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hobbesmaster posted:You're saying that the insurer caused this mess because they truncated the input to just "arthritis"? Here's another one I know of: Routine lung function testing is pretty critical in anyone with COPD which should be obvious. There are various stages of COPD someone can jump around based on the damage done to their lungs, how reversible the damage is with inhaled med use, and how many instances of "flare-ups" the person has in a year requiring additional medical attention like antibiotics, hospitalizations, etc. to get over. Any doctor who sees a COPD patient should be doing at least a pulmonary function screen at every visit assuming the provider has the capability. If it's a Pulmonary doc, they drat well better be doing some kind of screen every visit. Lung function numbers are pretty critical to know even if they are normal. You can never assume normal numbers with minimal symptoms however since many many people have high thresholds for pain/discomfort and will sometimes only notice an issue when it is already pretty severe. If a COPD patient initially referred to a pulmonary specialist is seen every 6 months for 2 years and begins to demonstrate normal, consistent numbers after proper treatment, education, help with smoking cessation, etc. then they can often be taken off a lot of their medications and discharged from specialty care completely instead of being seen for specialty care follow-up appointments for eternity. Normal numbers are important data. So you would think a routine pulmonary screen ("Spirometry") would be covered under the ICD 10 J44.9 (COPD). It's often not with many private insurers. CLAIM DENIED. It's only covered under the ICD 10 code for dyspnea (basically difficulty breathing) or the ICD 10 code for hypoxemia (low concentrations of O2 in the blood beginning to lead to cell death). In fact, many insurers will deny the claim for the ENTIRE APPOINTMENT if Spirometry even pops up under a COPD ICD 10 code. Not every COPD patient seen is going to have dyspnea or hypoxemia assuming they are well managed, taking all their meds, using their O2 if they need O2, stopped smoking, etc. So this discourages practitioners from even doing Spirometry screens what appear to be "normal" patients because they wont get paid if they bill properly, and they could be charged with billing fraud during an audit if they add something like dyspnea when the patient doesn't have it at the time of appointment. Many still do the right thing and do the screen even though they don't get paid for it, but they essentially eat the cost for maintaining testing equipment, buying new testing equipment, staff time to do the screen, etc. What's next? No, sorry we won't pay for someone to check your blood pressure unless you have high blood pressure cause apparently humans have the innate ability to know their BP in millimeters of mercury at all times. No, sorry we won't pay for labs to check how thick your blood is unless you blood is already really thick or really thin. No, sorry we won't pay for an x-ray to see if your arm is broken unless your arm is already broken. And if your arm was set and put in a cast, we won't pay for an x-ray to see if it has been healing correctly because it is not presently broken. And we will not pay for an x-ray to see if the arm is indeed broken or you just have a really bad immensely painful bruise running the entire length of your radius/ulna because your arm might not be broken and we only pay for scans where the arm IS confirmed broken.
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Apr 30, 2017 06:59
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Night10194 posted:For reference, each month's supply of this drug costs 6000 dollars from my pharmacy, so by managing to deny me for 4 months my insurer saved 24,000 dollars. Hey fellow "I need humira to not be crippled" friend. Every time I place my prescription refill, I just laugh and laugh and laugh....
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Apr 30, 2017 07:14
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Also, Doctors went to medical school to practice medicine. They did not go to medical school to become insurance claims adjusters. They should not be pressured to pigeonhole their standards of care to accommodate the profit-seeking motives of insurance companies. Are there bad actors out there ordering MRIs or CT scans on a whim or charging for poo poo they shouldn't? Sure. But those providers are violating care standards set forth by the AMA, and the standards set forth by their specialty. There's not too many medical conditions out there where the first option is to do an MRI.
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Apr 30, 2017 07:18
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empty whippet box posted:Aren't they required to pay out 80 percent of premiums as healthcare anyway? How do they meet that standard while doing this? Presumably not doing this would require them to raise premiums to hit that same 20% overhead/profit margin and then they'd lose market share to insurers who keep premiums low by screwing a certain percentage of customers.
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Apr 30, 2017 07:38
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https://twitter.com/jakesherman/status/858684036394430464 he's gonna blow it up again
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Apr 30, 2017 15:31
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Zikan posted:https://twitter.com/jakesherman/status/858684036394430464 Wait isn't that how the bought off the HFC?
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Apr 30, 2017 15:36
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Couldn't one solution be that we require insurers to accept all claims and if they deny they have to prove it? I mean, the best solution is to not allow for-profit health insurance companies but baby steps.
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Apr 30, 2017 16:23
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Zikan posted:https://twitter.com/jakesherman/status/858684036394430464 It would be a huge development, if it weren't coming out of the mouth of a pathological liar.
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Apr 30, 2017 16:30
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axeil posted:Couldn't one solution be that we require insurers to accept all claims and if they deny they have to prove it? Healthcare Fraud is already estimated at $100+ billion a year. In the US it is big business. You've probably seen commercials for healthcare fraud and not realized it. To put that into perspective the size of the movie + videogame industry globally is about $100 billion.
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Apr 30, 2017 16:49
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Xae posted:There is always a trade off. With that plan the amount of waste, fraud and abuse in the system would skyrocket, driving up costs for everyone. It is worth noting that insurers do give a reason codes for denials and adjustments. I believe that most state's have laws requiring it. Huh. Good stuff. I figured there was something suspicious with all those HoverRound wheelchair commercials
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Apr 30, 2017 16:58
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Yeah, while when insurance companies commit fraud it's far more blatantly evil- straight up killing people to make a buck- hospitals are by no means innocent. Fun fact: the all-time champion for Medicare fraud is currently the Governor of Florida. Rick Scott oversaw an institutional program of inventing patients, falsifying documentation, miscategorizing routine services, etc, to the tune of 1.7 billion in fines, and that's just what they caught him doing. When you get right down to it, the root of the problem is that hospitals are incentivized to rip off insurers, insurers are incentivized to rip off hospitals, and neither one really has any incentive to give a poo poo about you being healthy.
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Apr 30, 2017 17:00
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DaveWoo posted:It would be a huge development, if it weren't coming out of the mouth of a pathological liar. Well, also, removing that bit would just bring them back to the FIRST bill, which couldn't pass the house anyway and still would've turbofucked millions.
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Apr 30, 2017 17:07
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hobbesmaster posted:You're saying that the insurer caused this mess because they truncated the input to just "arthritis"? No. There are diagnosis codes in claims. In icd 9 those codes are often less specific and the doctor probably sent the icd 9 code for a general diagnosis of arthritis. On icd 10 there's much more specific codes and the insurer likely denied it on specificity grounds despite, at the time, the deadline for provider icd 10 compliance being delayed. A lot of insurers have been playing that game since the first delay several years ago.
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Apr 30, 2017 20:05
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https://twitter.com/petersuderman/status/859169260609863680
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May 1, 2017 23:29
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https://twitter.com/retrocampaigns/status/859153288389771265 I like when they peel the mask right off and leave no doubt about what they really think of the sick and poor. Kinda refreshing actually.
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May 2, 2017 00:00
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Rhesus Pieces posted:https://twitter.com/retrocampaigns/status/859153288389771265 The just-world fallacy is the worst thing to come out of religion.
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May 2, 2017 00:13
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So they've already reached 22 No's on this new bill that has the HFC on board. If Trump demands a change so that states can't request waivers that just means we go back to the first bill which had zero HFC support, which was more than 22 No's. So either way this latest attempt to bring down Obamcare is dead in the water. Again.
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May 2, 2017 00:35
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So, this is it for the year, right? They needed a budget resolution to be able to repeal Obamacare, they need to do the budget now, so they've lost this years window to actually repeal, and will need to try again in 2018, when the threat of voter backlash is worse?
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May 2, 2017 00:41
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Fulchrum posted:So, this is it for the year, right? They needed a budget resolution to be able to repeal Obamacare, they need to do the budget now, so they've lost this years window to actually repeal, and will need to try again in 2018, when the threat of voter backlash is worse? From my extremely limited understanding of the situation, I think so.
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May 2, 2017 00:51
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Fulchrum posted:So, this is it for the year, right? They needed a budget resolution to be able to repeal Obamacare, they need to do the budget now, so they've lost this years window to actually repeal, and will need to try again in 2018, when the threat of voter backlash is worse? A simple majority of either house can suspend the rules and vote on anything the presiding officer (speaker of the house/president of the senate) puts up for a vote. So as a practical matter, hopefully, but its up to Paul Ryan. Or McConell I guess, but he'd have to kill the filibuster.
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May 2, 2017 00:56
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hobbesmaster posted:A simple majority of either house can suspend the rules and vote on anything the presiding officer (speaker of the house/president of the senate) puts up for a vote. Keep in mind that they can also sabotage Obamacare to death. Republicans would (probably) bear the brunt of the blame for that, though.
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May 2, 2017 01:01
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hobbesmaster posted:A simple majority of either house can suspend the rules and vote on anything the presiding officer (speaker of the house/president of the senate) puts up for a vote.
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May 2, 2017 01:03
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hobbesmaster posted:A simple majority of either house can suspend the rules and vote on anything the presiding officer (speaker of the house/president of the senate) puts up for a vote. Ryan has nothing to do with it. It's all Senate rules. They get 2 reconciliation bills: 2017 and 2018. 2017 must be used for Obamacare. If they don't pass it, and they start the 2018 bill ("tax reform"), it's gone. I believe that due to the quirks of reconciliation instructions it may not be possible to swap them at this point but I do not know that for sure. They might be able to do the 2019 one before elections intervene as well, I'm not clear on that. McConnell can at any point try to eliminate the filibuster but he's not going to because he has no loving interest in passing Trumpcare and the filibuster is a great excuse. Even if he tried there's at least three senators who wouldn't back the play for the same reason.
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May 2, 2017 01:20
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hobbesmaster posted:A simple majority of either house can suspend the rules and vote on anything the presiding officer (speaker of the house/president of the senate) puts up for a vote.
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May 2, 2017 01:23
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Old Kentucky Shark posted:Ryan can't do poo poo and McConnell has shown zero interest in killing the filibuster over Obamacare at any point so far and I don't imagine that'd he'd do it for a bill that polled at 15% approval before it hosed with pre-existing conditions. Turtleman is awful, but he ain't stupid. Yertle is the one Republican leader who is undeniably good at their job.
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May 2, 2017 02:29
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evilweasel posted:Yertle is the one Republican leader who is undeniably good at their job. Truth. How is Paul Ryan so loving terrible at his job? I guess he just came of age politically when all you had to do is fill a fake budget full of red meat for the Tea Party without worrying about what the wider public would do to you if they found out what was in it, because you can count on the Senate or the Democratic President to kill it without it even making the news. Then go back to your district and say you tried to do all this great stuff but obummer wouldn't let you. And now he thinks the same rules apply when you're in the majority, you can just slap something together with "America" in the title and no one will look at CBO scores or care what's in it. This is probably the leadership positions should only go to people who have been around long enough to have experienced being in government and in opposition E: wait poo poo, I just looked him up and Ryan first got elected in 1998. He's been in the majority under a Democratic and Republican administration, I guess he's just a loving idiot then, nevermind. VitalSigns fucked around with this message at 02:43 on May 2, 2017 |
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May 2, 2017 02:41
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VitalSigns posted:Truth. he's got the same problem spicer has - he's bad at his job, but even if he wasn't, the job is impossible to do well
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May 2, 2017 02:45
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No, there have been effective Speakers of the House. Boehner was not one of them though, and was selected precisely because he was weak. Ryan was selected not because he was any good but because he was the only one who was acceptable to 218 republicans after years of Boehner had destroyed leadership's control over its caucus.
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May 2, 2017 02:47
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Paul Ryan was the last to say "not it"
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May 2, 2017 02:49
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evilweasel posted:No, there have been effective Speakers of the House. Boehner was not one of them though, and was selected precisely because he was weak. Ryan was selected not because he was any good but because he was the only one who was acceptable to 218 republicans after years of Boehner had destroyed leadership's control over its caucus. I don't know that it would be possible to have an effective speaker of *this* house. The current majority seems unleadable, to me. e: other people (can't name any, but...) could probably do a better job, but I don't think anyone could really get the stated legislative priorities of the republican party passed.
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May 2, 2017 02:58
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awesmoe posted:I don't know that it would be possible to have an effective speaker of *this* house. The current majority seems unleadable, to me. Sure there could be, you get rid of the Kid Toucher Hastert rule and what ever one ended riders and start putting up proposals that contain enough provisions that Dems will vote for them.
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May 2, 2017 03:06
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You could stop proposing toxic garbage bills that do nothing but make America hate you for being too evil/not evil enough, and also make you look incompetent because your own party won't even vote for them, while the whole time the president blames you for not being able to craft the impossible bill he promised everyone. "The President has been meeting with insurance executives to develop a tremendous plan, just tremendous, that will lower premiums and deductibles for everyone while expanding coverage. We're excited to introduce the President's Obamacare replacement just as soon as he reveals it, we have no doubt it will be just as tremendous as he promised". Done and done. VitalSigns fucked around with this message at 03:17 on May 2, 2017 |
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May 2, 2017 03:15
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evilweasel posted:No, there have been effective Speakers of the House. Boehner was not one of them though, and was selected precisely because he was weak. Ryan was selected not because he was any good but because he was the only one who was acceptable to 218 republicans after years of Boehner had destroyed leadership's control over its caucus. Honestly, on balance, Pelosi is probably the most effective speaker of the house of the 21st century. Well, successful at things other than molesting underage boys.
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May 2, 2017 03:15
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Fulchrum posted:Honestly, on balance, Pelosi is probably the most effective speaker of the house of the 21st century. Ambivalent GOP moderates got Steve Bannon impotently threatening them. Back when the ACA went through, moderate Democrats were receiving calls from childhood classmates and coworkers from a decade ago asking why they weren't going to protect children with preexisting conditions. She's a goddamn titan.
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May 2, 2017 03:36
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evilweasel posted:Ryan has nothing to do with it. It's all Senate rules. They're allowed to combine AHCA and tax reform into a single reconciliation bill. I don't think anyone in congress is stupid enough to actually bundle the toxic AHCA with something they actually want to pass though.
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May 2, 2017 13:31
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From what I understand they can't. Reconciliation can contain changes to spending or revenue but not both, and only one reconciliation bill is allowed per fiscal year.
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May 2, 2017 13:43
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Fulchrum posted:Honestly, on balance, Pelosi is probably the most effective speaker of the house of the 21st century. Yeah she's only middling as an actual representative but as head of the caucus she's scary good.
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May 2, 2017 13:57
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VitalSigns posted:From what I understand they can't. Reconciliation can contain changes to spending or revenue but not both, and only one reconciliation bill is allowed per fiscal year. Who makes that call?
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May 2, 2017 14:38
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Play it again, Sam https://twitter.com/MEPFuller/status/859424033162629121 https://twitter.com/costareports/status/859427645754310656
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May 2, 2017 16:28
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I've yet to see any indications that they can thread the needle between the HFC and the sane-by-contrast GOP House reps.
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