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BALN5000 t1_jdz8tul wrote

Because they are for-profit corporations, whose holy grail is shareholder value and growth every fucking quarter.

Human wellbeing and care runs a distant second place.

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Drumbelgalf t1_jdzhlh4 wrote

Even for profit Companies can be regulated to ensure proper treatment.

And the question is why not found a non profit insurance company? That works in the favor of the insured person.

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gogogadgetrage t1_jdziz4c wrote

But let's also be honest. The health care providers are very frequently also for profit entities. Even if the institutions may be non profit they pay some very lucrative salaries to individuals who may be compensated for doing expensive procedures. The doctors are just as likely to be overly aggressive in their use of expensive procedures because that's how they get paid. In that sense there is some control needed.

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Kancelas t1_jdzfjsx wrote

The short answer is money. The long answer is those companies lobbied hard to be them to decide who gets treatment or not.

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cmlobue t1_jdzfqud wrote

Because the laws in the US were written to (1) allow them to do that, and (2) require for-profit companies to put shareholder gains above everything else.

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jamesgelliott t1_jdzhuma wrote

Point #2 isn't correct. Even non-profit companies like Blue Cross and the various healthcare coops engage in cost containment measures.

Why pay $1000 for a newer more expensive treatment when a $100 proven treatment will work.

There are things called clinical pathways that are guidelines that start with least expensive yet generally effective treatments first.

It's why you have to get an inexpensive X-Ray before the MD can order a more expensive CT scan.

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haspfoot t1_jdzin4y wrote

But ideally, the system would deal with the pathway/guideline issue on a provider level and eventually drop Doctors/facilities from their network if they have a demonstrable track record of inappropriate clinical practices. Not shift the burden upon the individual. In particular, not drop it on the individual after service has been provided.

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jamesgelliott t1_jdzokfa wrote

It's not inappropriate treatment. You can't expect every MD, Nurse practitioner and Physician's assistant to know every clinical pathway for every insurance provider.

Recently I had a colonoscopy. The MD ordered a prep that wasn't covered by my insurance but it did cover an older less expensive option. The pharmacy simply had to contact the MD and get the order changed.

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haspfoot t1_jdzovcx wrote

Well, if providers can't be expected to know, then certainly the burden shouldn't be shifted onto the patient. Ideally the whole thing would be overhauled with a focus on medical outcomes and not profits.

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zorecknor t1_jdzgxfq wrote

This is the right answer. In most of the countries I know off Insurance must cover everything the doctor say unless they can prove it is not in the coverage (always check your coverage before taking insurance). They still fight tooth and nail not to pay, but it is easier to push back and get paid.

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Gnonthgol t1_jdz8yqg wrote

When a doctor approves a treatment that just means you are allowed to have that treatment. It does not mean that you need the treatment or that you want the treatment, just that it would not do you much harm. It is up to you to decide if you want the treatment, you might deny it for any number of reasons including the cost. The insurance company can deny to pay a treatment even though it is approved by a doctor claiming that you do not need the treatment or that other more suited treatments are available to you.

For example if you brake your arm your doctor might give you the option of putting it in a cast for two months to let it heal itself or to have a surgery which will make the arm usable in a couple of days. He might approve both treatments and leave it up to you to decide. He might recomend you have the surgery but that is just his oppinion. There are of course more complications with a surgery and the cost is of course higher. The arm is also not going to be the same after a surgery as there will be implants left behind. So you are free to chose whatever treatment you want. An insurance company might say they only cover the cast and not the surgery as their contract only say they cover the cheapest option. However other contracts say they cover the fastest option within reason so they would cover the surgery.

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