The Medical Thread: We're experts on everything else; why not?

[WisconsinWildcard]

And that's the worst part. You'll never speak to the person that made the decision. You'll never speak to the person that designed the actuarial table, or the adjuster/case manager that (allegedly) read through your Utilization Review or clinical notes. You'll get that front-end person that, however well-meaning they may be, has no idea why your procedure is being denied and can provide no real help to you or the patient.

I recently spent >1 hour explaining to some insurance company why I wanted a particular MRI. They wanted me to diagnose the patient with a certain kind of nerve tumor so it would be approved. I kept saying that is why I am getting the MRI in the first place, in order to see if there is a tumor, but the actuarial table stated they had to have a known tumor to get the MRI approved. I am a subspecialist so by definition, I see very focused and rare diseases, so very often the insurance company representative has never heard of the disease they are arguing with me about.

Retirement plan is similar to Dr. D but on a shorter time scale. FIRE then do what I actually enjoy doing in medicine without a care for money.

[Swansong]

I recently spent >1 hour explaining to some insurance company why I wanted a particular MRI. They wanted me to diagnose the patient with a certain kind of nerve tumor so it would be approved. I kept saying that is why I am getting the MRI in the first place, in order to see if there is a tumor, but the actuarial table stated they had to have a known tumor to get the MRI approved. I am a subspecialist so by definition, I see very focused and rare diseases, so very often the insurance company representative has never heard of the disease they are arguing with me about.

Retirement plan is similar to Dr. D but on a shorter time scale. FIRE then do what I actually enjoy doing in medicine without a care for money.

Ugh. Is there no screening test available to you? There are other tests like the PSA that require a screen before a diagnostic, and insurance won't reimburse if you do the diagnostic before (or even at the same time as) the screen.

What makes that PSA situation so silly is that they're the EXACT SAME TEST at the lab. But for insurance purposes we have to have two records built out, that link to two different workflows, and try to convince every provider to order them sequentially so that phlebotomists don't try to draw them concurrently.

[ScoobyDoo]

I recently spent >1 hour explaining to some insurance company why I wanted a particular MRI. They wanted me to diagnose the patient with a certain kind of nerve tumor so it would be approved. I kept saying that is why I am getting the MRI in the first place, in order to see if there is a tumor, but the actuarial table stated they had to have a known tumor to get the MRI approved. I am a subspecialist so by definition, I see very focused and rare diseases, so very often the insurance company representative has never heard of the disease they are arguing with me about.

Retirement plan is similar to Dr. D but on a shorter time scale. FIRE then do what I actually enjoy doing in medicine without a care for money.

This is why we need single payer. Insurance companies are a joke.

[The Sicatoka]

If we, as a country, were honest with ourselves we'd admit that the mental health pandemic makes covid-19 look like a piker.

[The Sicatoka]

This is why we need single payer. Insurance companies are a joke.

Nobody likes insurance companies. --> Motto: Give me your money and I'll give it back when I think you need it. < glare >

But are we sure folks in single-payer places are getting the scans/treatment they need in any more timely a manner?

(I fully discount the urban legends of Canadians coming to Roseau or Grand Forks for treatment. That ain't real.)

[French Rage]

concern!

[ScoobyDoo]

concern!

It is almost like America is just a complete ****hole and no problems with any system can be overcome and made better for the citizens. Republicans are starting to make everyone believe that. And it's pretty sad.

[The Sicatoka]

Toss out 'single payer' as the solution.
But look back at these pages of self-critique of medical professionals by medical professionals admitting the biases and shortcomings in the existing system of medicine.

You can't use single-variate thinking on a multi-variate problem like this. There is no magic bullet. Insurance needs to be fixed; the profession needs to be fixed. The way we all view and use medicine and (personal) healthcare needs to be fixed.

[Kepler]

Toss out 'single payer' as the solution.

No.

[psych]

Toss out 'single payer' as the solution.
But look back at these pages of self-critique of medical professionals by medical professionals admitting the biases and shortcomings in the existing system of medicine.

You can't use single-variate thinking on a multi-variate problem like this. There is no magic bullet. Insurance needs to be fixed; the profession needs to be fixed. The way we all view and use medicine and (personal) healthcare needs to be fixed.

I don’t think single-payer is the answer, but universal healthcare certainly is.

[Kepler]

I don’t think single-payer is the answer, but universal healthcare certainly is.

So is the end of insurance.

We don't pay insurance for our police or military or clean air.

Socialize needs. Privatize wants. There should be no profit motive in things everyone must have to live.

[Deutsche Gopher Fan]

I don’t think single-payer is the answer, but universal healthcare certainly is.

Ans there are tons of permutations on how to fund. Germany Switzerland France etc.

thidbis one of my stress of expertise but I’ll wait and be mansplained to by concerned people

[SJHovey]

Socialize needs. Privatize wants. There should be no profit motive in things everyone must have to live.

Don't people need food and shelter way more than they need healthcare to live?

[Deutsche Gopher Fan]

Don't people need food and shelter way more than they need healthcare to live?

Is there a reason that they can’t all be in the same category?

[SJHovey]

Is there a reason that they can’t all be in the same category?

In a broad sense, maybe. Personally I think that there should be a certain level of those items that needs to be socialized, instead of just socializing the entirety of them.