So tone deaf it's almost a dog whistle

This is still validating the profit incentive of private health insurance.

If the doctor prescribes unnecessary care, it should be none of these peoples' business, because they shouldn't be allowed any stake in the decision whatsoever.

It’s the same trick as rebranding bank robberies to identity theft. It puts the blame on the consumer who can’t afford to defend themselves.

Really what it should be is that if a doctor prescribes unnecessary care

That's the core problem. The entity that defines unnecessary care is health insurance. And there are TONS of stories of them denying Diabetes medication for people with diabetes and anti-nausea meds to pediatric patients getting chemo.

If they were doing the right thing, no one would be pissed off. The "recent target" was the one to decided to run on AI driven denials that were denying 90% of care for months.

They are not fulfilling their duty to take the money from the subscribers and pay their righteous medical bills and instead using it as raw profit.

They are employing their own 'doctors' to prove stuff that is definitely necessary is labeled unnecessary.

Patients usually have the least amount of power. That's why.

My attitude is that if the doctor prescribes unnecessary care there's a professional board for that.

Though let's be real, the health insurance for profit industry is the problem and it's not going to get better until we get rid of it

They are done by medical professionals who have no obligation or incentive to serve the best interests of the patient. If your doctor fucks up, he can be found liable. If the insurance doctor fucks up, there is no liability whatsoever. Cases have been brought to court and then immediately thrown out because there is no legal basis for holding them accountable.

Except in this case, they used AI to help them make decisions. The lawsuit is still ongoing so I shouldn't speak in definitive terms, but considering the circumstances and evidence I think it's pretty clear than they have tried to automate some processes and didn't audit them properly.

Medical professionals that spend an average of 6 seconds per case. And keep getting caught with revoked/expired licenses. And well outside their area of expertise (the classic example is failed dentists deciding on cancer treatments).

There is a lot of crap that they’re able to instantly deny through your plan’s terms and conditions.

It’s worth reading the plan summary of what won’t be covered, even if it’s prescribed treatment. Some of the shit that’s hidden in there is fucked up.

This year someone in my family started to have to pay out of pocket for their GLP1s because their diseases didn’t progress far enough for the treatment to be covered. They’d rather you hurry up and die than pay for expensive drugs that keep you alive for longer.

I don't have a source. But i've read they are incentivized to go through as many claims as they can, and not to approve too many.

Even if this were the case (it is not in any real sense, see your other replies), the fact that it is done by a for profit entity that will lose money by approving a claim all but ensures the process will not be neutral or correct.

I don't have sources, but I seem to recall reading somewhere that the OGs aged out or got caught, and the new gen that replaced them weren't as ideologically driven or competent or something. I think they still technically exist but aren't nearly as influential as they once were

I think they all just got jobs, honestly.

Poh-tay-toh tuh-mah-toh

It's WeeGee time.

And you wish that'd prevent them from talking. Alas here we are.

I know right?

Now I'm a bit jealous!

So it's a good argument for single payer healthcare

No it doesn't but I can understand why they don't greenlight everything. This all is a glaring example why we need single payer health care and doctors that earn a flat rate and not get paid per procedure (there is a name for this, i don't know it).

A few. I had a primary care doctor who would talk my ear off. After we discussed whatever my problem was he would talk about religion and politics. He was pretty right wing, me having a catholic school education and have long paid attention to politics can hold my own. The odd thing, there was always a waiting room full of patients but he would gab on and on. Eventually I came in for an appointment and I said to his receptionist "the doctor sure doesn't rush me out of there". That's when she said "yeah most insurance companies want you out in fifteen minutes". At that moment it clicked. The doctor was always looking at his watch, if he went over fifteen minutes he could charge for another fifteen minutes. He also had a waiting room full of posters and pamphlets paid for by pharmaceutical companies. He suggested prescribing me medication for my anxiety, i just laughed. My doctor now has none of that propaganda in his waiting room. My last visit he pushed eating fresh fruit and vegetables. I told him that's why I come to him, he tells me what I don't want to hear. I had a dentist who was the same way. Also very religious and right wing.