• 30 Posts
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Joined 11 months ago
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Cake day: October 25th, 2023

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  • Then fair enough, I apologize for assuming she works in private insurance. Your initial framing and argument made it seem otherwise. I still think you and I disagree on the need for widespread chart reviews for medical necessity.

    When you said doctors are not infallible, you said it in response to my claim that, in essence, the treating doctor should always get deference. It is natural to assume that you did not believe the same standard applied to reviewing doctors at Medicare since you’ve been arguing the same.

    As you note, treating doctors frequently appeal Medicare denials. That’s a lot of wasted time and money. I see no evidence that these denials are saving more money than is being wasted fighting them. I’m having trouble finding data for traditional Medicare, but for Medicare Advantage, appeals routinely get overturned to such a degree that Congress investigated it.

    You stated earlier that doctors are required to take notes and your wife relies on these notes when making a recommendation. Doctors are notoriously bad at documentation. It’s why relying on their notes to make a judgment as to medical necessity is a terrible idea. I firmly believe no one should be denied coverage because their doctor sucks at writing a report.


  • Medicare or Medicare Advantage? Because Advantage is private. Medicare has like 5 levels of appeal, including to a federal court, most of which is free. There are systems in place to allow challenges to the reviewing doctor’s denial. Private insurance typically forces arbitration.

    I have problems with Medicare’s system too, especially when it comes to claims denials. If it is a covered item or procedure, the claim is not fraudulent, and the insurance provider has not met the patient to perform any exam, then going off of notes and comparing with best practices is insufficient to deny a claim. This may surprise you, but the doctors hired by insurance are not magically better than the ones treating the patient.


  • Yes, of course you’re right. That’s why my surgeon friend who works in oncology has to frequently waste his time calling insurance over denied claims regarding fucking treatments for cancer patients. Truly medically unnecessary, which is why they’re pretty much always reversed and when they’re not, he gets to tell the patient they are going to die because someone who has never met them denied their claim as medically unnecessary. Same goes for my friend in the PICU, except she gets the added bonus of telling a little kid’s parents.

    And my guess is it would have literally been cheaper for everyone involved for insurance to just pay for the $200 seat cover. Modern American insurance companies are capitalist enterprises providing a socialist benefit. And the doctors denying claims on behalf of the insurance companies are not seeing the patients in question so are basing their decision on questionable documentation and “industry standards” that are based on heavy insurance influence. All to maximize value for the company rather than ensure patient welfare, which is the fucking point of insurance.

    There is plenty of abuse of the system through over billing, but somehow fucking Medicare is the most efficient health insurance system in America. If private insurance is so great, why are they more inefficient with worse outcomes?














  • The US didn’t sign on to the treaty that creates the ICC’s jurisdiction. In most countries, you still need to at least pretend to have jurisdiction to bring criminal charges. Unlike people, states can only be sued to the degree they consent to be sued. It’s what sovereign immunity is based on and it’s a very double-edged sword.

    Also, outside of a few warlords, the ICC is pretty bad at enforcing international law because they have no way to do so. The ICC is inefficient and slow. Someone has to actually bring the defendant to them to stand trial, then countries negotiate over who doesn’t have to deal with jailing the person if they’re convicted.

    It’s also arguably super imperialist, given that it was designed by a bunch of Western powers and has mostly been used to enforce international law against individuals from Africa. The two Russians who are being “prosecuted,” Putin and Lvova-Belova, can’t be detained because the ICC has no power to enforce their warrants. Granted, these people are often evil, but it’s not like the West doesn’t have its fair share of evil people.

    All that to say, while this looks good, it’s mostly just PR. We also arguably don’t want the ICC prosecuting Americans. We should instead make our domestic system better.

    Source: Used to work on analyzing ICC cases and I’ve read thousands of filings from various cases. It’s a well-intentioned but highly flawed system that is basically only designed to prosecute international crimes in Africa and doesn’t really focus on anything else.