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Posted
1 minute ago, MRMOUSE said:

Absolute crap.

My mates Mum, 80s, waited 3 months for gallbladder surgery. I dont see many Brits singing the praises of the NHS, and the dental work isnt an advertisement.

Posted
On 12/5/2024 at 11:27 PM, impulse said:

 

The AI could have been programmed to pay out any percentage of claims they decided.  Someone decided on 90% rejection.

 

Personally, I have health insurance horror stories going back to the '80s.  To the point I was never confident that I wouldn't be bankrupted at the whim of the insurance companies.  My claims were always in the "few thousands of dollars" range.  But I can see where someone who lost their home, their marriage or, God forbid, a loved one would feel justified in taking it out on the CEO. 

 

Boeing's recent cases prove that individuals won't be held responsible for deliberate decisions that killed hundreds.  The innocent shareholders took it in the shorts.  That's millions of retirees and others, who had nothing to do with the decisions.  Along with Betty, who serves coffee and slings hash in the Boeing employee dining hall.

 

And if the law fails like that, what other option do people have?

 

Maybe I am just lucky but I have never had a claim denied and I don't know anybody who has. At a 90% denial rate I should have been denied multiple times and same with people I know. 

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Posted
14 minutes ago, runamok27 said:

At a 90% denial rate I should have been denied multiple times and same with people I know. 

Going back to OP, that 90% figure was misstated: The 90% refers to the number of denials of one very specific Medicare Advantage coverage in that 90% of denials which were formally appealed were reversed.


The type of Medicare Advantage insurance with which Mr. Thompson over saw -- much as with CVS/Aetna and Humana -- dealt with "post-acute care facilities.”  Covered persons could receive per Medicare mandate up to 100 of post-inpatient care days following a minimum of 3 days impatient.

 

A big difference in USA and Thailand is that in USA you can have inpatient surgery and be sent home in 1-3 days e.g. for hip replacement whereas in Thailand at a private hospital you can spend a week inpatient for the same.

 

And post-operative care is judgment call of a patients physician i.e. when is the person is stable enough to go home with only minimal/family care.

 

That 'judgment call' is pretty much the root cause of all 3 big insurers relying upon AI models based up millions of outcomes as referenced in the OP.

Posted
16 minutes ago, runamok27 said:

Maybe I am just lucky but I have never had a claim denied and I don't know anybody who has. At a 90% denial rate I should have been denied multiple times and same with people I know. 

 

Having held several different jobs at companies of varying sizes, I've had great luck with some insurance companies.  And horrific experiences with others.  Never an outright denial.  Generally a fight over what was covered and at what rates. 

 

For example a procedure I had in Wyoming was only done at one facility in the whole state.  My insurance covered a maximum of $2,000, at 80%.  The only facility in the state said "tough noogies, our price is $3,000.  So I was reimbursed $1600 on a $3000 bill.  No biggie for a couple of thousand, but I was always worried what would happen if I had a $million procedure.  It would have bankrupted me, even with "full coverage".

 

Edit:   I tried to be smart and get the procedure done in Houston the next time I visited my parents.  It was only $1800 in Houston.  But the insurance only covered $1000 in Texas because they claimed that was the "reasonable and customary" fee in that market.  I could never find a facility that charged their reasonable and customary fee.  

 

Posted

The dislike of the insurance companies is understandable but the problems with healthcare in the USA start with outrageous fees charged by most hospitals.

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Posted
On 12/7/2024 at 6:39 PM, Screaming said:

Unlike the UK socialist health care system where recipients must wait over a year for primary care and end up dying of their illness.

You obviously know nothing about the UK's NHS system. Nobody waits a year for primary (GP or primary care clinic) care. For instance, the last time I was in the UK for a while I was able to get primary care within 1 to 3 days on four separate occasions. 

 

Non-urgent secondary or specialist appointments can take months to get, it is true but again, it depends on the condition. 

 

On the first of the four occasions I had gone in for a mouth lesion that was flagged by my GP as possibly cancerous, I received an appointment to see a specialist at the nearest NHS hospital within 3 days. He excised the lesion and sent a sample for biopsy. He had already reassured me that it was almost certainly non-cancerous and I got the results confirming that a few days later.

 

As I say, no-one waits a year for primary care in the UK.

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Posted
2 hours ago, impulse said:

FWIW, here's (allegedly) the whole manifesto, from which the MSM is cherry picking snippets:

 

https://www.kenklippenstein.com/p/luigis-manifesto

From the manifesto but not quoted in the MSM:

 

A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy. 

 

Not good. But this is a (coloried) map of life-expectancy by US state as of 2020:

 

image.png.8ee5beb50989028e3a6d1c20e22132d8.png

 

https://www.cdc.gov/nchs/data/nvsr/nvsr71/nvsr71-02.pdf

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Posted

I suspect his killing is just the beginning of middle class people who are incredibly frustrated with their lives, going out and deciding enough is enough. It just doesn't make sense when a CEO makes 6,000 times more than I do, and gets a $70 million golden parachute when he's fired.

 

I suspect this will extend to healthcare, big pharma, insurance and banking in particular, all of which are perceived to be mafias. 

 

Are we noticing how little sympathy this guy is getting? They're trying to drum up sympathy by saying he's a father of two young boys. Who cares? What does that mean? Absolutely nothing. What kind of devastation did he preside over? How many claims did he deny? How many claims were denied during his leadership? How many people were sent at the poor house over his decisions? 

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Posted
1 hour ago, jerrymahoney said:

Going back to OP, that 90% figure was misstated: The 90% refers to the number of denials of one very specific Medicare Advantage coverage in that 90% of denials which were formally appealed were reversed.


The type of Medicare Advantage insurance with which Mr. Thompson over saw -- much as with CVS/Aetna and Humana -- dealt with "post-acute care facilities.”  Covered persons could receive per Medicare mandate up to 100 of post-inpatient care days following a minimum of 3 days impatient.

 

A big difference in USA and Thailand is that in USA you can have inpatient surgery and be sent home in 1-3 days e.g. for hip replacement whereas in Thailand at a private hospital you can spend a week inpatient for the same.

 

And post-operative care is judgment call of a patients physician i.e. when is the person is stable enough to go home with only minimal/family care.

 

That 'judgment call' is pretty much the root cause of all 3 big insurers relying upon AI models based up millions of outcomes as referenced in the OP.

Yeah in a subsequent post I read the actual denial rate was 37%. But, even at 37% I or someone I know should have seen a denial. I'm not saying it doesn't happen but it would seem it happens in specific instances for specific types of care and not overall. 

Posted
1 hour ago, impulse said:

 

Having held several different jobs at companies of varying sizes, I've had great luck with some insurance companies.  And horrific experiences with others.  Never an outright denial.  Generally a fight over what was covered and at what rates. 

 

For example a procedure I had in Wyoming was only done at one facility in the whole state.  My insurance covered a maximum of $2,000, at 80%.  The only facility in the state said "tough noogies, our price is $3,000.  So I was reimbursed $1600 on a $3000 bill.  No biggie for a couple of thousand, but I was always worried what would happen if I had a $million procedure.  It would have bankrupted me, even with "full coverage".

 

Edit:   I tried to be smart and get the procedure done in Houston the next time I visited my parents.  It was only $1800 in Houston.  But the insurance only covered $1000 in Texas because they claimed that was the "reasonable and customary" fee in that market.  I could never find a facility that charged their reasonable and customary fee.  

 

Was this before or after Obamacare passed?

Posted
17 minutes ago, jerrymahoney said:

From the manifesto but not quoted in the MSM:

 

A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy. 

 

I'm not in favor of what the guy did, but I want to understand his motives before I presume to judge him.  The fact that the MSM is squelching the manifesto (and other information about the victim, insider trading, etc) is why I don't trust the MSM. It's almost as if they're putting forth a narrative that their advertisers can do no wrong.  And yes.  That's dripping with sarcasm.

 

Posted
1 hour ago, Thingamabob said:

The dislike of the insurance companies is understandable but the problems with healthcare in the USA start with outrageous fees charged by most hospitals.

This is actually more of the issue than insurance companies. I read an article a while back that compared cost of procedures between the EU and the U.S.A.. One example was some kind of breast cancer treatment. It cost $1500 USD in the EU but it was $5500 USD in the U.S.A.. 

Posted
The MSM may think releasing the whole thing -- not that most people are going to actually read it -- could prove prejudicial at trial.

And maybe like Hegseth's mother, the writing was just a temporary indiscretion.

I have noted that a California pension fund holding UnitedHealthcare Group stock has filed a lawsuit over the alleged insider trading by the late Mr. Thompson and others.
Posted
6 minutes ago, runamok27 said:

Was this before or after Obamacare passed?

 

That was before Obamacare.  For which I was paying $1,400 a month with a $5,000 deductible.  So I wasn't too impressed with ACA, either.  (But that's another timeframe and a whole 'nother topic)  I was pleased when I hit Medicare age...  

 

Posted
27 minutes ago, jerrymahoney said:

From the manifesto but not quoted in the MSM:

 

A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy. 

 

Not good. But this is a (coloried) map of life-expectancy by US state as of 2020:

 

image.png.8ee5beb50989028e3a6d1c20e22132d8.png

 

https://www.cdc.gov/nchs/data/nvsr/nvsr71/nvsr71-02.pdf

Life expectancy is not a good indicator of healthcare. I saw a study a while back that determined that the U.S. had the second highest life expectancy when removing murders, suicides and accidents, which would be actual life expectancy. We have way too many murders and suicides, far more than any other country and they are usually very young people so that brings life expectancy way down.

Posted
5 minutes ago, impulse said:

 

That was before Obamacare.  For which I was paying $1,400 a month with a $5,000 deductible.  So I wasn't too impressed with ACA, either.  (But that's another timeframe and a whole 'nother topic)  I was pleased when I hit Medicare age...  

 

I believe Obamacare took care of that issue but that is also one of the reasons why healthcare insurance is so expensive. They need to drastically lower the prices of medical care in the U.S..

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Posted

There are some interesting threads over on X.  Some people are suggesting that Mangione was the fall guy, that he'll somehow commit "suicide" ion prison, and that there's more to the story than meets the eye.  The murdered CEO was under investigation and others could have been implicated in the process.  More than a few important people. 

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Posted
4 minutes ago, runamok27 said:

Life expectancy is not a good indicator of healthcare.

Well that is US CDC data. I was more interested in that there was a suggestion that MSM was somehow massaging the manifesto output on a pollical slant, And the manifesto itself compares life expectancy data.

Posted
18 minutes ago, jas007 said:

There are some interesting threads over on X.  Some people are suggesting that Mangione was the fall guy, that he'll somehow commit "suicide" ion prison, and that there's more to the story than meets the eye.  The murdered CEO was under investigation and others could have been implicated in the process.  More than a few important people. 

The graphic I posted above says that Mr. Thompson was pronounced dead at Mount Sinai West (formerly Roosevelt) Hospital at 7:12 AM.

 

So I guess they were in on it.

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Posted
2 hours ago, Thingamabob said:

The dislike of the insurance companies is understandable but the problems with healthcare in the USA start with outrageous fees charged by most hospitals.

 

Yes. That is the key. Physicians make outrageous sums. And see what happens with a trip to an emergency room. It can bankrupt you, even with insurance. Too much money is being sucked out of the rest of the economy just for health care. 

Posted
1 hour ago, spidermike007 said:

I suspect his killing is just the beginning of middle class people who are incredibly frustrated with their lives, going out and deciding enough is enough. It just doesn't make sense when a CEO makes 6,000 times more than I do, and gets a $70 million golden parachute when he's fired.

 

I suspect this will extend to healthcare, big pharma, insurance and banking in particular, all of which are perceived to be mafias. 

 

Are we noticing how little sympathy this guy is getting? They're trying to drum up sympathy by saying he's a father of two young boys. Who cares? What does that mean? Absolutely nothing. What kind of devastation did he preside over? How many claims did he deny? How many claims were denied during his leadership? How many people were sent at the poor house over his decisions? 

 

People celebrating his death are wrong. I think the proper response is simply to acknowledge it without comment and go on to discuss the depredations of his and other similar insurance companies and, indeed, the entire medical system and its employees.

Posted
On 12/6/2024 at 12:40 PM, John Drake said:

 

I think the US healthcare system has become such an abomination that there are likely thousands, if not tens of thousands, of time bombs out there who feel they haven't got anything to lose.

I confess at 77 and a heart patient … threaten to take away my earned Social Security had me reflecting on just where is the “breaking point”?

Posted
1 hour ago, impulse said:

 

That was before Obamacare.  For which I was paying $1,400 a month with a $5,000 deductible.  So I wasn't too impressed with ACA, either.  (But that's another timeframe and a whole 'nother topic)  I was pleased when I hit Medicare age...  

 

I am interested in your experience with Medicare as I continue to pay the Part B monthly premium but (unlike fully retired military) I receive no coverage outside the country. $175 usd a month for nought, return and faced with deductibles, co-pays? Your thoughts?

Posted
1 hour ago, John Drake said:

 

People celebrating his death are wrong. I think the proper response is simply to acknowledge it without comment and go on to discuss the depredations of his and other similar insurance companies and, indeed, the entire medical system and its employees.

Well I'm in agreement with you from a moral point of view, but you just have to ask yourself what is the breaking point for the average person?

 

How much abuse will people tolerate?

 

Will there be blowback from extreme corporate greed and generational gouging, that we saw during covid. 

 

 I think there will be, and I think the sympathy is going to be minimal. 

Posted

The whole system is completely corrupt and under the vile orange blob and his cronies it will only get worse.

Because he favours those with money and dispises everything and everyone else.

 

Can anyone shoot straight...

 

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