Despite Americans paying nearly double that of other nations, the US fares poorly in list of 10 countries
The United States health system ranked dead last in an international comparison of 10 peer nations, according to a new report by the Commonwealth Fund.
In spite of Americans paying nearly double that of other countries, the system performed poorly on health equity, access to care and outcomes.
“I see the human toll of these shortcomings on a daily basis,” said Dr Joseph Betancourt, the president of the Commonwealth Fund, a foundation with a focus on healthcare research and policy.
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The fund said the US would need to expand insurance coverage and make “meaningful” improvements on the amount of healthcare expenses patients pay themselves; minimize the complexity and variation in insurance plans to improve administrative efficiency; build a viable primary care and public health system; and invest in social wellbeing, rather than thrust problems of social inequity onto the health system.
My wife broke her ankle and insurance denied the entire claim for being “not medically necessary”. The “medical professional” (not doctor) who denied the claim had experience in OBGYN, not orthopedics.
100% going to win the appeal because like, we have x-rays of the shattered bones in her leg, but seriously wtf. People seriously believe this is the ideal medical system?
Cigna doctors spend an average of 1.2 seconds per case. Their whole system is to deny everything right off the bat, and then they only have to potentially pay out for patients who have the resources to appeal.
When I was in the insurance industry, for a company who administered various policies from Aetna, BCBS, Cigna, United and Medicare, that was the SOP. Deny anything that took more than a few seconds of brain power, put clients through endless rounds of appeals. The medical director was amoral AF too, because well, the insurance company exists for profit, and bonuses are dependent on paying out as little as possible. It got pretty bad, too, enough that my immediate supervisor started signing off a bunch of approvals, circumventing the medical director, where any shred of plausibility was available.
Now, there is automated software. HIPAA has it’s pros and cons.
Oh, I read this John Grisham book.
I’m on appeal #3 right now with my insurance for something they told me would be 100% covered. I’m getting my doctor in on it to do a peer to peer. He sounded so fed up with everything he was like “it’s probably some retired pediatrician who doesn’t know anything about what you need” when talking about who he’d need to talk with. If this one doesn’t work then I’m on to the “threaten to sue” stage which I’m not excited about. The whole thing is a mess and the process and money that’s gone into it would have easily bankrupted or put me homeless at most previous times in my life
I’m not a lawyer, but a piece of legal advice I’ve seen repeated many times is “Never threaten to sue. Just sue.”
As soon as you threaten to sue, you’ll never be able to talk to anybody except the legal team, and they’ll do nothing to help your case.
I’m sorry you’re having to deal with this. This is an issue that’s deeply personal to me.
When my wife was pregnant with our daughter, she was severely preeclamptic going into the third trimester. She ended up having to stay in the hospital for five weeks with her blood pressure being constantly monitored and nurses ready to pump her full of medications anytime it went too high. It was so severe that when she was being discharged a doctor told us that there was a good chance she would have died had she been admitted to another hospital less equipped to deal with it.
Our insurance tried to stick us with a bill that was hundreds of thousands of dollars, saying that the whole thing “medically unnecessary.” Thankfully we had an amazing patient advocate that handled all of that for us and I heard from her later that my wife’s OBGYN (who is an amazing, kind hearted, and soft spoken man) had called up the insurance and absolutely ripped them a new one.
Private insurance is a parasite on society. The goals of a private medical insurance company are at odds with providing good care to people and they leach resources better spent elsewhere.
For those wondering, wife and baby thankfully ended up happy and healthy in the end.
Sorry for the rant, this kind of shit gets me absolutely inflamed.