Wondering why health insurance executives get shot?

[msc545]

Here is why:

"In an unprecedented move, Anthem Blue Cross Blue Shield plans representing Connecticut, New York and Missouri have unilaterally declared it will no longer pay for anesthesia care if the surgery or procedure goes beyond an arbitrary time limit, regardless of how long the surgical procedure takes. "

https://bsky.app/profile/moreperfectunion.bsky.social/post/3lciowinhec2f?utm_source=substack&utm_medium=email

Updates

1 y

Waking up mid-surgery to "you've run out of anaesthesia credits. Please insert $300 or your credit card to continue, or press CANCEL to continue your surgery without anaesthesia"

Updates

1 y

"When you make your living denying medical care to as many people as possible while squeezing them for as many pennies as possible, it’s just a very predictable consequence, really. Make enough enemies, eventually one takes serious aim.

[lightbulb27]

Wholly crap that is insane, goes to show how whacked the system is. I've heard of lots of issues in hospitals and had issues finding Dr in network.

It's reasonable to assume surgeries in 2040 will be "he Bob I saw you have a nice exacto set in the garage, hate to bug ya, but could you cut this splinter out and do some stitches?"

My uncle was in vietnam and shot. Had to treat his own wound and stitch up himself. Cheap! Going that direction...

[msc545]

I once sutured my own face in a mirror when I was in New Zealand and I had cut myself on a rock while white water rafting. The emergency room was actually closed and is neither do it myself or be left with a nasty scar over my eyebrow because it would have taken about 2 days to actually get it done which was about a day and a half too long. It actually came out really nice though.

[lightbulb27]

thats not easy... yikes. smart to know you had to do that, I'd just try to tape it if possible.

[msc545]

It took me awhile to do it...

[monorprise]

@lightbulb27 A cherry picked case of a single insurance company doing something you don't understand.

[lightbulb27]

@monorprise maybe and probably. but then again, if "insurance" wasn't paying for such procedures, you would go looking for a cheaper solution for most issues. the medical field/insurance/disease complex has been used to inflate the US economy for decades. it's not like they made "that" much progress in health over prior 30 years, but cost is up huge. Maybe in diagnostics and artificial knees, hips, body parts. Heart surgery... ok... that was improved with balloons rather than open heart. Some improvement... but it's really pricy. This why you go to nurse now for a lot of what a Dr used to give.
It's the govt inflating the system... raising costs... that creates such tensions. I summize... let some grad school students figure it out:)

[monorprise]

Why is it difficult to understand that any industry's prices will go up as fast as it it can when you remove price selection? @lightbulb27 This is true of healthcare just like Education which really is the way is the fastest inflating industry in the last 30 years by a lot.

Heath insurance regardless of who pays for it removes price selection from the only 2 parties that actually control both the need for and cost of the product. So yes the price will go up as fast as it can.

People get services from nurses because they are more common and require less education as well as less liability.

[lightbulb27]

@monorprise correct, but that was decided by whom?
I agree on both... when govt sticks their hands into it deeply, price goes up... that is their intent. They are not about efficiency. Education is an example.

[Juxtapose]

I mean he literally got people killed with his greed so I can't at all condemn this. For the sake of a stable society people shouldn't be doing this but at the same time these CEOs should not be playing with people's lives.

He got what he deserved.

[msc545]

Well, not only that to make it kind of worse, it turns out that the company that he worked for United health refused to pay for protection for any of its executives. The Guy received directly about a million dollars a year which seems like a lot of money and it is but executives in other companies in his position get paid up to $35 or $40 million a year. So he was underpaid on top of it. This all tells me that not only did United health not value the lives of patients. They also really didn't even value this guy's life or the lives of their executives. What does that tell you about culture in this corporation?

[msc545]

Here in California the guy that is the CEO of Kaiser health makes $35 million a year. Here is quite a difference.

[Juxtapose]

CEOs get paid way too much but at the same time yeah, that entire company is fucking evil.

[msc545]

Yes. A culture of greed.

[ProbablyClueless]

The concept of an anesthesia credit made me laugh

[msc545]

Glad I got you to laugh, although it is kind of grim humor...

[Anonymous]

Leftist blame health insurance executives for what their own goverment has via mandates and anti-competitive regulations & taxes made them.

Otherwise the response of people to healthcare companies behaving badly would be simply to go to a different company, or if they were not honoring their contract to sue them in court.
There is never anything to gain by going after the people who work there.

[msc545]

Government regs are NOT responsible for the behavior of healthcare companies no matter how you try to spin this. GREED is responsible along with the fact that the executives are sociopaths. Go try to sue a healthcare company and - if you can get an attorney - see how much it costs, how long it takes, and how much you do not collect even if you "win".

[Opinion Owner]

Not sure why you have such a had time believing politicians and their countless bureaucrats are not also greedy.

Greed is only checked by competition, and like it or not a goverment tasks with actually important to everyone else responsibility like physical security is not in very much if any competition on making everyone much-less the minority with your particular medical issue happy.

They are however responsible for a ridiculously over complicated and pricely court system.
They are likewise just as they are responsible for the tax rules that make your employer (not you) the buyer thus eliminating most of the quality and price selection in insurance market.

They are entirely responsible for most of the cost and policy mandate both directly via laws and indirectly via an unaccountable and lawless court system.
They are for the same reasons entirely responsible for the enormous web of regulations that make running any insurance business heavily favor the big over the small and thus the very few providers that are available even to your employer.

[msc545]

I don't think you are wrong about all this, but there is a lot more to it. Politicians don't make up a rule like "we will only pay for X minutes of anesthesia no matter if the surgeon is finished or not". That actually happened yesterday even though it was rescinded when someone reminded the people that were instating it that they were very likely to be sued vigorously over it.

[msc545]

The people who created that rule did so specifically to increase PROFITS. That is all there was to it, and that is not complicated at all.

[Opinion Owner]

@msc545
Its hard to blame insurance companies for making such rules when they as a 3rd party payer are in an impossible position. As the only party that is selected on price at all they are asked to control costs however they control neither patent making the poor health choices nor provider.

The fact that they are further removed from the patent by way of the employer makes it all the more difficult for them to get the patient to understand their role and responsibility.

Health insurance would be more like car insurance without the employer middle man, still expensive but more people would do more to take care of it themselfs, or see doctors out of pocket thus creating a little more of a market.

All of which we can easily do with modern teli-medicine and AI.

Regardless the idea of insurance creates what is called in market speak a "a moral hazards" which all but garrentees the price of the insured goes up as fast as possible. It only works if only a minority really uses it, with everyone else is engaged in price selection for the same services.

This is the kind of thing that a good goverment managing an economy would actually outlaw.

[msc545]

So amidst all that verbiage my take from it is that you think that only people who don't take good care of themselves need anesthesia, correct? Maybe we should schedule some surgery for you but forget the anesthesia and see how well you do it.

[Opinion Owner]

@msc545 All I said was that insurance company created a crazy rule to try and control cost and avoid abuse because they didn't have any better options.

[msc545]

They have the option of denying payment which is very simple and widely used. Very occasionally it leads to a lawsuit but most often it does not.

[Opinion Owner]

@msc545 Yes they do have that right, but your 1 assuming its them who changed the terms and not the provider or if it was that the are not saying a doctor should be able to do the job in that much time and that is how much they are willing to pay.

This represents a valid way to control cost and make the provider assume responsibility for the failure to do the job in a timely way. In other-words deny cost+ billing.

[msc545]

Yeah why don't we just have insurance claims adjusters doing all the medical care.

[Opinion Owner]

@msc545

Maybe you should which appears to be the direction this insurance company did in setting what they think should be necessary. The trouble is they are in a poor position to know or control costs. An adjuster is suppose to be a contractor or in healthcare anther doctor.
Which might as well just do the work given diagnoses is most of what doctors do.

So your really talking about the original employer health care benefit plans such as offered by Kaiser. But that only allows for a limited network the plan directly owns and really does limit what you can get often enough by not even telling you it would be helpful.

This is what some government's simply run and why its easy for their leaders to kill off undesirable groups, via policy changes. Thus it only works if you have a small homogeneous country where any policy will have a more uniform effect who's desperate impacts on individual have a better chance of being both known and important to an electoral majority.

So it is still a unstable system anytime the indiviual getting the service is not paying directly for it.

[msc545]

No we do not just do diagnoses, We also do treatment as you might have noticed.

[Opinion Owner]

@msc545
Unless your hospitalizing someone a doctors billable encounters with each patent are mostly relative brief. They are not spending weeks non-stop doing work for each patent as a contractor might.

This changes the math in terms of the cost of having a insurance company doctor diagnose you.
The other treatment services can still be handled by someone else. But that often involves similar discretion unlike say a house where a maximum scope of work is fairly clear cut at the cost of the house.

[msc545]

I hospitalize people.

[goaded]

Republicans normalised political threats and violence, now the violence is being targeted at people they approve of (but normal people don't). Shame.

[KrakenAttackin]

Damn, WTF? Maybe a few more CEO's need to get schwacked.

[msc545]

" In fairness, someone did do something about an insurance company CEO earlier today in NYC"

[exitseven]

I think I smell a bunch of malpractice suits the first time people start waking up halfway through a heart transplant

[msc545]

People do occasionally come far enough out of anesthesia to see and feel what is going on, but dissociative anesthetics are often used, and when they finally regain consciousness at the appropriate time they have no memory of this fortunately.

[exitseven]

If a wake up on the table there will be hell to pay

[msc545]

You will neveer remember that it happened, but I hope it never does.

[exitseven]

I woke up during a colonoscooy and I asked the doc what was on TV,?

[msc545]

That should not have happened.

[exitseven]

It really did and I remember it

[msc545]

ouch

[msc545]

So it turns out that Blue Cross got the message from about a zillion people, and late today decided that this particular scam was a bad idea and decided they would not try to limit anesthesia time after all - which means that some bean counters that work there figured out it would cost them more to keep it in place than to rescind it at least for now.

In other news, they are still in the business of denying claims and making sure they don't have to pay for the medicines and procedures you need to stay alive and healthy. They just want your money.

[exitseven]

It really did not hurt and it was pretty entertaining once he explained what I was looking at. He said i had the cleanest colon he ever saw.

[msc545]

Lucky you!

[exitseven]

@msc545 I am a perfect asshole

[msc545]

Good to know.

[Agape93]

Guarantee you they'll change their tune if they start getting killed left and right for it

[DryGermanGuy]

American „health“care is downright crazy.

[dustybiker2]

File this next to demonic psychopathic.

[coachTanthony]

Yep that’s terrible