Sunday, April 2, 2023

Big Money In Medical

Tonight I heard on The PBS Newshour how CIGNA can process tens of thousands of claims at two seconds a claim.

And they can achieve that stupendous volume of processing without needing to look at patients' medical records.

It's really efficient: a claim comes in, the system identifies it as having no medical merit and the system passes it to a physician who signs off on the denial.

It's a bulk process denial system.

Decided in advance, no adjudication is required.

It makes a lot of money for CIGNA.

People pay CIGNA for coverage CIGNA decides in advance what their profit margin will allow to be covered.

The bulk denier bundles everybody up and sends them off to the pysician in charge of denial.

It puts a lot of Americans one step closer to bankruptcy.

A few weeks ago, after several HIPPA compliant back and forths with my Primary Care Physician, involving a prescription and its trivial future use I added this message to our message stream.

"Thank you for the amount of time you devoted to this.  

"I love MyChart because of the access it gives patients, but, the manner in which that access dodges the real question of how, and how much health professionals ought to be paid, and how it cedes the answers to those obviously vital questions to the insurance industry, an industry which is really a parasite, not an industry, makes me angry.  

"A few years ago, because I wanted to do a blog post that would, after the necessary discount for me having written it, be somewhat factual, I did a Google study of the European health apparatus. 

"The short story was that that apparatus comes in several flavors: they all have an insurance-like spine, some with a private enterprise body (Switzerland) some a hybrid with both private and public body parts (France) and some public only (UK).  

"None of them were/are for-profit.

"They all are universal.

"In France, I have had personal experience with taxi drivers telling me how good their health care system is, and expressing the deep belief that their coverage is the same as the President's.

"They all cost substantially less than the vaunted US 'Merican system, and they all yield better results. 

"Putting our 'system' in the hands of for-profit insurance seems to me to be archetypical moral malfeasance". 

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