills.

www.rollingstone.com

 

[steross]

https://twitter.com/x/status/1765490792074764353

 

[steross]

https://twitter.com/x/status/1765884094980690161

 

[steross]

https://twitter.com/x/status/1767192767485325504

https://twitter.com/x/status/1767390210097078292

 

[steross]

UNH owns Change Healthcare. Change Healthcare’s inability to control their online security causes clinic to not be paid. UNH is there to buy up the nearly bankrupt clinic, I’m sure at rock bottom prices.

https://prospect.org/health/2024-03...VnQkI4ub6DQxqlUDEm_PZEnVFPv5QWJWgs10nlQQmdKmU

UnitedHealth Exploits an ‘Emergency’ It Created​

The Change ransomware attack left an Oregon medical practice with an empty bank account, and only one quick way to fix it: sell to UnitedHealth.
BY MAUREEN TKACIK

MARCH 10, 2024


Last Thursday, the medical colossus UnitedHealthcare applied for an emergency exemption that would fast-track its takeover of a medical practice in Corvallis, Oregon, in a letter warning regulators that the practice might close its doors if the merger were not approved right away.

Although the specific reason for the exemption request is redacted from the publicly posted version of the application, a clinic insider says the “emergency” is the same one that has plunged thousands of other health providers across the nation into a terrifying cash crunch: the weeks-long outage of UnitedHealth’s Change Healthcare clearinghouse and claims processing systems, which has halted the flow of information that enables physicians, hospitals, and other health care providers to get paid for their work.

“Our claims processing goes through [Change], so all of a sudden there was no money coming in,” the insider, an employee of The Corvallis Clinic who did not want to be identified for fear of jeopardizing the transaction, told the Prospect. The clinic’s shareholders, who include include more than half of its 110 physicians and one of its behavioral health providers, worked without pay last week in order to “scrape together enough money to pay the staff,” the insider said, but on Thursday the shareholders explained that they weren’t sure they would be able to open the doors Monday without an emergency cash injection. “They’re praying that the sale’s going to go through and that Optum will front them the money

 

[Polds4OSU]

View this content on Instagram

View this content on Instagram

 

[steross]

This is your money they take, everybody.

https://twitter.com/x/status/1767907929435336979

 

[steross]

https://www.wjfw.com/news/wisconsin-family-speaks-out-against-pbms-after-the-loss-of-their-son/article_489e5590-e003-11ee-ae20-fb51d5ece985.html?utm_medium=social&utm_source=twitter&utm_campaign=user-share

“January 10th,, he went to the pharmacy to get his prescription and was told it was no longer covered by his insurance,” said Shanon.

He was told there was no alternative option and no generic drug would be covered. Cole didn’t know how to respond and couldn’t cover the extreme out-of-pocket cost of his Advair inhaler on a $19/hour income. An inhaler-dependent patient left the Walgreens Pharmacy with no medication. Five days later he suffered an extreme asthma attack and was taken to the hospital. He arrived at the Emergency Room lifeless and spent the next six days in the ICU on a ventilator.

“We were told he’s never going to wake up again,” said Bil.

A generic version of Advair only costs $15-$20. What happened to Cole is happening all over the country, according to Hometown Pharmacy co-founder Dan Strause.

“Unfortunately, we see even the state plan now no longer will allow for the generic, they force people into the brand. Why? It’s not hard to figure out it must be about the profit margin. Unfortunately, they’re making people decide between life-saving medicine [and paying bills, even though] the cost of the actual item is so low,” said Strause.

 

[steross]

UNH owns Change Healthcare. Change Healthcare’s inability to control their online security causes clinic to not be paid. UNH is there to buy up the nearly bankrupt clinic, I’m sure at rock bottom prices.

https://prospect.org/health/2024-03...VnQkI4ub6DQxqlUDEm_PZEnVFPv5QWJWgs10nlQQmdKmU

UnitedHealth Exploits an ‘Emergency’ It Created​

The Change ransomware attack left an Oregon medical practice with an empty bank account, and only one quick way to fix it: sell to UnitedHealth.
BY MAUREEN TKACIK

MARCH 10, 2024


Last Thursday, the medical colossus UnitedHealthcare applied for an emergency exemption that would fast-track its takeover of a medical practice in Corvallis, Oregon, in a letter warning regulators that the practice might close its doors if the merger were not approved right away.

Although the specific reason for the exemption request is redacted from the publicly posted version of the application, a clinic insider says the “emergency” is the same one that has plunged thousands of other health providers across the nation into a terrifying cash crunch: the weeks-long outage of UnitedHealth’s Change Healthcare clearinghouse and claims processing systems, which has halted the flow of information that enables physicians, hospitals, and other health care providers to get paid for their work.

“Our claims processing goes through [Change], so all of a sudden there was no money coming in,” the insider, an employee of The Corvallis Clinic who did not want to be identified for fear of jeopardizing the transaction, told the Prospect. The clinic’s shareholders, who include include more than half of its 110 physicians and one of its behavioral health providers, worked without pay last week in order to “scrape together enough money to pay the staff,” the insider said, but on Thursday the shareholders explained that they weren’t sure they would be able to open the doors Monday without an emergency cash injection. “They’re praying that the sale’s going to go through and that Optum will front them the money

Truly unbelievable. No way this would be allowed in any other industry. Imagine if VISA/Mastercard had a cyberattack and no longer reimbursed hardware stores after customers made purchases. Then, a VISA/MASTERCARD owned hardware chain started buying up the hardware stores with government approval because the hardware stores were bankrupt because VISA wasn't paying them anymore.

https://twitter.com/x/status/1768701268191818023

 

[GOGETUMPOKE]

The World’s Most Expensive Drug Is Now a $4.25 Million Gene Therapy

It's a one-time treatment for children with a rare genetic disease.

time.com

A new gene therapy for an ultra-rare disease will have a wholesale cost of $4.25 million, making it the world’s most expensive drug.

The one-time treatment, Lenmeldy, won U.S. regulatory approval on Monday to correct the underlying cause of a hereditary condition called early-onset metachromatic leukodystrophy, or MLD.

MLD is a fatal disease in which infants sometimes start to lose the ability to walk and talk. Orchard Therapeutics said the drug’s price “reflects its clinical, economic and societal value” in a statement Wednesday.

 

[steross]

The World’s Most Expensive Drug Is Now a $4.25 Million Gene Therapy

It's a one-time treatment for children with a rare genetic disease.

time.com

A new gene therapy for an ultra-rare disease will have a wholesale cost of $4.25 million, making it the world’s most expensive drug.

The one-time treatment, Lenmeldy, won U.S. regulatory approval on Monday to correct the underlying cause of a hereditary condition called early-onset metachromatic leukodystrophy, or MLD.

MLD is a fatal disease in which infants sometimes start to lose the ability to walk and talk. Orchard Therapeutics said the drug’s price “reflects its clinical, economic and societal value” in a statement Wednesday.

"The field of gene therapy has sparked debate over its high prices. Pharma companies say they are justified because the treatments can potentially cure patients, generating savings for the health-care system over time and delivering other societal benefits."

Twitter is filled with people claiming that pharmaceutical companies do not want us to be healthy and they enjoy the cash cow of treating disease. An obvious example is Type 2 diabetes which with proper diet and exercise can be "cured" or "remission" depending on preferred semantics. But, giving them insulin and Trulicity makes more money.

I don't necessarily blame the companies fully as some people won't/can't do it even if told how to fix their disease. But, statements like this, which are basically saying, "Hey, we normally would make millions off of these people treating their disease over their life, so, since we are curing them, we want the millions right up front."

Can you imagine a doctor saying the equivalent of this? "Well, if I don't put this stent in, you will develop congestive heart failure and require tons of medications and repeated hospitalizations for years. And, all that is gonna cost you at least $5 million dollars. Therefore, I want $2.5 million to put this stent in."