Health insurers are increasingly interfering in care, an NBC News investigation found. Doctors say the stakes are highest in cancer care, when delays can be the difference between life and death.

cross-posted from: https://lemmy.world/post/23596638

Summary

Health insurance companies are increasingly denying cancer treatments and screenings recommended by physicians, leading to delays and potential harm for patients.

These denials, often based on internal rules lacking transparency, can result in serious adverse events, disease progression, and even death.

While prior authorization is intended to save money, physicians argue that the current system is inefficient and detrimental to patient care.

  • @clockwork_octopusEnglish
    2•3 hours ago

    Ultrasound screenings identify cancers that can be missed in mammograms, radiologists say. And they are imperative for women with dense breast tissue, a condition affecting nearly half of women over the age of 40, according to the National Institutes of Health.

    Uh, being a certain age has fuck-all to do with breast density. It doesn’t suddenly change when you turn 40. And yeah, not only do mammograms become impossible to read after a certain density, but they’re painful as fuck, and ultrasounds don’t have this issue. So what the fuck? Why deny covering the cost of screenings? It doesn’t make any sense at all.

  • @[email protected]English
    10•19 hours ago

    Deny coverage, delay and argue. Even if you eventually do have to pay for coverage some of the patients will die before then, saving money statistically.

    The oncologists described the serious adverse event as “delay of treatment” 96% of the time, “denial of treatment” 87% of the time, “disease progression” 80% of the time, and “loss of life” 36% of the time.

    Just a financial perverse incentive. Once someone demonstrates a expensive chronic condition you save money by exiting them from coverage as fast as possible. Either through rejections, denials, or waiting out their deaths… Not to mention sick people are usually not in a good position to fight a Kafkaesque nightmare of bureaucracy

    • sunzu2
      7•19 hours ago

      a Kafkaesque nightmare of bureaucracy

      A key piece within the extraction machine. Corporate bureaucracy expects you to act in good faith, while they are acting in bad faith.

  • FartsWithAnAccent
    21•1 day ago

    I got scans denied after I hit my head and got a concussion, they didn’t even give a reason but the doctor said I might have a brain bleed.

    Fuck these companies.

  • 𝔼𝕩𝕦𝕤𝕚𝕒
    10•1 day ago

    I imagine the internal conversation plays out a little like this:

    “generally speaking, there’s very slim chances of surviving cancer, so we should deny it.”

    Ok but there’s many forms and locations for it, this particular case is treatable and has a high success rate.

    “Are there really? Oh well, we only have a slip here says Diagnosis- Cancer and survival chances of ‘cancer’ listed as 10%. It doesn’t seem worth the money to gamble on a 10% chance for anything!”

    You realize this is a human…right? Like we’re talking about prolonging the life of another human for a few years, hopefully another 20+ by giving them care?

    “Oh I’ve never met them, shame about them passing but don’t’t we all eventually? 10% is 10% and that’s what we go by. Anyway so…denied”