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Out of curiosity did you try the nose mask or just write it off due to sinus issues? Unless you're a mouth breather (which the sleep study should tell you) it might be worth a shot to see if it works better for you. One of the big concerns I had going in was "what if I have a cold?" As it turns out when it comes to the "snot vs high pressure air" war the snot doesn't stand a chance. No matter how stuffed up I am about a minute after I put the mask on I'm breathing free. Granted I'm near maxed out on the machine, I don't know where you stand.
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# ? Nov 22, 2018 08:06 |
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# ? Jun 5, 2024 07:25 |
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That probably varies greatly on your particular sinuses because while I’m not a mouth breather while sleeping if I don’t have a cold I am when I do have a cold. I eventually switched to a full face mask from nasal pillows because of that.
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# ? Nov 22, 2018 08:37 |
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Malcolm XML posted:Also ban drug ads a fun game to play is to see a commercial for some medication, google the out of pocket cost, and see that it's like $1,300 for a months supply
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# ? Nov 22, 2018 09:03 |
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VitalSigns posted:Turning a drug that is already full-blown medicine into a product isn't like coming up with an iPhone after capacitive touchscreens and flash memory were invented. 85% of drugs do not make it past FDA clinical trials. The product development isn't a layup. It is more like a heavily contested 3 point shot. Again, going back to my original post, I think you are under-rating the difficulty, investment, and effort involved in the product development. My interpretation of this failure rate is that the theory of medicine is not as great as we'd like it to be. When a researcher says that they have found the drug that does X, you really need to take the claim with a grain of salt, because the researcher often doesn't understand the subject at a deep enough, fundamental level to make good predictions. This is not due to some deficiency of the researcher--this is because no one has that level of understanding! Also, when the researcher makes the claim that they have found the drug that does X, often there are practical problems the researcher has externalized and ignored, which are needed to be solved to make a real product and a real, practical contribution to society. silence_kit fucked around with this message at 16:07 on Nov 22, 2018 |
# ? Nov 22, 2018 12:59 |
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BlueBlazer posted:Just keep those little floss picks everywhere. It ain't that hard. And destroy the environment with all that plastic? Nice try big oil
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# ? Nov 22, 2018 14:29 |
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edit: wrong thread
EugeneJ fucked around with this message at 04:58 on Nov 24, 2018 |
# ? Nov 22, 2018 16:06 |
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Azhais posted:Out of curiosity did you try the nose mask or just write it off due to sinus issues? Unless you're a mouth breather (which the sleep study should tell you) it might be worth a shot to see if it works better for you. One of the big concerns I had going in was "what if I have a cold?" hobbesmaster posted:That probably varies greatly on your particular sinuses because while Im not a mouth breather while sleeping if I dont have a cold I am when I do have a cold. I eventually switched to a full face mask from nasal pillows because of that. That did come up, and the consensus was that, while sleeping, my body will naturally default to breathing more easily through my mouth and a nasal mask would be useless. I agree wholeheartedly that, if I were able to properly use the nose-only mask, I would have had a much better experience in terms of comfort. I am still of the opinion that it would not help me feel more rested as I am of the mind that my problem is more mental than physical.
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# ? Nov 22, 2018 17:24 |
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CPAP chat: My doctors and insurance were at least honest that, "yes, we will be monitoring usage to determine if we will cover this" upfront. It works well, and I'm such a heavy sleeper that I don't notice it when I'm knocked out anyway. I get charged $45 a month for 5 years the machine and whatever weird random amount they come up with for supplies. The machine is able to be bought outright for $450 online. So, I make 60 PAYMENTS of $45 a month for something that should be 10 payments of $45, or a one time sunk cost of $450. The rental and supplies were supposed to auto charge to my HSA card. They didn't. And I wasn't notified until I was $900 in arrears and my supplies were cut off. I made a $500 payment (enough to keep it turned on), turned off the auto pay, and now I basically pay what I feel like I can afford each month towards the remainder. The supplies also seem random and never quite what I need. I have 50 little fabric filters. But I order hoses and masks from Amazon sometimes... especially masks, since the lifespan of the silicone in the mask before it won't make a proper seal is about 3 weeks to 1 month, but I get a new one every two months or so. Oh, and I got a call from the urgent care that I went to 9 months ago for an ankle sprain but paid off asking for more money. No notice in the mail, just a message on my phone. Need to call them back still and see how much THAT is going to cost me. Ugh.
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# ? Nov 22, 2018 17:45 |
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cpap.com is also a decent place for supplies. It's a little cheaper for the stuff than Amazon (last I checked anyway) but slower shipping. Should get me a 3d printer for the frames and never think about my home medical supplier again
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# ? Nov 22, 2018 18:03 |
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blackmet posted:CPAP chat: I realize CPAP machines are necessary for the vast majority of people they’re prescribed to, but the more I hear about the sleep study and CPAP machine business the more it sounds like a corrupt fly-by-night racket. Paying $2700 over 5 years for a $450 machine sounds worse than rent-a-center except it’s for vital medical equipment instead of lovely flatscreens.
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# ? Nov 22, 2018 18:32 |
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Depends on insurance I suppose, my machine cost me nothing and my insurance is otherwise crap. Or would have cost me a ton of I didn't hit their 90% usage minimum tho
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# ? Nov 22, 2018 18:46 |
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Rhesus Pieces posted:I realize CPAP machines are necessary for the vast majority of people they’re prescribed to, but the more I hear about the sleep study and CPAP machine business the more it sounds like a corrupt fly-by-night racket. Sleep studies are manually scored too so if a doctor wants to be corrupt and get kickbacks from a DME provider...
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# ? Nov 22, 2018 19:37 |
Yeah, DME fraud is a booming business.
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# ? Nov 22, 2018 19:47 |
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I always figured fraud was at the heart of the motorized scooter ads as well. (Your rascal is covered by Medicare!) Anyone post the picture of the letter denying the heart transplant until the GoFundMe is set up yet?
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# ? Nov 24, 2018 16:53 |
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Amniotic posted:I always figured fraud was at the heart of the motorized scooter ads as well. (Your rascal is covered by Medicare!) https://twitter.com/danriffle/status/1066340719189786626?s=21 Great system we have going here
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# ? Nov 24, 2018 17:24 |
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Rhesus Pieces posted:https://twitter.com/danriffle/status/1066340719189786626?s=21 Private sector death panels are clearly preferable to government run ones
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# ? Nov 24, 2018 17:43 |
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hobbesmaster posted:Private sector death panels are clearly preferable to government run ones Especially DeVos family-run ones.
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# ? Nov 24, 2018 17:46 |
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Discendo Vox posted:I want to emphasize it's not really SCOTUS that's the issue here- it's a combination of 1. the WLF, which is a decades-old, terrifyingly competent Koch litigation entity, 2. decades of funding strangulation and capture and brain drain at FDA (which is still actually a really clean agency when all's said and done) and 3. the DC circuit, which has had this issue with libertarian judges since the 80s. Out of curiosity I looked up the WLF and the first thing I see on wikipedia that leaps out is quote:the Foundation's stated goal is "to defend and promote the principles of freedom and justice." I immediately winced.
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# ? Nov 25, 2018 12:37 |
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Tiler Kiwi posted:Out of curiosity I looked up the WLF and the first thing I see on wikipedia that leaps out is I'm with you; I feel genuinely kill when these days when I see the word "freedom", particularly when talking about the US. It's become a buzzword for "my supposed right to be able to do anything I want and have no social conscience, regardless of consequences."
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# ? Nov 25, 2018 17:35 |
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Rhesus Pieces posted:https://twitter.com/danriffle/status/1066340719189786626?s=21 Eagerly awaiting US diagnosis's/insurance to take into account subscriber numbers of your social accounts to treat you. "Sorry, but you only have 50 Instagram followers, and 40 non family Facebook friends. The projected Gofundme results from this will not be enough justification for us to offer to cover your cancer treatment."
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# ? Nov 25, 2018 17:39 |
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happyhippy posted:Eagerly awaiting US diagnosis's/insurance to take into account subscriber numbers of your social accounts to treat you. FTFY
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# ? Nov 25, 2018 17:44 |
Tiler Kiwi posted:Out of curiosity I looked up the WLF and the first thing I see on wikipedia that leaps out is Yeah, and they're among the worst of the bunch. For those not familiar with how the Kochs run things (I only know a tiny bit of it), one of their contributions to the world of policy influence was they set up their foundations with a relatively sophisticated, fairly meritocratic (here meritocratic meaning "best at doing terrible things") funding structure based on means testing. This was pretty revolutionary and created a genuinely competitive space where more effective (again, read: evil) conservative organizations kept funding, while those that couldn't produce results, didn't stick around. It's part of why the Kochs have such a huge network and so much influence- they effectively select and fund winners, and other groups and stakeholders glom onto that. WLF is a winner of winners, a real champion. I have no idea how they're composed internally, but I know they're legally effective. They're insanely flexible legally, able to rapidly roll with any particular case outcome to bring up a new line of attack, and they set up test cases in advance that frame the next win, in advance of their ongoing lawsuits, for multiple outcomes. Very few organizations can do that. Ultimately, they're able to prevail because there have been Rebublican legislatures and judicial appointees, but they're able to capitalize on that in a way few others do.
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# ? Nov 26, 2018 19:18 |
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Discendo Vox posted:Yeah, and they're among the worst of the bunch. For those not familiar with how the Kochs run things (I only know a tiny bit of it), one of their contributions to the world of policy influence was they set up their foundations with a relatively sophisticated, fairly meritocratic (here meritocratic meaning "best at doing terrible things") funding structure based on means testing. This was pretty revolutionary and created a genuinely competitive space where more effective (again, read: evil) conservative organizations kept funding, while those that couldn't produce results, didn't stick around. It's part of why the Kochs have such a huge network and so much influence- they effectively select and fund winners, and other groups and stakeholders glom onto that. WLF is a winner of winners, a real champion. I have no idea how they're composed internally, but I know they're legally effective. They're insanely flexible legally, able to rapidly roll with any particular case outcome to bring up a new line of attack, and they set up test cases in advance that frame the next win, in advance of their ongoing lawsuits, for multiple outcomes. Very few organizations can do that. Ultimately, they're able to prevail because there have been Rebublican legislatures and judicial appointees, but they're able to capitalize on that in a way few others do. This sounds like 'evolution by natural selection' Does the left have anyone/anything Koch-sized doing this? If not, why not? It's a good idea.
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# ? Nov 26, 2018 19:54 |
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Accretionist posted:This sounds like 'evolution by natural selection' you need to be obscenely rich in order to fund so many different organizations at once. oddly, the obscenely rich aren't on the side of the left, especially when it comes to reforming healthcare. also, i'm not sure that the left should buy into social darwinism as an organizational tactic; it is trump's organizational style and you can see in real time how having departments fight with each other handicaps his own administration.
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# ? Nov 26, 2018 20:17 |
Accretionist posted:This sounds like 'evolution by natural selection' I should note that I have only the slightest, dimmest understanding of how the Kochs operate (you've pretty much just gotten the extent of my knowledge with these posts), and my limited understanding is that this means testing thing is one of a large set of things they did that were revolutionary. Some of these things are apparently common, some of them can't be replicated by liberals because they're fairly expensive or monstrous or require a degree of immunity from optics that Dems don't have. I really don't know more on the subject.
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# ? Nov 26, 2018 21:03 |
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Accretionist posted:This sounds like 'evolution by natural selection' Capitalists are very protective of their capital which makes them right-wing by default
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# ? Nov 26, 2018 21:07 |
Pablo Nergigante posted:Capitalists are very protective of their capital which makes them right-wing by default OK, that's the other caveat I gotta give here, and I guess another tidbit about the Kochs. They're genuinely libertarian, beyond the scope of their own benefit or protecting their position. I mean, yes, it's often self-serving capitalist libertarianism, but the WLF sometimes goes for anti-regulatory positions so severe that industry trade groups sometimes wind up on the opposite side. People on the right who pay lip service to inconsistent, incoherent belief systems often also, simultaneously actually believe in those systems. It's a common trait and issue of rhetoric and ideology; genuine belief relieves the cognitive dissonance of lies, so people who promote or create propaganda usually wind up believing it. Tobacco executives smoke.
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# ? Nov 26, 2018 21:22 |
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If I win a billion dollar powerball, I'll see how much socialism I can fund before I'm assassinated. GoluboiOgon posted:[...] I wouldn't connect 'evolution' to 'social darwinism.' Before going off on a tangent about that, here's where I meant:
You can pick whatever selection pressure you'd like:
That kind of thing. As for the tangent -- quote:also, i'm not sure that the left should buy into social darwinism as an organizational tactic -- I would argue that Social Darwinism has nothing to do with evolution. Evolution is a universal 'systems' thing. It is filtered variation. Any system which self-replicates forward through time and is subject to both filtering and variation will display evolutionary change. Humans evolve (via genetic information). Guns evolve (via schematics). Bread evolves (via recipes). And this is in the absolute literal sense of the concept -- no stretching. Social Darwinism is a human social thing. It's, "might makes right," but dressed up. It's for people who use 'wealth & power' as their definition for 'winning at life' and who want to add one more way the universe affirms this. Imagine a scenario involving:
Evolution: Rich loner's selected against. Poor landscaper's selected for. Landscaper has a future. Social Darwinism: Rich guy's selected for. Landscaper's selected against. Rich guy's entitled to be a poo poo to the landscaper. Social Darwinists are off in la-la land. quote:it is trump's organizational style and you can see in real time how having departments fight with each other handicaps his own administration. I think Social Darwinism fetishizes conflict because power wins conflict and that's how these people define success. Prerequisite to being a Social Darwinist is an ego which requires seeing success that way, too, I suspect. Evolution can be benign. For example, AB Testing. I moved my conclusory paragraph up top because I didn't want to bury the lede. Accretionist fucked around with this message at 21:54 on Nov 26, 2018 |
# ? Nov 26, 2018 21:42 |
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it's also worth noting that a lot of koch funded organizations are quite incompetent; look at tpusa for example, where charlie kirk is a complete joke and that protest where they wore diapers permanently damaged their image. project veritas would be much scarier if it wasn't run by the most egotistical moron on earth. like, it is a private billionaire-funded informant network with 100s of operatives that infiltrates groups that are a threat to the kochs agenda, but less than half of their stings work because of the colossal fuckups and poorly fabricated data that are routine. this is the person that the kochs are funding to head their private fbi: they still manage to be somewhat effective, as the judicial system is clearly biased towards organizations with deep pockets and the federal charges against their operatives seem to just fade away. the organization would be far more effective with almost anyone else at the head tho.
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# ? Nov 26, 2018 21:57 |
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If I could lead the string of oligarchs off to the guillotine, and wouldn't that be fun, Charles Koch would be at the head of the queue. He's the most dangerous of the horrible people that run the world: A zealot with horrible beliefs and near-infinite resources who is competent. Trump is a piece of poo poo, but his ego and stupidity trip him up; Charles knows exactly what he is doing and uses that to the systematic imiseration of the masses. The most disgusting part is that I live in a world that tells me that I should admire him because he's
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# ? Nov 26, 2018 22:42 |
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I've had three other probublica tabs open since that cpap thingy a while back and finally got around to reading them. 1. In Montana, a Tough Negotiator Proved Employers Don’t Have to Pay So Much for Health Care (Cool story about how a state regulator forced provider-pricing controls for the state's employees; the new stat I learned is that 1/2 of American workers are covered by employer self-insured plans.) quote:Montana, like many large employers, self-funds its plan. That means it pays the bills and hires an insurance company or other firm to process the claims. More than half of American workers are covered by self-funded plans. As the boss in this arrangement, Bartlett assumed she’d have access to detailed information about how much the plan, which was managed by Cigna, paid for procedures at each hospital. But when she asked Cigna for its pricing terms with the hospitals, Cigna refused to provide them. 2. Why Your Health Insurer Doesn’t Care About Your Big Bills (Former insurance guy takes on the industry's opaque pricing with providers; points out how the ACA's "limit" of profits against costs actually incentivizes insurers' collaboration with providers to keep costs high.) quote:The Affordable Care Act kept profit margins in check by requiring companies to use at least 80 percent of the premiums for medical care. That’s good in theory but it actually contributes to rising health care costs. If the insurance company has accurately built high costs into the premium, it can make more money. Here’s how: Let’s say administrative expenses eat up about 17 percent of each premium dollar and around 3 percent is profit. Making a 3 percent profit is better if the company spends more. 3. Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates ("Wellness" programs are an excuse for insurers to suck up personal data & working with data brokers--sometimes owned by the insurers themselves--to aggregate personal information.) quote:To understand the scope of what they were offering, consider Optum. The company, owned by the massive UnitedHealth Group, has collected the medical diagnoses, tests, prescriptions, costs and socioeconomic data of 150 million Americans going back to 1993, according to its marketing materials. (UnitedHealth Group provides financial support to NPR.) The company says it uses the information to link patients’ medical outcomes and costs to details like their level of education, net worth, family structure and race. An Optum spokesman said the socioeconomic data is de-identified and is not used for pricing health plans. ProPublica has other excellent stories on the topic.
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# ? Nov 27, 2018 04:59 |
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Willa Rogers posted:I've had three other probublica tabs open since that cpap thingy a while back and finally got around to reading them. employer self insurance is huge because employers can construct very nice risk pools. most big companies will transition to it.
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# ? Nov 27, 2018 07:32 |
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Malcolm XML posted:employer self insurance is huge because employers can construct very nice risk pools. most big companies will transition to it. Yah, and one of those stories mentioned how insurers love it; they get paid to administer the plans (as they do Medicaid & Medicare, which are both very profitable for insurers) without having to underwrite the actual costs. The difference with the government programs, though, is that the government sets the provider pricing with the hospitals & docs, instead of the opaque & corrupt practice of insurer/provider secret pricing that benefits both by having higher costs.
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# ? Nov 27, 2018 07:38 |
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Mandating price transparency would go a long way to unfucking health care All charge masters must be open. All negotiated rates must be open.
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# ? Nov 27, 2018 07:48 |
Willa Rogers posted:Yah, and one of those stories mentioned how insurers love it; they get paid to administer the plans (as they do Medicaid & Medicare, which are both very profitable for insurers) without having to underwrite the actual costs. Just a quick correction; Insurers are not paid as TPAs (third party administrators) for Medicare. The PDP and MA plans are just that - health insurance plans that people opt into in lieu of traditional Medicare (or in addition in the case of the PDP). While there is a standard benefits package that must be covered, premiums, copays, and additional benefits can differ significantly. It is very different. I can't recall whether the MA plans pay Medicare rates. I want to say they do not. Reimbursement rates do tend to be fairly close though. The insurers are underwriting costs for Medicare. I believe many are for Medicaid as well - they essentially bid a PMPM to cover all services and then are responsible for the costs. So unlike Medicare, with MA you could have out of network hospitals or providers and actually be denied service. I had an aunt on a MA plan who was referred to an oncologist that was the specialist for her kind of cancer. He refused to treat her because he was out of network for her MA plan but took traditional Medicare so he could not allow her to pay him out of pocket. Zauper fucked around with this message at 09:44 on Nov 27, 2018 |
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# ? Nov 27, 2018 09:38 |
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What a great Thanksgiving break, I think I'll just catch up on the healthcare thread to see what I mis--Flesh Forge posted:Maybe you don't have any contact with CPAP users but a) you need to use the equipment a certain amount for it to be therapeutic at all, i.e. if you use it 1 night out of 10 then it does not provide any long term benefit to your health; b) the machines and their supplies are very expensive; and c) people literally do get them as prescribed, stick them on a shelf and never use them. When people waste expensive resources, yes, even fully socialized medicine systems will withhold them. Oh lol it's the supposedly leftist forum wigging out about greedy welfare queens stealing exorbitantly expensive luxurious $500 CPAP machines that they aren't even using, probably, and now we need a corporate police state to spy on everyone's sleep habits, not so the information can be confidentially shared with a doctor who can adjust the treatment plan to improve compliance rates for better patient outcomes, but secretly provided to private industry death panels so they can withhold care to punish apnea sufferers for their moral turpitude, satisfying at once their profit margins and our spiteful attitude to our fellow man. America is so hosed lol. VitalSigns fucked around with this message at 20:41 on Nov 27, 2018 |
# ? Nov 27, 2018 20:30 |
I'm curious if CPAP devices might have been identified as another potential locus of Medicare fraud. That would explain a lot about the circumstances.
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# ? Nov 27, 2018 21:08 |
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In that case though you'd be going after the doctors improperly prescribing unnecessary CPAP devices (presumably in exchange for kickbacks from manufacturers), right? You wouldn't be just withholding care from patients everyone agrees needs the CPAP machine but aren't using them properly for whatever reason.
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# ? Nov 27, 2018 21:11 |
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VitalSigns posted:In that case though you'd be going after the doctors improperly prescribing unnecessary CPAP devices (presumably in exchange for kickbacks from manufacturers), right? The genius is that pretty much everyone is tired all day sometimes, most people have a couple apneas a night (5 is the threshold for "minor" disease) and the sleep studies are manually scored.
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# ? Nov 27, 2018 21:15 |
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# ? Jun 5, 2024 07:25 |
VitalSigns posted:In that case though you'd be going after the doctors improperly prescribing unnecessary CPAP devices (presumably in exchange for kickbacks from manufacturers), right? You'd think BUT Provider networks and doctors have authority and can afford to hire attorneys. If you just deny individual sick patients, a certain number are going to fail to jump that hurdle -- because they're sick and tired and don't have attorneys -- and then you can claim savings of whatever percentage. Nobody ever went to a doctor and tried to scam themselves extra medical care they didn't believe they needed. (Or rather, anyone who has, probably has some other medical issue going on that needs treatment instead, like Munchausen's). Nobody goes to the trouble of getting a CPAP machine if they don't think it would help them with a real problem. (They might have been fooled or tricked in some way -- the victim of systemic fraudsters who convinced them they needed something they didn't, etc. -- but actual patients are almost universally sincere in believing they have a real need). I've done a lot of work fighting individual-level care denials and they are almost always based on the thinnest of reasons or the most cursory review -- fifteen minutes spent looking at a thirty-pound stack of medical records, "standards of care" lifted from out-of-context, misquoted powerpoint slides that happen to be the top hit on google for the condition, etc. (neither of those examples are hypothetical or exaggerated). A good system would go after actual systemic fraud as a criminal offense. But that doesn't happen in the case of most denials. Why doesn't it happen in the case of most denials? Because most denials are using the system of "fraud" review as a pretext for denying expensive claims (you can tell this by the fact that nobody prosecutes anyone for attempted fraud). Discendo Vox posted:I'm curious if CPAP devices might have been identified as another potential locus of Medicare fraud. That would explain a lot about the circumstances. This was such a goddam headache. There was one wrinkle to this story that really did gently caress over end users and I don't think it really got covered much in the media. See, some people who got wheelchairs through those scams actually *did* in fact need the chairs, they just happened to buy from a scam provider instead of a real one, but they didn't know anyy better. Then a month later, the lovely scam wheelchair would stop working. Medicare doesn't cover maintenance on wheelchairs for the first year, it's supposed to be under warranty from the manufacturer then, and it only covers one wheelchair purchase every five years. But of course the scam companies wouldn't honor their warranties, or would go bankrupt, or have their assets seized . . . then the poor sick victims would have no functioning wheelchair, no way to get one, and no way to get the broken one they had repaired. Good times! Some crimes make me want to bring back the stocks. Hieronymous Alloy fucked around with this message at 21:42 on Nov 27, 2018 |
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# ? Nov 27, 2018 21:34 |