Posted by ceejayoz 14 hours ago
> But the insurer’s defense went even further, to the very meaning of “prior authorization,” which it had granted women like Arch to pursue surgery. The authorization, they said in court, recognized that a procedure was medically necessary, but it also contained a clause that it was “not a guarantee of payment.” Blue Cross was not obliged to pay the center anything, top executives testified. “Let me be clear: The authorization never says we’re going to pay you,” said Steven Udvarhelyi, who was the CEO for the insurer from 2016 to 2024, in a deposition. “That’s why there’s a disclaimer.
> At the trial, Blue Cross revealed that it had never considered any of the appeals — nor had it ever told the center that they were pointless. “An appeal is not available to review an underpayment,” acknowledged Paula Shepherd, a Blue Cross executive vice president. The insurer simply issued an edict — the payment was correct.
> On several occasions, though, Blue Cross executives had signed special one-time deals with the center, known as single case agreements, to pay for their wives’ cancer treatment.
But at the same time, i guess i'll be contrarian and say the other notable bit to me is that the person wants the absolute best doctors working on her, at the absolute best place possible because they pioneered the technique. I get why. But it's not necessarily reasonable. Obviously, if her cases needs that, she should get it. But it's really unclear from the article - is her case one that any competent surgeon could do, or only these surgeons can do. It does say they pioneered one technique, but that doesn't mean they are the only ones who do it or are good at it. She just says "i want the people who teach other people working on me", which certainly resonates with lots of people (i'm sure that's why it's there), but also, probably too high of a standard?
In the end - the absolute best of everything is expensive. Very expensive. I doubt a system can afford to have that happen for everyone, even if the insurers were not evil fraudsters. So even if we ever fix the insurer side, I think we will also have to fix the patient expectation side around standards of care.
Agreed.
Company wise, I’d like to see these things handled like the FDIC handles a bank failure. The Feds come in, wipe out upper management, and have another org take over as caretaker.
Otherwise these fines just get paid out of increased premiums. Which probably makes the folks responsible giggle as they immediately go and do the same thing again.
It's not a question of money. If there's one person who's acknowledged as "the best" at something, that puts a hard limit on the number of people who can hire "the best" for that thing in any particular time window. Paying more won't give that one expert more hours in their day.
At a systems level someone pioneering surgery techniques should probably spend most of their time researching and teaching, with surgery being a small portion of their time used to maintain the practical knowledge needed to better teach/research.
Patient primary expectation is always to have a doctor they can trust. That can be fixed only when all doctors get the decent money and comfortable work environment and that means several things: the less middlemen the better, the cost of living including housing should be affordable and put them in middle class, the treatment standards should give them enough time and flexibility, etc.
I will poke at one part:
"Patient primary expectation is always to have a doctor they can trust. "
I don't believe this was the expectation here - trust was not even mentioned. Only credentials were.
I don't disagree it should be the expectation, but it's definitely not in the US and i don't think you'll get there without changing how people think.
Even when it is, trust here seems to be often equated to "how impressive/popular a doctor they are", rather than "how effective a doctor they are" or something sane. At least in the US, the doctors patients trust the most are the ones with the most credentials, awards, etc. It's a popularity contest instead of a baseline competency contest.
If you listen to lots of people in the US talk about choosing and trusting doctors, it's about what school they went to, or what awards they've won, or who else they've treated. Not always, but lots of times. This is not a new thing.
For example - my parents (in their 80's), all of their friends, and heck everyone i've ever met in their community is the same way, and have been for at least 50 years. They don't actually trust doctors who didn't go to harvard, etc.
I think that has to change as well.
Doesn’t it say that most people post-masectomy get “a relatively straightforward surgical procedure using implants filled with silicon or another gel,” which, judging by how unusual the article makes out this surgical center to be, seems to have medically reasonable outcomes?
One big argument missing here is why the “natural reconstruction” option is different from the normal option, aside from the patient who explained that “the idea appealed” because she “felt like [she] was taking something foreign out of my body, cancer, and [she] did not want to put something foreign back in.”
So it seems like, faced with this medical need, some people want a procedure that involves “five operations” in a setting “combining the luxury feel of an upscale plastic surgery practice with the mission-driven zeal of a medical clinic,” where instead of the implants the proprietors do “lengthy and complex operations [that] can last up to 12 hours with big medical teams involved.”
It’s true that the latter probably costs more than the average—and it’s more than reasonable that, when it comes to their own care, anybody might prefer the luxury (or just humane) setting and the dozens of hours of painstaking hand-reconstruction.
It’s also obvious (and settled in court) that the insurer got up to some shady business in this particular case (not least the “for me but not for thee” stuff).
In the general case, though, I have a hard time making the case that it’s fair for a patient’s preference alone to be enough to justify bumping the cost by an order of magnitude or two—especially since insurance spreads those costs out among all the other people paying for insurance, not the dastardly execs directly.
If you can afford luxury then pay extra for luxury, fine. But the insurance feels to me like it’s there to meet the basic medical part of the requirements.
Just when I thought healthcare reached new lows...
Wow. Just wow.
The American people basically legalized fraud and looting for the next four years.
The outcome here was obviously what was going to happen. They promised these actions.
As an analogy, I understand why someone might not trust the Boeing 737 Max. I would consider them in need of a court appointed guardian if they determined the alternative was to jump off a building as a safer way to fly.
>“SNCF was very angry. They told the state they were leaving for North Africa, which was less politically dysfunctional."
No surprise that enough people would say "we gotta do something else."
Or the Weimar Republic in 1932, say. Apparently its economy was in shambles. But that gives me no sympathy for those that installed its successor.
The Democrats have succeeded at suppressing the populist wing of their party, which led to them being defeated by the populist wing of the Republican Party.
But nobody had ever accused the voting public of the U.S. of being able to see the past the end of their nose.
https://www.bu.edu/sph/news/articles/2024/project-2025-could...
I didn’t vote for Trump but I get it and him winning doesn’t surprise me.
That's just government in a nutshell, regardless of country, party, political leanings, etc.
How does it go? "What's the difference between government and organised crime? One of them is organised."
https://www.theverge.com/2024/10/16/24266512/jd-vance-curtis...
If the dictator promised to round up these CEOs and send them to El Salvador without a trial, that would be one thing... but the opposite is true, and I think the electorate understood that well enough.
If people could pull their heads out of their partisan asses they'd see this. The color of the dictator may as well be the result of a coin toss. This is the result of a long term trend.
I very very very very much doubt these were the same people
But also, you might be surprised. Elections aren't decided by the bulk of partisan voters who show up to always vote for the same party and then cancel each other out. They're decided by the much smaller number of people willing to vote for a candidate instead of a party, and therefore move votes from one column to the other.
Some people voted for Obama because he made them hope for a better future. Some people voted for Trump because he promised them hell for other people. They are nothing alike.
That seems disingenuous. Obama: "Vote for me and I'll bring you hope and change and healthcare and all this other stuff." Trump: "Vote for me and you won't have to bother voting again."
There is simply no room for BSAB rationalization here.
I'm not saying I agree with their voting decision, but I can, in part, understand their frustration.
In my country which was targeted to the max by Russian propaganda, they are using the same playbook as in the US right now.
1. take any real complicated issue and blow it out of proportion so people think that it is a life and death situation.
2. heavily promote the most unfit person for the job
3. blame the worsen outcome to the predecessor
Rinse and repeat and you'll see the country drown in chaos and everyone blames everyone.
You can always argue that it is the real people, but if you look really close to the systems of promoting the divisive content - the powerhouse of it is always bot networks only followed by real people.
I think that the most of the division in western societies have to be studied from the perspective of foreign influence.
Score voting is simple: It's the voting system the judges use in the Olympics. Voters give each candidate a score. Highest average (i.e. the one who would get the gold) gets the seat.
The flaw in first past the post is that it gives any viable third party the powerful incentive to merge with the major party they're most similar to, because otherwise they split the vote and both lose. So you get a two party system. Score voting doesn't have that, you don't have to change any other part of the system to make it work, and then the two party system everybody hates goes away.
PR puts the party instead of the voters in control of who gets the seats or otherwise requires the voters to support a party when they want to support a specific candidate.
Score voting also thwarts gerrymandering because you can't make two 55% districts for your party and one 90% district for the other party or the districts for "your" party would go to a moderate party instead.
For example I see on the Irish social media the misplaced efforts of Russian propaganda which doesn't make much traction because of the lack of deeper understanding of the issues and just copy-pasting the rage baits from other countries.
However, I expect that it is temporary, until more budget is allocated to it.
I would encourage everyone to study what is open from the Russian KGB archives to understand that it has a century of experience of influence, supercharged by social media, access to paid influencers and now AI.
KGB failed to prevent catastrophic dissolution of USSR and you suggest that they are some sort of masterminds who excelled in propaganda. That’s quite an exaggeration. Since 1990s both the West and Russia have lost their expertise in each other’s affairs. Russia may still have some influence in Central and Eastern Europe, but their conservative ideological drift limits significantly what they can achieve. A lot of local political mess there is basically local politicians shooting in the leg.
It is a massive amount of information and it is studied rigorously by a lot of researchers. Unfortunately, most of the information I consumed are in Ukrainian. For example there is a book in Ukrainian released just few years ago from one of those [0]. But basically any researcher can get access to the whole archive and domestic ones wrote a lot of material. I am sure that it will get more popular on the west as well, while people will get understanding of the systems at work.
As far as I know Timothy Snyder is well known for his researches into Russia in his books such as [1]. However I've read only excerpts from it as we have better material in Ukrainian.
West generally doesn't understand Russia, it overestimates its military power and underestimates its propaganda influence. It also completely misunderstands its culture. Also west have a history to dismiss the voices of countries who do know Russia very well. But it is changing bit by bit.
[0] https://www.yakaboo.ua/ua/arhivi-kgb-nevygadani-istorii.html
This is a great achievement of the American media environment: people vote for the status quo fully believing they’re voting against it. And somebody ending up in a prison in El Salvador is the sacrificial lamb that is needed to make this equation work.
https://www.yahoo.com/news/fact-check-rfk-jr-misrepresented-...
In the 2019-20 Congressional funding cycle, Sanders received more money from people employed in the field classified by OpenSecrets as "pharmaceuticals/health products" ($1.4 million) than any other member of Congress. He also received roughly $400,000 from people employed in "pharmaceutical manufacturing."
This does not mean he received nearly $2 million from "the pharmaceutical industry," — it means the money was from people employed, in any capacity, in that field." So pharmaceutical companies cannot donate money directly to candidates, so they fact check it as false, saying it was the employees donating the money and not Pfizer directly, but acknowledging he did receive $1,400,000 from people that work in pharmaceuticals/health products, and $400,000 from people working in pharmaceutical manufacturing. Are we to presume that there is no strings attached when Bernie Sanders is receiving the money? Or are we supposed to offer the benefit of the doubt you wouldn't offer to a Republican politician who said that he didn't receive 1.4 million dollars from the NRA, but employees of the NRA, and a further $400,000 from people in Firearm Manufacturing
Big Pharma spent big on Bernie Sanders
Look at Trump’s talking points. It’s all about immigrants, foreigners and wokeism that are coming to get what you have.
The US is a wealthy, prosperous nation, and I think even lower income segments of the US population are aware they’re night and day better off than people in the same economic segment in the countries immigrants come from. Wanting more is part of it, but it’s mainly about not sharing what Americans have, even though it’s not actually under threat. That doesn’t matter, people still feel threatened.
I’m a Brit. My mother is a wealthy middle class retired woman in a safe idyllic bit of countryside, but she is utterly obsessed with foreigners coming to rape and steal and destroy British society. They’re all coming to get us. She reads in the papers (The Daily Mail) and sees it on TV (GB News) every day.
President Lyndon Baines Johnson
..and frankly they’re not wrong. No unjust system can maintain itself in the long term, the choice is “personal sacrifice” or “destroy everything” and it’s quite easy to make
Not necessarily? That’s hardly within the traditional American notion of the scope of government. Core american principles focus on protecting people from the government, not the government protecting people from each other.
What part of "life, liberty, and the pursuit of happiness" do you think doesn't involve protecting people from each other?
To a certain extent, that’s a baseline function of every government, sure. But there is a tension between “a government big enough to protect people from each other” and a “government big enough to deprive citizens of life, liberty, and the pursuit of happiness.” The founding American principles draw the line between those two in a different place than other traditions.
That's literally the purpose of both criminal and civil laws.
We wrote out a detailed plan for jumping off a cliff, took several slow but steady and large steps toward the edge of the cliff, inched our shoes right over the edge, grabbed the railing, leaaaaaned way over, a little farther, a little farther, released finger go, then another, then completely let go. We're in free fall, the decades in which anyone could have stopped it are all in the past. There's nothing to grab, no path to turn around on, we're just falling now.
Insurance premiums have been on a steady sloped upwards march since the 1970s.
You may want to go look at how all the individual attributes of the ACA poll once they're phrased that way and not as in "Obamacare"
People were not happy with the system. I'm old enough to remember the pre-existing condition bullshit insurance companies pulled to avoid paying out in all situations. They classified the stroke my mother had in 2004 as a preexisting condition and refused coverage sending my family into bankruptcy.
It was still a bandaid solution on a rotting wound but this revisionist history of the pre-ACA era does not exist.
That doesn’t align with what I saw. Can you provide evidence? Because it was pretty clear to me that it would go exactly as it has, which is pretty terribly for Ukraine.
- https://en.m.wikipedia.org/wiki/2025_Trump%E2%80%93Zelenskyy...
Seems like if you genuinely cared about the Biden molehill you'd care even more about the Trump mountain?
I don’t give a shit about Hunter Biden, he wasn’t the president. Nepotism happens everywhere, good luck stopping it. Hunter Biden is a crackhead and shouldn’t have had the position he did, but he is a sideshow to distract you. Trump himself was impeached for withholding foreign aid from Ukraine to try and boost his reelection chances, but you conveniently left that part out. I’ll admit it was partly political, but it still happened.
If the Biden family was doing corrupt things like receiving bribes, by all means prosecute them. If there’s evidence Joe Biden got kickbacks from Burisma, the DoJ should file charges. There’s not a personality cult for Biden like there is for Trump.
Trying to compare an actual convicted felon who is nakedly corrupt in public vs a guy who has a few accusations is ridiculous in the same way as presenting young earth creationism as equally valid as the universe being 13.7B years old. It’s “but both sides!” at its worst. Joe Biden is no saint, he’s a politician after all, but he’s not even close to Trump. Bob Menendez (D, NJ) is much closer to Trump than Biden, he was actually tried and convicted for corruption. I’m glad he was found guilty.
That quote is far less damning when you consider the surrounding context. The reasoning he gave for why "authorization never says we’re going to pay you" is that there might be deductibles, and out of network deductibles might be higher. That seems totally reasonable to me?
[1] https://www.documentcloud.org/documents/25882446-steven-udva...
> They acknowledged that the disclaimer was not meant as a general excuse to free the company from paying bills. A prior authorization “usually” resulted in a payment, testified Brower, who reviewed the center’s bills. He said that the notice was intended for specific situations. For instance, Blue Cross would not cover a woman who dropped out of her insurance before the operation. Nor would it pay anything if a patient had not met her deductible. But otherwise, Brower said, Blue Cross intended to compensate for a procedure that it had authorized. “It’s inappropriate for us as a company to approve a code and then turn around and deny it,” Brower said.
Are you talking about the "Targeted Provider List"? The article says:
>The blocked list meant that each bill from the center received a manual scrub by payment specialists before reimbursement.
That's not the same as “lol we have no intention of paying for this ever”.
> Some 60% of the claims weren’t reimbursed at all.
The article gives examples of very normal billing errors that were used as the pretext for this.
It’s very clear they knew they didn’t want to pay the claims. Even in advance of the procedures.
> Then, a week or so before her surgery, Arch was wrangling child care and meal plans when she got a call from the insurer. The representative on the line was trying to persuade her to have the surgery elsewhere. She urged Arch to seek a hospital that, unlike the center, was in network and charged less.
>The article gives examples of very normal billing errors that were used as the pretext for this.
Are you talking about this blurb?
"Blue Cross did not accuse the center of any intentional miscoding — but the sloppy billing led to additional scrutiny, the company’s witnesses said. "
I'm not sure what the alternative is. Are they supposed to pay even though the are errors? Are they saying, "you only have one chance to file a claim, and there's a typo in it so we won't reimburse you a dime?". It's not clear from the article why exactly they're denying the claim, aside from maybe the place being overpriced.
Fuck. These. Monsters. Fuck them and their friends and family. Fuck them to the moon and back. Fuck them until humans evolve to the point that we don't have genitals and then find a new way to fuck them.
But also how is that legal?
https://www.noahpinion.blog/p/insurance-companies-arent-the-...
The big insurers own the PBMs, the specialty pharmacies, the doctors, the urgent care networks. United Healthcare is the country’s single largest employer of physicians. https://www.statnews.com/2025/03/07/unitedhealth-surgery-cen...
They pay their controlled ones higher rates, even. https://www.statnews.com/2024/11/25/unitedhealth-higher-paym...
This is completely wrong.
A general practicioner doctor is unlikely to be making much more than 300K, or $144/hr. But my visit to said doctor costs $450 for 15 minutes, or $1800/hr.
Many people are making a fortune out of the system, the money is not going to the person doing useful work, the doctor. Where is the other $1656/hr disappearing?
Eliminate all those grifters from the loop and I could go see this doctor for $36 per 15min visit. Heck I wouldn't even need insurance, I can pay that out of pocket.
Sure, I'm ignoring rent/utilities/supplies, so it'd be a bit more than $36 but those costs are a tiny percentage. In any case it'd be less than $50, far below the current $450.
Everyone angry about Big Tech and the like need to know that healthcare was patient zero for the monopolization and enshittification cycle that seems to have consumed everything in the world economy.
Once one industry consolidates, their vendors and customers need to consolidate too, or they don't have any negotiating leverage. If you don't consolidate, you're the deal taker, and that deal will be incredibly garbage. This cycle continues until it reaches the one place where you can't consolidate: end customers. There's no such thing as a "customer union" that can fight back against this bullshit. This turns business into a conspiracy to screw the customer, purely through normal, logical business actions that were already illegal but unenforced.
The problem with merely pinning the blame on one entity is that it doesn't fix the system. You don't care about whether or not it's the hospital's fault or the insurer's fault, you just want the problem fixed. Law enforcement actually has a solution for this: joint and several liability, which is a way of saying "I don't care who did it, someone either fixes it or I'm punishing both of you". Pin the blame on both entities if you want the shenanigans to stop.
Does it lead to wait times? Sure! So does the US system!
But of course that has been captured as well
Why can the hospital in France (even the private one) tell me ahead of time how much something will cost, while American providers will scream that this is absolutely impossible to do?
The plan at this point is to just ignore it and hope it goes away, since they can't put it on your credit anymore.
I'm definitely not paying it
My guess: they know they can get more money from the insurer than the individual (or a combination of both!) so they want to scare you from not allowing them to negotiate with the insurers.
It might be worth reaching out to your state (local, not federal) rep and also your state’s insurance commissioner.
Insurers will add more and more indirections instead of outright denial. First indirection: get a prior authorization(PA). Second indirection: only a particular telehealth provider has the authority to ask for a prior authorization--and this is a new trend. Expect more layers of indirections.
I understand that healthcare costs are exorbitantly high. The people who have the power to control these costs are politicians, super wealthy, and the elites (lawyers, executives) serving the super wealthy. The latter groups get the care they want without any hurdles. Others just pay all insurance premiums, only to find that they are denied care when they need the most.
[1] Blue Cross of Louisiana doesn't give a shit about breast cancer - https://pluralistic.net/2025/04/12/pre-authorization/
We’ve legalized bribery. Politicians are genuinely very cheap to buy.
It doesn’t matter who you vote for. Everyone has a price.
What would be the point, honestly?
Calling for his assassination would, rightly in my opinion, be prosecutable.
I'm too demoralized at the moment to hope for what I'd consider an appropriate response by state or federal governments / courts.
The third most likely solution, revolution / civil war, would probably cause far more suffering than any fixes it might enable.
I'm curious if America will soon reach a tipping point where a sizeable portion of its population actually makes an effort to emigrate, rather than just talking about it.
Whether this will usher in a free market utopia remains to be seen, but I think the health insurance industry is going to collapse under the weight of its own greed.
If Medicare goes away, much of the healthcare system will simply implode rather than getting more expensive. Looking it up, the system my hospital is part of gets 36% of revenues from Medicare. I expect my hospital is slightly higher than that.
Emigrate where? The parts of the world where quality of life is equal or better don't just have open door policies letting Americans in freely, last I checked. I imagine it's going to get even harder.
Changing insurer's incentive landscape.
The moment a company capitulates as the result of murder, they’ve now incentivized more murder.
Such attacks on the people running these companies can only impede change I think by forcing companies to become more entrenched in their existing practices.
ooor they're incentivized to force some legal resolution to make crowd "believe in system working" instead of "despair in neither system nor murder working"
The world is filled with complexity and systems that are broken. They require thoughtful solutions, not chaos. Setting aside the moral and ethical dilemmas that arise, advocating for the murder of company leaders is essentially a roll of the chaos dice attached to a wish that somehow the resulting situation will sort itself out.
If you remove all moral/ethical considerations (not the least of which is that blame is shared by many people), it’s far from obvious that the result would resemble the thing people want. Pragmatically, it’s a poorly considered idea that introduces potential for equivalent or greater harms.
I think this misses the 'fuck it, I'm going out like a grenade' aspect. Someone facing death or long-term painful chronic illness due to lack of access to medical care, and who has the perception that this is in part or wholly due to health insurance problems, might not care that they're as you said, rolling the chaos dice. They won't be around for long to deal with those consequences. They might want to roll those dice as a desperate attempt to exert some control, to make some kind of statement, to a world they feel has trodden on them.
There's a kind of logic to it, one borne from pain and desperation. But there's a reason the cliche about a cornered rat exists.
I think this is very separate from the disturbingly popular trend to advocate for violence as a solution.
I do agree that the trend for the more average person to be okay with or even advocate for violence as a solution is disturbing. But a massive part of why it's disturbing is that it's a symptom. There are always fringe groups who resort to it as their primary approach, but when your regular person starts looking at violence as the way to solve things, there's some kind of broader sickness happening - a large scale societal malaise.
My great grandmother used to compare war, revolution, mass civil unrest and other such breakouts of violence as a fever for the body that is humanity; She'd lived through far too many of these fevers. They're rarely idiopathic, and while they might help fight off the current sickness, they also often killed. And even if you survive a fever, it's never a particularly pleasant experience.
I’m with the poster who suggested emigration. If this chaos continues, I’ll be tempted to renew my UK passport and/or apply for an Irish passport.
Think about how you didn't really hear about movie theater shootings until someone shot up the one in Aurora. Now they're more common. There is a huge element of social contagion because shooters are very much copying each other's work.
Which would suggest that we would see a rise in CEO assassinations over time[0]. But the thing is, it's also legitimately harder to assassinate a CEO than shoot up a school. Schools are soft targets with predictable schedules for their occupancy. A CEO might be in 20 different countries over the course of a month; you'd have to engage in a LOT of cyberstalking to even have a chance of catching a CEO in your hometown. And not to mention, they usually have security detail specifically to prevent this exact thing from happening.
But who knows. There's a lot of people pissed off about corporate power, in every country, across party lines. It only takes one security fuck-up.
[0] This is what the phrase "propaganda of the deed" refers to
That's incredible.