Patients, advocates and researchers welcome regulations but argue rules don’t go nearly far enough to tackle scale of problem
A new set of rules from the Biden administration seeks to rein in private health insurance companies’ use of prior authorization – a byzantine practice that requires people to seek insurance company permission before obtaining medication or having a procedure.
The cost-containment strategy often delays care and forces patients, or their doctors, to navigate opaque and labyrinthine appeals.
The administration’s newly finalized rules will require insurance companies who work in federal programs to speed up the approval process and make decisions within 72 hours for urgent requests. The regulations will also require companies to give a specific reason as to why a request was denied and publicly report denial metrics. The regulations will primarily go into effect in 2026.
But I thought if we had universal healthcare there would be death panels deciding whether gradma got her medicine! Now you’re telling me its the private insurers that do that?
Now you’re telling me its the private insurers that do that?
Always has been.
I was being ironic
Hence the meme response.
Medicare for All would have evil government death panels. Health insurance is evil corporate death panels, which are better because reasons.
They were outraged that the death panels wouldn’t be able to use profit motive any more.
I want my death panels incentivized by … keeping me alive to keep paying taxes, instead of incentivized to reduce costs and increase short-term profits.
Everyone does that. Unless you are filthy rich you cannot afford whatever medical costs you might have. Private insurance means you get to choose which death panel decides your case - except that the way insurance is setup in the US you don’t get that choice.
Okay, stupid question, as an European I don’t know if that’s the case with our insurance. Sure there may be waiting times for organ donors or whatnot, but healthcare is not going to put me into debt. I’ve had one in a million illnesses in my family where one has to stay at a hospital for months before and after a complex surgery, but it never has been a money issue.
Most beople have health insurance here and don’t go into debt. it is a minority that run into problems.
you may not be allowed some expensive care, but your doctor won’t tell you it is an option elsewhere as you can’t get it. If you have such a condition you could go to a different country for care, but odds are you don’t as such things are rare.
My friend just went through this recently.
She had significant sinus problems, one side being blocked entirely. Went to see her doctor, went to see a specialist, tried some things, but what she needed was surgery to get rid of polyps. She schedules it, takes off of work, gets a blood test, goes to the surgical center, and as she is being prepped for surgery, finds out they have to cancel, because her insurance was denying a part of the procedure.
What a huge fucking waste of time and money.
She did get a reason in the rejection letter, but it just pissed me off even more. The insurance company has a “doctor” who said the procedure might not be necessary, so they want to try doing X and Y first. Things she’s already done. Things her PMC doctor and specialist already know, but this one asshole who sold his soul to an insurance company gets paid to skim shit and say “no.” There are plenty of people in the insurance company structure to hate, but some of them are outright scum.
Also, to state the obvious, this is just slowing down the misery machine, when we should be dismantling it. I know it will help people, it’s a small victory, and the Republicans will want to turbo-charge said misery machine, but still.
Going through this right now. Had to change insurance because of new job, this new insurance is fighting tooth and nail to not pay for the medicine I’ve been taking for years that keeps my Crohn’s under control. I’ve been without it for over a hundred days, and things are starting to backslide.
Literally, I’m getting sicker as they waste my time. They’re shit genuinely sickening.
Name and shame
For what it’s worth, contact your employer’s benefits coordinator. They can often slap the insurance company around since they’re the people essentially paying the bill.
Time for my link:
Frame Canada
Wendell Potter spent decades scaring Americans. About Canada. He worked for the health insurance industry, and he knew that if Americans understood Canadian-style health care, they might… like it. So he helped deploy an industry playbook for protecting the health insurance agency.
Thanks for that link!🏆
Health Net does this BS all the time. Even care that has been previously approved and paid for is regularly denied if needed again because “It’s not a covered service.” It would literally take hours on the phone to convince Health Net’s customer service that they needed to pay a claim, and even then there was no guarantee that they would actually pay it. Three 60 minute calls to get a bill paid were not unusual.
One time Health Net refused to pay for care they had previously approved in writing. Monthly calls were ignored for 8 months until the medical center sent the bill to collections.
Increasing profits because your company refuses to pay for contracted & covered care should be illegal.
i love how we constantly jerk off about how we’re the best and richest and freeest country in the world but we do this to our citizens
In what universe is 72 hours considered an acceptable response time for anything considered “urgent”?
US healthcare is extortion.
Fun fact, a prior authorization is not a guarantee of payment. They’re just definitely denying payment without. They still could deny even when this process is followed. And for many treatments and situations it’s totally unfeasible anyways.
Federalize the health insurance industry.
Just ban prior authorization and don’t let them deny care. Or even better, switch to single payer and get those parasitic businesses out of healthcare.
The answer to the whole mess is single payer. Where the hell is Biden on that?
Pretty much the same place any other American president is when they try to change the health care system. Hog tied by the insurance industry.
The administration’s newly finalized rules will require insurance companies who work in federal programs to speed up the approval process and make decisions within 72 hours for urgent requests.
All I’m seeing is suddenly every request will not be urgent. Your heart transplant isn’t that urgent, see your not dead yet.
