alt Hacker NewsI'm married to a provider. It is absolutely insane what she has to do for insurance. She's not a doctor, but she oversees extensive therapy for 5-10 kids at a time. Insurance companies completely dictate what she can and can't do, and frequently she is unable to do more in-depth, best-practice analysis because insurance won't pay for it. So her industry ends up doing a lot of therapy based on educated guesswork. Every few months, she has to create a 100+ page report for insurance. And on top of it, insurance denies the first submissions all the time which then cause her to burn a bunch of time on calls with the company appealing the peer review. And the "peer review" is almost always done by people who have no background in her field. It's basically akin to a cardiologist reviewing a family therapist's notes and deciding what is or isn't necessary. Except that my wife's job can be the difference between a child ever talking or not, or between a child being institutionalized or not when they become an adult. People who think private insurance companies are more efficient than government-run healthcare are nuts. Private insurance companies are way worse and actively degrade the quality of care.
Replies
I generally agree (and sympathize with your wife), but let's not present an overly rosy view of government run healthcare or single-payer systems. In many countries with such systems, extensive therapy simply isn't available at all because the government refuses to pay for it. Every healthcare system has limited resources and care is always going to be rationed, the only question is how we do the rationing.
> Insurance companies completely dictate what she can and can't do, and frequently she is unable to do more in-depth, best-practice analysis because insurance won't pay for it.
The distinction between "can't do" and "can't get paid for" seems to get lost a lot with medical providers. I'm not saying this is necessarily what's happening with your wife, but I've had it happen to me where someone says, "I can't do this test. Your insurance won't pay for it," and then I ask what it costs and it's a few hundred or a couple thousand dollars and I say, "That's OK. I'll just pay for the test myself," and something short-circuits and they still can't understand that they can do it.
The most egregious example was a prescription I needed that my insurance wouldn't approve. It was $49 without insurance. But the pharmacy wouldn't sell it to me even though my doctor had prescribed it because they couldn't figure out how to take my money directly when I did have insurance.
I get that when insurance doesn't cover something, most patients won't opt to pay for it anyway, but it feels like we need more reminders on both the patient and the provider side that this doesn't mean it can't be done.