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aniviron posted:Yeah it's definitely that and not because every time people try to get poo poo fixed it gets derailed or shut down by powerful entrenched interests who have a lot of money on the line and have set up a tried and tested system to prevent the citizenry from effecting change. that's a weird way to describe a failed riot
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Oct 30, 2023 09:21
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it's ok though little timmy is going to be a pimp and minecraft streamer he doesn't need to read for poo poo
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Oct 30, 2023 09:24
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Private Cumshoe posted:Oh no think of the lost parasite jobs for assholes Seriously. They can still use most of the people at the bottom of the insurance company who are already doing the administrative stuff and not being giant pieces of poo poo. Administrative tasks will still be necessary to make sure medical staff gets paid. It just hopefully won’t be nearly as much of a waste of time once all of the hoops are removed. It is such a waste of time and money currently. With negative health outcomes for patients. McSpanky posted:There should be loving nationwide riots over how bad our health insurance/cost of care situation is. But then we’ll get the medical bills after treatment for the police brutality suffered during the riot…those of us that aren’t killed, at least. Bored fucked around with this message at 16:50 on Oct 30, 2023 |
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Oct 30, 2023 16:46
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McSpanky posted:There should be loving nationwide riots over how bad our health insurance/cost of care situation is. Americans are taught from age zero that if you have problems, it's no one's fault but your own, and if you are healthy it means god loves you and you're on the right path and nothing should change.
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Oct 30, 2023 17:08
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Bored posted:But then we’ll get the medical bills after treatment for the police brutality suffered during the riot…those of us that aren’t killed, at least. You optimist you. I was in hospital once and got to fill out the forms, and it had the best (patient facing) question: did the patient die? ✔
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Oct 30, 2023 17:13
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I get insurance through my husband, who works for the family business. Our health insurance costs the business $2000 a month. I still have to pay about a hundred out of pocket every month for just my meds. They also refuse to pay for any of my Paxil, because they say the dosage is too high, even though it was prescribed by a physician who is also a pharmacist. I don’t understand why my father in law doesn’t change to another company, but the business does well enough that I guess he doesn’t care. It’s still insane. The insurance company’s excuse for the high prices is that the employees are all old, save for my husband,. The average age of the employees is 55. They’re not spring chickens, but they’re not in a nursing home or anything.
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Oct 30, 2023 18:27
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Skinnymansbeerbelly posted:You optimist you. gently caress. I’ve considered putting together an will that is just notifying my mom that since I have nothing, she will inherit nothing, and she is also not responsible for any of my debts regardless of what any future credit collectors try to tell her.
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Oct 31, 2023 21:18
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The health insurance industry is legalized fraud.
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Nov 15, 2023 21:20
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skooma512 posted:The health insurance industry is legalized fraud. Yes.
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Nov 17, 2023 20:34
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I was born in Canada and live in Canada. I'll never forget the first time I learned, from an American friend, that medical bankruptcy was not only actually a thing in the US, but accepted in your culture as a definite possibility. I was very angry.
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Nov 17, 2023 22:03
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tango alpha delta posted:I was born in Canada and live in Canada. I'll never forget the first time I learned, from an American friend, that medical bankruptcy was not only actually a thing in the US, but accepted in your culture as a definite possibility. Not only is it a thing in America, its the cause of of like ~60% of all bankruptcies.
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Nov 17, 2023 22:16
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Even *with* insurance this can still happen. Lol lmao
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Nov 17, 2023 22:27
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skooma512 posted:The health insurance industry is legalized fraud.
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Nov 17, 2023 22:28
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the us medical system gets off on abusing people and holding them ransom one of the world's most powerful death cults
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Nov 18, 2023 09:47
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I just remembered I tried to use my dental insurance a while back for a cleaning and they said the plan I had was a pediatric plan... I don't even have any children. I haven't remembered to call about it and it'll probably just end up that I sign up for another plan for the next year before I ever remember to call about it. Having adhd makes it 10 times harder to deal with this red tape poo poo.
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Nov 19, 2023 00:21
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skooma512 posted:The health insurance industry is legalized fraud. It's basically paying rent on life itself.
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Nov 19, 2023 01:13
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Dixville posted:I just remembered I tried to use my dental insurance a while back for a cleaning and they said the plan I had was a pediatric plan... I don't even have any children. I haven't remembered to call about it and it'll probably just end up that I sign up for another plan for the next year before I ever remember to call about it. Having adhd makes it 10 times harder to deal with this red tape poo poo. That's by loving design, too, the evil bastards.
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Nov 19, 2023 03:44
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Married, three kids, paying out the rear end for employee healthcare. Deductible is absurd, we have to pay some amount of medical debt each year because fffuck paying that 1500 bill when you get it. Last year got a $8k bill after my wife tried some infusions. Total clusterfuck horseshit. My youngest was adopted from our of state and is on Medicare so whatever tests or visits she needs the answer is always "yes." When she had a seizure at 2 calling an ambulance was a no-brainer but when her brother broke his arm it was like "but like is it actually broken?"
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Nov 19, 2023 05:41
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pencilhands posted:I have health insurance for the first time through an employer. I'm a single person no wife or children. It costs me about $800 a month in premiums but my deductible before literally anything at all is covered is $2500. So I could potentially spend $12000 on healthcare costs in a single year with literally no benefit? Move to Canada it's boring but much safer
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Nov 19, 2023 06:26
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chainchompz posted:That's by loving design, too, the evil bastards. I should have just called them right away but I was angry and I didn't want to take it out on the poor sap that has to answer those calls
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Nov 19, 2023 06:59
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BONE DOG posted:Move to Canada it's boring but much safer i would if i could its not like you can just go up there and demand to be let in lol
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Nov 19, 2023 07:04
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https://x.com/brian_goldstone/status/1727093755998613840?s=20
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Nov 23, 2023 18:00
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And if you try to talk to a human being at Cigna about it, these days they'll tell you "Well the AI denied the claim, there's nothing we can do, it's all on the Blockchain you know."
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Nov 23, 2023 18:37
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Animal-Mother posted:And if you try to talk to a human being at Cigna about it, these days they'll tell you "Well the AI denied the claim, there's nothing we can do, it's all on the Blockchain you know." Really? They’re blaming AI now? I know for a fact that authorization packets often have pages that are missed by humans because nothing is apparently uniform between with regards to what different insurance companies can require. Story time, which turned out to be way more  than I expected.Tdlr: the American insurance industry is a clusterfuck. The insurance companies should all be sued for malicious incompetence and waste. Then the system should be abolished. It would be so much easier to track down fraud, which is what insurance companies cite as the reason they require all of these authorizations, if all payment requests were going to a central database. Anyway, onto the story, which is confusing because that’s how the insurance industry likes it: I am a master of reading medical handwriting, so could generally find poo poo that multiple people in our company would misfile, overlook, or at least I could clarify the exact piece of information missing that caused a denial when the company wording was unclear. I don’t think AI is ready to be making those reviews. However, at least one company that specializes in medical reviews and is therefore contracted with multiple insurance companies has an extremely rigid computer system that allows no overrides. I’m betting they could approve at 1st receipt, their guidelines changed, the authorization dates had to k be moved around, and now they have no way approve with the previous guidelines. I had one with with home-care, and this was through Medicaid which tends to have less awfulness written into the contract with the managed care companies that win the bid, where the guidelines had changed prior to the approval of the previous 3 months. So this change was listed in the approval letter, stating that they could not approve for the requested 6 months due to the patients age (as had previously been the norm) and to resubmit close to the end of that 3 months for the following 3 months. But because the home health agency had originally asked for 6 months, which was, again, the usual for an obvious long term care for that age range, it had to be entered for the 6 month time frame, and those final 3 months were denied. That part was not listed on the approval letter because it wasn’t truly a denial, but that’s what the stupid work instructions for the system required. So I get a call from the agency politely asking why they keep being told they already have a denied authorization on file. I found out the above information, but my team lead and all the way up to my manager’s manager were apparently baffled as to who to have fix this. Instead of doing anything, they just ignored me. Luckily, the nurse who approved the authorization before the hosed up partial authorization was available via teams. So I contacted him. He’s like,”oh this is absurd.” He transferred it to his boss who sent the info to the vp who reached out to the home health data entry team and told them to fix it. But, because of those stupid loving work instructions, and that the system and processes wouldn’t let you just change that, the team lead in the home care data entry department said she couldn’t do what the vp wanted. And, yeah, because of that present denial, the system was not going to let her change it, but she assumed the VP knew anything about what the system allowed them to enter. Since I had already overstepped my job function but giving a poo poo of the medically fragile patient died because home care is expensive and the agency could only afford to work for free for so long before they had to stop, I jumped in the explain the work process and then suggested they enter it as if the denial period is currently going through an appeal, which means that denial date is “unfinalized” and overlapping dates of the same service may be entered. So that finally got done EXCEPT whoever it was passed to to enter into the system did not get the memo that this was requested 28 days before the end of the previously approved days to begin the day after the original authorization approval ended, so he started it on the day we received the 3rd request for approval because that is how late requests are supposed to be entered. So I had to go back to my favorite grumpy nurse to let him know, since unlike most at our company, he was also quickly able to locate information by date of receipt. It took another day to get that fixed. Thanks lady at home care agency, and thanks to your agency, for actually being tenacious while being polite. I still would have spent a bunch of time getting this sorted, but it’s easier to organize when someone’s not getting mad that I’m putting them on hold while organizing all of the poo poo for the escalation team because the team lead hates doing her job. Also, thanks, agency, for continuing to provide care so that the patient did not die or end up in the hospital with worse health problems. They took away the privilege of talking to the nurses shortly after this. But that was actually due to a coworker taking offense to a nurse that replied in text speak which she thought was anger, not a complaint by my favorite curmudgeonly nurse about me bothering him. Also, this is the reason I did not have high enough productivity. Because I was not able to say,” this is just a job “ and get people off the phone as quickly as possible. Knowing how our poo poo is supposed to work is how I managed to keep the job for over 3 years. I would constantly get coworkers trying to forward me calls on request because their callers had called multiple times to have things fixed and no one was actually doing anything. Sometimes I would have to tell them I could not do anything because the fax they sent split (fax is still better,imo, because cloud authorizations sometimes forces really stupid options or just outright trashes paperwork so a review can’t be done, and with a fax, even an e-fax, the provider can have a record of when they sent something which is valid in court, worst case scenario) and I was unable to find the rest of the document that time*.And they were fine with that answer. It let them fix the paperwork. *the fax server was very easy to search for misfiles, whether ai or human error, if you had the date and time. Opening up all the images could take time, but they could have easily had a team for that, like maybe somewhere you could escalate a call to so that the person looking it up didn’t have to have 60 or more calls in a day, and wouldn’t be reprimanded for keeping someone on hold. Hell, maybe the person that the issue was “escalated” to wouldn’t even have to constantly be on an inbound call so that they could concentrate on searching for the document images and notes needed to figure out why what this provider’s office said happened hasn’t quickly ended in the result they expected. Nah! Let’s just keep letting the computer and medically illiterate peons continue rushing callers off the phones as quickly as possible. It’s much easier than doing anything positive. We will create an escalation team where the head of it doesn’t feel like doing their job but DOES love giving people errors without actually checking if it was escalated in error unless the escalation walks them through the error step by step and the others on the escalation team don’t actually know all the rules, most just haven’t been taught where to look, but some just don’t care. Gotta be fast!
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Nov 23, 2023 19:39
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Animal-Mother posted:And if you try to talk to a human being at Cigna about it, these days they'll tell you "Well the AI denied the claim, there's nothing we can do, it's all on the Blockchain you know." so who implemented the policy to use AI for these decisions? Maybe those people should also have their neck on the line if they're just going to kill people through automated miscare also protip - "while(true){deny(care)};" isn't AI as much as anyone loving screams it is, it's just a drinky bird set to hit the 'No' button
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Nov 23, 2023 21:33
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Bored posted:Really? They’re blaming AI now? Maybe. We'll see how this suit goes: https://www.cbsnews.com/news/unitedhealth-lawsuit-ai-deny-claims-medicare-advantage-health-insurance-denials/
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Nov 23, 2023 22:15
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Animal-Mother posted:Maybe. We'll see how this suit goes: https://www.cbsnews.com/news/unitedhealth-lawsuit-ai-deny-claims-medicare-advantage-health-insurance-denials/ what the gently caress, a 90% error rate? I'd call that medical russian roulette but 10% accuracy is literally noise at that point
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Nov 23, 2023 22:47
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