That’s easy. Because some people will delay the surgery and the insurance company makes more profit.
Once I turned age 65, the first thing I did was to make sure that I didn’t have a $25 MM/year health insurance CEO between me and my doctor.
intersct
What’s not to love about private* market solutions to healthcare?
The invisible hand reduces societal wellness incrementally and puts some more coin in someone’s pocket.
*I did write free, but decided private is more accurate.
Yes. This is probably the only thing I’m looking forward to about getting older. Medicare. No more for-profit insurance meddling in my care. Can’t tell you how many times over the years I’ve had to call insurance companies and argue about (and/or correct) errors on their part. For a while, every claim was being denied until I called them, and then it’s “oh, we’ll take care of that for you”. Absurd.
Ours is probably one of the worst systems of any first-world nation.
It’s a mistake to think that Medicare financed care is automatically denial/prior authorisation free. Nor any other third party payer anywhere else in the world, come to that.
Certainly, nothing like the tomfoolery you could expect with a Medicare Advantage plan, but whenever you’re faced with a third party payer, you can expect some degree of constraints on spending. As I frequently say, if a physician is inclined to act like House and order any and every test to “rule out” obscure conditions without actually thinking through a differential diagnosis, there will be some pushback.
Yes, That’s true.
For example, Medicare is building a custom, lightweight carbon fiber wheelchair for me at the cost of $3,000. (Having an above knee amputation qualifies me for this largess.)
The order has to be submitted for approval before fabrication starts. Vendor told me it takes between 2 weeks and 3 months for approval. I told her I have regular Medicare. She said they’ll approve it within 2 weeks.
“Where does it take 3 months?”, I asked.
“United Healthcare and Kaiser Permanente”, she replied.
If I had any of these private insurers with my current condition, I’d be choking on red tape and waiting months for care.
intercst
Nearly two years ago I had my heart surgery to repair a valve. My primary care sent me to a cardiologist after hearing a murmur, at 56. Cardiologist ordered an ECG - a sonogram of the heart. Originally approved, then denied after the reading happened. The ECG was inconclusive because the mitral valve is hidden by ribs, so they ordered a TEE - a sonogram through the esophagus. They tried to block that. It came back “moderate to server regurgitation” and all got approved.
I could have died. Leaky heart valves can kill people.
This is an odd story. It sounds like your insurance company didn’t pay for the echo initially because of poor diagnostic quality, right? To be honest, I think your cardiologist should’ve been the one to have noticed this ….. or a halfway decent ultrasonographer shouldn’t even have tried to capture the image but rather used a few different positions for the probe. Not saying the TEE was unnecessary….and for sure anatomical variation presents it’s own challenges ….. but most beyond the extremes of obesity etc can be overcome by good technique.
You needed a veterinary cardiologist on the job. In spite of experience limited to contact with fur, feather and scale rather than epidermis, my daughter did a bang up job of capturing necessary images of my husband’s about-to-dissect ascending aorta and resultant aortic incompetence. She saw, but couldn’t manage to capture, the third leaflet of the valve (I think the aorta was distracting her mightily) The hospital ultrasonographer didn’t get either image…..probably didn’t see, come to that. The irony did not escape the cardiothoracic surgeon ….and, give him credit….he wondered just how many surprises he could be spared with specialist cardiology echo techs.