In today's "God Damn America" news: 1,000 patients at Cincinnati Children’s Hospital left out in cold after insurer drops coverage

[Commissar SFLUFAN]

1,000 patients at Cincinnati Children’s left out in cold after insurer drops coverage

WWW.FOX19.COM

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‘We don’t know what we’re going to do.’

 

Quote

 

The families of nearly a thousand Cincinnati Children’s patients are scrambling after a major insurer ended its contract with the world-renowned hospital in Avondale.

 

CareSource notified Cincinnati Children’s last month that it would terminate its Ohio Marketplace contract effective Aug. 1. As a result, according to a hospital spokesperson, about 1,000 patients considered “in-network” through insurance with Cincinnati Children’s and its physicians will soon be “out of network.”

 

 

Quote

 

A Cincinnati Children’s representative says the hospital has contacted families in an effort to ensure continued care and to “minimize financial burden.”

 

The representative also says Cincinnati Children’s patients and families may qualify for 90 days of continued coverage by CareSource if their care is for a diagnosis that is serious or complex.

 

 

[Ghost_MH]

This, this right here is the hardest thing to explain to people not from the US. I talk to colleagues in the EU and they get that healthcare in the US is wildly expensive and even after paying thousands for health insurance you still owe hundreds and thousands thanks to your deductible. However, so many of them assume insurance is as good as money and accepted anywhere. Nope. I haven't changed the company I work for in for years. In that time, I've had to change primary care doctors multiple times because of moving from Cigna to United Healthcare to Anthem Blues Cross. All of it outside my control. It's pretty cool.

[finaljedi]

CareSource is a shit company.  The only place I've interviewed at where they "forgot" about my interview and left me sitting in the lobby with the person who was supposed to be interviewing me not even showing up for work that day.  Also the job was "grievances and appeals analyst" which means one thing at Anthem and UHC and apparently at CareSource meant "incoming call center".  They apologized and set me up with an interview the next week, they sent a random employee down to do the interview, not a manager, not even a team lead, just some lady who worked on the team.  Since my resume has gotten a lot better and my skillset has broadened I occasionally get emails from third party companies for like 3 months contracts there, no...

 

I don't know who's at fault with this story but I'm going to jump to a conclusion and just say fuck CareSource.

[Mr.Vic20]

If there were an alternative list to the "Seven Wonders of the World", called "The Seven Blunders of the World", surely the American health care system, the war in Iraq and the war in Ukraine would all make the list. 

[GeneticBlueprint]

6 minutes ago, Ghost_MH said:

This, this right here is the hardest thing to explain to people not from the US. I talk to colleagues in the EU and they get that healthcare in the US is wildly expensive and even after paying thousands for health insurance you still owe hundreds and thousands thanks to your deductible. However, so many of them assume insurance is as good as money and accepted anywhere. Nope. I haven't changed the company I work for in for years. In that time, I've had to change primary care doctors multiple times because of moving from Cigna to United Healthcare to Anthem Blues Cross. All of it outside my control. It's pretty cool.

 

At my first real job at a real company they changed health insurance companies every year because they were always trying to save money. People used their health insurance to get care (imagine that) so the cost would go up every year for the company when renewal time came. So they'd go out for bids with their requirements and just choose the lowest bidder. I went through five different health insurance companies in my time there. My final year there they I Reply All-ed the meeting invite in November for the "Explanation of Benefits for 2019" and asked them to "change the title of the meeting to 'Explanation of the Benefits of socialized medicine' because all we're going to hear is that, like every other year, you need to go find new doctors and specialists, transfer all your records, and move your HSA funds to a different HSA provider that takes weeks and charges a fee again."

[Brick]

Working as intended according to Republicans. 

[Keyser_Soze]

Maybe Joe Burrow will help the families out.

[Commissar SFLUFAN]

1 minute ago, Brick said:

Working as intended according to Republicans. 

 

If only this deplorable condition was solely limited to Republicans.

 

If only.

[GeneticBlueprint]

Health insurance executives and administrators are the most deserving victims of firing squads and guillotines on this planet.

[finaljedi]

6 minutes ago, GeneticBlueprint said:

 

At my first real job at a real company they changed health insurance companies every year because they were always trying to save money. People used their health insurance to get care (imagine that) so the cost would go up every year for the company when renewal time came. So they'd go out for bids with their requirements and just choose the lowest bidder. I went through five different health insurance companies in my time there. My final year there they I Reply All-ed the meeting invite in November for the "Explanation of Benefits for 2019" and asked them to "change the title of the meeting to 'Explanation of the Benefits of socialized medicine' because all we're going to hear is that, like every other year, you need to go find new doctors and specialists, transfer all your records, and move your HSA funds to a different HSA provider that takes weeks and charges a fee again."

 

Working for health insurance for years really makes you see the positives of a single payer system.

 

I remember when Republicans would talk about government death panel boogeymen and it's like... stuff like that exists, except it's a panel of people in a corporate conference room in Indianapolis or a web meeting determining medical policy once a quarter and second level appeals were panel appeals where most of the denial's were upheld. 

 

I refuse to believe the government would handle healthcare less efficiently than Anthem did when I was there.

[Jason]

8 minutes ago, Commissar SFLUFAN said:

 

If only this deplorable condition was solely limited to Republicans.

 

If only.

 

 

[Jason]

3 minutes ago, finaljedi said:

 

Working for health insurance for years really makes you see the positives of a single payer system.

 

I remember when Republicans would talk about government death panel boogeymen and it's like... stuff like that exists, except it's a panel of people in a corporate conference room in Indianapolis or a web meeting determining medical policy once a quarter and second level appeals were panel appeals where most of the denial's were upheld. 

 

I refuse to believe the government would handle healthcare less efficiently than Anthem did when I was there.

 

Anthem notoriously used to refuse to cover anesthesia for colonoscopies. They were technically right that it's not strictly medically necessary and there's a nonzero risk of not waking back up after anesthesia...but how many people who aren't Trump unwilling to give Pence power for a day are willingly going to rawdog a colonoscopy? But it was probably all penny-pinching hoping that colon cancer and the other shit colonoscopies screen for will be cheaper to treat for a couple of months when it's late stage and is gonna kill you rapidly than paying for colonoscopies yearly and catching things early.

[CitizenVectron]

1 hour ago, finaljedi said:

 

Working for health insurance for years really makes you see the positives of a single payer system.

 

I remember when Republicans would talk about government death panel boogeymen and it's like... stuff like that exists, except it's a panel of people in a corporate conference room in Indianapolis or a web meeting determining medical policy once a quarter and second level appeals were panel appeals where most of the denial's were upheld. 

 

I refuse to believe the government would handle healthcare less efficiently than Anthem did when I was there.

 

In fact, I'd wager there is less denial in public systems. Speaking only for Canada (which, technically, is actually 10+ different universal systems held together by overarching federal funding), it is very difficult for the government to refuse paying for a treatment if you can get a specialist to demand it. An example of this is the current state of MS treatment (of which I am familiar). The rules state (similar to in the US with most private insurers) that you must "fail" lower-efficacy treatments (i.e. cheaper) before you can start better treatments. However, treatments have gotten so much better over the past five years (and they all cost pretty much the same, around $100,000/yr), that neurologists are pushing more and more for people to be started on level 2 (or 3) treatments right off the bat. Sometimes they will get pushback, but they almost always win, because the system is set up so that doctors (and especially specialists) are the final arbiter of what treatment you need, not the organization paying for the treatment (in Canada's case, the government). 

 

Now, it gets a bit muddled because we also have private extension plans in Canada for prescriptions (though that may change a bit if the current government brings in some kind of universal Pharmacare, like it says it wants to), but generally speaking if a specialist says you need a drug/treatment, then you are going to get it. You may wait a bit longer than a very rich person in the US, but I would wager that if you include all the people who are denied treatment in the US (or simply never seek it knowing that they will not receive it), then most people in Canada receive treatment in a shorter timeframe. The key thing is that no one is (theoretically) denied treatment.

 

The biggest issue facing our system right now is that because it's not designed for competition, we don't have the massive excess capacity of hospitals/nurses that the US had prior to the pandemic (we had enough to cover normal demand). But a huge number have quit because of horrible work conditions (just like in the US), but because we didn't have the excess capacity, we now face shortages in ERs, hospitals, etc. 

[Ghost_MH]

1 hour ago, GeneticBlueprint said:

 

At my first real job at a real company they changed health insurance companies every year because they were always trying to save money. People used their health insurance to get care (imagine that) so the cost would go up every year for the company when renewal time came. So they'd go out for bids with their requirements and just choose the lowest bidder. I went through five different health insurance companies in my time there. My final year there they I Reply All-ed the meeting invite in November for the "Explanation of Benefits for 2019" and asked them to "change the title of the meeting to 'Explanation of the Benefits of socialized medicine' because all we're going to hear is that, like every other year, you need to go find new doctors and specialists, transfer all your records, and move your HSA funds to a different HSA provider that takes weeks and charges a fee again."

 

It's such a dumb feature of US healthcare. This is why it's so hard for non-Americans to wrap their heads around it. What do you mean your doctor can't just bill any insurance provider and get paid?

 

It's also the most hilarious trying when I hear people argue against universal healthcare saying they like their own healthcare. 99% of this country doesn't have the ability to choose their own healthcare outside of some meager and almost inconsequential elections their employer allows them.

 

If anyone not from the US wants to know how ridiculous it is, work for Amazon in the US. Do that and you get Amazon Care. Oh yeah, and Amazon also bought One Medical so some Amazon employees will get insurance by Amazon and have a primary care doctor be another Amazon employee.

 

Amazon buying One Medical is only its most recent dive into the health care industry

WWW.NPR.ORG

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Amazon is buying One Medical, a primary care practice. The tech giant has already stepped into the health care world, but experts said this is a big step to expand Amazon's physical health presence.

 

[silentbob]

We have seen some E.R’s in the Toronto area closing down early or not even opening on some days because they have no one to cover right now. There’s a big push to allow foreign/new immigrants who have a medical degree from their country to get them working in local hospitals. We brag about our health care but we are hanging on by a thread right now. I still haven’t gotten my results back from my colonoscopy/endoscopy from the beginning  of June. Called my family doctor but no results. Called the doctors office of the physician who did my procedure and they too have no results yet. She said she might of seen something in my stomach/lower track but who knows now. The receptionist just said “Well we will have your results when you come for your follow up appointment on Nov 9th” I sure as fuck hope so by then. 

[b_m_b_m_b_m]

Had my mother in law say that someone she knows has a kid with club feet and “socialized medicine” in Canada wont cover the operation to correct it and all I can think is that she’s not far from the median voter and she’s dumb as shit and gets her information from Facebook. Yes sue that’s why they moved to Florida 

[finaljedi]

1 hour ago, Jason said:

 

Anthem notoriously used to refuse to cover anesthesia for colonoscopies. They were technically right that it's not strictly medically necessary and there's a nonzero risk of not waking back up after anesthesia...but how many people who aren't Trump unwilling to give Pence power for a day are willingly going to rawdog a colonoscopy? But it was probably all penny-pinching hoping that colon cancer and the other shit colonoscopies screen for will be cheaper to treat for a couple of months when it's late stage and is gonna kill you rapidly than paying for colonoscopies yearly and catching things early.

 

Medical policy on what's covered for what vs what's not is incredibly specific.  My last job there was claims inquiries, an inquiry would come in from a provider sent trough the host BCBS plan and I would have to research what it bumped into on medical benefits or plan exclusions and send back a detailed response.   Got a lot of ones for end stage renal disease because at a certain time from the start of dialysis Medicare takes over as prime and private insurance shifts to secondary, I think it was 18 months.  One day I overrode a bunch of ESRD denials and paid them because their private insurance was still primary and shelled out about $70,000 in claims payments in one afternoon, I got "randomly" selected for a full quality audit of my work the next week.  The treatments for stuff like varicose veins got weirdly specific and a lot of stuff that was tried wasn't covered, inpatient mental health services were only covered if you were practically about to eat the end of a shotgun.  I remember working appeals and single guys would call the appeals voicemail to initiate an appeal because medical guidelines said home recovery from a lot of surgery can be handled by a family member and that a visiting nurse to change dressings or whatever is not medically necessary.

 

17 minutes ago, CitizenVectron said:

 

In fact, I'd wager there is less denial in public systems. Speaking only for Canada (which, technically, is actually 10+ different universal systems held together by overarching federal funding), it is very difficult for the government to refuse paying for a treatment if you can get a specialist to demand it. An example of this is the current state of MS treatment (of which I am familiar). The rules state (similar to in the US with most private insurers) that you must "fail" lower-efficacy treatments (i.e. cheaper) before you can start better treatments. However, treatments have gotten so much better over the past five years (and they all cost pretty much the same, around $100,000/yr), that neurologists are pushing more and more for people to be started on level 2 (or 3) treatments right off the bat. Sometimes they will get pushback, but they almost always win, because the system is set up so that doctors (and especially specialists) are the final arbiter of what treatment you need, not the organization paying for the treatment (in Canada's case, the government). 

 

Now, it gets a bit muddled because we also have private extension plans in Canada for prescriptions (though that may change a bit if the current government brings in some kind of universal Pharmacare, like it says it wants to), but generally speaking if a specialist says you need a drug/treatment, then you are going to get it. You may wait a bit longer than a very rich person in the US, but I would wager that if you include all the people who are denied treatment in the US (or simply never seek it knowing that they will not receive it), then most people in Canada receive treatment in a shorter timeframe. The key thing is that no one is (theoretically) denied treatment.

 

The biggest issue facing our system right now is that because it's not designed for competition, we don't have the massive excess capacity of hospitals/nurses that the US had prior to the pandemic (we had enough to cover normal demand). But a huge number have quit because of horrible work conditions (just like in the US), but because we didn't have the excess capacity, we now face shortages in ERs, hospitals, etc. 

 

It can get really silly here when it comes to covered vs not covered, especially if you have to go to a hospital.  You can go to a hospital that is in your plan's provider network but the actual clinicians who tend to you there are out of network which can kick off a flurry of denials and appeals.  Some of the services provided will get denied because they weren't preauthorized or medical policy says that procedure isn't cleared for that diagnosis code or some lab work wasn't medically necessary.  Sometimes it's about cost savings, sometimes it feels pretty arbitrary.  I had a zirconia crown installed 2 years ago and the dentist was telling me some dental plans will only cover the metal based hybrid crowns or whatever even though those are starting to be more expensive, but that they have to do that or charge the patient full price since some dental plans won't cover it.

 

Fuck am I glad Anthem canned my ass in 2015.

[Kal-El814]

A non trivial amount of taking care of yourself in the US healthcare system involves looking over your claim forms in detail, calling your insurance company, and being unwilling to get off the phone until stuff gets approved or processed. When I had surgery after breaking my leg, a couple of the providers who were only present when I was unconscious weren’t in network. When I pointed out that I couldn’t have confirmed the service providers were in network while anesthetized, nor would I have been in a position to do so even if I was conscious, lo and behold, the claim got processed. I’m SURE other people just pay, because why wouldn’t they.

 

These people are the least pleasant people on earth to haggle with, very close only to small Cambodian women tying to sell you bottled water outside Angkor Wat and that’s because they called me a filthy white boy when I decided to buy water from someone else.

[Jason]

6 minutes ago, Kal-El814 said:

they called me a filthy white boy

 

[Kal-El814]

6 minutes ago, Jason said:

 

 

It hurt because it was real.

[CitizenVectron]

28 minutes ago, Kal-El814 said:

A non trivial amount of taking care of yourself in the US healthcare system involves looking over your claim forms in detail, calling your insurance company, and being unwilling to get off the phone until stuff gets approved or processed. When I had surgery after breaking my leg, a couple of the providers who were only present when I was unconscious weren’t in network. When I pointed out that I couldn’t have confirmed the service providers were in network while anesthetized, nor would I have been in a position to do so even if I was conscious, lo and behold, the claim got processed. I’m SURE other people just pay, because why wouldn’t they.

 

These people are the least pleasant people on earth to haggle with, very close only to small Cambodian women tying to sell you bottled water outside Angkor Wat and that’s because they called me a filthy white boy when I decided to buy water from someone else.

 

An important difference between living in the US and other western nations (that I don't think a lot of Americans think about, though I imagine those here do) is never even considering your health coverage, especially when considering your job options. I never have to worry about being laid off, or taking a different job based on my health coverage. 

[Jwheel86]

What's wild to me about the US system, being covered by both work and Medicaid, is what services are easy vs hard to get despite costs and overall benefits. 

 

-Medicaid covered nursing home where I can't work, no family support, probably cost the state $200/yr: one phone call to Adult Protective Services and I'm in a bed before the end of the day or hospitalized until they get one. 

-Medicaid Home care where I work full time (paying taxes), have social life that enables more family support, significantly cheaper than a nursing home ($135k/yr): fuck you 15 year waiting list. 

 

-$30k powerchair to replace a 7 year old one (built to last 5) that's barely running: three appeals including independent review, all denied. Provider simply resubmits and it goes through clean. 

-$370k-$1.5m/yr specialty medication: DNA test and a simple letter from the PT, approved every time no push back. 

 

Every spinal injection I got covered by Medicaid was the exact cost of a Medicaid Home Care slot with a 15 year waiting list, and I got 4 to 6 every year. 

[Ghost_MH]

22 minutes ago, Jwheel86 said:

-Medicaid Home care where I work full time (paying taxes), have social life that enables more family support, significantly cheaper than a nursing home ($135k/yr): fuck you 15 year waiting list. 

 

Oh, this is an easy one to explain. I don't know if the option exists in all states, but sometimes you can get family members to cover care and they'll get paid by the state to render services. Someone along the chain probably thought this was ripe for poors and minorities to take advantage of, so money was pulled away from the program and made entering it as painful as possible. Even in Massachusetts the rules are dumb and restrictive. Like parents aren't eligible to be paid caregivers of their own children, even if giving them care is a full time job and keeps them from being able to work. Also can't be a spouse, which is wild bullshit. The state would rather pay a random person more money to be a caregiver than give that person's spouse less money to do the exact same job. It doesn't make sense until you think of it in terms of racist lawmakers being wary of Welfare queens.

[Jwheel86]

1 hour ago, Ghost_MH said:

 

Oh, this is an easy one to explain. I don't know if the option exists in all states, but sometimes you can get family members to cover care and they'll get paid by the state to render services. Someone along the chain probably thought this was ripe for poors and minorities to take advantage of, so money was pulled away from the program and made entering it as painful as possible. Even in Massachusetts the rules are dumb and restrictive. Like parents aren't eligible to be paid caregivers of their own children, even if giving them care is a full time job and keeps them from being able to work. Also can't be a spouse, which is wild bullshit. The state would rather pay a random person more money to be a caregiver than give that person's spouse less money to do the exact same job. It doesn't make sense until you think of it in terms of racist lawmakers being wary of Welfare queens.

 

That part of it, which in turns explains Electronic Visit Verification where paid caregivers have to clock in and out on their personal phone which checks their GPS, meaning I have to register with the state every possible location they might start or end a shift with me (home, work, friend's house, a bar, etc). Thanks Obama HHS for misreading the Cures Act under EVV vendor lobbyist pressure.

 

The other reason is that Medicaid Home Care is an optional service requiring the State Legislatures to budget their end of what slots cost, other services like nursing homes are mandatory services the state has to pay. Nursing Home execs lobby those State Legislatures to keep the waiting lists in place. 

[Ghost_MH]

50 minutes ago, Jwheel86 said:

 

That part of it, which in turns explains Electronic Visit Verification where paid caregivers have to clock in and out on their personal phone which checks their GPS, meaning I have to register with the state every possible location they might start or end a shift with me (home, work, friend's house, a bar, etc). Thanks Obama HHS for misreading the Cures Act under EVV vendor lobbyist pressure.

 

The other reason is that Medicaid Home Care is an optional service requiring the State Legislatures to budget their end of what slots cost, other services like nursing homes are mandatory services the state has to pay. Nursing Home execs lobby those State Legislatures to keep the waiting lists in place. 

 

Checks out. Anytime anything in this country doesn't make sense, it's always pretty safe to assume it's because either racism, we need to keep the poors in check, lobbyists, or some combination of those.

[Anathema-]

Health insurance. A scam for the most morally depraved and nothing more. 

[Anathema-]

Thing is health care is cheaper the more people are on it. I don't see why it wouldn't be incredibly easy, on both a policy and political level, to create a federal health insurance provider that utterly dominates the market and ultimately muscles its way to a monopoly. 

 

No need to ban health insurance, just make private insurance obsolete. 

[Signifyin(g)Monkey]

22 minutes ago, Anathema- said:

Health insurance. A scam for the most morally depraved and nothing more. 

I’ve always found the question of why American industrial capital didn’t push more for a nationalized healthcare system during the twentieth century interesting.

 

A privatized system rewards finance capital at their expense—it makes labor more expensive for them and increases their operating costs, all while boosting profits for finance.  By not pushing for it, they essentially handed finance a competitive advantage on a silver platter.

 

I’ve theorized that maybe it was because American industrialists had literally zero competition during the first half of the twentieth century due to the world wars, so they didn’t perceive a need to get a leg up on the financiers, and didn’t think American financiers would use the advantage they were ceded to effectively conquer industrial capital a few decades after the wars concluded, as they did.

 

Maybe if the world wars hadn’t been such a bonanza for US industry, we’d have nationalized healthcare.  But then we wouldn’t have the good old American empire, so…you win some, you lose some.

[Jwheel86]

3 hours ago, Anathema- said:

Thing is health care is cheaper the more people are on it. I don't see why it wouldn't be incredibly easy, on both a policy and political level, to create a federal health insurance provider that utterly dominates the market and ultimately muscles its way to a monopoly. 

 

 

Lobbyists, look at Medicare vs Medicare Advantage. 

[CitizenVectron]

3 hours ago, Anathema- said:

Thing is health care is cheaper the more people are on it. I don't see why it wouldn't be incredibly easy, on both a policy and political level, to create a federal health insurance provider that utterly dominates the market and ultimately muscles its way to a monopoly. 

 

No need to ban health insurance, just make private insurance obsolete. 

 

11 minutes ago, Jwheel86 said:

 

Lobbyists, look at Medicare vs Medicare Advantage. 

 

Same thing is true of home insurance, car insurance, etc. A great example in Canada is my own province, where we have a government insurance monopoly on basic auto insurance. As a result of this, even though we are a small province (pop 1.1 million), we have one of the largest insurance pools in the country since everyone is in it. So, our rates are the lowest, we use the least-discriminatory factors when assessing risk (we don't include sex/gender, credit score, age, etc), and any/all profits go into the reserve fund for the government insurer...and when the reserve fund gets too large, everyone gets a rebate cheque back. Compare this to Ontario (largest province, pop 14.5 million) where their rates are exorbitant because of so much competition and private systems.

 

Basic, needed stuff should be handled by government since there is far less overhead cost with a single provider, no profit motive, and the goal is to help everyone, not to make money off them.