Waiting times for tests and treatment after cancer diagnosis

[rivrrat]

And I would prefer to NOT have my health care managed by a profit motive. Whether I get treatment or not being managed by whether it makes the company money or not places my care, not in my health providers hands, but in the insurance company's stockholders hands. I don't want a stockholder telling me whether I should have the prescription I need or not.

They can't tell you that. All they can tell you is that they won't cover it.

 

[WI Crippler]

I'm sure there are problems with the NHS, no health service is perfect but i would never wish to replace NHS for a US model in which only the rich can afford it....

I'm not rich, and I can afford good health insurance.

 

[WI Crippler]

I don't want a stockholder telling me whether I should have the prescription I need or not.

Stockholders don't make that decision. A liscenced healthcare professional employed by the insurance company does.

 

[WI Crippler]

It's birds of the same feather, Goshin. I don't want it in the private insurers hands because they make decisions based on their profit margin and their stockholders...not my health. Greed rules. Reason and sense goes out the window.

So you'll trade that for your healthcare being decided according to a government budget? Our government is increasingly going broke(beyond that point really). At least if my healthcare provider is making profit, they can afford to continue to provide healthcare.

 

[WI Crippler]

That is an oversimplification. I have lost count of how many times insurance companies have denied treatment, even when the provider has deemed it medically necessary...so unless the client can afford out of pocket costs, the treatment doesn't happen. The thing that lots of folks miss is that with the expense of medical care, many people wait until problems get out of control. I see it all the time. Proactivity and attending to minor issues until they become major is one way for overall medical costs to be reduced.

But the UHC proposals are not proactive in nature Captain. Will they ban policyholders from smoking? Will they prohibit users from drinking alchohol in excess? Will they prevent people from engaging in extreme sports/activities? Will they take steps to reduce dangerous lifestyles that lead to traumatic injury and/or increased levels of sickness?

No it will not. And thus is will always be a reactive system, and doomed to failure.

 

[Ethereal]

Greed rules. Reason and sense goes out the window.

What are you basing this on? What actual statistics can you provide that would indicate insurance companies operate absent reason, or that they are consumed with greed?

 

[Laila]

Everyone has access, politicians and supporters of a UHC system like to portray it as otherwise.

Government has no business setting prices, it costs money to research and make drugs and to develop new technologies to treat patients. They should be able to charge what the market will support.

The FDA regulates medical devices and drugs, however, the FDA is full of political hacks and industry insiders that all screw our system up.
If I had it my way they would be fired and possibly thrown in jail.

The FDA is one of the most corrupt institutions in our government.

So theoretically speaking, a cure inside US can cost astronomical prices and be impossibly expensive in which only few can afford it if the company wished to put it at that level and Government cannot stop it?
Another reason i am happy to have a NHS, No such thing as ridiculously high prices for medicine.
The companies get some form of a profit but not at the expensive of others.

The problem with NHS is that it doesn't offer an incentive to not use it.

If you have to flu you shouldn't go to the doctor, there is nothing s/he can do for you. It's a problem here, people run to the doc when they have a cold or flu and ask for antibiotics which don't work on virus'. They don't bother to learn that though.

I only ever use NHS if i am near death, otherwise i do not bother but i notice everytime i go into GP. It is old people wanting to talk to their doctors about the most minor of things or parents.

and the incentive to go private is there. Govt. will take half as they are the ones getting the bargain and it eases up the NHS lists if more people go private.

 

[Harry Guerrilla]

So theoretically speaking, a cure inside US can cost astronomical prices and be impossibly expensive in which only few can afford it if the company wished to put it at that level and Government cannot stop it?

Theoretically yes, practically no.

If something is so astronomically high priced, a companies customer base will be incredibly tiny. To the point where they may go out of business.

Lets think about initial high costs though.
Remember when flat screen TV's first came out?
Who do think could most likely afford them? Rich people

Look at the prices now, an average person can buy one at a reasonable price.
Why is that, because rich people paid for all the R&D costs associated with that new product.

Now replace flat screen tv with medicine or a new treatment.
The same effect follows.

Another reason i am happy to have a NHS, No such thing as ridiculously high prices for medicine.
The companies get some form of a profit but not at the expensive of others.

Most medicine prices are reasonable though.
Walmart and Kroger(grocery store) have $3 prescriptions on the most common medicines people take.

New medicines and the kind for very rare illnesses are expensive but is your life worth $500 a month?
Most people don't blink an eye at that when they are financing a car.

I only ever use NHS if i am near death, otherwise i do not bother but i notice everytime i go into GP. It is old people wanting to talk to their doctors about the most minor of things or parents.

and the incentive to go private is there. Govt. will take half as they are the ones getting the bargain and it eases up the NHS lists if more people go private.

I think you should use it when you need it. It's what you have and I'm not faulting you with that.

I think you would be quite surprised at the level of care people receive here.
I have a family member that has had tons of surgeries and nearly every single time she has always had a private hospital room. We do have a high level of care.

 

[CaptainCourtesy]

What are you basing this on? What actual statistics can you provide that would indicate insurance companies operate absent reason, or that they are consumed with greed?

This is pretty much basic common sense.

1) Why is an insurance company in business? To make money. Unless a company is non-profit, the purpose of a company is to make money. These companies are publicly owned. Stockholders want a return on their investment. Best way to do that is to minimize cost and maximize intake. Denying services, as much as possible, without completely destroying the supposed premise of the company is the best way to do that. Pretty basic business model: more in, less out = more profit. Greed with less regards to services.

2) The insurance industry's flaw and the best example of why their focus is the bottom line and NOT health care is the utilization review system. A reviewer, one who never sees the patient, can deny a service...just because. I have had reviewers say to me, "that's too costly", or "this is taking too long...I'm denying service", when the benefit is available. This is not only medical care without reason, but unethical. Someone, not the patient's provider, is dictating medical care.

I am not for UHC, but I am for stringent regulations on the insurance industry, including the elimination of the utilization review system, caps on malpractice payouts, and the ability to sue an insurance company if they deny treatment when a patient's medical professional says the treatment is necessary. Though I am not for UHC, if I have a choice between what we have now and that, I choose UHC.

 

[Laila]

I think you would be quite surprised at the level of care people receive here.
I have a family member that has had tons of surgeries and nearly every single time she has always had a private hospital room. We do have a high level of care.

I probably would be.
Health care in US is really painted as the worst thing you can imagine over here with millions unable to get care and medicine costing alot and people going into debt to have operations and only the rich able to get away with it and drug companies having a stranglehold over your system. It's the stuff of nightmares.

 

[Harry Guerrilla]

I probably would be.
Health care in US is really painted as the worst thing you can imagine over here with millions unable to get care and medicine costing alot and people going into debt to have operations and only the rich able to get away with it and drug companies having a stranglehold over your system. It's the stuff of nightmares.

It's not really like that at all.

I do admit that some medicines cost a lot, but a great many people bitch about have to pay for any prescription or service even though it may be saving their life. Any common prescription is reasonably priced here.

I make about 30k a year and have insurance, I had to get some vaccinations for school and some lab work about 2 weeks ago. I called them Thursday to see if they accept walk ins. I went back Tuesday paid my $30 copay got my stuff done. had to go back 1 week later because the lab dropped my blood and it broke so they had to get another vial. Waited for the results, had to go back and get another vaccination. They took me in on the same day that my results came back even though I hadn't made an appt.
I was in and out in 10 mins.

I had to make 3 visits and it only cost me $30, it did cost the insurance company more than that but I haven't been to the doctor in about 8 years and this is the first time I used my insurance in 2 years.

A good portion of the complaining comes from elderly or near retirement people who never saved and are on Medicare. They think that their treatment should be free, even though they never paid enough to cover what they are getting now.
Our Medicare deficit is in the trillions of dollars.

 

[CaptainCourtesy]

Something I'm finding interesting. The perception of US healthcare in countries that have a UHC is pretty similar to the perception that some in the US have about the healthcare in countries with a UHC. I am starting to conclude that this is nothing more than a partisan issue and that nothing is going to be resolved until folks from both sides can drop their adherence to their respective ideologies and work together to create something that makes sense, both from a cost-effective standpoint, and from a healthcare needs standpoint. When one side only focuses on one, and the other only focuses on the other, we have what we generally have had for a long time. Gridlock and a system that works poorly.

 

[Ethereal]

This is pretty much basic common sense.

1) Why is an insurance company in business? To make money. Unless a company is non-profit, the purpose of a company is to make money. These companies are publicly owned. Stockholders want a return on their investment. Best way to do that is to minimize cost and maximize intake. Denying services, as much as possible, without completely destroying the supposed premise of the company is the best way to do that. Pretty basic business model: more in, less out = more profit. Greed with less regards to services.

2) The insurance industry's flaw and the best example of why their focus is the bottom line and NOT health care is the utilization review system. A reviewer, one who never sees the patient, can deny a service...just because. I have had reviewers say to me, "that's too costly", or "this is taking too long...I'm denying service", when the benefit is available. This is not only medical care without reason, but unethical. Someone, not the patient's provider, is dictating medical care.

I am not for UHC, but I am for stringent regulations on the insurance industry, including the elimination of the utilization review system, caps on malpractice payouts, and the ability to sue an insurance company if they deny treatment when a patient's medical professional says the treatment is necessary. Though I am not for UHC, if I have a choice between what we have now and that, I choose UHC.

So, what is it specifically health insurance companies are doing that you find objectionable? Arbitrarily denying claims? What would you consider an “arbitrary” denial? What percentage of claim denials are actually arbitrary? Do you have any data which would help confirm your implications of unfettered greed?

 

[Renae]

Horror stories abound, but for the most part, they are only stories. Remember you can hear horror stories about capitalistic system health care as well. Here are some facts comparing Canadian and US systems:

Mythbusting Canadian Health Care -- Part I | OurFuture.org


Mythbusting Canadian Health Care, Part II: Debunking the Free Marketeers | OurFuture.org

ourfuture.org

Yes a propaganda special interest site, LOOKS LIKE A GREAT SOURCE TO ME!

/not


Seriously, it's amazing the places people go for information.

 

[Renae]

Something I'm finding interesting. The perception of US healthcare in countries that have a UHC is pretty similar to the perception that some in the US have about the healthcare in countries with a UHC. I am starting to conclude that this is nothing more than a partisan issue and that nothing is going to be resolved until folks from both sides can drop their adherence to their respective ideologies and work together to create something that makes sense, both from a cost-effective standpoint, and from a healthcare needs standpoint. When one side only focuses on one, and the other only focuses on the other, we have what we generally have had for a long time. Gridlock and a system that works poorly.

People that don't know anybetter tend to not realize they are getting shafted. 6 months for treatment, well hey that's the norm so why complain?

 

[CaptainCourtesy]

People that don't know anybetter tend to not realize they are getting shafted. 6 months for treatment, well hey that's the norm so why complain?

And people who don't know any better tend to not realize they are getting shafted. Treatment denied because someone who has never seen the patient says so, arbitrarily. But if that's the norm, why complain?

See how this works?

 

[Ethereal]

And people who don't know any better tend to not realize they are getting shafted. Treatment denied because someone who has never seen the patient says so, arbitrarily. But if that's the norm, why complain?

See how this works?

What's an "arbitrary" denial? What percentage of claims are "arbitrarily" denied?

 

[CaptainCourtesy]

So, what is it specifically health insurance companies are doing that you find objectionable? Arbitrarily denying claims? What would you consider an “arbitrary” denial? What percentage of claim denials are actually arbitrary? Do you have any data which would help confirm your implications of unfettered greed?

An arbitrary denial would be one where the provider states that the patient needs a specific treatment and gives the reasons for this. In response, the insurance company denies treatment because "this is too costly", "it is taking too long", "we don't pay for treatment this way", or "we don't agree", all of these without seeing the patient. I have heard each of these statements many, many times. I haven't looked at the data, but I have 20 years of dealing with insurance companies on a near daily basis to speak of. I also have spoken to many in the industry who report the same things...or worse. Insurance companies are businesses. Their focus is to make money.

 

[Ethereal]

An arbitrary denial would be one where the provider states that the patient needs a specific treatment and gives the reasons for this. In response, the insurance company denies treatment because "this is too costly", "it is taking too long", "we don't pay for treatment this way", or "we don't agree", all of these without seeing the patient. I have heard each of these statements many, many times. I haven't looked at the data, but I have 20 years of dealing with insurance companies on a near daily basis to speak of. I also have spoken to many in the industry who report the same things...or worse. Insurance companies are businesses. Their focus is to make money.

Solidus has already provided an excellent argument to the contrary:

1) How often do insurance companies "arbitrarily" deny claims?
This figure doesn't seem to be popular, even amongst groups or lawyers who help you appeal insurance denial claims. For example, "healthclaimappeals.org" only quotes a percentage for Medicare (10%, non-sourced) but declines to give one for private insurers.[1] Office of Health and Human Services sampled Medicaid in 8 states in 2000, finding "On average, about 15 percent of claims submitted for payment contain fatal
errors."[2] Maryland passed "clean claims" legislation in an effort to reduce the various clerical errors that result in denied claims. They now track claim denial rates to guage the success of the legislation. Using a Base Group of both private insurers and HMOs they find that in 2007 15.7% of all claims were denied.[3] Assuming Maryland is average, then both public and private insurance have effectively the same denial rate.

Answer: Both public and private insurers deny claims roughly 15% of the time.

2) What are the "arbitrary" reasons to deny claims?
"healthclaimappeals.org" suggests three:

" * It is a duplicate or inauthentic claim. This happens more than you might think. Sometimes individuals or their health insurance provider will accidentally submit the same claim more than one once for payment. Insurance plans are also on the lookout for health insurance fraud, which is a major problem confronting the system.
* The policy that was purchased by you or your employer or established by the public program doesn’t cover the service or product in the claim. As an example, some plans don’t cover dental services or elective procedures.
* The claim is for a service or product that the medical community considers to be experimental because it has not been proven to be safe and effective. Most plans purchased by employers and individuals do not cover experimental treatment."

[1]

Office of Health and Human Servies suggests:

"The most common fatal errors include missing or erroneous:
* provider and patient identification numbers,
* birth dates,
* diagnostic information, and
* prior authorization information."

[2]

Maryland Insurance Administration reports the most common reasons are:
"* Duplicate claim submission (31.7 percent)
* A pre-treatment authorization or referral for services was not obtained or unauthorized services performed were not covered by plan (19.8 percent)
* The patient was not covered or eligible for benefits at the time services occurred (9 percent)
* The patient had met the maximum benefit at the time services occurred (9 percent)"

[3]

Answer: The most common reasons are either insufficient information (for Medicare), or the claim is a duplicate (for private insurers). Procedure not covered or procedure considered unsafe or ineffective are secondary.

3) Of the reasons given for denying claims, what impact do doctors employed by insurance companies have?

If we assume that Maryland's "clean claims" represent those claims that are free of clerical errors, and that the only remaining reason for denial was the influence of an "in house" doctor (this is a generous assumption); then the percentage of clean claims denied can work as a proxy for "claim denied due to insurance doctor influence". For 2007 5.3% of "clean claims" were denied. For 2004 - 2006 the average was 1.5%.[3] Possible reasons for the increase in 2007 are provided in the report, "The most significant change in 2007 from the previous three years is the nearly four-fold increase in the number of claims denied because a pre-treatment authorization or referral for services was not obtained or unauthorized services performed." [3]

Answer: Insurance company doctors are responsible for between 1.5% and 5.3% of claims being denied (probably closer to former given both the lax assumptions and the anomaly of 2007 data).

Conclusion: Roughly 15% of claims are denied, and almost a third of those are denied because they are duplicates. Medical doctors employed by insurance companies have very little impact on the rate of claim denials, accounting for 5% or less of denials. Further, this assumes that all "in house" doctors act contrary to overall medical "best practices"; which has yet to be demonstrated. Banning doctors from being employed by insurance agencies will have little impact on reducing claim denials.

J

[1] Frequently Asked Questions - HealthClaimAppeals.org
[2] http://www.oig.hhs.gov/oei/reports/oei-05-99-00071.pdf
[3] http://www.mdinsurance.state.md.us/sa/documents/Cleanclaimsreport05-07-final01-09.pdf

 

[CaptainCourtesy]

Solidus has already provided an excellent argument to the contrary:

I reject Solidus' position. I do not consider those situations denying arbitrarily, Those are denials due to error. Happens all the time. But there are plenty of other denials that may seem arbitrary, but are a bit too coincidental. How about sending a claim to one place, being told it should go to the other, and when you send it to the other, being told it goes to the first? When this happens over and over, over a 6 month period with no resolution, one needs to start to wonder.

How about when one gets a denial because a worker misread a subscriber's policy regarding their deductible or benefit, and then refuses to correct this? Happens a lot where I work. The fix it...after countless calls and several months. Their hope is that the provider gives up.

Along with the arbitrary denials I already mentioned, these are the kinds of things I am discussing. Solidus is discussing errors. Errors happen and are not what I mean.

 

[BWG]

I reject Solidus' position. I do not consider those situations denying arbitrarily, Those are denials due to error. Happens all the time. But there are plenty of other denials that may seem arbitrary, but are a bit too coincidental. How about sending a claim to one place, being told it should go to the other, and when you send it to the other, being told it goes to the first? When this happens over and over, over a 6 month period with no resolution, one needs to start to wonder.

How about when one gets a denial because a worker misread a subscriber's policy regarding their deductible or benefit, and then refuses to correct this? Happens a lot where I work. The fix it...after countless calls and several months. Their hope is that the provider gives up.

Along with the arbitrary denials I already mentioned, these are the kinds of things I am discussing. Solidus is discussing errors. Errors happen and are not what I mean.

CC, I pointed this out to him about 3 weeks ago...:shrug:

Did you look at the at the 'proof' that you quoted from Solidus?

These aren't studies on denial or cancellation of coverage by insurance companies.

All three sources are talking about the costly, inefficient, confusion of filing of paperwork and the appeals process after the fact. The first two 'suggest' reasons why the claim was originally denied, the Maryland one spoke of clerical errors.


http://www.debatepolitics.com/break...sses-deathbed-measures-14.html#post1058111215

 

[Anima]

Really so no one in the UK is waiting on the Government to approve treatment?

Nope, not unless the treatment required hasn't been liescenced for general use. The government doesn't approve individual tretaments in the UK; that responsibility goes to the doctors involved with each individual case.