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Posted by ceejayoz 4/12/2025

"Slow Pay, Low Pay or No Pay": Blue Cross Approved Surgeries Then Refused to Pay(www.propublica.org)
171 points | 227 commentspage 2
trashface 4/12/2025|
Sort of surprised BCBSA doesn't seem to do anything when a licensee runs amok like this. As I understand it, they can revoke the license. Then again maybe most of the BCBS companies have similar business models. Still could get rid of the worst offender, make an example.
aaomidi 4/12/2025|
Are you genuinely surprised?

We’ve legalized bribery. Politicians are genuinely very cheap to buy.

It doesn’t matter who you vote for. Everyone has a price.

_DeadFred_ 4/13/2025||
The supreme court has ruled it's not a bribe if it's a gratuity after the fact.

https://www.skadden.com/insights/publications/2024/07/us-sup...

bawana 4/12/2025||
Inflation continues. Salary bumps reward the bureaucracy. Meanwhile i get paid less every year - even medicare is going to cut me 2% next year. I guess doctors will suffer the same fate as teachers. I discourage every young person i see from going into medicine. Unless they want to live like a missionary- exposed to disease every day, under equipped to help the sick, and become targets of political forces beyond their control.
rcbdev 4/13/2025||
The USA will see a civil war once the majority is overburdened with debt (check), unable to cover their basic needs (getting there) and unable to afford basic medical treatment anymore. (getting there/check)

It is an untenable situation that would require radical restructuring at this point. I don't see it getting any better.

CoastalCoder 4/12/2025||
Responding to a now-deleted comment that seemed to suggest a violent response:

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.

candiddevmike 4/12/2025||
I think the provider side will be the breaking point. You'll start seeing hospitals stop accepting insurance, especially if Medicare goes away, and everything will be cash based. Things will be expensive until hospitals have cut enough fat/figured out the real cost of everything, and this will be a dangerous time to have an illness.

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.

sublimefire 4/12/2025|||
I would prob say the hospital knows the optimal price already. It might not be 100% applicable to the US but here is an example in Ireland, if I go to the hospital without any referral or by not being brought in an ambulance which would make it free, I have to pay. The funny thing is that they ask you beforehand if you have insurance and substantially increase the price of an overnight stay, etc if you do, to which point insurers are suggesting customers to withhold such a fact and lower the bill.
maxerickson 4/12/2025|||
With the majority of payments getting approved, why would providers stop accepting insurance?

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.

y-c-o-m-b 4/12/2025|||
> 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.

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.

jemmyw 4/12/2025||
No where would have an open door policy for a sizeable portion of the population. It's not that easy to legally move anywhere and the systems in place are designed for around the number they currently process.
BobaFloutist 4/13/2025|||
I don't know that stochastic terrorism is actually illegal in the US, especially if you're not a person of note. I'm pretty sure it's legal to say "Someone should really shoot that guy, he deserves to die and I hope someone does it."

Now, it might violate Hacker News's policies and get deleted, but that's different from it being against the law.

AlexeyBelov 4/14/2025||
I'm sure there is a line where it's OK to say on HackerNews, but also clearly hints at "where are Mario Bros. when you need them".

Maybe we need more of plausible deniability.

like_any_other 4/12/2025|||
> What would be the point, honestly?

Changing insurer's incentive landscape.

haswell 4/12/2025|||
I’ve seen people use this argument, but I think it fails to consider the complexity of the situation.

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.

NooneAtAll3 4/12/2025|||
> The moment a company capitulates as the result of murder, they’ve now incentivized more murder.

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"

like_any_other 4/12/2025||||
They're already incentivized to effectively murder by denying care.
haswell 4/12/2025||
Without defending or justifying the practices of health insurance companies (I’m going through a hellish denial/appeal process at the moment), there’s a major difference between advocating for and resorting to violence as a way of attempting to bring about change and the very real consequences of a broken system.

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.

genocidicbunny 4/12/2025||
> 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.

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.

haswell 4/12/2025||
> I think this misses the 'fuck it, I'm going out like a grenade' aspect.

I think this is very separate from the disturbingly popular trend to advocate for violence as a solution.

genocidicbunny 4/12/2025|||
I think in the case of something like healthcare, which can be literally life and death, these are not entirely separate. Many cheered LM's actions because they or someone they knew had been hurt by the healthcare insurance industry in the US, which again goes back to those feelings of pain, desperation and lack of control that they feel.

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.

salawat 4/13/2025|||
Explain to me how care denial is non-violent.
haswell 4/13/2025||
Words have meaning. Care denial is a serious problem that causes much harm and requires a solution, but to call it violent is to make the word meaningless.
salawat 4/15/2025||
It is not. The care denial, coupled with financial siphoning to pad a risk pool is a form of inflicted harm. I do not qualify unreasonable financial shenanigans as exempt from being considered violent. I in fact find it aggravates above traditional violence because it is systematized, and automated, thus amplifying the scope and reach of the harm caused.

To constrain violence to physicality is to ignore and minimize the myriad creative ways we've concocted as a society to inflict harm. Maybe to you it seems to dilute meaning, but to me that's more of an indication of a dependence on the narrowed definition on your part, than a problem with the increased scope per se.

haswell 4/16/2025||
I suspect we feel the same way about the actual harms of care denial, i.e. they’re unacceptable, immoral/unethical, cause unnecessary suffering and death, are tragic and horrific, and reforms are required.

But we disagree about the use of language. Many people reduce complexities to the most extreme word they can think of. It’s very popular these days to call many things “violent”.

The issue is that this kind of reductionism makes people stop taking the word seriously, and by proxy the people using it. In my opinion, this ultimately hurts the underlying message.

> To constrain violence to physicality is to ignore and minimize the myriad creative ways we've concocted as a society to inflict harm

This is fallacious and untrue. There is no reason to believe that using precise/accurate (and no less expressive) language is synonymous with ignoring harms. To reiterate the point above, overloading language is far more likely to cause this problem because at some point people have no idea what the word means to the person using it.

I consider myself “woke” by the original definition and spirit of the word. But you’d get 10 different answers about what that actually means these days.

The looser these definitions become, the less able we are to communicate effectively and this is one of the many ingredients driving increased polarization and the feeling that we exist in separate realities.

alabastervlog 4/12/2025|||
Hopefully they'll beg for ordinary justice to be applied to them, so vigilante justice isn't the only kind that can possibly touch them.
alistairSH 4/12/2025|||
How? Congress has abdicated its role. Trump and his cronies aren’t interested. And the GOP is actively disenfranchising anybody that they consider “other”. State and local governments are only slightly better.

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.

mschoch 4/12/2025||
[dead]
LorenPechtel 4/12/2025||
Noteable here: Out of network. What did she expect to happen?
ceejayoz 4/12/2025||
My insurance has a separate deductible and max out-of-pocket for out-of-network providers.

When I reach those, I’d expect them to pay the remainder. As agreed. As implied by a prior authorization.

jjav 4/13/2025|||
> When I reach those, I’d expect them to pay the remainder.

They won't. "Out of pocket maximum" means something completely different to the insurance company than it does to any normal person.

Out of every dollar you pay out of pocket, the insurance company will decide how much they feel like counting it. Might be the full dollar, or some pennies, or nothing.

You might have paid $20K out of pocket in a year, but the insurance company will say you've only paid $1000 because just because. Good luck reaching that "out of pocket maximum".

Source: I've been there.

ceejayoz 4/13/2025||
I reach my out-of-pocket maximum, every year. The rest of the year, we pay no more copays.
LorenPechtel 4/14/2025|||
I've never seen a max out of pocket for out of network.
ceejayoz 4/14/2025||
You have now! https://imgur.com/a/Qw62Vhl

That's via Aetna.

antisthenes 4/12/2025||
No sane healthcare system that puts ordinary citizens first should ever have this distinction.
CamperBob2 4/12/2025||
There is basically no way to make progress here, as far as I can see. If the insurance companies weren't running open-loop before, they certainly are now.
candiddevmike 4/12/2025|
Stop having employer provided insurance and make health insurance like buying car insurance ("free market") or do single payer ("communism"). The current status quo of insurance cartels is terrible for everyone involved--employers/employees get fleeced, providers get stiffed, and America gets more unhealthy.
alistairSH 4/12/2025|||
I agree but I don’t see a way to get there… Why would the donor class want that? They’d rather have medical insurance as a limit on job mobility for us peons.
HumblyTossed 4/12/2025||||
This!! We will never have any form of HC reform as long as it's tied to employment.
Spooky23 4/12/2025||
Yes. Health insurers are partially hired villains to take blame and ire. My employer has a multi-vendor plan that is mostly UHC. They even have specialist cancer care that will pay in full for just about everything, including travel and food. We have almost none of the issues that you hear about insurance nightmares.

That's because they negotiated and paid for such a plan.

My sister works for a similar large employer. They hired Cigna as the insurer/benefits administrator, and every interaction is a problem. Your two kids have an ear infection? Cool, we've determined that the second one is due to an auto accident. It's so bad that the company hired another company to argue with Cigna for you.

End of the day, the employer controls the purse, and the insurer is doing what the employer paid for. It's cheaper to hire another company to argue for the folks who have noticed problems than to pay for a level of service.

mjevans 4/12/2025||||
Almost.

Stop having employer provided insurance / benefits; just tax and then provide services. No more billing department. Just single payer (we the people) get what a patient needs healthcare.

gsibble 4/12/2025||
[flagged]
TheDong 4/12/2025|||
Let me give a small anecdotal story of american wait times.

My doctor wanted to give me an MRI for a pain near the heart, and insurance told them they wouldn't cover it until they did various other forms of cheaper treatment, including taking antacids for one month, and 5 months of physical therapy. Which of course didn't work. The waiting time for the first appointment was 3 months.

It took over 9 months for my doctor, the only person to actually properly know the details of my case, to be able to give an MRI that he thought was necessary because someone at the insurance company, who I never met, who had less medical expertise than my doctor, wanted to save the insurance company money.

Anecdotally, all the people I know who live in countries with socialized medicine haven't ever had a wait time as long as that, and haven't ever had a simple MRI be delayed by their socialized insurance.

gafferongames 4/12/2025||
I grew up in Australia. You need an MRI your doctor simply refers you, you hand your medicare card over, and you get that MRI. No private health insurance is involved at any point.

Australia has a combination of public and private health insurance, and they both work well together. The public health options provide the safety net, while the private health insurance is optional.

Where the private option makes sense is if you want to go to specific private hospitals, or if you have elective surgery (the classic example being a knee reconstruction for sports injury) and you don't want to be in a queue behind people waiting for public hospital beds for more serious conditions like heart surgery and so on.

My dad in Australia had open heart surgery 2 years ago, and is doing very well. His cost for the entire procedure? $0 and this was done by one of the very best heart surgeons in the country. He has private health insurance, but elects to go to public hospitals, which have excellent surgeons committed to the best care, because he's a patriotic sort and he's paid into the public health system through taxes for his entire life.

Meanwhile I pay > $3k per-month for not even top tier care in Upstate New York for myself, my wife and my 10 year old daughter, with no serious pre-existing conditions, and I have absolutely no guarantee that any surgery or anything that any of us need in the future will be even covered, even if my primary physician says it's medically necessary.

The rest of the world would do well to study how the combination of public and private health insurance is done in Australia.

genocidicbunny 4/12/2025||||
Exactly.

Far better to instead wait for 11 months, spend a couple hundred hours bouncing around phone trees for my health insurance provider, and pay a few thousand dollars per month for having the privilege to do so. So much less stress for me and my doctors to get jerked around by barely medically competent insurance company employees, makes it much easier to sleep at night. Especially fun to have PA withdrawn because due to how long it's taken to get the MRI has allowed the issue to progress to the point where the kind of MRI needed is now different and requires a new PA.

skort 4/12/2025||||
Is there a legitimate reason you believe it will take 9 months to get a MRI? Or is this baseless fearmongering just to protect the status quo?

There are already large swaths of people who can't get a MRI period because they are excluded from healthcare in this country. And if your belief is that a single payer system will be hampered by measures such as austerity, then say that. Because then your issue isn't with single payer healthcare but instead with politicians who believe institutions need to be run as a business instead of what they actually are, which are public services.

neerajsi 4/12/2025|||
I experienced the uk system briefly and it seemed decent for the simple thing I needed: wait for the NHS or pay a modest fee for private service. The price of private service is bounded by the fact that you can wait for the NHS.
candiddevmike 4/12/2025||
IMO, this should be the model for everything folks depend on (including internet, shelter). Pay to get it faster/better, otherwise the government provides a good enough service that private companies must compete with.
burkaman 4/12/2025||||
> make health insurance like buying car insurance ("free market")

This option doesn't work because healthcare can't be a free market. Car insurance companies have to compete not only with each other but with alternatives like not owning a car at all. There is no alternative to being alive, so health insurance companies can effortlessly collude to raise prices across the industry knowing that they have the most captive customer base possible.

franktankbank 4/12/2025|||
Its the doctors who need to compete and fucking advertise 1 single price. We need a market first, not random ass prices based on some n-dimensional rubric which oh we don't actually follow anyway that was just there to confuse you. Now go sit on hold for a part-time job shitface.
SoftTalker 4/12/2025||||
But things like deductibles and covered treatments are negotiable. The majority of health care is not “you will die without this specific treatment” there are usually options.
zeroonetwothree 4/12/2025||||
(a) in most of the US not owning a car isn’t an option

(b) if we had a reasonable market then some people could have an alternative like paying out of pocket

gruez 4/12/2025||||
>Car insurance companies have to compete not only with each other but with alternatives like not owning a car at all. There is no alternative to being alive, so health insurance companies can effortlessly collude to raise prices across the industry knowing that they have the most captive customer base possible.

US healthcare has to compete against cheap healthcare in mexico or whatever

ndriscoll 4/12/2025|||
This is nonsense that continues the status quo. We were recently trying to understand our options for something time-sensitive, and no one could tell us with any certainty it would cost $2k or $20k if insurance denied it. We were fully willing to pay thousands out of pocket (the price insurance apparently usually pays after "negotiations"), but couldn't get any assurance about the cost or even whether they could correctly bill just this one procedure at their out-of-pocket rate (and what that might be) when everything else was with insurance. It's not like we were the first to ever get it done. The system is just full of blatant unmitigated racketeering.

A good first step would be banning price discrimination for medical procedures. Right now you get three different prices for "I pay", "insurance pays", and "insurance denies and I pay". People can't tell you what those prices will be. The whole point of insurance is supposed to be to derisk these kinds of decisions, not increase uncertainty and risk. Attempting to use insurance and getting denied can 10x your cost, so what is the purpose of the insurance?

like_any_other 4/12/2025||||
There are plenty of good healthcare systems, and they can be identified by looking at other countries and copying what works. That's not the problem. The problem is how to get there.
aaomidi 4/12/2025||||
IMO at the very least we should have free catastrophic coverage covered by taxes.

Otherwise we end up paying more anyway. Someone needs to bail out hospitals.

gafferongames 4/12/2025||
This is exactly what is done in Australia. Medicare for all. Private health insurance optional on top of this for non-catastrophic care.
yardie 4/12/2025|||
Single payer isn’t communism because there is no payment. In communist healthcare The government owns every aspect of the market, healthcare providers are employees. Single payer the provider is free to open a practice just and send the bill to the government. It’s not quite elastic as free market since government doesn’t negotiate based on demand.
Gud 4/12/2025||
Lock and load.
xnx 4/12/2025||
Delay, deny, defend by another name.
permo-w 4/12/2025|
this title is missing a comma
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