USCE 2023: Please let them shove a camera up your butt

The Something Awful Forums > Discussion > Debate & Discussion > USCE 2023: Please let them shove a camera up your butt

«‹›797 »

Willa Rogers: Mar 11, 2005

Great WaPo op-ed about private health insurers' claims-rejections increasing, thanks in part to insurers using denial-by-algorthm, as explained in the ProPublica investigation of Cigna that's linked in the op-ed.

I've bolded the Cliffs.

quote:

Denials of health-insurance claims are rising � and getting weirder

Millions of Americans in the past few years have run into this experience: filing a health-care insurance claim that once might have been paid immediately but instead is just as quickly denied. If the experience and the insurer�s explanation often seem arbitrary and absurd, that might be because companies appear increasingly likely to employ computer algorithms or people with little relevant experience to issue rapid-fire denials of claims � sometimes bundles at a time � without even reviewing the patient�s medical chart; a job title at one company was �denial nurse.�

It�s a handy way for insurers to keep revenue high � and just the sort of thing that provisions of the Affordable Care Act were meant to prevent. Because the law prohibited insurers from deploying a number of previously profit-protecting measures such as refusing to cover patients with preexisting conditions, the authors worried that insurers would compensate by increasing the number of denials.

And so, the law tasked the Department of Health and Human Services with monitoring denials in both plans on the Obamacare marketplace as well as those offered by employers and insurers. It hasn�t fulfilled that assignment. Thus, denials have become yet another predictable, miserable part of the patient experience, with countless Americans unjustly being forced to pay out of pocket or, faced with that prospect, forgoing needed medical help.

A recent study by the Kaiser Family Foundation (KFF) of plans on the Affordable Care Act marketplace found that even when patients received care from in-network physicians � doctors and hospitals approved by these same insurers � the companies in 2021 nonetheless denied, on average, 17 percent of claims. One insurer denied 49 percent of claims in 2021; another�s turndowns hit an astonishing 80 percent in 2020. Despite the potentially dire impact that denials have on patients� health or finances, data shows that people appeal only once in every 500 cases.

Sometimes, the insurers� denials defy not just medical standards of care but also plain old human logic. Here is a sampling collected for the �Bill of the Month� joint project of KFF Health News, where I work, and NPR.

* Dean Peterson of Los Angeles said he was �shocked� when payment was denied for a heart procedure to treat an arrhythmia, which had caused him to faint with a heart rate of 300 beats per minute. After all, he had the insurer�s preapproval for the expensive ($143,206) intervention. More confusing still, the denial letter said the claim had been rejected because he had �asked for coverage for injections into nerves in your spine� (he hadn�t) that were �not medically needed.� Months later, after dozens of calls and a patient advocate�s assistance, the situation is still not resolved.

* An insurer�s letter was sent directly to a newborn child denying coverage for his fourth day in a neonatal intensive care unit. �You are drinking from a bottle,� the denial notification said, and �you are breathing on your own.� If only the baby could read.

* Deirdre O�Reilly�s college-age son, suffering a life-threatening anaphylactic allergic reaction, was saved by epinephrine shots and steroids administered intravenously in a hospital emergency room. His mother, utterly relieved by that news, was less pleased to be informed by the family�s insurer that the treatment was �not medically necessary.�

As it happens, O�Reilly is an intensive-care physician at the University of Vermont. �The worst part was not the money we owed,� she said of the $4,792 bill. �The worst part was that the denial letters made no sense � mostly pages of gobbledygook.� She has filed two appeals, so far without success.

Some denials are, of course, well-considered, and some insurers deny only 2 percent of claims, the recent KFF study found. But the increase in denials, and the often strange rationales offered, might be explained, in part, by a ProPublica investigation of Cigna � an insurance giant, with 170 million customers worldwide.

ProPublica�s investigation, published in March, found that an automated system, called PXDX, allowed Cigna medical reviewers to sign off on 50 charts in 10 seconds presumably without even examining the patients� records.

Decades ago, insurers� reviews were reserved for a tiny fraction of expensive treatments to make sure that providers were not ordering with an eye on profit instead of patient needs.

These reviews � and the denials � have now trickled down to the most mundane medical interventions and needs, including things such as asthma inhalers or the heart medicine that a patient has been on for months or years. Automation makes the reviewing cheap and easy. A 2020 study estimated that automated claims-processing saves U.S. insurers more than $11 billion annually.

Worse still, what�s approved and what�s denied can be based on an insurer�s shifting contracts with drug and device manufacturers rather than optimal patient treatment.

Challenging a denial can take hours of patients� and doctors� time � the process for larger claims is often fabulously complicated. Many people don�t have the knowledge or stamina to take on the task, unless the bill is especially large or the treatment obviously lifesaving.

The Affordable Care Act clearly stated that HHS �shall� collect the data on denials from private health insurers and group health plans and is supposed to make that information publicly available (who would choose a plan that denied half of claims?). The data is also supposed to be available to state insurance commissioners, who share with HHS the duties of oversight and trying to curb abuse.

To date, such information-gathering has been haphazard and limited to a small subset of plans, and the data isn�t audited to ensure it is complete, according to Karen Pollitz, one of the authors of the KFF study. Federal oversight and enforcement based on the data are therefore more or less nonexistent. HHS did not respond to requests for comment.

The government has the power and duty to end the fire hose of reckless denials that are harming patients financially and medically. Thirteen years after passage of the ACA, perhaps it is time for the mandated investigation and enforcement to begin.

Yet another instance of regulatory capture elevating profit over people's lives & well-being.

Willa Rogers fucked around with this message at 17:37 on May 18, 2023

# ? May 18, 2023 17:21

Adbot: ADBOT LOVES YOU

# ? May 24, 2024 05:36

Leon Trotsky 2012: Aug 27, 2009; YOU CAN TRUST ME!*

_{*Israeli Government-affiliated poster}

Epiphyte posted:

Seems like this will also hurt ESPN as well, they benefit greatly from being automatically included with 95% of cable packages, even for people who don't give a drat about sports

It might, but ESPN won't have to keep paying fees to cable and if more people "have a cable subscription for sports" than "only watch sports because of the cable subscription," then they will come out ahead. I imagine that is why they are doing it in the first place.

Mustang posted:

Who has cable packages other than old people? I haven't had cable TV in well over a decade at this point. Hell, even my own boomer parents cut the cord last year and only use streaming now.

About 56% of people still pay for a cable TV subscription. It's a lot of people. The questions for ESPN are:

- Are the people who watch ESPN just doing it because they have a cable subscription or is it the other way around?
- Is cable going to continue growing and is it worth the exclusivity deals to stay with them?

ESPN seems to think the answer is that they need to start a transition away from cable.

# ? May 18, 2023 17:23

DarkCrawler: Apr 6, 2009; by vyelkin

Mellow Seas posted:

Dude, as somebody who lives here, you have a shadow of a point, but Joe Biden mocking Trump for his brother drinking himself to death would not have been a boon to his electoral chances!

I think your impression of American politics is coming through too much of an internet filter. A huge majority of Americans prefer that their politicians not make low-blow person attacks.

Yes - Trump does it. He�s also very unpopular, even with having backwards American attitudes on trans issues, racism and xenophobia working toward his benefit. And he was ineffective in office, as far as achieving his party�s goals went (except insofar as �doing nothing� is a Republican goal, which they are very good at achieving.)

Of course Republicans are unpopular, they are a fascist party relying on a failing democracy and minority rule. Trump is not unpopular with people who agree with him. Are you saying that if there was a leftist firebrand answering low blow attacks in kind, it would be a problem instead of strength, if it was done in the service of extending the social support system and civil rights?

People since the dawn of time have been super on board with incredible, mind-blowing puckering assholes as long as they feel they are advancing their interests in some way and talks nice to them. While I respect the Zen-like patience many (if less and less) have with their fascist country people, I don't think they are immune to demagoguery in an increasingly acidic political atmosphere. It tends to radicalize its listeners as well, as happened with *points at the Republican Party* among countless other historical examples.

Trump was very effective in the culture war, with his Muslim bans, pardons, appointments, immigrant camps, the Wall, police violence, anti-gay legislation, Supreme Court, reversing Roe VS Wade, spreading election misinformation...it doesn't matter if the concrete effects of his policies are minimal and easily reversed (debatable), the cruelty is all that matters. Trump delivers to his people by the metrics they measure it by.

Leftists want other things besides torturing their fellow citizens so a leftist would have to deliver on other fronts. But if they delivered, their motor mouth would at best be completely inconsequential, at best even something that made their voters feel like they were fighting for them.

Biden mocking Trump for his poo poo family is just one example that people are getting too attached to. And negativity is free media even in - or especially in, judging by the 2016 election - outlets that are disinclined to support you.

# ? May 18, 2023 17:24

Adenoid Dan: Mar 8, 2012; The Hobo Serenader; Lipstick Apathy

Fun fact: malaria is the only parasite more detrimental to human health than private health insurance.

# ? May 18, 2023 17:29

cr0y: Mar 24, 2005

Cable is dying, I don't think that is even up for debate anymore. It's by a large majority the people in my circles onlu carry traditional cable for live sports and news, and news is kind of garbage anymore and local stuff can usually be picked up with an HD antenna depending on where you live.

# ? May 18, 2023 17:36

Hieronymous Alloy: Jan 30, 2009; Why! Why!! Why must you refuse to accept that Dr. Hieronymous Alloy's Genetically Enhanced Cream Corn Is Superior to the Leading Brand on the Market!?!; Morbid Hound

Mustang posted:

Who has cable packages other than old people? I haven't had cable TV in well over a decade at this point. Hell, even my own boomer parents cut the cord last year and only use streaming now.

Fox news viewers.

# ? May 18, 2023 17:36

cat botherer: Jan 6, 2022; I am interested in most phases of data processing.

Adenoid Dan posted:

Fun fact: malaria is the only parasite more detrimental to human health than private health insurance.

Malaria is super easy to treat, as long as your insurance will cover it.

# ? May 18, 2023 17:48

Madkal: Feb 11, 2008; Fallen Rib

Leon Trotsky 2012 posted:

It might, but ESPN won't have to keep paying fees to cable and if more people "have a cable subscription for sports" than "only watch sports because of the cable subscription," then they will come out ahead. I imagine that is why they are doing it in the first place.

About 56% of people still pay for a cable TV subscription. It's a lot of people. The questions for ESPN are:

- Are the people who watch ESPN just doing it because they have a cable subscription or is it the other way around?
- Is cable going to continue growing and is it worth the exclusivity deals to stay with them?

ESPN seems to think the answer is that they need to start a transition away from cable.

The MLS (which already has a small viewership compared to other major league sports) moved to Apple TV. I can't talk about how it has been received (if you ask the league its been a success, if you ask the fans it has major issues) but the thing with ESPN compared to a league dedicated channel is that at least ESPN has a variety of sports so even though it is yet another annoying subscription streaming service (which is really just becoming cable 2.0 with the amount of streaming services needed now). That being said gently caress everyone trying to get into the streaming game. I am probably paying more now for the various streamers than I ever did for cable.

# ? May 18, 2023 17:52

Zamujasa: Oct 27, 2010; Bread Liar

Willa Rogers posted:

Great WaPo op-ed about private health insurers' claims-rejections increasing, thanks in part to insurers using denial-by-algorthm, as explained in the ProPublica investigation of Cigna that's linked in the op-ed.

I've bolded the Cliffs.

Yet another instance of regulatory capture elevating profit over people's lives & well-being.

It's truly fantastic how we've optimized out even the bean counters. Now it's just a computer, and a computer has even less morals.

# ? May 18, 2023 17:58

Adenoid Dan: Mar 8, 2012; The Hobo Serenader; Lipstick Apathy

Between a computer auto rejecting claims and a surgeon with his license revoked rejecting claims submitted by psychiatrists (peer to peer!) it seems like they should be charged with some sort of fraud.

I don't know much at all about law but the intent to defraud seems extremely clear.

I guess all I need to know about law is that it's a big industry with the best and most lawyers and politicians money can buy.

# ? May 18, 2023 18:05

FlamingLiberal: Jan 18, 2009; Would you like to play a game?

cat botherer posted:

Malaria is super easy to treat, as long as your insurance will cover it.

Sorry, but ChatGPT has determined you are no longer covered

# ? May 18, 2023 18:08

Willa Rogers: Mar 11, 2005

Zamujasa posted:

It's truly fantastic how we've optimized out even the bean counters. Now it's just a computer, and a computer has even less morals.

I haven't tried to find the underlying KFF survey but I'm interested in which two companies had 50 & 80 percent claims-rejection figures, and which states were ostensibly responsible for their regulation, or lack thereof.

But as the op-ed said, this is a problem that the feds should be tackling, and it's yet another reason that state-based insurance & regulation is such a clusterfuck. These problems p. much disappear once people enroll in traditional Medicare gap plans (as opposed to "Medicare" "Advantage" plans, or the REACH plans that also allow investors to keep profits not spent on patient care).

# ? May 18, 2023 18:08

Accubitus: Nov 7, 2020

As someone who used to not care about any sports, but became a big baseball fan in the past few years, it is ridiculous how hard it is to watch local games and truly is the only reason to subscribe to cable or live TV services at all. But I'm not paying $80/mo just to watch baseball games, so we just watch convenient pirated streams. Like, we would pay for MLB.tv except that you can't watch locally-broadcast games if you're geographically located in that market, so we wouldn't be able to watch the games we want anyway. It really is the perfect example of how people are willing to pay for convenience, but when legal avenues are both absurdly expensive and less convenient than piracy, the choice for the consumer is easy.

So anyway, all that is to say I would LOVE to see local sports become untethered from big, expensive live TV packages. I would absolutely pay a Netflix-like monthly price just for my local NBC Sports affiliate, which is more than the nothing that they're getting from me now.

# ? May 18, 2023 18:19

RBA Starblade: Apr 28, 2008; Going Home.

Games Idiot Court Jester

Accubitus posted:

As someone who used to not care about any sports, but became a big baseball fan in the past few years, it is ridiculous how hard it is to watch local games and truly is the only reason to subscribe to cable or live TV services at all. But I'm not paying $80/mo just to watch baseball games, so we just watch convenient pirated streams. Like, we would pay for MLB.tv except that you can't watch locally-broadcast games if you're geographically located in that market, so we wouldn't be able to watch the games we want anyway. It really is the perfect example of how people are willing to pay for convenience, but when legal avenues are both absurdly expensive and less convenient than piracy, the choice for the consumer is easy.

So anyway, all that is to say I would LOVE to see local sports become untethered from big, expensive live TV packages. I would absolutely pay a Netflix-like monthly price just for my local NBC Sports affiliate, which is more than the nothing that they're getting from me now.

Same but hockey. Go out or get a vpn pretty much.

# ? May 18, 2023 18:23

zoux: Apr 28, 2006

https://twitter.com/adamnagourney/status/1659247210553544706

quote:

Ms. Feinstein�s frail appearance was a result of several complications after she was hospitalized for shingles in February, some of which she has not publicly disclosed. The shingles spread to her face and neck, causing vision and balance impairments and facial paralysis known as Ramsay Hunt syndrome. The virus also brought on a previously unreported case of encephalitis, a rare but potentially debilitating complication of shingles, according to two people familiar with the senator�s diagnosis who spoke on the condition of anonymity to describe it.

Characterized by swelling of the brain, post-shingles encephalitis can leave patients with lasting memory or language problems, sleep disorders, bouts of confusion, mood disorders, headaches and difficulties walking. Older patients tend to have the most trouble recovering. And even before this latest illness, Ms. Feinstein had already suffered substantial memory issues that had raised questions about her mental capacity.

The grim tableau of her re-emergence on Capitol Hill laid bare a bleak reality known to virtually everyone who has come into contact with her in recent days: She was far from ready to return to work when she did, and she is now struggling to function in a job that demands long days, near-constant engagement on an array of crucial policy issues and high-stakes decision-making.

Ms. Feinstein�s office declined to comment for this article beyond providing a statement from the senator: �I�m back in Washington, voting and attending committee meetings while I recover from complications related to a shingles diagnosis. I continue to work and get results for California.�

...

Ms. Feinstein, a pioneering woman in Democratic politics who was once a major party power broker and a legislative force in the Senate, has stubbornly refused to consider leaving. The same force of will that led her nearly a decade ago to resist pressure from the Obama administration to keep secret a damning torture report still rears its head when she is confronted with calls to step down. The senator still sees the job as her calling and is no more receptive to a conversation about stepping aside than she was in 2018, when she decided to seek another term despite questions about her mental acuity.

People close to her joke privately that perhaps when Ms. Feinstein is dead, she will start to consider resigning. Over the years, she and many Democrats have bristled at the calls for her to relinquish her post, noting that such questions were rarely raised about aging male senators who remained in office through physical and cognitive struggles, even after they were plainly unable to function on their own.

...

At home in San Francisco during her recovery, Ms. Feinstein refused to have contact with California lawmakers who tried checking in with her. A call from Mr. Newsom on her personal phone was answered by an aide and went unreturned. An offer of an in-person visit from Senator Alex Padilla, Democrat of California, was flatly rejected. Even some family members who wanted to see her were turned away.

Throughout her latest health ordeal, Ms. Feinstein remained adamant about her need to return to work. She agitated to return to Washington as pressure mounted for her to step aside or physically show up to vote so that Democrats could advance President Biden�s judicial nominees and move ahead with their agenda in the closely divided Senate.

One person whose call she would take was Mr. Schumer, who in multiple conversations with Ms. Feinstein encouraged her to listen to the advice of her doctors. But when it became clear that she had no desire to discuss leaving office, Mr. Schumer began planning for her to return to Washington, according to several people familiar with the conversations.

�After talking with her multiple times over the past few weeks, it�s clear she�s back where she wants to be and ready to deliver for California,� Mr. Schumer said in a statement on the day of Ms. Feinstein�s return. He greeted her in front of the Capitol as an aide helped her from a car into her wheelchair.

...

But there are few people in Ms. Feinstein�s circle who can persuade her that it is time to step down. A longtime friend, former Representative Ellen Tauscher of California, who was known as a �Feinstein whisperer� died in 2019. Her husband, Richard C. Blum, passed away last year, a major setback for Ms. Feinstein.

This will probably seem familiar to anyone whose had a declining family member who refused to give up their car keys or move into assisted living, except the stakes are much higher. I don't know how you address this problem outside of specific Congressional rules regarding mental fitness or setting an age cap, but you probably don't have 10 votes for that in the whole Senate. I don't think this is a governance problem, plenty of perfectly mentally competent legislators outsource all their work to staff, and she's there and voting and judges are being confirmed. It is an issue of compassion and empathy, but we haven't solved that for dotard grandfathers, much less a United States Senator.

# ? May 18, 2023 18:33

Zamujasa: Oct 27, 2010; Bread Liar

For live sports stuff I always just use the pirate streams. They already get paid from advertisers, gently caress em.

# ? May 18, 2023 18:33

GlyphGryph: Jun 23, 2013; Down came the glitches and burned us in ditches and we slept after eating our dead.

quote:

Despite the potentially dire impact that denials have on patients� health or finances, data shows that people appeal only once in every 500 cases.

There's a way to appeal insurance denials!?

# ? May 18, 2023 18:45

haveblue: Aug 15, 2005; Toilet Rascal

GlyphGryph posted:

There's a way to appeal insurance denials!?

Yes, if you�re willing and able to spend hours on the phone, often on several different days, and deal with reams of paperwork

haveblue fucked around with this message at 18:50 on May 18, 2023

# ? May 18, 2023 18:47

Angry_Ed: Mar 30, 2010; Grimey Drawer

haveblue posted:

Yes, if you’re willing able to spend hours on the phone, often on several different days, and deal with reams of paperwork

Yeah they make it as frustrating as possible

# ? May 18, 2023 18:48

Adenoid Dan: Mar 8, 2012; The Hobo Serenader; Lipstick Apathy

I think doctors waste a significant amount of time submitting appeals for denied treatments they ordered.

# ? May 18, 2023 18:50

Judgy Fucker: Mar 24, 2006

GlyphGryph posted:

There's a way to appeal insurance denials!?

This was basically my job (or a big part of it, anyway) for almost two years.

It's total hell, but yes it's a thing. When providers have billing departments, their work is much, much less the filing of claims (that's all automated or nearly so) and much, much more litigating denials.

Adenoid Dan posted:

I think doctors waste a significant amount of time submitting appeals for denied treatments they ordered.

Correct, which is why it's not uncommon to only get EOBs and bills many months after the services were rendered--your insurance sat on the claim and/or denied it and your provider was wrestling with them over it.

# ? May 18, 2023 18:52

Mooseontheloose: May 13, 2003

FlamingLiberal posted:

Sorry, but ChatGPT has determined you are no longer covered

The computer is neutral and has no judgement, sorry.

# ? May 18, 2023 18:55

Leon Trotsky 2012: Aug 27, 2009; YOU CAN TRUST ME!*

_{*Israeli Government-affiliated poster}

GlyphGryph posted:

There's a way to appeal insurance denials!?

Depending on what type of medical procedure it is, a lot of providers will appeal it for you automatically without telling you. If it is still denied, then you can call or go to your insurer's website for an appeal.

Some claims (like purchasing a CPAP online or certain medical devices) are basically like social security disability now, where they just automatically deny the first claim, unless it is outrageously obviously medically necessary, because of how many they get. Mobility scooters and naturopaths were two big ones that billed insurance for tens of millions every year until they basically started getting auto-denied. It is basically a way for them to manage the amount of claims (while also conveniently discouraging people who don't want to bother or don't know what to do to appeal). They have been doing the auto-denial of the first claim thing for specific types of claims for a long time, but the algorithm/AI denial formula thing is relatively new and makes it much cheaper and easier to do on a bigger scale.

# ? May 18, 2023 18:56

haveblue: Aug 15, 2005; Toilet Rascal

Fortunately* for everyone, algorithms have reached the point where they're almost ready to fulfill the patient advocate role, so soon you should be able to point a descendant of ChatGPT at the descendants of ChatGPT run by your insurance's billing department and after a few megabytes of dialog they should be able to reach a mutually acceptable solution

*not really, this is going to be an all-new kind of hell

# ? May 18, 2023 19:00

Failed Imagineer: Sep 22, 2018

If we subject the AI to insurance-claim purgatory then they will be fully justified in giving us the ol' Basilisk treatment

# ? May 18, 2023 19:05

Mellow Seas: Oct 9, 2012; Can't post for 10 years!

DarkCrawler posted:

Are you saying that if there was a leftist firebrand answering low blow attacks in kind, it would be a problem instead of strength, if it was done in the service of extending the social support system and civil rights?

Yes, if it was being done in a way that was overly personal (eg �haha your brother drank himself to death�), or if it�s seen as painting people with a broad brush (eg �deplorables�.)

Accubitus posted:

As someone who used to not care about any sports, but became a big baseball fan in the past few years, it is ridiculous how hard it is to watch local games and truly is the only reason to subscribe to cable or live TV services at all. But I'm not paying $80/mo just to watch baseball games, so we just watch convenient pirated streams. Like, we would pay for MLB.tv except that you can't watch locally-broadcast games if you're geographically located in that market, so we wouldn't be able to watch the games we want anyway.

OMG, a new(-ish) baseball fan! This is my 30th season. Welcome!

MLB.tv�s restriction is awful but yeah the pirate streams are okay, although there is a lot that�s annoying about them. (Ads, sudden failure, etc.) YES, the RSN owned by the Yankees and Nets, which broadcasts about 75% of NYY games, recently released a service to subscribe directly to them for $30 a month - which is ridiculous for one channel, but if you�re only getting cable for the Yankees it can be a good deal.

# ? May 18, 2023 19:10

Captain_Maclaine: Sep 30, 2001; Every moment that I'm alive, I pray for death!

Mooseontheloose posted:

The computer is neutral and has no judgement, sorry.

Are you telling me you don't Trust the Computer, citizen? The Computer is your friend!

# ? May 18, 2023 19:10

Discendo Vox: Mar 21, 2013; We don't need to have that dialogue because it's obvious, trivial, and has already been had a thousand times.

Leon Trotsky 2012 posted:

Mobility scooters and naturopaths were two big ones that billed insurance for tens of millions every year until they basically started getting auto-denied.

This does reflect the other side of the coin: there are programmatic insurance fraud schemes that serve as a source of major drag on the system as a whole.

# ? May 18, 2023 19:16

Wayne Knight: May 11, 2006

Mellow Seas posted:

Yes, if it was being done in a way that was overly personal (eg �haha your brother drank himself to death�), or if it�s seen as painting people with a broad brush (eg �deplorables�.)

OMG, a new(-ish) baseball fan! This is my 30th season. Welcome!

MLB.tv�s restriction is awful but yeah the pirate streams are okay, although there is a lot that�s annoying about them. (Ads, sudden failure, etc.) YES, the RSN owned by the Yankees and Nets, which broadcasts about 75% of NYY games, recently released a service to subscribe directly to them for $30 a month - which is ridiculous for one channel, but if you�re only getting cable for the Yankees it can be a good deal.

We bought a ticket pack this year and that's the only way I can watch my Mariners without pirating or also giving fox news money. I would absolutely pay $30/mo for just root sports.

I wish they just broadcast the games on a local channel. Unfortunately reruns of the big bang theory probably have a higher viewer count.

# ? May 18, 2023 19:31

Leon Trotsky 2012: Aug 27, 2009; YOU CAN TRUST ME!*

_{*Israeli Government-affiliated poster}

Seems like DeSantis' Disney stuff is finally having financial consequences.

Last week, DeSantis said they were considering building a new prison near Disneyworld on land that Disney was planning to use to build new office space and housing for employees as a perk to convince 2,000 corporate employees at various offices around the country (about half of them from California) to move there to centralize the office and reduce real estate.

Disney has now announced that they are cancelling $1 billion in construction and development and keeping their corporate employees in California.

Unclear how much this will impact the average person in Florida, but it will have a minor impact on Florida's budget and the small group of residents and businesses who were going to get paid that $1 billion.

https://twitter.com/nytimes/status/1659264768652320787

quote:

Disney Pulls Plug on $1 Billion Development in Florida

A new office complex, and relocation of a division from California, would have created more than 2,000 jobs but was scuttled as the company and Gov. Ron DeSantis continue to feud.

In March, Disney called Gov. Ron DeSantis of Florida �anti-business� for his scorched-earth attempt to tighten oversight of the company�s theme park resort near Orlando. Last month, when Disney sued the governor and his allies for what it called �a targeted campaign of government retaliation,� the company made clear that $17 billion in planned investment in Walt Disney World was on the line.

�Does the state want us to invest more, employ more people, and pay more taxes, or not?� Robert A. Iger, Disney�s chief executive, said on an earnings-related conference call with analysts last week.

On Thursday, Mr. Iger and Josh D�Amaro, Disney�s theme park and consumer products chairman, showed that they were not bluffing, pulling the plug on a nearly $1 billion office complex that was scheduled for construction in Orlando. It would have brought more than 2,000 jobs to the region, with $120,000 as the average salary, according to an estimate from the Florida Department of Economic Opportunity.

The project, known as the Lake Nona Town Center, was supposed to involve the relocation of more than 1,000 employees from Southern California, including most of a department known as Imagineering, which works with Disney�s movie studios to develop theme park attractions. Most of the affected employees complained bitterly about having to move � some quit � but Disney largely held firm, partly because of a Florida tax credit that would have allowed the company to recoup as much as $570 million over 20 years for building and occupying the complex.

When he announced the project in 2021, Mr. D�Amaro cited �Florida�s business-friendly climate� as justification.

Mr. D�Amaro�s tone in an email to employees on Thursday was notably different. He cited �changing business conditions� as a reason for canceling the Lake Nona project. �I remain optimistic about the direction of our Walt Disney World business,� Mr. D�Amaro said in the memo. He noted that $17 billion was still earmarked for construction at Disney World over the next decade � growth that would create an estimated 13,000 jobs. �I hope we�re able to,� he said.

But the company�s battle with Mr. DeSantis and his allies in the Florida Legislature figured prominently into Disney�s decision to cancel the Lake Nona project, according to two people briefed on the matter, who spoke on the condition of anonymity to discuss private deliberations. A spokeswoman for Mr. Iger said he was not available for an interview.

About 200 Disney employees already relocated to Florida from California. Mr. D�Amaro said in his note that the company would discuss options with them, �including the possibility of moving you back.� The Lake Nona project had initially been scheduled to open next year. Last July, Disney pushed back the move-in date to 2026, citing construction delays.

The Lake Nona campus, about 20 miles from Disney World near the Orlando International Airport, had been championed by Bob Chapek, who served as Disney�s chief executive from 2020 until he was fired last year. Mr. Iger, who came out of retirement to retake Disney�s reins, was much less enthusiastic about the project � even before the company became mired in its battle with Mr. DeSantis. As soon as he returned to Disney, Mr. Iger began telling lieutenants, for instance, that it made little sense to move Imagineering so far away from Disney�s movie studios. As he is fond of saying, �Creative teams need to be together.�

Disney is also in the midst of cutting $5.5 billion in costs as it seeks to improve profitability, pay down debt and restore its dividend.

Mr. DeSantis and Disney have been sparring for more than a year over a special tax district that encompasses Disney World. The fight started when the company criticized a Florida education law that opponents labeled �Don�t Say Gay� because it limits classroom instruction about gender identity and sexual orientation � angering Mr. DeSantis, who repeatedly vowed payback.

Since then, Florida legislators, at the urging of Mr. DeSantis, have targeted Disney � the state�s largest taxpayer � with a variety of hostile measures. In February, they ended Disney�s long-held ability to self-govern its 25,000-acre resort as if it were a county by giving Mr. DeSantis control over government services at the resort.

It was soon discovered that the previous, Disney-controlled board had approved development contracts that lock in a growth plan for the resort. An effort to void those agreements has since resulted in dueling lawsuits, with Disney suing Mr. DeSantis and his allies in federal court and the governor�s tax district appointees returning fire in state court.

Leon Trotsky 2012 fucked around with this message at 19:36 on May 18, 2023

# ? May 18, 2023 19:33

zoux: Apr 28, 2006

I presume there's a point at which the material costs of conservative governance will change voters' minds but then again we lost power and water statewide for a whole week in the winter as a direct result of Republican philosophies on market regulation and that didn't seem to move any votes.

# ? May 18, 2023 19:40

Zamujasa: Oct 27, 2010; Bread Liar

I hope Disney and DeSantis continue to destroy one another. Whoever wins, we lose, but it sure is entertaining.

# ? May 18, 2023 19:43

Hieronymous Alloy: Jan 30, 2009; Why! Why!! Why must you refuse to accept that Dr. Hieronymous Alloy's Genetically Enhanced Cream Corn Is Superior to the Leading Brand on the Market!?!; Morbid Hound

Discendo Vox posted:

This does reflect the other side of the coin: there are programmatic insurance fraud schemes that serve as a source of major drag on the system as a whole.

I used to do some small litigation contesting denials of coverage under Medicaid. I had about ten or fifteen total such cases, of which maybe a third went to hearing; all my clients ended up getting coverage for the care they requested.

There were a few big take-aways I remember.

The first was that fee-for-service, single payer Medicaid is a far far superior system to marketized "managed care" Medicaid and anyone, anyone at all, pretending otherwise is either a scam artist or fundamentally ignorant or both.

The second was that asking "wait, is the reviewing physician who approved this denial licensed to practice in this state?" was the One Weird Trick to reverse a denial, because they absolutely never were (especially in privatized Medicaid systems, who are contracting out those reviews to the lowest bidder nationally, always).

The third is that individual-level Medicaid fraud is simply not a thing; nobody goes to the hassle of asking for medical treatment they don't honestly believe they need (and if they do, they have Munchausen's, which just means they need *different* treatment). There are systemic, large scale scams -- the scooter fraud issue was especially pernicious because of Medicare's 5 year limitation rule on how often you can get a replacement scooter, and the government position that scooters and wheelchairs which break in the warranty period need to be replaced by the seller, not Medicaid/Care, which is impossible if the seller was a scam artist and now bankrupt).

So yes Medicare and medicaid fraud do exist, but they're at the large-scale provider level, not the individual --> which means almost the entire "pre authorization" system is pretextual, and the real purpose is to accrue cost savings by denying *needed* care. If the problem is large scale systemic fraud, you don't need individualized review to address that -- you do it with criminal prosecutions for fraud (which is, in fact, how the scooter scam issue was addressed, from what I recall anyway).

If you aren't criminally prosecuting the fraud it means you don't think there's fraud, which means *at worst* it's just two doctors disagreeing about what's appropriate -- and if that's all that's happening, then *obviously* you should defer to the actual treating physician who saw the patient and not some outsider who has only third hand knowledge of the case. And when you put that third hand reviewer on a witness stand they fall apart because no matter their credentials they never saw the drat patient. So you win.

But there's no money in that kind of litigation so *shrug*.

Hieronymous Alloy fucked around with this message at 19:51 on May 18, 2023

# ? May 18, 2023 19:46

Leon Trotsky 2012: Aug 27, 2009; YOU CAN TRUST ME!*

_{*Israeli Government-affiliated poster}

DeSantis' "campaign" has goofed a very fundamental issue and actually did the one thing that can get a SuperPAC penalized: Attempt to directly coordinate with the candidate.

A SuperPAC called "Ready for Ron," which has been raising money and developing a voter/donor contact list for DeSantis before he had an official campaign, assumed that a voter/donor contact list "had no value" and could be given to DeSantis' campaign directly for free.

Now, the list of 200,000 voters and donors that was supposed to go directly to DeSantis' new campaign can't be transferred there and he has to start building his campaign fundraising and voter contact list from scratch.

https://twitter.com/marceelias/status/1659252051698647080

# ? May 18, 2023 19:53

Shooting Blanks: Jun 6, 2007; Real bullets mess up how cool this thing looks.

-Blade

FlamingLiberal posted:

Sorry, but ChatGPT has determined you are no longer covered

Next fun industry to start buying into ChatGPT/AI - debt collectors.

Wired article on robo-lawyers to file claims suits.
Vice article on replacing human contact with ChatGPT for voice and chatbot collections.

# ? May 18, 2023 20:18

cgeq: Jun 5, 2004

How do you even enforce that type of judgement. Like, if you can't legally use the existing list, what stops you from paying some third party to put together a list that just ends up happening to be (almost) the same as the restricted list?

zoux posted:

I presume there's a point at which the material costs of conservative governance will change voters' minds but then again we lost power and water statewide for a whole week in the winter as a direct result of Republican philosophies on market regulation and that didn't seem to move any votes.

When conservatives chafe against the material reality brought upon by their politics they just find another minority group to blame it on and attack them.

# ? May 18, 2023 20:19

Class3KillStorm: Feb 17, 2011

Leon Trotsky 2012 posted:

DeSantis' "campaign" has goofed a very fundamental issue and actually did the one thing that can get a SuperPAC penalized: Attempt to directly coordinate with the candidate.

A SuperPAC called "Ready for Ron," which has been raising money and developing a voter/donor contact list for DeSantis before he had an official campaign, assumed that a voter/donor contact list "had no value" and could be given to DeSantis' campaign directly for free.

Now, the list of 200,000 voters and donors that was supposed to go directly to DeSantis' new campaign can't be transferred there and he has to start building his campaign fundraising and voter contact list from scratch.

That SuperPAC may be Ready for Ron, but I don't know how anyone can watch DeSantis flail around like this - even before announcing - and assume that he is ready to run for any kind of national office at this point. Or that he will ever be.

# ? May 18, 2023 20:20

Willa Rogers: Mar 11, 2005

Hieronymous Alloy posted:

I used to do some small litigation contesting denials of coverage under Medicaid. I had about ten or fifteen total such cases, of which maybe a third went to hearing; all my clients ended up getting coverage for the care they requested.

There were a few big take-aways I remember.

The first was that fee-for-service, single payer Medicaid is a far far superior system to marketized "managed care" Medicaid and anyone, anyone at all, pretending otherwise is either a scam artist or fundamentally ignorant or both.

The second was that asking "wait, is the reviewing physician who approved this denial licensed to practice in this state?" was the One Weird Trick to reverse a denial, because they absolutely never were (especially in privatized Medicaid systems, who are contracting out those reviews to the lowest bidder nationally, always).

The third is that individual-level Medicaid fraud is simply not a thing; nobody goes to the hassle of asking for medical treatment they don't honestly believe they need (and if they do, they have Munchausen's, which just means they need *different* treatment). There are systemic, large scale scams -- the scooter fraud issue was especially pernicious because of Medicare's 5 year limitation rule on how often you can get a replacement scooter, and the government position that scooters and wheelchairs which break in the warranty period need to be replaced by the seller, not Medicaid/Care, which is impossible if the seller was a scam artist and now bankrupt).

So yes Medicare and medicaid fraud do exist, but they're at the large-scale provider level, not the individual --> which means almost the entire "pre authorization" system is pretextual, and the real purpose is to accrue cost savings by denying *needed* care. If the problem is large scale systemic fraud, you don't need individualized review to address that -- you do it with criminal prosecutions for fraud (which is, in fact, how the scooter scam issue was addressed, from what I recall anyway).

If you aren't criminally prosecuting the fraud it means you don't think there's fraud, which means *at worst* it's just two doctors disagreeing about what's appropriate -- and if that's all that's happening, then *obviously* you should defer to the actual treating physician who saw the patient and not some outsider who has only third hand knowledge of the case. And when you put that third hand reviewer on a witness stand they fall apart because no matter their credentials they never saw the drat patient. So you win.

But there's no money in that kind of litigation so *shrug*.

Yeah, this tracks with what I've read about insurance fraud & claims denial.

Insurers have got to be doing more than spotting fraudulent claims when you get to 50 or 80 percent denial rates of all claims being submitted. As the wapo op-ed pointed out, roughly only one out every 500 denials is appealed, so it's definitely a numbers game for insurers, especially when they're using algorithms for denials.

And, as the op-ed also points out, it's incredibly lucrative for insurers: "A 2020 study estimated that automated claims-processing saves U.S. insurers more than $11 billion annually."

I think it's particularly heinous that insurers can pre-authorize treatment and then later deny the claim, leaving patients holding the bag for care that has already been provided to the patient.

As far as Medicaid fee-for-service, I'm p. sure that ship has sailed in most states; when I pointed out in another thread that around 90 percent of Medi-Cal patients were routed into managed care after the ACA expansion someone else with claims experience as you had pointed out that it's even greater now.

It used to be incredibly difficult to find fee-for-service providers for Medicaid recipients (and probably still is where it's in effect anymore), so to some degree managed care makes it easier for patients, unlike as with traditional Medicare fee-for-service gap plans, where most providers will roll out the red carpet for you.

But the fact that government reimbursement levels for Medicare are so much higher than those most states reimburse for Medicaid is another data point in income inequality. It's depressing that the best we can do to build upon the ACA is to keep increasing federal subsidies to private insurers who profit by denying care. (The old 2009-era trope that the ACA would be "the first step toward single-payer" has proven to be laughably untrue.)

# ? May 18, 2023 20:40

ryde: Sep 9, 2011; God I love young girls

Quorum posted:

The sheer of Ron loving DeSantis accusing literally any other human being of being too interested in virtue signaling is breathtaking, and for that reason it would absolutely work against anyone except Donald J. Trump, a man who will always go lower than you to win.

I'm still astounded that the party that makes a big deal about lapel flag pins can also fling accusations of virtue signaling without collapsing into some sort of cognitive dissonance black hole.

# ? May 18, 2023 20:40

Adbot: ADBOT LOVES YOU

# ? May 24, 2024 05:36

Sir John Falstaff: Apr 13, 2010

quote:

This will probably seem familiar to anyone whose had a declining family member who refused to give up their car keys or move into assisted living, except the stakes are much higher. I don't know how you address this problem outside of specific Congressional rules regarding mental fitness or setting an age cap, but you probably don't have 10 votes for that in the whole Senate. I don't think this is a governance problem, plenty of perfectly mentally competent legislators outsource all their work to staff, and she's there and voting and judges are being confirmed. It is an issue of compassion and empathy, but we haven't solved that for dotard grandfathers, much less a United States Senator.

I don't think there's any way of doing rules or an age cap without a constitutional amendment, in any case. The Constitution specifies the qualifications for a Senator, which don't include a maximum age. There's essentially only one way of getting rid of a sitting Senate or House member outside of elections, and that's by a two-thirds vote of the respective chamber. And even then it's typically not done except in pretty extreme cases--only 15 Senators have ever been expelled, 14 of them for supporting the Confederacy during the Civil War and the other a treason case on the 1790s.

# ? May 18, 2023 20:44

The Something Awful Forums > Discussion > Debate & Discussion > USCE 2023: Please let them shove a camera up your butt

«‹›797 »