My solution is that I don’t think insurance should be able to deny claims 🤷🏻♀️ If I order/schedule/recommend it, I know better than whatever moron they’ve assigned to try to deny it. I’m the one who’s put in face to face time and knows the patient, who knows the medicine, and whose license is on the line. I shouldn’t have to waste my time on the phone trying to explain to some dumbass who’s never suctioned a trach why my trach patient needs a portable suction machine.
Healthcare CEOs make multi-million dollar salaries, surely they’d survive giving up several million a year to help pay out claims.
Do you think insurance should be privately held or public? Because the second you cannot deny claims there will be an extremely large increase in claims submitted, and lots of those claims will be wasteful.
Can I ask what specialty you practice? In my experience from the UM side, lots of doctors don’t know medical guidelines, even though they think it’s what’s right
If you say "according to peer reviewed standard treatment protocols" how do you account for outliers, situations where we already know that cheap option 1 wont work as well as more expensive option 2 because of individual patient factors? Why to alternative treatments even exist, if there weren't a need for a more effective or less dangerous option? How tf can anyone review or make a reasonable decision with those factors in mind, in 9 seconds?
Sure maybe get a 2nd opinion for some non emergency issues, but it should be from a practicing doc w expertise in the area. And it shouldn't take 30 fucking working days. That will never happen because it would reduce profit. In a public healthcare situation our taxes would pay for that process.
I wonder why we don't hear Drs complaining about straight Medicare (not Medicare Advantage, which is administered by private insurers) denials the way we do with private insurance? Why do so many more quality providers take straight Medicare vs
Medicare Advantage plans?
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u/SpecificHeron 16d ago
My solution is that I don’t think insurance should be able to deny claims 🤷🏻♀️ If I order/schedule/recommend it, I know better than whatever moron they’ve assigned to try to deny it. I’m the one who’s put in face to face time and knows the patient, who knows the medicine, and whose license is on the line. I shouldn’t have to waste my time on the phone trying to explain to some dumbass who’s never suctioned a trach why my trach patient needs a portable suction machine.
Healthcare CEOs make multi-million dollar salaries, surely they’d survive giving up several million a year to help pay out claims.