Death Panels - Aetna to pay $25.5M for denying coverage

CanadianJudo · 2018-11-11T10:00:49.211Z

sometimes private insurance can get you some nice perk like mine comes decent amount of money for Massage therapy.

CanadianJudo · 2018-11-11T10:03:30.446Z

I wouldn’t say you need private insurance, but it is a huge plus to have for dental coverage alone.

Janet_Miller · 2018-11-11T10:25:52.017Z

Massage therapy, oo, that sounds nice! May try it for hip with osteoarthritis.

Janet_Miller · 2018-11-11T10:28:43.588Z

I’ve always said I understand the rationale behind universal health insurance if and only if it’s provided with private insurance in tandem or even as an alternative.

Sounds like you guys need it for dental care. I’m having the opposite problem.

Obamacare messed up many employee health plans. However I can honestly say it hasn’t impacted our low cost dental plan at all.

BlueTex · 2018-11-11T12:26:32.927Z

Janet_Miller:

I’m confused.

I’m very sorry about the loss of this lady.

But about 2/3 of the way through the article, it states her tumor was shrinking, the treatment was working.

She and her husband took out a mortgage and set up a GoFundMe to pay for the treatment out of pocket.

Which treatment? Did she get the standard therapy? Or the recommendation of proton based therapy with a patient billing?

She received proton therapy with funds from a mortgage on their home and a GoFundMe fundraiser. The GoFundme raised $17,790.

Also the article notes the patient was in Stage IV with the tumor by her brain stem. Possibly with the cancer was this far along, standard or proton based radiation, she may not have survived.

Of course nobody would be able to predict how a patient will do on any therapy but that is irrelevant to Aetna’s obligation to cover medical treatments under a health insurance policy for which they gladly accept premium payments.

CaughtInTheMiddle · 2018-11-11T12:44:14.267Z

Dissident_Aggressor:

reflechissez:

Are you under the impression that doctors would be employees of the government? That’s now how single payor works

Whether doctors are the employees, or money is taken from others to pay those doctors, somebody still has a responsibility to bestow that right, no?

Under our old and current systems money was taken from others to pay them.

CaughtInTheMiddle · 2018-11-11T12:50:37.842Z

7ranz:

Dissident_Aggressor:

7ranz:

LOL

Freedom to die because you are poor.

Because the poor are incapable of helping themselves, you call for others to help them through force of government. And hey, that’s fine. But it still is a part of the morality discussion even thought you really don’t want it be. At least you conceded that doctors aren’t in just to help people.

I don’t want a GoFundMe nation for healthcare. As we have now.

I’m cool with you and others talking about the morality of free universal healthcare being wrong because for some reason that will make doctors slaves. No one buys that ■■■■■

For the older folks…

Remember when you’d walk into a gas station and they’d be a glass jar by the cash register with a picture of a kid with some type of cancer and the family (many times farmers) would be begging for money so they could save their child. We’d all throw change in them.

We still have that. It’s just more sophisticated and called GoFundMe.

CaughtInTheMiddle · 2018-11-11T13:11:30.834Z

Jezcoe:

Dissident_Aggressor:

Jezcoe:

Do you know the difference between an elastic and an inelastic demand?

Nope. I’ll look it up later, I suddenly became busy, so I’ll pick this up later.

Look it up and you will see that however Capitalism is great for a lot of things… there are some things where profit motive serve to increase human misery.

Exactly true.

Almost everything about our society is capitalistic. Even many of our churches.

But there are some things that should not be. For example, no one should make money off of our best and bravest soldiers dying.

Heck, even our most profitable sports league (NFL) saw that they had to get away from pure capitalism/freedom (like MLB was) to be massively successful/profitable. They won’t even let their potential new employees work where they want to work.

mobulis · 2018-11-11T13:29:00.537Z

Dissident_Aggressor:

7ranz:

Healthcare for everyone is a moral position.

I curious about this statement. So you view health care as a right, then?

Yep…

mobulis · 2018-11-11T13:29:54.583Z

Dissident_Aggressor:

7ranz:

Well, I think rights are ■■■■■■■■ philosophically speaking. But, basically, yeah. Everyone should get healthcare. Full stop.

So, if a person has a right to health care, who then has the responsibility to provide it? Essentially, the provider is now in servitude to the recipient by virtue of the recipient’s existence. That certainly has to be considered when discussing the morality of the issue, no?

No…

moonshine · 2018-11-11T13:49:00.620Z

Hitting the company with a 25m judgement is all well and good but what needs to happen is the individuals need to be hit with judgements. Maybe multi million dollar judgements against the doctors working fircaetba that denied the claim and the top Aetna execs would change things

CaughtInTheMiddle · 2018-11-11T13:52:45.420Z

moonshine:

Hitting the company with a 25m judgement is all well and good but what needs to happen is the individuals need to be hit with judgements. Maybe multi million dollar judgements against the doctors working fircaetba that denied the claim and the top Aetna execs would change things

Correct. That’s all that can stop this type of crime.

Otherwise, it’s just an accounting write off (which most instances companies plan for).

Isn’t that cool? They plan on killing some people because they can afford it.

Janet_Miller · 2018-11-11T13:53:09.859Z

“Aetna’s obligation to cover medical treatments”

This wouldn’t be the first time I’ve seen an insurance company refuse to cover services not that necessarily are experimental, jut that they consider new & experimental.

And are insurance companies required to cover all medical treatments? For example, relatively few insurers cover LASIK as glasses have been around since antiquity, & contacts are available.

There was an instance in your state, I believe, where a child covered by Tri Care was denied a gastric bypass (age 12). Child was obese due to a pituitary tumor that, even when removed, her body didn’t respond to diet & exercise & she was openly ridiculed in public.

Tri Care refused to cover citing safety concerns for a child still growing (it isn’t commonly performed on growing children). Parents appealed & got the procedure covered.

Once again, is insurance, even under the ACA, required to cover all medical treatments? It appears the lady in the original article received the proton based therapy & died. Would insurance coverage or payments made otherwise have made a difference?

Jezcoe · 2018-11-11T14:11:27.005Z

Dissident_Aggressor:

Jezcoe:

The argument isn’t about fairness, because life isn’t fair.

We can work to reduce human misery though, especially when that human misery exists because of profit motive.

I will also posit this to you to think over.

Out of all of the OECD countries, we do not have single payer yet we spend twice what the next country does on health care and we are incapable of providing even the most basic services to all of our citizenry.

Can one make the argument that our health care is twice as good? We pay twice as much… so it should be.

So strip out all of the thoughts about what is and isn’t “fair” and look at it as a purely economic problem.

Is the consumer getting what we pay for or are we paying too much for worse results?

I still haven’t had time to look up the other stuff, but let me address this.

If you attribute profit motive to human misery and seek to eliminate or reduce the latter by addressing the former through government action, you are absolutely trying to balance the scales in the fairness department.

In regard to what you posted about our expenditure versus other countries, I would need a lot more data to convince me single payer would be better service for a lesser cost based simply on that comparison.

Instead of comparison, focus strictly on our country. As I understand the complaint, we have people in this country that can’t afford health care (this after Obamacare and all), or can’t afford the proper coverage to cover all of their needs. The fan favorite pick to solve all of this is single payer, and according to you is a cheaper route, to boot. Now, I really can’t wrap my head around how increasing demand quite heartily, while letting the government run it somehow ends with us also seeing a great cost reduction. Perhaps you can explain it to me. How would it work exactly?

If you want to address it as a fairness issue, then who am I to stop you? But it really isn’t. In a lot of ways it is an issue that we as a nation are paying way more for services that all other Western Nations enjoy for less cost and better results.

Something is broken with our system. We should look to theirs and take what works best.

BlueTex · 2018-11-11T14:38:18.428Z

Janet_Miller:

“Aetna’s obligation to cover medical treatments”

This wouldn’t be the first time I’ve seen an insurance company refuse to cover services not that necessarily are experimental, jut that they consider new & experimental.

Proton therapy is neither new or experimental… Heck, even Medicare covers proton therapy… The FDA certainly has approved proton therapy. Who should decide what is “new” and “experimental”? The insurance companies?

And are insurance companies required to cover all medical treatments? For example, relatively few insurers cover LASIK as glasses have been around since antiquity, & contacts are available.

There was an instance in your state, I believe, where a child covered by Tri Care was denied a gastric bypass (age 12). Child was obese due to a pituitary tumor that, even when removed, her body didn’t respond to diet & exercise & she was openly ridiculed in public.

Tri Care refused to cover citing safety concerns for a child still growing (it isn’t commonly performed on growing children). Parents appealed & got the procedure covered.

Once again, is insurance, even under the ACA, required to cover all medical treatments? It appears the lady in the original article received the proton based therapy & died. Would insurance coverage or payments made otherwise have made a difference?

Who should decided what is the appropriate treatment for the patient? Their physicians or the insurance company?

Janet_Miller · 2018-11-11T15:50:19.551Z

Oh, definitely the physician, & if the patient isn’t comfortable with the recommendations, they’re free to consult another. Or turn down one treatment in favor of another.

That’s one of the issues dependents on health insurance has created: physicians possibly not going by what’s best for their patients, but what their insurance will cover.

BlueTex · 2018-11-11T15:53:38.821Z

[quote=“Janet_Miller, post:111, topic:43790”]
Oh, definitely the physician, & if the patient isn’t comfortable with the recommendations, they’re free to consult another. Or turn down one treatment in favor of another.
/QUOTE]

Orrana’s physicians wanted her to receive proton therapy but their decision was overruled by Aetna…

That’s one of the issues dependents on health insurance has created: physicians possibly not going by what’s best for their patients, but what their insurance will cover.

How does dependent coverage cause this? I’m not following…

Janet_Miller · 2018-11-11T16:43:54.381Z

Wrong word choice I meant dependence.

When I started in the medical field in the early ‘90’s, services could be Third Party, or insurance; Client Billing, where either insurers or taxpayers (as with the correctional clients) ordered services & those accounts, like hospitals & jails, paid for services, and Patient billings, where the patients absorbed the cost.

Health care seems inflexibly oriented towards the possession of health insurance now, & even with it the patient still may have copays or high deductibles. Physicians have their hands tied by insurers as to what treatments or medications they may recommend ex. A certain medication appears to be the best option but isn’t covered by the plan’s formulary.

Janet_Miller · 2018-11-11T16:45:58.662Z

Does anyone know what services are mandatory per the Affordable Care Act?

My understanding is it’s largely geared towards preventive care services, like eye, dental, pap & mammo as well as colonoscopy coverage.

BlueTex · 2018-11-11T16:46:32.519Z

Janet_Miller:

Wrong word choice I meant dependence.

When I started in the medical field in the early ‘90’s, services could be Third Party, or insurance; Client Billing, where either insurers or taxpayers (as with the correctional clients) ordered services & those accounts, like hospitals & jails, paid for services, and Patient billings, where the patients absorbed the cost.

Health care seems inflexibly oriented towards the possession of health insurance now, & even with it the patient still may have copays or high deductibles. Physicians have their hands tied by insurers as to what treatments or medications they may recommend ex. A certain medication appears to be the best option but isn’t covered by the plan’s formulary

I get it now and you are spot on… Do be fair, the insurance companies are trying to run a business and limiting treatments is one way to make the costs more predictable… It’s in direct conflict with patient centered care but it’s what we have today…