U.S. doctors have accused the US health insurance giant a fatal delay in important medical treatment and care, and is making profits more than the patient’s health.
According to doctors who talked to the Guardian, companies, including United Healthcare, were several months to refuse basic scanning and reconsider.
“There is a good evidence that these types of delays are literally killed,” said Dr. ED Weisbart, formerly the highest medical manager of Express Scripts, one of the largest prescription managers in the United States. “For some people, this is not just inconvenience, inconvenience and worse.
“It’s a death sentence, and the only reason that the insurance company is to maximize profits is that the fact that they may be killing you is not in the equation they care about.”
According to the Federal Foundation analysis, Americans spend the worst health results, although they spend the most in the world in which the estimated $ 4.9 tons, estimated in 2023, in the world of $ 4.9 tons.
Last month, the fatal gunshot of Brian Thompson, the CEO of UnitedHealthcare, has poured public anger in the healthcare industry. Private insurance companies report billions of profits every year, but many patients and their doctors are having a hard time navigating the complex financial systems to get what they need.
Insurance company lobbyist claims that they are working to protect people from higher costs, and everyone in the space, including doctors, makes it easier to navigate US medical system care at an affordable price. I emphasize that I have a responsibility.
However, in a series of interviews, medical experts explained frustration about the powerful industries that prevented patients from supporting patients.
“We are packed with this terrible, vicious cycle.”
Dr. Sheryl Kunis, a doctor and director of a national health program in New York, still thinks what happened when one of the patients needed a pet scan. He had a tumor and before deciding how to treat it, Kunis and her colleague wanted to establish whether it had spread.
Without a six -month delay to receive scanning, there was a reasonable possibility that he would have been in a better shape.
Dr. Sheryl Kunis
“It was very honest that the surgeon wanted to perform surgery only when the tumor was localized. He couldn’t really make that decision without Pet Scan,” Kunis said. 。 “Surgeon, his office, and my office spent many hours on the phone. We didn’t really know about the basic medical issues and tests that were seeking what they had in patients. I was talking to the person sitting in UnitedHealthcare in front of the computer screen.
After the first denial, the patient’s appeal to the scan was finally approved six months later. By that time, the patient had died.
“If he had been diagnosed earlier, he would assume that he could have improved,” Kunis said. “There is no way to prove it, but there was a reasonable chance that he would have been a better shape if there was no delay in acquiring scanning six months.”
The healthcare system said, “I’m really full of this terrible, vicious circle,” she said, saying, “I’m using a constant rise price, lack of regulations, and unfortunately taking care of care.”
“It’s morale and I’m humiliating in.”
Health insurance companies often need a “peer -to -pier” review. Here, doctors need to talk to medical representatives of a health insurance company to justify treatment. However, according to doctors who talk to parents, insurance representatives are often not experienced and may not even train in specific fields that are weighing.
When engaging in the review of “Pia to Pier”, Pear is not my trained doctor. ” Former President, Dr. Philip Ver -Hoev, said. program. “It’s a kind of farce that you can even call it” Pia to Pier “. I have never had a conversation with “Pia to Pier” with the real peer. “
Instead, the representative claimed, “I have again guessed our judgment as a clinician.” “I don’t have a financial incentive to the ICU to clarify. I saw a claim that bureaucrats submitted from the hospital somewhere and” I have made a wrong decision to recognize the ICU. ” When you say, it loses morale and humiliates in. “
Verhoef said that he often sees patients entering the centralized treatment room for preventive diseases caused by health insurance companies, such as insulin and other necessary drugs and asthma inhalers.
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“If people need to use private health insurance, they will actually fail,” he added. “Insurance should be there to cover you from financial disasters when something unfortunate happens, and the current system that we are based on private health insurance is really everyone. I don’t think we will regulate how to get out of this confusion.
According to WeisBart, many frictional patients when seeking medical and support are the basics of insurance companies’ business models. “They don’t care about you. They don’t need you as a cost and need to improve your health,” he said. “The more you are, the more you want them to have them as their insurance, and the more you get sick, the more you are dissatisfied with you and are looking for another insurance company.
“If they get the money, every time someone needs health care, it’s the only expense they don’t want to let go.”
Wisebart claimed that the benefits of the insurance industry are focusing on medical delays and refusal. “It’s not a random event when they completely deny your care a day, one week, a month, or completely,” he said. “It’s a calculated business strategy to maximize their profits.”
“Problems that worsen even more”
Many doctors have recently expressed similar issues to private insurance companies. Dr. Bayo Curry-Winchell in Nevada wrote in an article in Katie Couric Media, “In addition to our medical expert, I became an insurance expert and can not count in documents instead of patient care. Regarding the health of Cook County, he wrote that he had been forced to spend his time to fill in the health insurance company. In recent years, I know that this problem has been worse. “
The solution is to completely overhaul the system and start from zero from the national health insurance system.
Dr. Philip Dr. Verheev
UnitedHealthCare did not respond to multiple requests in comments. AHIP, an industry lobby group, states in an email statement as follows: The people we serve together. The health plan is working to protect the patient from the full effect of the rise in cost while connecting the patient to the adjusted care based on evidence. “
Doctors who talked to the Guardian suggested that the problem of fixing the problem in the US medical system would require more than the end.
Both WeISBART and Verhoef claim that solutions need to shift from private health insurance to a single payment person’s medical system, as well as other wealthy countries that provide health care to everyone. did.
“The solution is to completely overhaul the system and start with zero from the National Health Insurance System,” said Verhoeff. “Solutions that depend on trying to regulate the private insurance industry will simply fail.”
“There is no way to modestly reform the fundamental flaws of business models,” said WeisBart. “Their business models are designed for health care delays, refusal, and redirect. We know much better. The better method is to build a system in the conventional med care program. Correct what is wrong with Medicate.
According to 2020 academic analysis, the universal healthcare system that moved to a single -payer seems to be lower than the current national medical expenses, and will save tens of thousands of lives every year.
