Reply to UHC CEO Gunned Down in Midtown Manhattan

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[quote=Anonymous][quote=Anonymous][quote=Anonymous]Did anyone read the CNN article about health insurance denials?  On a personal level, they are all terrible stories … but on an economic/policy level, I’m not so sure.

The 70 year old woman from Worcester complains that she pays hundreds of dollars a month but her insurer would not cover more than 6 weeks in a post-acute rehab center after her surgery, although it appears that center cost about 5K a week…..the economics just don’t add up.  Most elderly people will have multiple health issues and surgeries are not uncommon.  If the insurer is charging hundreds in premiums, yet paying out tens of thousands in provider charges, how can this make sense?  It used to be that these large costs were rare so the premiums paid by healthy people covered the costs of the unlucky, but now it seems like almost everyone has some health condition or needs a surgery to improve quality of life.  Post-acute in patient care is great but that wasn’t even really a thing 20-30 years ago—you just had to have family that would stay with you to help you post-surgery.

And the young girl with cancer probably picked a cheaper plan with a higher co-pay, figuring she was young and healthy.  Should insurance companies not be permitted to offer those types of plans?  I really don’t know.  The problem is that most health care consumers don’t really adequately assess their potential risks and everyone is operating with insufficient information about what their health needs might be, and what things actually cost.

As far as the paramedic and his MRI….that seems ridiculous and he probably has a good appeal.

https://www.cnn.com/2024/12/12/business/us-health-care-insurance-frustrations/index.html

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5% of the population accounts for 50% of healthcare spending. There are a lot of people like me who rarely visit doctors and have no prescriptions. I do screenings, blood work, etc., as recommended, but I'm a healthy 47 yo F who pays about $5K a year in premiums.[/quote]

This is only going to get worse as science advances.  We now have 80 something yr olds getting dialysis multiple times per week and 90 something yr olds in nursing homes that are regularly sent to trauma center hospitals for full work ups because they “fell” or are confused and sent for a head CT.   Then there’s the subset of very expensive people that are constantly going to the doctor demanding something and the doctor usually agrees or orders whatever they want because they don’t want a bad review, they get paid, and they are better off from a litigation standpoint point of they over-treat vs tell the patient no. [/quote]

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