Futile care.

[ambiturner]

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It’s about handling stress. We have some mentally weak people.

Even the asa has become mentally weak. Publishing guidelines how to handle death and stress of patients in the OR. How team members should if possible take the rest of the day off. We discussed this a few years ago when then statement came out.

This is the same Asa who can’t come up with blanket statements how big of bmi is too big in stand a lone surgery centers. So they can’t come up with standard statements about bmi 55 in ent asc. But can come up with statement about grief?

Statement on Peer Support After Unexpected Outcomes - Treatment of the "Second Victim"

www.asahq.org

These sort of statements/guidelines are ways for junior academics to get promoted and probably make the ASA look like they’re making a positive impact. Guidelines on BMI would evoke untold levels of screeching from surgicenter owners while this will cause no one any fuss.

 

[Gern Blansten]

You seem to need this reminder at least semi-annually. People forget how high costs were rising pre-ACA.

“You never know what worse luck your bad luck has saved you from”
-Cormac McCarthy-No County for Old Men

 

[cittykat]

Post a followup if you ever need to file a claim.

No major claims yet but she’s had some routine claims. So far so good. All the doctors that she had when she was on the family UHC plan are also on the Blue Shield Covered California network so she hasn’t had to switch. Pharmacy co-pays are slightly less on the Covered California plan. Purely from a patient perspective it has been working for her.

 

[cittykat]

These sort of statements/guidelines are ways for junior academics to get promoted and probably make the ASA look like they’re making a positive impact. Guidelines on BMI would evoke untold levels of screeching from surgicenter owners while this will cause no one any fuss.

Thus no statement on PE and AMC ownership of anesthesia practices.

Look at the annual meeting sponsors.

 

[rowsdower88]

“You never know what worse luck your bad luck has saved you from”
-Cormac McCarthy-No County for Old Men

I'll take this as a sign to reread Blood Meridian.

 

[cittykat]

Our healthcare dollars at work. “Health tech entrepreneur” celebrates $150 mil deal by spraying over $200k of champagne over strangers. Awesome.

She Makes the Impossible Happen for Her Ultrarich Clients

Olivia Ferney grew up a child of schoolteachers in Ontario. Now she’s an expert in private jets, luxury cabanas and champagne-soaked revels.

www.nytimes.com

 

[chessknt]

No major claims yet but she’s had some routine claims. So far so good. All the doctors that she had when she was on the family UHC plan are also on the Blue Shield Covered California network so she hasn’t had to switch. Pharmacy co-pays are slightly less on the Covered California plan. Purely from a patient perspective it has been working for her.

Until there is a consequence to denying services the MO of all private insurance and Medicare advantage plans is to deny over petty nonsense, sometimes for several rounds, because even if all but a single claim get appealed/approved they still made money because the cost of the denial is functionally 0. The time cost sunk in to this nonsense is an enormous negative economic impact borne by both physicians and patients. It is a system that absolutely deserves to die. The people profiting from this add absolutely nothing to care in this country.

 

[Account1]

You said everyone handles grief differently. So is it mental toughness or that some people handle it differently?

What he meant to say was “poorly”. Some, or many people handle grief poorly. I see it all the time at work and in daily life.

 

[Account1]

Until there is a consequence to denying services the MO of all private insurance and Medicare advantage plans is to deny over petty nonsense, sometimes for several rounds, because even if all but a single claim get appealed/approved they still made money because the cost of the denial is functionally 0. The time cost sunk in to this nonsense is an enormous negative economic impact borne by both physicians and patients. It is a system that absolutely deserves to die. The people profiting from this add absolutely nothing to care in this country.

We already have penalties for not covering services:

Medical Loss Ratio | CMS

Many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing.

www.cms.gov

“If an issuer fails to meet the applicable MLR standard in any given year, as of 2012, the issuer is required to provide a rebate to its customers.“

If you want to complain why your 20k per year disease modifying drug isn’t covered fully, look at the title of this thread. Futile care is automatically covered because of the nature of it

 

[sevo00]

It’s about handling stress. We have some mentally weak people.

Even the asa has become mentally weak. Publishing guidelines how to handle death and stress of patients in the OR. How team members should if possible take the rest of the day off. We discussed this a few years ago when then statement came out.

This is the same Asa who can’t come up with blanket statements how big of bmi is too big in stand a lone surgery centers. So they can’t come up with standard statements about bmi 55 in ent asc. But can come up with statement about grief?

Statement on Peer Support After Unexpected Outcomes - Treatment of the "Second Victim"

www.asahq.org

Taking a day off to mourn your father’s passing is not “mentally weak”. Da fuq is wrong with you dude

 

[aneftp]

Taking a day off to mourn your father’s passing is not “mentally weak”. Da fuq is wrong with you dude

Dad died Monday morning at 6am. I worked

Wake was Friday at 430pm. I worked till 4pm. Ran over to the funeral home.

Funeral was Saturday morning.

It was fine.

He had anaplastic thyroid cancer. The end was near the previous weekend. I said my goodbyes 2 days before he died.

Death is always among us.

But seriously some people milk it. Someone’s random grandmother dies who they haven’t seen in years and they want 3 days off.

So there are extreme ends how people respond.

 

[cittykat]

Taking a day off to mourn your father’s passing is not “mentally weak”. Da fuq is wrong with you dude

Only in America

 

[HemeOncHopeful19]

What's the alternative though?

I’m not policy maker but when I worked for the Feds they had a list of 10-15 employee plans from basically all the different insurance companies and you could change each year during open enrollment instead of (?every) other job where you get the one option HR has figured out, take or leave it oh and if I decide not to take it I get to pay a penalty to be on my wife’s insurance (it is +XYZ$/month for family plan if the spouse has an option through their own employer).

I’d like to see a system like that on the national level in some fashion such that the different companies are forced to compete against each other the same way auto or home insurance companies do. Obviously there’s details and holes in that basic system but the general concept is what I’d like to see (Yes I know - what do you do with people who pick to have no insurance to save $$$)

 

[kidthor]

I’d like to see a system like that on the national level in some fashion such that the different companies are forced to compete against each other the same way auto or home insurance companies do. Obviously there’s details and holes in that basic system but the general concept is what I’d like to see (Yes I know - what do you do with people who pick to have no insurance to save $$$)

That's what the ACA did when it created the health exchanges!!! That's the exact system the ACA created, except that it's on the state level (which makes sense since all insurance companies operate on a state level) and the individual mandate required you to have insurance (till nullified by the supreme court).

 

[HemeOncHopeful19]

That's what the ACA did when it created the health exchanges!!! That's the exact system the ACA created, except that it's on the state level (which makes sense since all insurance companies operate on a state level) and the individual mandate required you to have insurance (till nullified by the supreme court).

Not really though.

The ACA exchange is essentially only for people who don’t have access through their employer, because otherwise you can’t qualify for a subsidy and thus you’d have to almost certainly pay a much higher rate than whatever option you have through your employer. <7% of people use exchange plans. Plus I’d rather it be national so if you want your plan you have to offer it to all which is how the Fed plans work.

 

[kidthor]

Not really though.

The ACA exchange is essentially only for people who don’t have access through their employer, because otherwise you can’t qualify for a subsidy and thus you’d have to almost certainly pay a much higher rate than whatever option you have through your employer. <7% of people use exchange plans. Plus I’d rather it be national so if you want your plan you have to offer it to all which is how the Fed plans work.

It would be better to fully disentangle health insurance from employment, yes.

It could be better to be national, but it'd be very challenging to legally execute it because of the way health insurance is regulated - plus it might put people at risk if the federal government went insane and executed onerous restrictions (e.g. what they want to do now with abortion).

Personally I think our health insurance should be Medicare for All plus a private supplement.

 

[aneftp]

It would be better to fully disentangle health insurance from employment, yes.

It could be better to be national, but it'd be very challenging to legally execute it because of the way health insurance is regulated - plus it might put people at risk if the federal government went insane and executed onerous restrictions (e.g. what they want to do now with abortion).

Personally I think our health insurance should be Medicare for All plus a private supplement.

Most of all want a Medicare for all system and private insurance for those who pay extra.

In theory.

Somehow someone always wants the other guys to pay for it

 

[kidthor]

Most of all want a Medicare for all system and private insurance for those who pay extra.

In theory.

Somehow someone always wants the other guys to pay for it

I'd be ok just using the 18% of US GDP spent on healthcare to be spent on actual healthcare, rather than funneling half of it to private equity bros so they can send their third ex-wife's butler's horses to boarding school.

 

[HemeOncHopeful19]

I'd be ok just using the 18% of US GDP spent on healthcare to be spent on actual healthcare, rather than funneling half of it to private equity bros so they can send their third ex-wife's butler's horses to boarding school.

Why do you think Medicare for all would suddenly fix this, how do you think we got to where we are if not by our government?

Edit: just to clarify, I agree it would be nice. But there are a LOT of useless people in the healthcare system who are pulling a paycheck and those people are voting age. Current system is a jobs program

 

[aneftp]

I'd be ok just using the 18% of US GDP spent on healthcare to be spent on actual healthcare, rather than funneling half of it to private equity bros so they can send their third ex-wife's butler's horses to boarding school.

We are so focus on gdp more for political talking points and of course economics stability.

But absolute dollar spending matters way more for operational power. By this I mean the USA spends more on defense. Usa spends 3x more than China on defense alone

China and Russia combined defense spending isn’t even close to what the USA spends. You can throw in Germany absolute spending on defense and all 3 won’t equal what the USA spends on defense.

Let’s cut defense and healthcare. Get the budget down. We won’t. Because everyone has their hands in the cookie jar.

 

[cittykat]

It would be better to fully disentangle health insurance from employment, yes.

It could be better to be national, but it'd be very challenging to legally execute it because of the way health insurance is regulated - plus it might put people at risk if the federal government went insane and executed onerous restrictions (e.g. what they want to do now with abortion).

Personally I think our health insurance should be Medicare for All plus a private supplement.

Swedish friend says it’s weird how Americans tether jobs with healthcare and sports with school. In Sweden they have nothing to do with each other.

 

[Burned_Out]

We already have penalties for not covering services:

Medical Loss Ratio | CMS

Many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing.

www.cms.gov

“If an issuer fails to meet the applicable MLR standard in any given year, as of 2012, the issuer is required to provide a rebate to its customers.“

If you want to complain why your 20k per year disease modifying drug isn’t covered fully, look at the title of this thread. Futile care is automatically covered because of the nature of it

Gee, I have never received a rebate check from any health insurer I was enrolled with. But they sure love denying my personal claims. Even if they did have to pay “some” penalty, it would be well worth it to them to do so vs. actually having to pay valid claims.

 

[cittykat]

Let’s cut defense and healthcare. Get the budget down. We won’t. Because everyone has their hands in the cookie jar.

Capitalism disincentivizes cutting anything. Grow the pie, take a bigger slice. Defense, healthcare, and AI are what keeps our current economy humming. Without them we’d be in a depression.

 

[Burned_Out]

Is coverage by United Healthcare different if you obtain it via ACA vs your employer? I have United Healthcare through my employer and they have been very good about covering extremely expensive (7 figures) cancer treatment. Monthly specialty pharmacy bill alone is over $40k. Never had a single delay or denial even for off label use of an expensive drug before an even more expensive FDA approved treatment became available. I do wonder if cancer center doctors or their staff just know how to get things approved quickly.

When I had UNH, it was through my employer. When they denied my torn rotator cuff injury, I appealed and they forced upon me and my surgeon mountains of paperwork. Despite the appeal, they still denied my claim. I had a bonafide rotator cuff tear and they tried to claim it was pre-existing condition and I had not disclosed it to them when I applied for insurance. It was not pre-existing. Even if it was, I thought ACA covered that. Nope. They told me pre-existing conditions would have to go through workman’s comp, but not their insurance. Since I am a sole proprietor, I am not covered by workman’s comp.

 

[HemeOncHopeful19]

When I had UNH, it was through my employer. When they denied my torn rotator cuff injury, I appealed and they forced upon me and my surgeon mountains of paperwork. Despite the appeal, they still denied my claim. I had a bonafide rotator cuff tear and they tried to claim it was pre-existing condition and I had not disclosed it to them when I applied for insurance. It was not pre-existing. Even if it was, I thought ACA covered that. Nope. They told me pre-existing conditions would have to go through workman’s comp, but not their insurance. Since I am a sole proprietor, I am not covered by workman’s comp.

On the other hand, with Medicare there is no appeal.

Scan not indicated
Drug not covered

End of discussion

You should’ve complained to state insurance commission IMO unless it really was a clear cut injury that occurred during a prior job I guess

 

[chessknt]

Gee, I have never received a rebate check from any health insurer I was enrolled with. But they sure love denying my personal claims. Even if they did have to pay “some” penalty, it would be well worth it to them to do so vs. actually having to pay valid claims.

There is no penalty that the insurers have to pay out otherwise we wouldnt be seeing skyrocket mass denials for everything from inhalers to surgery using AI programs. If they had to backpay a check for the retail cost of a drug/service + a 100% cost-of-service penalty in cash split between the practice and the patient for each denied claim I guarantee their denials would plummet to only the most egregious cases. These claims are all getting appealed and eventually approved but the waste of effort in the process is astronomical and anything that produces that result is be definition a failure. Anyone who thinks otherwise has never worked in an outpatient setting.

 

[cittykat]

Gee, I have never received a rebate check from any health insurer I was enrolled with. But they sure love denying my personal claims. Even if they did have to pay “some” penalty, it would be well worth it to them to do so vs. actually having to pay valid claims.

It’s strange because I hear about claim denials all the time but we’ve never had a claim denial in our immediate family and we are unfortunately super consumers of healthcare with 4 cancer diagnoses. Everything has been prompt and frictionless. Within our group we’ve had a liver transplant and a couple of bone marrow transplants and they’ve all been covered as far as I know.

 

[Account1]

Gee, I have never received a rebate check from any health insurer I was enrolled with. But they sure love denying my personal claims. Even if they did have to pay “some” penalty, it would be well worth it to them to do so vs. actually having to pay valid claims.

Once again, check the title of this thread.

The reason you can’t have your claim filled is things like futile care and icu care for the drunk on his 8th motorcycle crash getting a 100000 dollar stay comped for the third time.

We decided a long time ago we’d cover the most expensive, most acute things. Your shoulder surgery and colonoscopy don’t count in that math unfortunately.

 

[cittykat]

Once again, check the title of this thread.

The reason you can’t have your claim filled is things like futile care and icu care for the drunk on his 8th motorcycle crash getting a 100000 dollar stay comped for the third time.

We decided a long time ago we’d cover the most expensive, most acute things. Your shoulder surgery and colonoscopy don’t count in that math unfortunately.

My colonoscopy was covered $0 copay.

 

[Account1]

There is no penalty that the insurers have to pay out otherwise we wouldnt be seeing skyrocket mass denials for everything from inhalers to surgery using AI programs. If they had to backpay a check for the retail cost of a drug/service + a 100% cost-of-service penalty in cash split between the practice and the patient for each denied claim I guarantee their denials would plummet to only the most egregious cases. These claims are all getting appealed and eventually approved but the waste of effort in the process is astronomical and anything that produces that result is be definition a failure. Anyone who thinks otherwise has never worked in an outpatient setting.

Are you just flat out denying the existence of medical loss ratios?

Live in the real adult world dude. This ranting about outpatient insurance coverage is ridiculous.

Insurance doesn’t exist to give people free top tier outpatient medicine every time. It exists to cover the 50 year old who has never exercised in his entire life and now has mesenteric ischemia with dead bowel and permanent tpn dependence.

I’m on your side here. I’d be much happier if we finally held people responsible for their personal decisions, but society decided that isn’t “nice” so no, you can’t have your entresto. Try a compounding pharmacy instead.

 

[Account1]

My colonoscopy was covered $0 copay.

Funny thing isn’t it? For all the denial claims around here a whole lot of routine care sure does get covered…

 

[VA Hopeful Dr]

Funny thing isn’t it? For all the denial claims around here a whole lot of routine care sure does get covered…

Under the ACA anything that's A or B rated by the USPSTF has to be covered at zero cost to the patient. Screening colonoscopies, mammograms, DEXA, paps, and so on.

 

[Southpaw]

Funny thing isn’t it? For all the denial claims around here a whole lot of routine care sure does get covered…

@cittykat a colonoscopy, like a mammogram, is a screening exam and under the rules of the ACA is a required covered service. Meaning you should pay nothing.

Interestingly, if the GI finds anything at all wrong (a single polyp) the exam becomes diagnostic and it is no longer covered. Meaning you pay.

Thats my understanding.

A whole lot of routine care is covered, as it should be. Thanks to the ACA. And insurers can’t kick people off their insurance for anything the insurance company deems ‘high risk’ (I.e. cancer or major heart disease). Thanks to the ACA.

Is the system perfect? Not at all. Do we need a system that doesn’t give so much power to insurance companies? Absolutely.

 

[Account1]

@cittykat a colonoscopy, like a mammogram, is a screening exam and under the rules of the ACA is a required covered service. Meaning you should pay nothing.

Interestingly, if the GI finds anything at all wrong (a single polyp) the exam becomes diagnostic and it is no longer covered. Meaning you pay.

Thats my understanding.

A whole lot of routine care is covered, as it should be. Thanks to the ACA. And insurers can’t kick people off their insurance for anything the insurance company deems ‘high risk’ (I.e. cancer or major heart disease). Thanks to the ACA.

Is the system perfect? Not at all. Do we need a system that doesn’t give so much power to insurance companies? Absolutely.

https://www.hematologyadvisor.com/news/most-americans-are-happy-with-health-insurance-poll-finds/

I agree with those last bits. I think we’re doing well in terms of private plan satisfaction. Maybe we’ll push those numbers up over time but 80% satisfaction is pretty good imo. Best I can tell this number was much lower in 2008 pre Obama

 

[aneftp]

My colonoscopy was covered $0 copay.

You keep saying $7.50 premiums for ur daughter

Zero co pay for colonoscopy.

Screening colonoscopies have had zero co pay since he bush 43 era of hsa plans

The issues with zero co pay is when patients get hit with bill bills when colonoscopy becomes non screenings even if it comes in as a screening

And the patients will care when they get hit with a $2000 bill.

 

[Southpaw]

You keep saying $7.50 premiums for ur daughter

Zero co pay for colonoscopy.

Screening colonoscopies have had zero co pay since he bush 43 era of hsa plans

The issues with zero co pay is when patients get hit with bill bills when colonoscopy becomes non screenings even if it comes in as a screening

And the patients will care when they get hit with a $2000 bill.

The ACA reduced the indcidence of CRC. Is also eliminated cost sharing for colonoscopy (copay and deductibles needing to be met). With regard to screening exams, the ACA is wonderful from a patient perspective.

Impact of the Affordable Care Act on Colorectal Cancer Incidence and Mortality - PMC

The Patient Protection and Affordable Care Act (ACA) eliminated cost sharing for preventive services, including colorectal cancer (CRC) screening for individuals aged 50–75 years with private health insurance. This study examines the impact of the ...

pmc.ncbi.nlm.nih.gov

I’m absolutely shocked to see you in a thread where the ACA is discussed. Sorry but your post is a half truth. I’m going to walk away from this now bc your beliefs are concrete and I have no interest in long lengthy online convos about the ACA and correcting a lot of what you write.

 

[arkgal]

@cittykat a colonoscopy, like a mammogram, is a screening exam and under the rules of the ACA is a required covered service. Meaning you should pay nothing.

Interestingly, if the GI finds anything at all wrong (a single polyp) the exam becomes diagnostic and it is no longer covered. Meaning you pay.

Thats my understanding.

A whole lot of routine care is covered, as it should be. Thanks to the ACA. And insurers can’t kick people off their insurance for anything the insurance company deems ‘high risk’ (I.e. cancer or major heart disease). Thanks to the ACA.

Is the system perfect? Not at all. Do we need a system that doesn’t give so much power to insurance companies? Absolutely.

That's 100% the case. A colonoscopy found polyps in my colon when I was 29. Now I have to get one every 5 years, but because it's diagnostic, it's covered at the same rate as any other non-screening procedure.

 

[cittykat]

You keep saying $7.50 premiums for ur daughter

Zero co pay for colonoscopy.

Screening colonoscopies have had zero co pay since he bush 43 era of hsa plans

The issues with zero co pay is when patients get hit with bill bills when colonoscopy becomes non screenings even if it comes in as a screening

And the patients will care when they get hit with a $2000 bill.

My GI removed 3 polyps and I received no bill at all.

 

[aneftp]

My colonoscopy was covered $0 copay.

You keep saying $7.50 premiums for ur daughter

Zero co pay for colonoscopy.

@cittykat a colonoscopy, like a mammogram, is a screening exam and under the rules of the ACA is a required covered service. Meaning you should pay nothing.

Interestingly, if the GI finds anything at all wrong (a single polyp) the exam becomes diagnostic and it is no longer covered. Meaning you pay.

Thats my understanding.

A whole lot of routine care is covered, as it should be. Thanks to the ACA. And insurers can’t kick people off their insurance for anything the insurance company deems ‘high risk’ (I.e. cancer or major heart disease). Thanks to the ACA.

Is the system perfect? Not at all. Do we need a system that doesn’t give so much power to insurance companies? Absolutely.

Everyone here knows how much I hate the ACA

There is no explaining from even the most liberals for the equality angle with doing no cost tubal ligation for women written in the bill. And yet they purposely excluded no cost vasectomy. They got too cute writing the law.

 

[aneftp]

My GI removed 3 polyps and I received no bill at all.

View attachment 423130

I covered endo centers and always get complaints from patients who call in for bills.

Screening colonoscopy. Path sends them a $500 path bill

 

[cittykat]

I covered endo centers and always get complaints from patients who call in for bills.

Screening colonoscopy. Path sends them a $500 path bill

Maybe my pathologist forgot to send a bill. I also had propofol and received no anesthesia bill.

 

[aneftp]

Maybe my pathologist forgot to send a bill. I also had propofol and received no anesthesia bill.

Every insurance is different. If you are in California. Ur insurance is different than someone in Arizona Florida etc.

 

[cittykat]

Following up on the original topic before this thread got derailed into an ACA thread. RIP

Donate to Support for Annelise’s Healing Journey, organized by Rachel Davis

Annelise Ramona Camp September 20, 2023 – August 3, 2026 Thank you all for yo… Rachel Davis needs your support for Support for Annelise’s Healing Journey

www.gofundme.com

https://apnews.com/article/annelise-camp-braindead-toddler-lawsuit-drowning-0996a4b6a03c82ced73fc2322c6e536f