corpoRATe Health Care Rationing
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DAGNABIT! Here’s how they do it! This from u.s. news & world report:
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How Crafty Health Insurers Are Denying Care
By Bernadine Healy M.D.
…private insurance companies, which make hefty profits managing half of America’s medical expenditures for the non-Medicare population, that in ways often hidden and arbitrary have the authority to deny coverage–and therefore, in all too many instances, care.
Outrage tends to bubble up when denials become human drama, triggering media interest. There’s the 17-year-old girl who died before her liver transplant was approved. Or the people in California whose insurers canceled their policies retroactively after they got sick. What’s often missed is that these cases are the tip of an opaque iceberg. An estimated 10 to 15 percent of claims are denied for various reasons, some of them technical, such as not meeting filing deadlines or failing to get pretreatment authorizations. Denials that produce the most disputes are those where insurers judge the care to be unnecessary or unproven, pitting a proverbial sick David against a multibillion-dollar Goliath. What few Davids know is that insurance contracts by law grant companies the legal right to manage a patient’s care, including denying it, sight unseen, and give them the final say, if challenged. Unless the state steps in.
Many denials are iffy calls and can appear distinctly arbitrary, with one insurer saying no to a particular therapy or procedure while others reimburse for it. An FDA-approved drug might be denied because it’s used off-label, even if it is shown to work in peer-reviewed reports. In cancer care, the generally expensive intravenous chemotherapy drugs given in a doctor’s office are typically covered, while an equivalent, if not better, therapy taken at home orally is not. When insurance authorization is required for each new service or each hospital stay for the same serious illness, who’s best to say what’s medically necessary? Doctors and their staff will spend hours trying to get the approvals, but patients should be warned that if the company ultimately denies payment, for whatever reason, it’s the patients who are responsible–with bill collectors ready at their door.
The problem is bound to grow as insurers make use of sophisticated data tools dubbed “denial engines,” which are touted to reduce reimbursements by 3 to 10 percent. Bearing brand names like Ingenix Detection Software and Bloodhound Technologies’ ClaimsGuard, they search patient records for any signs that claims have strayed outside company parameters. Weeding out fraud or speeding up processing is one thing; serving up excuses to deny legitimate coverage is another.
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SONOFABUSH! These corpoRATeer thieves have been getting away with literal MURDER! They deny sick people the treatment they need, and some of those denied treatment DIE! This is the truth concerning our failing health care system. The pig rich get gold plated health care, while the rest of us MAYBE get treated, if the insurance companies FEEL LIKE IT. That is RATIONING AT IT’S WORST!
How did this happen? Long about the 1970’s the dreaded HMO’s were born. We were told the usual corpoRATeer lies about this “new and improved” health care system. We were told that by “bringing the efficiencies of the free market” into our doctors offices, HEALTH CARE WOULD BECOME CHEAPER! Has health care become CHEAPER? NO, COSTS HAVE SKYROCKETED! What gets me the most SICK about all this, is that the present health care system is rife with taxpayer funded SUBSIDY! EVEN WITH HUGE GOVERNMENT HANDOUTS THE SYSTEM STILL FAILS! This is just another case of corpoRATe welfare! The health care companies make HUGE profits at OUR EXPENSE!
We have seen the dirty dems and filthy repubs take turns running our country into the ground! No matter which of the two parties of the apocalypse has held power, health care gets more expensive and more people wind up uninsured. The latest fools running under the banners of the two rotten parties, the syphilitic co-joined twins of the apocalypse called mcbama, SWEAR UP AND DOWN THAT THEY HAVE A HEALTH CARE PLAN THAT WILL FIX THIS MESS! I have seen what nobama and mcPain have in mind. Their plans will not work! There is only one way to fix the health care crisis. Single payer national health care! If YOU want more info on this very important issue, do a search on this blog. I have written quite a few posts here on the health care mess. The search bar on the upper right hand corner of this page will search this blog for you. Feel free to use it!
If YOU, like me, want single payer national health care, there is only thing YOU can do to get it! SUPPORT AND VOTE FOR THE ONLY PRESIDENTIAL CANDIDATE WHO WILL GIVE IT TO US, AND FIX ALL THE OTHER DISASTERS THE corpoRATeer two parties of the apocalypse have created:
The Telepathic Crickets™ on the ClapSotronics editorial board and I are pumped up with the real hope that YOU will vote NADER this election!
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