US Healthcare stinks thread (1 Viewer)

[Scoresman]

New photos out of shooter with a clear full face shot.

No matter how careful you think you are there is always something to trip you up. This guy is realistically a dead man walking at this point, someone will know who he is and will inform the police.

Looks young

I dunno. On other forums there are people suggesting gofundme's to help this guy escape and for legal funds. And I'm not seeing this in just one or two places. This guy is a hero to some. We all seem to be posting on one of the few sane places on the internet.

 

[IvanKaramazov]

New photos out of shooter with a clear full face shot.

Link

I should revise my assessment about this guy having really thought things through. Taking off his mask in a place where he had to know that he was being videotaped was a dumb mistake.

 

[Joe Schmo]

New photos out of shooter with a clear full face shot.

No matter how careful you think you are there is always something to trip you up. This guy is realistically a dead man walking at this point, someone will know who he is and will inform the police.

Looks young

I dunno. On other forums there are people suggesting gofundme's to help this guy escape and for legal funds. And I'm not seeing this in just one or two places. This guy is a hero to some. We all seem to be posting on one of the few sane places on the internet.

Yeah this world of ours is in a real state of sheet right now, fubar

 

[Ministry of Pain]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our work and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

 

[Joe Schmo]

New photos out of shooter with a clear full face shot.

Link

I should revise my assessment about this guy having really thought things through. Taking off his mask in a place where he had to know that he was being videotaped was a dumb mistake.

Probably blanked on the thought as it was a normal occurrence for him sort of like flicking the light switch in the kitchen during a blackout, you do it by rote.

 

[Ministry of Pain]

New photos out of shooter with a clear full face shot.

Link
@Ministry of Pain

Oh ****, yeah I had not seen that, outstanding Jamny!

Oh they will get a boatload of tips on this guy, I actually will be surprised if they don't catch him
Great post and link

 

[Scoresman]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our wrk and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

How do you feel about insurance companies arbitrarily putting a time limit on how long they will cover anesthesia? So doctors either have to hurry to finish a procedure within the limit or at some point all of the anesthesia costs are out of pocket?

People are mad because premiums keep going up, and the coverage keeps getting worse.

 

[FreeBaGeL]

Do ya'll remember your health care coverage in 2001?

That's when I entered the workforce. I don't remember my exact coverage back then. But what I do distinctly remember is in the November after that, we had a company wide meeting where they introduced the next year's healthcare plan, and everyone was irate. I was young and didn't care about much beyond buying a big TV with my new full time job money at the time so it didn't really bother me, but the people that actually needed healthcare were PISSED.

Then the next year we had the same meeting.

Then the following year the same one again.

Eventually we stopped having the meetings altogether, because people got tired of having to spin bad news and getting yelled at when people saw through it every year. But as I got old enough to care about health insurance, it just meant my wife and I privately had that meeting during open enrollment, where we looked at the plan and noticed our premiums had gone up, and our coverage had gone down. Every. Single. Year.

And that will continue, because it's by design. UNH isn't just a for profit company. They have a P/E ratio of almost 40. They're a GROWTH company. They don't need to just make profit every year, they need to make MORE profit every year.

How do you increase your profit every year? Higher premiums, less coverage.

This CEO, every year he worked there, signed off on changes that he well knew were implicitly saying "we're going to cause more people to die, and more people to go bankrupt this year, but we will make more profit to appease our shareholders and match our expected growth rate".

It's not his fault. As CEO of a public company, that's his job. And he was paid handsomely (to the tune of about $25M/yr) to execute that job. But it shows the, for lack of a meaner word, "challenges" of a system designed in this way.

It's essentially what people accuse some doctors of, but built right into the job description as a necessity. People worry that their doctor will choose a procedure or approach to their condition that is not really in their best interest, but rather makes the doctor more money. But most doctors are good people, who are determiend to (and literally take an oath saying they will) do what's best for their patient. And they certainly don't have shareholders at their backs requiring them to do the more expensive and less effective treatment. But this is the opposite. Imagine if it was literally in your doctor's job description that they had to find a way to give you the most expensive treatment, even if it was the least effective. That's essentially what for profit healthcare is.

And it's not just the cost, it's the limitations that cost creates, stifling innovation and happiness by tying people to their boring and unrewarding salaried jobs. If you ask people why they feel stuck slaving away at the 40 hour a week job that they hate instead of starting a business around something they like I would bet by far the #1 answer is healthcare. Nevermind the burden it puts on young companies to bear that expense on their end as well. Granted, we have made extreme strides in this last point over the last 15 years or so with several really large healthcare bills. Legislatively, of course, having nothing to do with generosity of the health insurers who were dragged into it kicking and screaming.

 

[Ministry of Pain]

New photos out of shooter with a clear full face shot.

Link
@Ministry of Pain

The photo in the coffee shop is very clear on the top half, they need to take that photo and then show the bottom half of this photo you linked and make a pretty good composite of exactly what this guy looks like, hard to see his eyes in the photo you linked but they are crystal clear on the coffee shop photo

 

[jamny]

New photos out of shooter with a clear full face shot.

Link
@Ministry of Pain

The photo in the coffee shop is very clear on the top half, they need to take that photo and then show the bottom half of this photo you linked and make a pretty good composite of exactly what this guy looks like, hard to see his eyes in the photo you linked but they are crystal clear on the coffee shop photo

The second pic, where he's smiling, will be the one that most people who know him will recognize, imo.

 

[Ministry of Pain]

Do ya'll remember your health care coverage in 2001?

That's when I entered the workforce. I don't remember my exact coverage back then. But what I do distinctly remember is in the November after that, we had a company wide meeting where they introduced the next year's healthcare plan, and everyone was irate. I was young and didn't care about much beyond buying a big TV with my new full time job money at the time so it didn't really bother me, but the people that actually needed healthcare were PISSED.

Then the next year we had the same meeting.

Then the following year the same one again.

Eventually we stopped having the meetings altogether, because people got tired of having to spin bad news and getting yelled at when people saw through it every year. But as I got old enough to care about health insurance, it just meant my wife and I privately had that meeting during open enrollment, where we looked at the plan and noticed our premiums had gone up, and our coverage had gone down. Every. Single. Year.

And that will continue, because it's by design. UNH isn't just a for profit company. They have a P/E ratio of almost 40. They're a GROWTH company. They don't need to just make profit every year, they need to make MORE profit every year.

How do you increase your profit every year? Higher premiums, less coverage.

This CEO, every year he worked there, signed off on changes that he well knew were implicitly saying "we're going to cause more people to die, and more people to go bankrupt this year, but we will make more profit to appease our shareholders and match our expected growth rate".

It's not his fault. As CEO of a public company, that's his job. And he was paid handsomely (to the tune of about $25M/yr) to execute that job. But it shows the, for lack of a meaner word, "challenges" of a system designed in this way.

It's essentially what people accuse some doctors of, but built right into the job description as a necessity. People worry that their doctor will choose a procedure or approach to their condition that is not really in their best interest, but rather makes the doctor more money. But most doctors are good people, who are determiend to (and literally take an oath saying they will) do what's best for their patient. And they certainly don't have shareholders at their backs requiring them to do the more expensive and less effective treatment. But this is the opposite. Imagine if it was literally in your doctor's job description that they had to find a way to give you the most expensive treatment, even if it was the least effective. That's essentially what for profit healthcare is.

And it's not just the cost, it's the limitations that cost creates, stifling innovation and happiness by tying people to their boring and unrewarding salaried jobs. If you ask people why they feel stuck slaving away at the 40 hour a week job that they hate instead of starting a business around something they like I would bet by far the #1 answer is healthcare. Nevermind the burden it puts on young companies to bear that expense on their end as well. Granted, we have made extreme strides in this last point over the last 15 years or so with several really large healthcare bills. Legislatively, of course, having nothing to do with generosity of the health insurers who were dragged into it kicking and screaming.

Outstanding post here as well, good summary and I just want to quote something you wrote
"It's not his fault. As CEO of a public company, that's his job"
Well said

 

[matttyl]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our wrk and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

How do you feel about insurance companies arbitrarily putting a time limit on how long they will cover anesthesia? So doctors either have to hurry to finish a procedure within the limit or at some point all of the anesthesia costs are out of pocket?

People are mad because premiums keep going up, and the coverage keeps getting worse.

You can say that about nearly anything. Cars? Average new car prices have been going up year over year for decades. Food? Gas? Electricity?

 

[TripItUp]

Elon Musk recently had a retweet of a graphic that depicted much of the wasteful spending in HC...not sure of its accuracy. I'll try to find it. (not a political post)

 

[NutterButter]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our wrk and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

How do you feel about insurance companies arbitrarily putting a time limit on how long they will cover anesthesia? So doctors either have to hurry to finish a procedure within the limit or at some point all of the anesthesia costs are out of pocket?

People are mad because premiums keep going up, and the coverage keeps getting worse.

Will there be an option on the intake form regarding how you would like this handled: a) wake up when limit reached, b) pay for overage oop (credit deposit required)?

 

[NutterButter]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our wrk and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

How do you feel about insurance companies arbitrarily putting a time limit on how long they will cover anesthesia? So doctors either have to hurry to finish a procedure within the limit or at some point all of the anesthesia costs are out of pocket?

People are mad because premiums keep going up, and the coverage keeps getting worse.

You can say that about nearly anything. Cars? Average new car prices have been going up year over year for decades. Food? Gas? Electricity?

Don't get MOP started on egg prices

 

[El Floppo]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our work and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

Over the last decade, I've been routinely denied access to the meds I know that work for me with a lifelong condition (cough variant asthma) and been given other meds that don't work insyead. That's fun. So instead, I wait until we do our annual trip to Mexico to buy them there at close to 1/20 the price. Mexico. Just had a Scottish coworker pick some up in the UK for me. He just put in his NIH number on the website and Wala. Didn't have to spend weeks on the phone with insurance and Dr offices just to be denied. He is horrified at the state of our system here relative to what he's used to in the UK.

My mom payed for full term in-house health care insurance for decades and finally had to use it the last year of her life while she died of ALS. We had to pay everything out of pocket (100k +/-), and we still haven't been reimbursed since she died in June. Also fun. My brother spends every day trying to get somebody to ok and send us the money..for something my mom paid for for decades.

 

[Scoresman]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our wrk and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

How do you feel about insurance companies arbitrarily putting a time limit on how long they will cover anesthesia? So doctors either have to hurry to finish a procedure within the limit or at some point all of the anesthesia costs are out of pocket?

People are mad because premiums keep going up, and the coverage keeps getting worse.

You can say that about nearly anything. Cars? Average new car prices have been going up year over year for decades. Food? Gas? Electricity?

Except cars keep getting better and better, health coverage gets noticeably worse over time.

Also health care is life and death. It shouldn't be in the same category as the other things you mention (except maybe food)., especially seeing how other countries handle it much better.

 

[dgreen]

New photos out of shooter with a clear full face shot.

No matter how careful you think you are there is always something to trip you up. This guy is realistically a dead man walking at this point, someone will know who he is and will inform the police.

Looks young

I dunno. On other forums there are people suggesting gofundme's to help this guy escape and for legal funds. And I'm not seeing this in just one or two places. This guy is a hero to some. We all seem to be posting on one of the few sane places on the internet.

I prefer to believe that a high percentage of online content is from bots and that there aren't really that many people out there who are in favor of shooting health insurance CEOs on the street.

 

[Joe Schmo]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our wrk and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

How do you feel about insurance companies arbitrarily putting a time limit on how long they will cover anesthesia? So doctors either have to hurry to finish a procedure within the limit or at some point all of the anesthesia costs are out of pocket?

People are mad because premiums keep going up, and the coverage keeps getting worse.

Will there be an option on the intake form regarding how you would like this handled: a) wake up when limit reached, b) pay for overage oop (credit deposit required)?

It'll be what it's always been, a personal liability form with your signature on it that you signed just before the operation while in admitting.

 

[matttyl]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our wrk and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

How do you feel about insurance companies arbitrarily putting a time limit on how long they will cover anesthesia? So doctors either have to hurry to finish a procedure within the limit or at some point all of the anesthesia costs are out of pocket?

People are mad because premiums keep going up, and the coverage keeps getting worse.

You can say that about nearly anything. Cars? Average new car prices have been going up year over year for decades. Food? Gas? Electricity?

Except cars keep getting better and better, health coverage gets noticeably worse over time.

Also health care is life and death. It shouldn't be in the same category as the other things you mention (except maybe food)., especially seeing how other countries handle it much better.

Re cars - ever hear the expression “they don’t build them like they used to”? It’s definitely true with my now 13 year old Toyota with 200k miles that’s literally had nothing break on it (knock wood). Sure new cars have lots of fancy bells and whistles, but give me dependability all day. Yes, off topic. Sorry.

 

[El Floppo]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our wrk and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

How do you feel about insurance companies arbitrarily putting a time limit on how long they will cover anesthesia? So doctors either have to hurry to finish a procedure within the limit or at some point all of the anesthesia costs are out of pocket?

People are mad because premiums keep going up, and the coverage keeps getting worse.

You can say that about nearly anything. Cars? Average new car prices have been going up year over year for decades. Food? Gas? Electricity?

You get what you pay for with those. If you paid 30k for a car and received a bicycle instead, that's closer to what I've been seeing with health insurance.

 

[Scoresman]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our wrk and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

How do you feel about insurance companies arbitrarily putting a time limit on how long they will cover anesthesia? So doctors either have to hurry to finish a procedure within the limit or at some point all of the anesthesia costs are out of pocket?

People are mad because premiums keep going up, and the coverage keeps getting worse.

Will there be an option on the intake form regarding how you would like this handled: a) wake up when limit reached, b) pay for overage oop (credit deposit required)?

or c) have the anesthesiologist provide a leather belt for you to bite down on when the coverage expires. Except the belt will have to be paid for out of pocket.

 

[djmich]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our wrk and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

How do you feel about insurance companies arbitrarily putting a time limit on how long they will cover anesthesia? So doctors either have to hurry to finish a procedure within the limit or at some point all of the anesthesia costs are out of pocket?

People are mad because premiums keep going up, and the coverage keeps getting worse.

You can say that about nearly anything. Cars? Average new car prices have been going up year over year for decades. Food? Gas? Electricity?

Exactly, these companies and so many others can be looked at as making life and death decisions through the choices they make around price and quality trade-offs. Just like health insurance.

While imperfect, a competitive marketplace, inclusive of shareholders seeking returns and the drive for profit have made all of these industries better over time.

 

[El Floppo]

Odds this guy gets caught today?

Like jammy said, that pic is going to be recogniZed by people who know him

 

[fatness]

All of you praising BCBS with anecdotal experiences better hope you don't need surgery anytime soon where you need anesthesia, because the surgeons are about to be racing against the clock while operating, trying not to go past the arbitrary point BCBS decided they would shut off coverage for anesthesia.

Doctors rail against insurer's new anesthesia time limits

The proposed policy will no longer reimburse anesthesia services for the complete duration of certain surgical procedures.

www.newsweek.com

I came to post the same article; thanks for beating me to it.

A couple details from the article.
- The change to stopping anesthesia coverage at a certain time limit right now is in 3 states: Connecticut, New York, and Missouri.
- What will happen is anesthesiologists will stop receiving payment for any they administer at X number of hours, and they will know this before and during the surgeries during which they'll providing anesthesia. It's reasonable to think that may affect quality and extent of care in some cases.
- The change has been made by Anthem Blue Cross Blue Shield. I believe there are multiple Blue Cross Blue Shield organizations in the US, so this may not affect all of them.

 

[matttyl]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our wrk and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

How do you feel about insurance companies arbitrarily putting a time limit on how long they will cover anesthesia? So doctors either have to hurry to finish a procedure within the limit or at some point all of the anesthesia costs are out of pocket?

People are mad because premiums keep going up, and the coverage keeps getting worse.

You can say that about nearly anything. Cars? Average new car prices have been going up year over year for decades. Food? Gas? Electricity?

Except cars keep getting better and better, health coverage gets noticeably worse over time.

Also health care is life and death. It shouldn't be in the same category as the other things you mention (except maybe food)., especially seeing how other countries handle it much better.

I’d also argue your health care getting worse argument. New technologies and treatments are being developed all the time. 10 years ago my father in law was diagnosed with cancer, stage 4. The chemo wrecked the last 3 months of his life, and he lost the battle within 90 days from diagnosis. Fast forward to last fall when my father was diagnosed, also stage 4. He’s still alive and doing extremely well, and the worst part of his chemo had been sensitivity to cold - that’s literally been it. I could go on with the treatment my son received for his idiopathic inter-cranial hypertension that wasn’t even available when I was a kid, but it would get technical really quick.

 

[Fat Nick]

I don’t think I’ve ever had a claim denied. Is it really a common occurrence that people can’t get stuff covered?

Same - and we've had UHC for coverage for about a decade or so. It's been fine. Not perfect, but covered our 2 kids, including a NICU stay, covered THREE meningioma spinal surgeries for my wife too. Probably close to $1M all-in for those. We were usually out of pocket $12K or so to hit our max, plus the cost out of my paycheck.

Admittedly my wife is very good at navigating the system. I think that's where the issues come in. You need an advanced degree to understand their fine print.

 

[Scoresman]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our wrk and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

How do you feel about insurance companies arbitrarily putting a time limit on how long they will cover anesthesia? So doctors either have to hurry to finish a procedure within the limit or at some point all of the anesthesia costs are out of pocket?

People are mad because premiums keep going up, and the coverage keeps getting worse.

You can say that about nearly anything. Cars? Average new car prices have been going up year over year for decades. Food? Gas? Electricity?

Except cars keep getting better and better, health coverage gets noticeably worse over time.

Also health care is life and death. It shouldn't be in the same category as the other things you mention (except maybe food)., especially seeing how other countries handle it much better.

I’d also argue your health care getting worse argument. New technologies and treatments are being developed all the time. 10 years ago my father in law was diagnosed with cancer, stage 4. The chemo wrecked the last 3 months of his life, and he lost the battle within 90 days from diagnosis. Fast forward to last fall when my father was diagnosed, also stage 4. He’s still alive and doing extremely well, and the worst part of his chemo had been sensitivity to cold - that’s literally been it. I could go on with the treatment my son received for his idiopathic inter-cranial hypertension that wasn’t even available when I was a kid, but it would get technical really quick.

It's the coverage that gets worse, but more expensive. Access to medications, limited providers, poor billing practices, higher OOP maximums, copays, etc.

 

[SteelCurtain]

Odds this guy gets caught today?

Like jammy said, that pic is going to be recogniZed by people who know him

I'm guessing the police will know his name by 3 p.m. and will move sometime after that to apprehend him.

 

[Scoresman]

I don’t think I’ve ever had a claim denied. Is it really a common occurrence that people can’t get stuff covered?

Same - and we've had UHC for coverage for about a decade or so. It's been fine. Not perfect, but covered our 2 kids, including a NICU stay, covered THREE meningioma spinal surgeries for my wife too. Probably close to $1M all-in for those. We were usually out of pocket $12K or so to hit our max, plus the cost out of my paycheck.

Admittedly my wife is very good at navigating the system. I think that's where the issues come in. You need an advanced degree to understand their fine print.

This has been circulating. Caveat: I'm not entirely sure of the source.

x.com

x.com

 

[matttyl]

Naive MoP wanting to pivot off the murder for a minute to understand why folks are angry at their health insurance providers

-I thought a lot of this was cleared up in the ACA/Obamacare, and to be blunt we have decent health insurance coverage thru our wrk and largely do not visit the doctor much so I guess I don't understand what the problem is. I thought we addressed these issues back with the ACA

-I had to wait on the phone almost 45 minutes the other day to get an eye exam scheduled, is that the type of things people are discussig?
I think most folks need to try and be their own doctor and take action so they don't frequent the doctor's offices.

But I understand people have pre-existing conditions and cannot help but see the doctor semi-often so I'm probably clueless what is really happening

How do you feel about insurance companies arbitrarily putting a time limit on how long they will cover anesthesia? So doctors either have to hurry to finish a procedure within the limit or at some point all of the anesthesia costs are out of pocket?

People are mad because premiums keep going up, and the coverage keeps getting worse.

You can say that about nearly anything. Cars? Average new car prices have been going up year over year for decades. Food? Gas? Electricity?

Except cars keep getting better and better, health coverage gets noticeably worse over time.

Also health care is life and death. It shouldn't be in the same category as the other things you mention (except maybe food)., especially seeing how other countries handle it much better.

I’d also argue your health care getting worse argument. New technologies and treatments are being developed all the time. 10 years ago my father in law was diagnosed with cancer, stage 4. The chemo wrecked the last 3 months of his life, and he lost the battle within 90 days from diagnosis. Fast forward to last fall when my father was diagnosed, also stage 4. He’s still alive and doing extremely well, and the worst part of his chemo had been sensitivity to cold - that’s literally been it. I could go on with the treatment my son received for his idiopathic inter-cranial hypertension that wasn’t even available when I was a kid, but it would get technical really quick.

It's the coverage that gets worse, but more expensive. Access to medications, limited providers, poor billing practices, higher OOP maximums, copays, etc.

Not to get too political, but the ACA was specifically built to do that (increase OOP max’s, copays, deductibles) - but you can choose a plan that has lower OOPs if you’d like (in the individual market), though it will obviously cost more.

Providers choose what networks to be in or out of - that said I’m vehemently against HMOs (both personally and professionally).

 

[El Floppo]

Odds this guy gets caught today?

Like jammy said, that pic is going to be recogniZed by people who know him

I'm guessing the police will know his name by 3 p.m. and will move sometime after that to apprehend him.

I like your confidence.

Agree they'll release his info sometime today, but may have to work a bit to find and apprehend him.

I wonder if he'll allow himself to be taken alive.

 

[Joe Schmo]

All of you praising BCBS with anecdotal experiences better hope you don't need surgery anytime soon where you need anesthesia, because the surgeons are about to be racing against the clock while operating, trying not to go past the arbitrary point BCBS decided they would shut off coverage for anesthesia.

Doctors rail against insurer's new anesthesia time limits

The proposed policy will no longer reimburse anesthesia services for the complete duration of certain surgical procedures.

www.newsweek.com

I came to post the same article; thanks for beating me to it.

A couple details from the article.
- The change to stopping anesthesia coverage at a certain time limit right now is in 3 states: Connecticut, New York, and Missouri.
- What will happen is anesthesiologists will stop receiving payment for any they administer at X number of hours, and they will know this before and during the surgeries during which they'll providing anesthesia. It's reasonable to think that may affect quality and extent of care in some cases.
- The change has been made by Anthem Blue Cross Blue Shield. I believe there are multiple Blue Cross Blue Shield organizations in the US, so this may not affect all of them.

Here is the update from Anthem NY:

Anesthesia billed time units update beginning February 2025​

At a glance:

• Effective Feb 1, 2025, Anthem will begin using CMS Physician Work Time values for anesthesia claims.
• Claims with anesthesia services time exceeding the set limit will only pay up to the CMS established amount; industry standards remain.
• Billing for pre- and post-operation time must follow ASA guidelines.
• Exemptions: patients under age 22 and maternity care. Follow American Society of Anesthesiologists (ASA) guidelines for pre- and post-op times.

Beginning with claims processed on or after February 1, 2025, Anthem will change how we evaluate billed time on professional claims for anesthesia services (for example, CPT® codes 00100 through 01999).

We will use the CMS Physician Work Time values to target the number of minutes reported for anesthesia services. Claims submitted with reported time above the established number of minutes will only pay up to the CMS established amount. This update will not change industry standard coding requirements or the ASA anesthesia formula.

This update will account for anesthesia work time that is included in the pre-service evaluations, intra-service period, and post-service period. The appropriateness of billing for pre- and post-operations time must be documented and follow the guidelines established by the ASA as the appropriate amount of time that should be counted and documented.

Exclusions:

• Patients under the age of 22
• Maternity-related care

Resources:

• Maximum Units Per Day reimbursement policy
• CMS Physician Fee Schedule (PSF) Federal Regulation Notice Final Rule Physician Work Time
• ASA

If you disagree with a claim reimbursement decision, please follow the claim dispute process as outlined in the provider manual. Documentation to support your request will be required.

If you have questions about this communication or need assistance with any other item, please contact your provider relationship management representative.

 

[HellToupee]

New photos out of shooter with a clear full face shot.

Link
@Ministry of Pain

Looks like a totally different backpack and jacket . I wonder where this is from

 

[Joe Schmo]

1

New photos out of shooter with a clear full face shot.

Link
@Ministry of Pain

Looks like a totally different backpack and jacket . I wonder where this is from

Thought the same thing re; the jacket and bag. Think I read this pic was from a hostile the suspect supposedly stayed at prior.

 

[massraider]

People can really defend anything, can't they?
They can defend a guy murdering someone else, and they can defend insurance companies.

Unreal.

 

[Scoresman]

Odds this guy gets caught today?

Like jammy said, that pic is going to be recogniZed by people who know him

I'm guessing the police will know his name by 3 p.m. and will move sometime after that to apprehend him.

I like your confidence.

Agree they'll release his info sometime today, but may have to work a bit to find and apprehend him.

I wonder if he'll allow himself to be taken alive.

They have to be careful releasing his full info. Starting to think there are many out there who will help this guy evade capture.

 

[Joe Schmo]

Odds this guy gets caught today?

Like jammy said, that pic is going to be recogniZed by people who know him

I'm guessing the police will know his name by 3 p.m. and will move sometime after that to apprehend him.

I like your confidence.

Agree they'll release his info sometime today, but may have to work a bit to find and apprehend him.

I wonder if he'll allow himself to be taken alive.

They have to be careful releasing his full info. Starting to think there are many out there who will help this guy evade capture.

Not with the $10,000 reward being offered, I'd sell the lot of you out for that.

 

[SteelCurtain]

The other interesting part of this health insurance debate is companies/organizations that self fund.

My work uses Aetna for the insurance. I work at a non-for-profit with 500-600 full time employees. I know my work self funds the health expenses. Therefore, we pay Aetna to administer the plan but any overage or under is paid by my employer. It almost seems like my employer pays Aetna to be the bad guy if things aren't being covered by the plan.

I'm not sure if @matttyl has any thoughts on this arrangement and how common it is. I would guess many large corporations do the same.

 

[ShamrockPride]

Idk, I'm not sure if these guys really look that similar.

One guy looks like Eminem, the other with the thick eyebrows/smile looks nothing like that.

 

[Sammy3469]

Odds this guy gets caught today?

Like jammy said, that pic is going to be recogniZed by people who know him

I'm guessing the police will know his name by 3 p.m. and will move sometime after that to apprehend him.

I like your confidence.

Agree they'll release his info sometime today, but may have to work a bit to find and apprehend him.

I wonder if he'll allow himself to be taken alive.

They have to be careful releasing his full info. Starting to think there are many out there who will help this guy evade capture.

Something's weird about the entire thing. How does a guy staying in a hostel (ie presumably not from the area) know the CEO's schedule?

 

[Stoneworker]

Right on cue with the inevitable FBG spiraling rants about corporate greed

 

[Scoresman]

Idk, I'm not sure if these guys really look that similar.

One guy looks like Eminem, the ither with the thick eyebrows/smile looks nothing like that.

The change in jacket color could be due to the lighting that is noticeably different in each photo. The color of the backpack strap, however, is telling and is clearly different. He certainly could have switched it out at some point too. The jacket in the first photo also does not appear to have pockets.

 

[IvanKaramazov]

People can really defend anything, can't they?
They can defend a guy murdering someone else, and they can defend insurance companies.

Unreal.

@FBG Moderator I don't think this is what you want on this forum.

 

[djmich]

The other interesting part of this health insurance debate is companies/organizations that self fund.

My work uses Aetna for the insurance. I work at a non-for-profit with 500-600 full time employees. I know my work self funds the health expenses. Therefore, we pay Aetna to administer the plan but any overage or under is paid by my employer. It almost seems like my employer pays Aetna to be the bad guy if things aren't being covered by the plan.

I'm not sure if @matttyl has any thoughts on this arrangement and how common it is. I would guess many large corporations do the same.

Many companies do. I'm not sure they're paying Aetna to be the bad guy, they are paying Aetna to administer the plan, which your company probably has no capability to do.

 

[Payne]

Idk, I'm not sure if these guys really look that similar.

One guy looks like Eminem, the other with the thick eyebrows/smile looks nothing like that.

I've read other sites that claim this is not the same person.

 

[Scoresman]

Imagine a photo is released of you as the suspect but you're not actually the murderer. I'd be in panic mode right now.

 

[the moops]

There aren’t that many high profile murders that go unsolved are there? I think it is like 90% they find this guy, and likely very soon.

I’m going with 99% now

 

[fatness]

This update will account for anesthesia work time that is included in the pre-service evaluations, intra-service period, and post-service period. The appropriateness of billing for pre- and post-operations time must be documented and follow the guidelines established by the ASA as the appropriate amount of time that should be counted and documented.

I'm not sure I understand this. It sounds like a requirement for anesthesiologists to keep track of their work time (makes sense) and then to match that amount of time to "the appropriate amount of time that should be counted". Submit your hours, then make them match what was pre-decided?

 

[General Malaise]

Elon Musk recently had a retweet of a graphic that depicted much of the wasteful spending in HC...not sure of its accuracy. I'll try to find it. (not a political post)

Tell you something that grinds my gears - Moda Health slapped their name on the Rose Garden here in Portland for a mere $40 Million. How are people struggling to afford healthcare supposed to feel when their insurance provider raises rates and then spends $40 Million to name a sports arena? Infuriating.

And as a dad with a type 1 diabetic, I can relate with some parents who might feel a slight tinge of anger towards their health care providers. Darth Vader had a better heart than some of these evil empires.