A long while back one of my responsibilities was helping to identify medical providers (doctors/clinics) engaging in fraud, via statistical profiling and a little light modeling. Essentially I was doing anomaly detection in their billing, but what I came away with was first, some astonishment at how pervasive it was, and second, a sense of wonder at how fucking stupid/greedy some of these doctors were…most of them could have flown beneath the radar by just doing a little less of it. [ETA I should say, by pervasive I mean something like 3% or 4% of doctors billing above a certain volume who were clearly identifiable… But I always assumed that there was some multiple on top of that not visible to me]
I’ve read a lot of comments in the last week about health insurance second-guessing doctors, but I get why it happens (in general, anyway; I don’t know any specifics about how stringent UHC is, and whether they are screwing people over).
In my province, I read a court case which stated that the single-payer UHC authority does exactly that sort of statistical modelling and brings civil claims against doctors who have over-billed. In extreme cases, it could lead to criminal fraud charges or professional discipline.
None of that affects the patients. The doctors file their bills after they have treated the patient, so there is no requirement for advance approval that could interfere with the patient’s care.
@wolfpup and I have addressed this in the parallel Ethics of Health Insurance thread. That is how it works in Canada, at lower cost than in the US, and producing better general results, measured by factors such as life expectancy and infant mortality rates. There is no “approval” process. The doctor provides medical treatment and sends in their bill to the single-payer.
Cost controls are done at the front end, by having a well-defined provincial budget for health care costs and an extensive list of covered procedures and treatments.
Cost controls after providing patient care are done as set out in my previous post.
I had an ophthalmologist who double billed my insurance company. I only know because the insurance company asked me if I’d received the service, and my initial thought was, “yes, of course” because this was months later so i didn’t remember the date, just the name. But i checked into it, and they’d made up an entirely false visit. They were smart enough not to bill me for that one.
I found a different doctor the next time i wanted my eyes checked out.
For a population of 330 million, that would be 193 billion, give or take, lost due to insurance fraud. According to Motor Vehicle Insurance - US | Statista Market Forecast , the overall U.S. insurance market is about 340 billion dollars, or just over $1K per capita.
So, more than half of revenue goes to pay fraudulent claims? I find that a little hard to believe.
But in the US your doctor (or their employer) is trying to squeeze money out of not just your insurer, but you as well. And the insurers have cooperated by offering high-deductible plans which means the insurer doesn’t give a flying fuck about the doctors fraudulently billing the patient up to $3,000 a year.
I’ve posted several examples in my Pit threat on the topic. And astonishingly we had people come in to say how this fraudulent activity (retroactively changing billing codes) wasn’t wrong.
If they were doing this to a government entity, in a country where people actually had faith in government, they’d be facing criminal sanctions. But in the US, they have only to deal with individuals who they are billing $200-500 for stuff they didn’t do or ridiculous markups, like “dispensing” a wrist brace for $200, that is sold to consumers on the manufacturers website for $13.
No, you’re fine. I’ve been confused in this thread too. To me, “UHC” means “universal health care.” Maybe we could use “UnHC,” or “UH,” or “United” to indicate the insurance company, just to clear up any confusion?
You Canadians… UHC in this context reads United Health Care to me, and probably to most Americans. That’s how it is usually abbreviated. I’ve also been confused by the same abbreviation, too. But really, the primary reading is UHC in this thread should be united health care. I mean, this is a thread about the assassination of the CEO of UHC.
(I’ve had lots of insurance statements from “UHC”. That really is what they are called.)
Honestly, what did these douchebags think was going to happen? They’re trying to pander to a group of people who just voted for a guy whose shtick revolved in large part around waving his middle fingers at the “elites.”
It is nice, though, seeing it slowly dawn on these assholes that they’re not the leopards they thought they were, but rather just another couple of blokes whose faces are liable to be eaten by the real leopards.
Anyway, I did take a peek the other day at the Facebook pages for Fox News and Newsmax to see what the comments were like on the stories they were posting about the shooting. There were plenty of snide remarks about how New York is a crime-infested hellhole, along with quite a few expressions of genuine sympathy for Thompson, but there was no shortage of people cracking the sorts of jokes we’ve seen elsewhere, including here (sympathy is out of network, thoughts and prayers require prior approval, etc.).
The Insurance Adjuster (the moniker that social media has bestowed upon the shooter), has seemingly accomplished the impossible - getting the left and the right in this country to agree, even if only on one matter.
Canadians do not have “UHC”, they have “Medicare”. But, when the conversation wanders into these topics, “UHC” never means “United Health Care” to me, it means single-payer. Context helps.
Single payer and universal healthcare are not synonymous. Many countries have universal coverage through very tightly regulated private health insurance.
CBS news did a story on this today. They showed 3 different women expressing how not sorry they feel.
Man, I gotta be honest, it was not a good look. I would feel like an absolute piece of shit if I knew that one of his children saw me say that.
Or his parents or his wife if she still feels anything for the father of her children.
Don’t get me wrong, I get the anger. My mom bought her first and only home when she was near 50 years of age and then lost it when she got sick. She didn’t even have health insurance since her job didn’t provide any and she couldn’t afford it on her low wage.
But anyway, wouldn’t this man have a board he had to answer to? Surely, he wasn’t the lone decision maker, was he?