Unfortunately this week a man lost his life, and another has had his life drastically changed forever. On December 4th early in the morning in New York City, United Healthcare CEO, Brian Thompson, was shot and killed walking to a shareholders meeting.
Along with this tragic event is the significantly changed life of the accused shooter, Luigi Mangione.
Health Insurance thrust into the spotlight
So with all the media coverage of this horrible tragedy, the idea of health insurance has been thrust into the spotlight.
All over social media was comments regarding people’s dissatisfaction and horror stories of denials of care from their insurance companies. There have been tremendous amounts of posts on all areas of social media blasting the insurance world. Mostly with the idea of these large companies being all about profit versus actually helping those in need of utilizing their benefits.
It effects all walks of life and age groups
I have repeatedly talked in this post about Medicare Advantage plans and how they have adversely effected the Geriatric population requiring hospital and rehab care. As much as we have seen difficulties with prior authorizations, denying coverage of services, or payment denials after the fact, this event has opened eyes and voices of those outside Healthcare and geriatrics.
This has quickly turned a spotlight on the whole heath insurance industry regardless of age group. It takes almost no effort to see post after post about claims or prior authorizations being denied. Claims of being out of network while dealing with emergency situations. Claims denied because there was a typo in the claim on one paper. Claims denied because the date of a surgical intervention had to be changed.
The amount of posts is overwhelming. There was actually a moment of time when Anthem Blue Cross and Blue Shield was going to stop paying for anesthesia if the surgery went longer than an average for that surgery based on an algorithm. Suddenly that was quickly taken back. Who knows they might try that again in the future and sneak it in.
Insurance Management now effecting long term residents of Skilled Nursing facilities.
Just recently this year, United Healthcare has started requiring prior authorization for Part B therapy services. Not only is care now being delayed while awaiting authorization (I have had to wait 2 weeks for a few so far), but we are now seing algorithm based authorization. Most recently residents have had the usual skilled nursing plan of care of 20 visits over 4 weeks dropped to 8 visits. If you do the math on that one, at the usual 5 times per week frequency they get a week and a half of therapy now instead of 4 weeks. Even with relatively healthy outpatients, the usual is 3 time a week for 4 weeks and these geriatric residents are expected to make a significant change in less visits? Sounds to me they are being written off as not worth the effort.
So what is next?
We all need to wake up and realize that we have the ability to make change. We need to stop sitting on the sidelines. The squeaky wheel gets the grease and we need to squeal as loud as possible for ourselves. Remember this directly effects every single one of us. We are all just one “oops” away from what very well could be a nightmare scenario for any one of us. Please be an advocate for all of us and make our leaders at the state level and federal level know that we need reform and a fair shake. It effects all of us.
