Insurers say prior authorization helps control costs by preventing medically unnecessary care, but patients say the process can delay or deny access to needed treatments.
What I like is having to get "prior authorization" for an antidepressant that I've been taking for years, and then I run out because it's the weekend and nobody can get hold of anybody for anything.
I’m sure there’s plenty of examples but I’m going to share one from my work experience.
We had a patient who survived a really bad car accident but their jaw was broken in 4 (four) places. One of those cases when the doctor will wire your mouth shut leaving a small hole for the straw so you can drink your soup for the next x weeks.
The patient had a facial reconstructive surgery coming and their surgeon ordered an MRI of their jaw to see where the pieces were before cutting them open. The patient, unfortunately, had one of those cheapo insurance plans that were provided by their employer. Said insurance denied the MRI authorization 3 (three!) times due to “lack of medical necessity”. It took us literal hours of arguing with that arsehole adjustor and their supervisors on the phone until they finally approved it.
The federal government has proposed ways to reform prior authorization that would require insurance companies to provide more transparency about denials and to speed up their response times.
So insurance companies can keep doing the same bullshit, they just need to send you more meaningless fine print about it more quickly. Gee, thanks Biden administration.
If finalized, those federal changes [wouldn’t ] be implemented [until] 2026.
Ok, I already said my sarcastic “thanks,” you can stop making it worse now.
But even then, the rules would apply only to some categories of health insurance, including Medicare, Medicare Advantage, and Medicaid plans, but not employer-sponsored health plans. That means roughly half of all Americans wouldn’t benefit from the changes.
We need nationalized healthcare. Now. There are 32 developed nations on earth. 31 of them have nationalized healthcare options. We are the only country that does not.
Why are conservatives (and neo-liberals) so opposed to modern healthcare?
There are, unfortunately, many people who only get enjoyment out of other people’s jealousy. They are proud that they have “good” insurance that covers everything, in the same way they are proud of their expensive house/car/boat/etc. If everyone has that thing, they aren’t special and it isn’t a cool toy because anyone could
I think it’s because it’d end a lot of jobs and moneymaking opportunities. Imagine all those huge insurance companies just… not being needed the day nationalized healthcare happens. What about all those administrators who fill out the paper work in doctor’s offices?
OTOH, it might also be what’s needed to cool down the job market in the US.
Lot of typewriter repair jobs got ended by the advent of computers but we didn’t let that stop us, we shouldn’t protect obvious economic inefficiencies like this just to reward already affluent people
I’m just saying that one thing most politicians do not want to be seen to do is get rid of any jobs. This is why it’s hard to get traction with it - it’ll hurt them politically directly(people think nationalized health care is worse or bad), it’ll hurt their campaigns (cause contributions), and it’ll hurt them on “the economy” because they “killed lots of good jobs”.
“I know my job makes the world a worse place and my boss treats me like trash, I wish I could just quit and pursue my own dreams, but I need health insurance!”
One of several reasons is they can’t make obscene amounts of money from socialized healthcare. Another would be their aversion to helping the less fortunate who they see as simply moral failures in life who don’t deserve handouts. And maybe a final point is that they know and trust the corruption of free market solutions instead of the “obviously inept and corrupt, gravy-train of welfare cheating governments” that they’ve been taught to hate (until the handout money comes to them during an emergency).
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