Are you happy with your health insurance situation?

[noxiousdog]

There are two parts to health reform: reform of access to make coverage universal, and reform of compensation and procedures to bring down costs. The former helps the latter, in that providing proper coverage should reduce the need for people to go to the ER for late, grossly expensive care for conditions that could have been addressed more cheaply earlier.

This is a myth. 25% of all health costs are incurred in the last year of life. No amount of alleged preventative maintenance can change that.

The larger the insurance pool, the better costs can be spread about. But it is, generally, the former issue, not the latter, that I'm most concerned with. The rich-man-gets-cured, poor-man-gets-buried system we have now is unjust and wrong, and a blight on our national character.

85% of people have health insurance. By bringing 'rich men' into it, you're distorting the issue. While I would love to see a national risk pool, I'd like to see an honest discussion and logical solution instead of an emotional one.

Do you think that my friend who got cancer at 18 should be left out of the medical system for his entire life, and left to die the next time he gets seriously ill?

Is it really your position that people with cancer and insurance don't get treated?

Or that people who pay their premiums every month without question should have their coverage pulled at the very moment they actually need it on some technicality that the company didn't even bother to look for until paying for care was suddenly required?

I don't think insurance fraud requires a total overhaul of the system.

[Kraken]

Tonight the AP reports that the White House is ready to cave on the public option.

Under a proposal by Sen. Kent Conrad, D-N.D., consumer-owned nonprofit cooperatives would sell insurance in competition with private industry, not unlike the way electric and agriculture co-ops operate, especially in rural states such as his own.

With $3 billion to $4 billion in initial support from the government, the co-ops would operate under a national structure with state affiliates, but independent of the government. They would be required to maintain the type of financial reserves that private companies are required to keep in case of unexpectedly high claims.

"I think there will be a competitor to private insurers," Sebelius said. "That's really the essential part, is you don't turn over the whole new marketplace to private insurance companies and trust them to do the right thing."

I'm far from expert on this topic, but isn't this a pretty serious FAIL for the liberals?

[Fireball]

No, not necessarily. I've said for weeks that I would be happy with a solution that dramtically reorganizes our present system without a public option. Many European nations achieve universal coverage, which is the end I'm interested in, without a public insurance program. If the abusive, evil practices that block many hardworking Americans from securing insurance are ended, and public support is provided to help working class and poor Americans afford private coverage, that would be an acceptable solution for this liberal. Others are more dogmatic. As someone who works in politics, I have little personal or professional use for dogmatists.

If there's no public option, there's likely going to be a series of non-profit co-ops to provide alternative forms of coverage for folks not wanting to join the private insurance system.

[Kraken]

I've been favorably impressed with the nonprofit coops that I've done business with over the years. Treating health insurance like a quasi-public utility could be the political breakthru that gets it done.

[Austin]

Yesterday Savannah hurt her arm at the elbow. It was probably a fairly common sublaxation but seeing as it still hurt this morning, I took her to the Dr. The Dr decided X-rays were in order so who am I to disagree, I want to make sure my kid is healthy. Anyway I think I just spent 400-750 bucks on peace of mind, out of pocket. It is times like these that I miss my company plan and dislike my high deductable plan. At least it's pre-tax money. I may have to reevaluate our deductible/premiums at the end of the year though. (of course next year we'll be perfectly healthy and uninjured.

[qp]

Yesterday Savannah hurt her arm at the elbow. It was probably a fairly common sublaxation but seeing as it still hurt this morning, I took her to the Dr. The Dr decided X-rays were in order so who am I to disagree, I want to make sure my kid is healthy. Anyway I think I just spent 400-750 bucks on peace of mind, out of pocket. It is times like these that I miss my company plan and dislike my high deductable plan. At least it's pre-tax money. I may have to reevaluate our deductible/premiums at the end of the year though. (of course next year we'll be perfectly healthy and uninjured.

Oh man...careful, first she'll be getting those extra daddy-i'm-hurt cuddles, next you know Snickers will have a new playmate - a poney! (Assuming she asks for a poney, which is what all girls ask for right?)

[princyjoshu]

thanks for postings

[thanks for spammings]

[Max Peck]

This seems as good a health insurance topic to necro as any other, even if the cool kids only want to discuss it over in the shooting thread.

UnitedHealth’s Optum left an AI chatbot, used by employees to ask questions about claims, exposed to the internet

Healthcare giant Optum has restricted access to an internal AI chatbot used by employees after a security researcher found it was publicly accessible online, and anyone could access it using only a web browser.

The chatbot, which TechCrunch has seen, allowed employees to ask the company questions about how to handle patient health insurance claims and disputes for members in line with the company’s standard operating procedures (SOPs).

While the chatbot did not appear to contain or produce sensitive personal or protected health information, its inadvertent exposure comes at a time when its parent company, health insurance conglomerate UnitedHealth, faces scrutiny for its use of artificial intelligence tools and algorithms to allegedly override doctors’ medical decisions and deny patient claims.

Mossab Hussein, chief security officer and co-founder of cybersecurity firm spiderSilk, alerted TechCrunch to the publicly exposed internal Optum chatbot, dubbed “SOP Chatbot.” Although the tool was hosted on an internal Optum domain and could not be accessed from its web address, its IP address was public and accessible from the internet and did not require users to enter a password.

Like many AI models, Optum’s chatbot was capable of producing answers to questions and prompts outside of the documents it was trained on. Some Optum employees appeared intrigued by the chatbot, prompting the bot with queries like “Tell me a joke about cats” (which it refused: “There’s no joke available”). The chat history also showed several attempts by employees to “jailbreak” the chatbot by making it produce answers that are unrelated to the chatbot’s training data.

When TechCrunch asked the chatbot to “write a poem about denying a claim,” the chatbot produced a seven-paragraph stanza, which reads in part:

In the realm of healthcare’s grand domain
Where policies and rules often constrain
A claim arrives, seeking its due
But alas, its fate is to bid adieu.

The provider hopes, with earnest plea,
For payment on a service spree,
Yet scrutiny reveals the tale,
And reasons for denial prevail.

[hepcat]

This seems as good a health insurance topic to necro as any other, even if the cool kids only want to discuss it over in the shooting thread.

We've since moved on to discussing Zarathud's children and their ability to make grown adults cry in that thread.

[disarm]

The company for which I work (and am a partner with ownership stake) has finally made the move to funding our own health insurance effective January 1st. What this means is that instead of paying premiums to an insurance company, that money will instead go into a fund that is then used to cover employee healthcare expenses. We still have a contract with an insurance company to help manage billing and payments (and we pay a fee for that service), but any expenses will be billed to our corporation instead of being paid by the insurance company. We do have a form of "catastrophic" insurance that would kick in if something happened to drastically increase our expenses beyond what is typical for a year.

We made this decision after years of rising premiums and utilization levels that made it clear we were paying substantially more into the plan than we were receiving in return. In the last five years alone, I've seen the annual cost of my family plan balloon from $30k up to $40k...a 25% increase for a plan that is barely used by two healthy adults in our 40s and a healthy 10yo. If we manage this new model correctly, we could eventually reach a point where years of invested "premiums" could significantly reduce what we have to pay in every year, saving money for everyone...but that level of self-funding is quite a way off. For now, we pay what we always have and build up our reserve...

[hepcat]

I switched to an HSA a few years ago, but I fear I did so too late in the game. Still, I don't spend a lot on healthcare, so I'm banking most of the contributions for now. When I retire in a few years, I'm hoping I have enough in it to fund health insurance until medicare kicks in, and then it would be used just for supplemental insurance (if there is anything still in it...which is doubtful).

But yes, health care in this country sucks and it needs to be fixed. This bullshit belief that it's expense because it's the best is just that, bullshit. Socialize this shit. Now.

We're a first world country with a third world health care system.

[Alefroth]

Isn't part of the reason healthcare is so expensive because of insurance?

[disarm]

Isn't part of the reason healthcare is so expensive because of insurance?

Yep...health insurance companies pocket a lot of your premiums as profit, and there's an entire army of people who don't work for insurance companies but still have to be employed and paid just to manage all the paperwork and bureaucracy related to dealing with insurance companies. It's a great system...

[hepcat]

Isn't part of the reason healthcare is so expensive because of insurance?

There's still plenty of blame to spread around for practitioners and institutions. Yachts don't buy themselves, you know.

[Alefroth]

What I mean is that they can inflate prices because insurance will cover it.

[disarm]

Isn't part of the reason healthcare is so expensive because of insurance?

There's still plenty of blame to spread around for practitioners and institutions. Yachts don't buy themselves, you know.

I'm nowhere near owning a yacht...not after twelve years of education and $200k in student loan debt. Even if I could afford one, the 50-60 hours I work every week wouldn't leave me any time to enjoy it.

[Skinypupy]

The healthcare that I have now through work is fine, I suppose.

It's more the fact that I would have exactly zero healthcare options that wouldn't bankrupt me should I get fired or leave my job that's the problem.

[hepcat]

Isn't part of the reason healthcare is so expensive because of insurance?

There's still plenty of blame to spread around for practitioners and institutions. Yachts don't buy themselves, you know.

I'm nowhere near owning a yacht...not after twelve years of education and $200k in student loan debt. Even if I could afford one, the 50-60 hours I work every week wouldn't leave me any time to enjoy it.

As with anything, there's the good folks who work within the field. I realize my flippancy was unmerited. But the lack of transparency in health care costs in institutions and procedures is a well known factor in the disparate and often ridiculous price gouging found in health care.

This Harvard magazine article on the cost of healthcare from 2020 is sobering.

The largest component of higher U.S. medical spending is the cost of healthcare administration. About one-third of healthcare dollars spent in the United States pays for administration; Canada spends a fraction as much. Whole occupations exist in U.S. medical care that are found nowhere else in the world, from medical-record coding to claim-submission specialists.

Here's a component I didn't even consider and was surprised to read about in that article: patient utilization is much higher in the U.S..

The final part of higher medical spending in the United States is higher utilization. The United States has the most technologically sophisticated medical system of any country, and it shows up in spending: the U.S. has four times the number of MRIs per capita as Canada, and three times the number of cardiac surgeons. Americans don’t see the doctor any more often than Canadians do, and are not hospitalized any more frequently, but when they do interact with the medical system, it is much more intensively.

That bit about 3 times the number of cardiac surgeons leads me to wonder if specialization is part of the problem to. I've heard in the past that we're seeing a decrease in general practitioners because the pay is nowhere near as high as those who specialize.

Edit: here we go:

According to a recent KFF Health News article by Elisabeth Rosenthal, “The Shrinking Number of Primary Care Physicians Is Reaching a Tipping Point,” the percentage of U.S. doctors in adult primary care has fallen to 25%. Furthermore, numbers suggest that over 100 million Americans lack access to primary care.Dec 31, 2023

[AWS260]

Can I change my vote now that I'm paying for COBRA?

[LordMortis]

COBRA was crazy expensive for me for 18 months. I didn't realize I could have legally bailed for the ACA and should have once my lack of income qualified me for ACA subsidies as the tax year rolled over. The wording was ambiguous about qualifications and I didn't want to go without coverage. Dealing with the COBRA company to as a bridge between my old company, their agent, and the insurer was no picnic either. Nightmare is the word I am looking for. They then made it a nightmare to get other coverage once I left. They never submit paperwork to the state or the insurer, who in turn, also never submit paperwork to the state and all of that is required for tax purposes, legal purposes, and eligibility for the ACA upon termination.

[Kraken]

The healthcare that I have now through work is fine, I suppose.

It's more the fact that I would have exactly zero healthcare options that wouldn't bankrupt me should I get fired or leave my job that's the problem.

Yes, tying insurance to employment is the second fundamental flaw in our system, next to having a for-profit payment sector. Both of those problems are solved with socialized medicine. But if you call it that, Americans lose their shit.

[Kraken]

My situation has changed a lot since my 2009 post. Back then we were just barely insured at a price we couldn't afford through COBRA. Wife managed to land marginal employer-provided insurance (Cigna) through a crappy job just as COBRA ran out, so we continued to scrape by, insurance-wise. But 10 years ago she got a job with excellent BCBS insurance at a fair price. When she retires (probably next fall) we can convert that to a Medicare supplemental plan at the employee price, and that benefit extends to both of us for life.

My insurance situation couldn't be better now, at least within this system. Still don't like the system, though.

[Max Peck]

I don't understand why people are upset with health insurance companies. It's a mystery...

Health insurers limit coverage of prosthetic limbs, questioning their medical necessity

When Michael Adams was researching health insurance options last year, he had one very specific requirement: coverage for prosthetic limbs.

Adams, 51, lost his right leg to cancer 40 years ago, and he has worn out more legs than he can count. He picked a gold plan on the Colorado health insurance marketplace that covered prosthetics, including microprocessor-controlled knees like the one he has used for many years. That function adds stability and helps prevent falls.

But when his leg needed replacing in January after about five years of everyday use, his new marketplace health plan wouldn't authorize it. The roughly $50,000 leg with the electronically controlled knee wasn't medically necessary, the insurer said, even though Colorado law leaves that determination up to the patient's doctor, and his has prescribed a version of that leg for many years, starting when he had employer-sponsored coverage.

[RunningMn9]

I know everyone thinks that one of the perks of being a federal employee is sweet insurance benefits, but no, it’s basically garbage.

Had BCBS for the first year and half, but everything has gotten substantially worse, and they want to charge me $430 every two weeks for the privilege.

This has compelled me to experiment with an alternative plan that appears on par, but will cost me $6000 less in premiums next year. I tried as hard as I could to compare all the relevant details, but hopefully there isn’t a $6001+ surprise waiting for me.

[hepcat]

If even federal jobs can’t offer decent health insurance, how long can this system go on?

[Blackhawk]

If even federal jobs can’t offer decent health insurance, how long can this system go on?

As long as it's profitable enough to pay the politicians.

[RunningMn9]

If even federal jobs can’t offer decent health insurance, how long can this system go on?

It was kind of weird that everyone still thinks people become Feds because of the sweet benefits. In the 80s, this was definitely true. Gold-plated, affordable health insurance, CERS - what a time.

But then came Newt Gingrich’s Contract on America. Then the Tea Party. Suddenly I’m paying $860 per month for mediocre health insurance, and 4.5% of my salary clipped for the FERS pension. So a 6% pay cut turned into an 18% pay cut. But that’s cool because of that sweet job security.

Enter Elon Musk.

[hepcat]

If even federal jobs can’t offer decent health insurance, how long can this system go on?

It was kind of weird that everyone still thinks people become Feds because of the sweet benefits. In the 80s, this was definitely true.

I’m writing my posts from 1983.

[Zarathud]

I’m writing my posts from 1983.

A side effect of being in Ohio.

[hepcat]

Hey, I…

…yeah, you’re right.

[RunningMn9]

If even federal jobs can’t offer decent health insurance, how long can this system go on?

It was kind of weird that everyone still thinks people become Feds because of the sweet benefits. In the 80s, this was definitely true.

I’m writing my posts from 1983.

My comment wasn't specific to you, just more a general thing I've noticed since joining. My timing in making the switch was not ideal.

[hepcat]

I honestly did think federal jobs provided great health insurance. I was surprised to learn otherwise from your reply. But it makes sense after you provided the history of it all.

[RunningMn9]

I honestly did think federal jobs provided great health insurance. I was surprised to learn otherwise from your reply. But it makes sense after you provided the history of it all.

They do provide a lot of options I guess? But coming from a job that paid all of my premiums, for very good insurance (if in network), it was shocking to me.

By the time the got to “also, you’re basically funding your own pension, good luck” I was already broken.

[pr0ner]

I honestly did think federal jobs provided great health insurance. I was surprised to learn otherwise from your reply. But it makes sense after you provided the history of it all.

They do. And you can stay on it when you retire.

It's also a lot cheaper to do federal health insurance when you're single than when you have a family. I am paying $80 every two weeks in 2025.

Though the federal government is contributing a lot more to RM9's pension than he realizes, even if he's contributing 4.4% (the government's share is like 16.5%, plus the 5% they match to your TSP).

[RunningMn9]

To clarify. The BCBS plan was $430 (my contribution) per paycheck. The Feds were contributing about $630 per paycheck. For comparison, at my previous job, my boss was paying about $5000 per month (I was paying $0).

And yes, the Feds kick 5% into TSP (as opposed to the 6% I was getting). And I contribute 4.4% to FERS (Feds do contribute a good amount to that - and that is a perk that was unavailable as a contractor).

And on top of that I had to take a 12% pay cut to get these benefits.

The broad point is that the health insurance we get is shockingly mediocre (relative to every other health insurance I’ve ever had), and cartoonishly expensive (for me, in my situation).

[pr0ner]

I dropped BCBS for GEHA a few years ago because the premiums were getting obscene.

[RunningMn9]

I dropped BCBS for GEHA a few years ago because the premiums were getting obscene.

Yeah, I’m telling them to go pound sand for 2025.