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Depressed woman loses benefits over Facebook photos

Tashah said:
I agree. Insurance companies should leave all diagnosis and disposition in the hands of the attending physician and/or psychiatrist.
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Yeah, because we all knw that docs are going to be the new watchdogs for insurance fraudsters. Not!!!!
 
Tashah said:
I agree. Insurance companies should leave all diagnosis and disposition in the hands of the attending physician and/or psychiatrist.
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That sounds fine, so long as no one expects the insurance company to pay for their medical expenses.
 
Ethereal said:
That sounds fine, so long as no one expects the insurance company to pay for their medical expenses.
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Paying for medical expenses based on one's benefits is what insurance companies do. Providing medical diagnosis/recommendations is NOT. That's what physicians do.
 
CaptainCourtesy said:
Paying for medical expenses based on one's benefits is what insurance companies do. Providing medical diagnosis/recommendations is NOT. That's what physicians do.
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WHich is why that insurance company needs to be sued six ways from sunday.

Make the corporate cockmonkey who made that call pay for his lack of brainpower.
 
CaptainCourtesy said:
Paying for medical expenses based on one's benefits is what insurance companies do. Providing medical diagnosis/recommendations is NOT. That's what physicians do.
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Let's not forget that there are some doctors who go nuts spending the insurance company's money. I have a neighbor and a sister who I feel have been physically abused by their doctors by doing tests and surgeries that did no good, and in fact caused some harm.
Not all doctors can be trusted with our bodies, or our money...
 
Vader said:
WHich is why that insurance company needs to be sued six ways from sunday.

Make the corporate cockmonkey who made that call pay for his lack of brainpower.
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You would prefer that insurance companies diagnose and treat you?

You want the same guys who are paying for it, and trying to save every dollar, decide what your problem is and how to treat it?

I sure don't.
 
UtahBill said:
Let's not forget that there are some doctors who go nuts spending the insurance company's money. I have a neighbor and a sister who I feel have been physically abused by their doctors by doing tests and surgeries that did no good, and in fact caused some harm.
Not all doctors can be trusted with our bodies, or our money...
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You can refuse tests and surgery, you know. And if they do harm, and it was intentional or negligent, you can sue.
 
misterman said:
You can refuse tests and surgery, you know. And if they do harm, and it was intentional or negligent, you can sue.
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The average person is pretty much at the mercy of the "professionals".
My sister just got a torn ligament in her foot, her doctor did it, by having her push way too hard against his hands while he was "diagnosing". She already has dying bones, lupus, fibromyalgia, RA, etc. and he kept telling her to push harder. She TRUSTED him, now she will be wearing a boot for a long time. Torn ligaments don't heal quickly...
My elderly neighbor has had several surgeries for back pain, hip pain, etc. and none of them killed the pain. Their latest diagnosis is poor leg circulation.
If you have medicare, or any form of good insurance, some of the doctors see you as a cash cow....
 
UtahBill said:
The average person is pretty much at the mercy of the "professionals".
My sister just got a torn ligament in her foot, her doctor did it, by having her push way too hard against his hands while he was "diagnosing". She already has dying bones, lupus, fibromyalgia, RA, etc. and he kept telling her to push harder. She TRUSTED him, now she will be wearing a boot for a long time. Torn ligaments don't heal quickly...
My elderly neighbor has had several surgeries for back pain, hip pain, etc. and none of them killed the pain. Their latest diagnosis is poor leg circulation.
If you have medicare, or any form of good insurance, some of the doctors see you as a cash cow....
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my doctor is nothing like that, thank goodness.
 
UtahBill said:
The average person is pretty much at the mercy of the "professionals".
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And that's the problem.

My sister just got a torn ligament in her foot, her doctor did it, by having her push way too hard against his hands while he was "diagnosing". She already has dying bones, lupus, fibromyalgia, RA, etc. and he kept telling her to push harder. She TRUSTED him, now she will be wearing a boot for a long time. Torn ligaments don't heal quickly...
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Sue him. Or at least ask for compensation.
 
CaptainCourtesy said:
Paying for medical expenses based on one's benefits is what insurance companies do. Providing medical diagnosis/recommendations is NOT. That's what physicians do.
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That's why health insurance companies hire physicians to make such determinations.

I once had a doctor order over $3,000 worth of tests on me and it turned out they were totally unnecessary. Do you honestly think my insurance company should've forked over the money without any consideration or analysis?
 
Ethereal said:
That's why health insurance companies hire physicians to make such determinations.
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These physicians never see the patient. Their determination is unethical, without merit and a conflict of interest. Under no circumstances should they be allowed to make medical decisions on a patient that they have not seen, nor should they be allowed to overrule a medical decision by the treating provider.

I once had a doctor order over $3,000 worth of tests on me and it turned out they were totally unnecessary. Do you honestly think my insurance company should've forked over the money without any consideration or analysis?
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If the doctor made the decision based on ethical standards of practice and in an effort to treat you, absolutely.
 
UtahBill said:
Let's not forget that there are some doctors who go nuts spending the insurance company's money. I have a neighbor and a sister who I feel have been physically abused by their doctors by doing tests and surgeries that did no good, and in fact caused some harm.
Not all doctors can be trusted with our bodies, or our money...
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There are folks who are unethical in every profession. Here's the thing, though. You have the folks at the insurance company...who's job it is to save money, making decisions on how to treat a patient. This is an absolute conflict of interest. This is the ONE practice that needs to be done away with, completely.
 
CaptainCourtesy said:
These physicians never see the patient. Their determination is unethical, without merit and a conflict of interest. Under no circumstances should they be allowed to make medical decisions on a patient that they have not seen, nor should they be allowed to overrule a medical decision by the treating provider.
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They aren't, for the most part. They are simply determining how much the physician should charge, not whether he should undertake the treatment.

On the other hand, you are basically arguing that a doctor can do whatever he wants and expect unlimited payment. It doesn't work that way. If someone is paying for something, they have a legitimate interest in it, and have a right to second-guess decisions to a certain extent.
 
CaptainCourtesy said:
If the doctor made the decision based on ethical standards of practice and in an effort to treat you, absolutely.
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If they were required to do that, what's likely is that they would pay - and then drop you and/or your doctor from all further coverage. Not a good way to do business.

Of course, part of what the insurance company is doing when it reviews payments is deciding whether ethical standards of practice were followed. Is it ethical to do completely unnecessary treatments or tests? I don't think so.
 
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Ethereal said:
That's why health insurance companies hire physicians to make such determinations.

I once had a doctor order over $3,000 worth of tests on me and it turned out they were totally unnecessary. Do you honestly think my insurance company should've forked over the money without any consideration or analysis?
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It's not your insurance company's place to decide what tests you need and which you do not.

That is beyond their scope. They should never involve themselves in such matters.
 
Vader said:
It's not your insurance company's place to decide what tests you need and which you do not.

That is beyond their scope. They should never involve themselves in such matters.
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Then there should be a third party that agrees to take legal responsibility if the patient decides to sue.

Some doctors do order unnecessary diagnostics. They may be a new doctor and extra cautious due to inexperience. They may be an old doctor who has been sued in the past, leading to paranoia. It may be a doctor who had an unfortunate sentinel event because a test was not ordered. There are many scenarios.

In real life there are patients who come through ERs feigning chest pain because they know they will get IV morphine and a private room, complete with room service. What do you do about these patients? They are the veritable boy who cries wolf. You have little old ladies who arrive 'suitcase in hand' (otherwise known as have a 'positive suitcase sign') to the ER with every stomach ache or headache. Their pain is 10 on a scale from 1-10 (with 10 being the worst).

The drug seeker has tattoos up the yin-yang, including two charming swastikas decorating both forearms. His druggie girlfriend spends the night too (in his bed) demanding a guest tray.
 
MyOwnDrum said:
Then there should be a third party that agrees to take legal responsibility if the patient decides to sue.

Some doctors do order unnecessary diagnostics. They may be a new doctor and extra cautious due to inexperience. They may be an old doctor who has been sued in the past, leading to paranoia. It may be a doctor who had an unfortunate sentinel event because a test was not ordered. There are many scenarios.

In real life there are patients who come through ERs feigning chest pain because they know they will get IV morphine and a private room, complete with room service. What do you do about these patients? They are the veritable boy who cries wolf. You have little old ladies who arrive 'suitcase in hand' (otherwise known as have a 'positive suitcase sign') to the ER with every stomach ache or headache. Their pain is 10 on a scale from 1-10 (with 10 being the worst).

The drug seeker has tattoos up the yin-yang, including two charming swastikas decorating both forearms. His druggie girlfriend spends the night too (in his bed) demanding a guest tray.
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Regardless, this type of situation is purely medical. As such, the insurance company needs to stay the hell out of it.
 
Vader said:
It's not your insurance company's place to decide what tests you need and which you do not.

That is beyond their scope. They should never involve themselves in such matters.
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By that logic, we should have no say in what the insurance companies charge us.....

If we want doctors to have unlimited control over our treatment, we better be very careful about choosing our doctors. It isn't just insurance companies who are potentially "greedy".

We are currently suffering a recession because our wise and benevolent leaders thought the banks could regulate themselves....:shock:
 
Vader said:
Regardless, this type of situation is purely medical. As such, the insurance company needs to stay the hell out of it.
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The insurance company already has a long list of tests and procedures that it will, and will not, pay for.
 
misterman said:
They aren't, for the most part. They are simply determining how much the physician should charge, not whether he should undertake the treatment.
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That is not true and that is the problem. As a provider, I have had insurance companies deny payment for services because they did not deem it clinically necessary. This is without seeing the patient and seeing my documentation identifying the necessity of the treatment. I have had this occur as a patient, too. The physician determines the medical necessity of the treatment...not someone who has never seen the patient or someone who has a vested interest in NOT providing treatment.

On the other hand, you are basically arguing that a doctor can do whatever he wants and expect unlimited payment. It doesn't work that way. If someone is paying for something, they have a legitimate interest in it, and have a right to second-guess decisions to a certain extent.
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If the physician determines, with documentation, that the treatment is medically necessary, and the treatment is covered under the patient's insurance plan, then the insurance company needs to pay for the treatment. Period.
 
misterman said:
If they were required to do that, what's likely is that they would pay - and then drop you and/or your doctor from all further coverage. Not a good way to do business.
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And if they do that often enough, they will have no subscribers or providers...and go out of business themselves. Not a good practice.

Of course, part of what the insurance company is doing when it reviews payments is deciding whether ethical standards of practice were followed. Is it ethical to do completely unnecessary treatments or tests? I don't think so.
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I am uninterested in unnecessary tests. I have little problem with insurance companies refusing to pay for this, but their way of determining this is completely arbitrary. My issue, however, is their refusal to pay for medically indicated treatment, not unnecessary, because they disagree..something that happens REGULARLY.
 
misterman said:
The insurance company already has a long list of tests and procedures that it will, and will not, pay for.
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And yet, they can refuse to pay for these tests if THEY decide that it isn't medically necessary...even if the provider believes they are and even though they have never seen the patient.
 
CaptainCourtesy said:
That is not true and that is the problem. As a provider, I have had insurance companies deny payment for services because they did not deem it clinically necessary. This is without seeing the patient and seeing my documentation identifying the necessity of the treatment. I have had this occur as a patient, too. The physician determines the medical necessity of the treatment...not someone who has never seen the patient or someone who has a vested interest in NOT providing treatment.
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Then they should have seen the documentation. Doesn't mean they can't ever question it.

You can have whatever test or treatment you want. You just can't expect someone else to pay for it unless it meets the terms of the contract between you and the other party.

If the physician determines, with documentation, that the treatment is medically necessary, and the treatment is covered under the patient's insurance plan, then the insurance company needs to pay for the treatment. Period.
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Then negotiate a new contract with the insurance company that says so. Good luck with that.
 
CaptainCourtesy said:
And if they do that often enough, they will have no subscribers or providers...and go out of business themselves. Not a good practice.
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So? They'll go out of business anyway if they pay for every claim, no matter how wasteful or unnecessary.
 
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