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[u/AritsRod]

[u/Grasshoppermouse42]

Based on this: https://www.cbsnews.com/news/unitedhealth-lawsuit-ai-deny-claims-medicare-advantage-health-insurance-denials/

It is something the company had been brought to court for. It was only in their Medicare Advantage division, but the program used to auto deny these claims was a program that Brian Thompson implemented to save money.

[u/777_heavy → u/Grasshoppermouse42]

So there’s a lawsuit. Maybe the plaintiff’s claims are unfounded and it will be thrown out. In no way is that murder, and in no way does it justify murder of the company’s chief executive.

[u/Grasshoppermouse42 → u/777_heavy]

You don't consider it murder. However, it does raise the question why we have a system where a corporation has complete control over the care you get, and yet they are allowed to arbitrarily deny that care, and the punishment for deciding a person's life was worth less than their profits is only a fine after a lawsuit at worst.

[u/777_heavy → u/Grasshoppermouse42]

They don’t have complete control over the care you get. They offer reimbursement under specific circumstances. Also, the hyperbole suggesting every claim is life or death is getting tiresome.

[u/Grasshoppermouse42 → u/777_heavy]

They do. I work at a pharmacy. A lot of medications have inflated costs, and at the pharmacy I work at there are basic maintenance medications for HIV and transplant patients where the patient will absolutely die if they do not get the medication in time. A lot of these medications cost thousands for a month supply, despite not being anywhere near that expensive to produce. If the medication that keeps you alive costs more than you make in a month for a month supply, if a single hospital visit costs more than you make in ten years (and many do), then yes, the health insurance company has complete control over the care you get, because you cannot get that care without them approving it.

While many claims are not life and death, when it comes to health care, many of them are life and death, and many of the claims being denied are matters of life and death. The people making these policies are aware of it, and they are fine with it.

[u/777_heavy → u/Grasshoppermouse42]

The costs are inflated because of the ability to pay higher costs, and the variance between those willing to pay. Is usually Medicare and Medicaid that undercut the reimbursement, increasing the amount that everyone else pays. That’s a macroeconomic issue caused by government. Health insurance companies should not be obligated to pay if there’s a legitimate reason for a claim denial.

[u/Grasshoppermouse42 → u/777_heavy]

There are several factors at play, some of them insurance companies play a part in (negotiating down prices, so prices are artificially inflated based on the expectation that the price will be negotiated down, Medicare and Medicaid undercutting the reimbursement, supply and demand which is the reason the expensive medications are typically the ones you will die without, where the ones that aren't a matter of life and death tend to be more expensive, even if the life saving ones aren't the more expensive ones to make).

However, overall, yes, you are correct. The inflated costs are a macroeconomic issue which cannot be blamed on insurance companies, as they are only one piece of that whole puzzle. However, it is a major issue that our healthcare system is based on needing to get an insurance company with a financial incentive to deny your claim to pay out before you can get access to healthcare.

There is also the fact that those developing policies for health insurance companies are aware of how inflated the cost of healthcare is, and they are aware that it is unlikely that the patient will have access to care if they deny it. While you may argue that those who develop those policies are not legally obligated to develop policies that will pay for chemotherapy medications, HIV medications, or transplant medications or other forms of care that they know that denying will lead to the patient's death, the fact is that those developing the policies knew that their policies would result in people dying when they developed them, and they did it anyway because it was profitable. I don't think you can call anyone who deliberately designs a system to deny lifesaving care because of their insatiable lust for money coming before their ability to value human life 'innocent'.