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Cracking down on insurance companies and providers would be a good start, even if socialized medicine isn't the ultimate solution here (as much as I'd like to see some sort of 50/50 system here in the US, realistically, I doubt it'll ever happen).
Instead, we should focus on making insurance companies accountable, and bringing in new tough legislation to prevent patients from having claims denied while waiting for potentially life-saving surgery (i.e. treat first, worry about claims later).
After that, who knows? The US will never have fully socialized healthcare and that's the reality of it. The best we can hope for is more government intervention (on our behalf) to crack down on insurance companies and to help make helathcare (and insurance) more affordable.
Instead, we should focus on making insurance companies accountable, and bringing in new tough legislation to prevent patients from having claims denied while waiting for potentially life-saving surgery (i.e. treat first, worry about claims later).
Treatment is by doctors, not insurance companies. It’s similar to auto insurance, the insurance company doesn’t fix your car, a mechanic does. Same thing with medicine, an insurance company doesn’t provide treatment, a doctor does.
If you’re going to demand legislation, remember who is actually providing the treatment, doctors. For your “treat first, worrry about claims later” legislation to work, it needs to be aimed at the right party, doctors.
Treatment is by doctors, not insurance companies. It’s similar to auto insurance, the insurance company doesn’t fix your car, a mechanic does. Same thing with medicine, an insurance company doesn’t provide treatment, a doctor does.
If you’re going to demand legislation, remember who is actually providing the treatment, doctors. For your “treat first, worrry about claims later” legislation to work, it needs to be aimed at the right party, doctors.
Well, yeah....that's why I mentioned providers too. Basically, the whole system is in major need of a crackdown and it just needs someone in power with enough balls to take a stand.
So basically, I agree with you - perhaps it's the doctors who should be sued in this case, although I don't know how an insurance company can refuse to pay for this treatment, considering it was potentially life-saving. However, insurance companies are also to blame for many of these cases. Hospitals having to deal with so many different insurance companies, each with their own forms, rules and regulations is a big creator of corporate bureaucracy. Hospitals and doctors are forced to employ a lot of non-medical staff just to deal with the billing/administration side of things.
Just one death like this should be enough for people to wake up and demand action. This is simply not acceptable.
Your missing a bit of the picture. There are not enough liver to go around. Thousands of people die each year waiting for a liver donor.
Even if the insurance co. had approved the surgery there is no guarantee she would have recieved a liver in time, if at all. If she was in a vegetative state which the article clearly stated then I can guarantee she would not have been a candidate. So it is really a moot point, and suing the insurance company a waste of time.
So basically, I agree with you - perhaps it's the doctors who should be sued in this case, although I don't know how an insurance company can refuse to pay for this treatment, considering it was potentially life-saving. However, insurance companies are also to blame for many of these cases. Hospitals having to deal with so many different insurance companies, each with their own forms, rules and regulations is a big creator of corporate bureaucracy. Hospitals and doctors are forced to employ a lot of non-medical staff just to deal with the billing/administration side of things.
In having to research everything for my issue, I can tell you that insurance is a willful venture, you’re not forced to take insurance, you agree to take it and when you do you agree to the terms of the contract they make with you. There are conditions on what they will pay for or in what situation they pay for services. I don’t know the specifics of what type of coverage the patient had so I cant fault the insurance for not agreeing to pay for the transplant.
However if it was such a potentially life-saving procedure, then why didn’t the doctors push for performing the service instead of delaying it and waiting for payment? I still cant see how there is any fault on the part of the insurance company. To find fault one must agree that the insurance company directs treatment, when in fact they only direct payment.
However, insurance companies are also to blame for many of these cases. Hospitals having to deal with so many different insurance companies, each with their own forms, rules and regulations is a big creator of corporate bureaucracy. Hospitals and doctors are forced to employ a lot of non-medical staff just to deal with the billing/administration side of things.
Just a hypothetical, if the patient did not have any insurance, then who would be to blame for a provider not performing a necessary service if they had the ability to do so?
Insurance does not become a legal guardian and direct services, they only pay. So I cant see how they are to blame at all when tragic things happen to a patient when the provider decides to direct their care based on what the insurance company will pay for.
Paraphrasing: this girl needed a liver transplant and the insurance company denied her. They later approved it, but it was too late - she died before the operation could begin.
I understand that for some people, the insurance business works. You know, become marketable, take responsibility, get a good job with good benefits.
This girl was 17 - a minor. This was beyond her control, but she paid the price. In a country with a NHS, she would've gotten the transplant immediately because it was urgent for her life. Instead, there was the insurance run around.
Mods: I put this in the controversy section so we could discuss how the health system is corrupt. If you need to move it, please do so.
While this infuriates me, i can't really say i'm surprised. Oprah did a show on this a few months ago and the lady who represented the health insurance companies was so cold and talked about how insurance companies shopped around for the best price while life hangs in the balance.
Unless we can some things changed stories like will become more common.
Insurance company's love to use a 2 step shuffle. A year ago my daughter was in desperate need of medical care. My primary insurance declined to cover claiming it was mental. ( My daughter is autistic) The mental health insurance declined to pay because they felt that her issues were physical. Her access insurance through the state refused to pay because the other private insurances declined... My daughter 5'6 weighed 85 pounds.... I took her from her mother's house and went directly to a hospital. She was suffering from gross neglect. She had formed a phobia about drinking fluids. She was afraid liquids would make her sick. I ended up taking her home,calling my sister who is an RN in GA. Between my sister and I we got my daughter back to health. What she really needed was hospital care. So there you have it. Private insurance declined to pay. State insurance declined to pay and the providers declined service. The attending physician actually took a measure of interest and on 3 occasions drove the 45 miles to my house to check up on my daughter. He filed a medical neglect complaint against the insurance company's and my ex wife. LOL nobody was made to answer up for what happened. I later had to fight legal battles because I took my daughter away from her loving mother. That is the system in a nut shell. And yes I am more than a tad bitter.
I don't get it. So you don't want good health care? Weird.
No, go back and read the post I quoted and was refering to.
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