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(12-04-2024, 07:01 PM)bigbone62 Wrote: I work in a community mental health center in a state where Medicaid has been privatized. I dealt with the UHC shit show for 3 years before they were quietly asked to drop out as an MCO. Their refusal rates for in/out patient mental health treatment, substance abuse treatment and services such as home and community based services was appalling.
Beyond that their member services and case management teams repeatedly ignored clients and let people get to the level of illness totally avoidable if they'd just do there job. The story below is lengthy but shines a light on one of their many shady practices.
Also gives you and idea of how hard getting help is. Even when you want it, have the cash and a well to do supportive family.
https://www.propublica.org/article/ambet...nsequences
Jesus.
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(12-04-2024, 09:38 PM)MaroonBells Wrote: Jesus.
This is usually an article I'll send friends and family when they tell me "fixing" ones mental health is simple "self-accountability" or asking for help. The article is a punch in the gut for sure.
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It was an execution and he was a target. As a mental health therapist, I can understand and appreciate the anger at the system and how difficult it can be. I have seen people get denied care due to changes in coverage and other issues. What I don't understand or accept is that anger being directed at a man that was a husband and father and taken out on the street like that. The comments on various platforms are absolutely grotesque. Obviously there are things that need to be improved in order for people to get access to the care they need but this helps no one.
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They found the shell casings on the sidewalk. They had words written on them.
Deny
Defend
Depose
There is clearly a message there.
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(12-05-2024, 12:05 PM)Vikergirl Wrote: It was an execution and he was a target. As a mental health therapist, I can understand and appreciate the anger at the system and how difficult it can be. I have seen people get denied care due to changes in coverage and other issues. What I don't understand or accept is that anger being directed at a man that was a husband and father and taken out on the street like that. The comments on various platforms are absolutely grotesque. Obviously there are things that need to be improved in order for people to get access to the care they need but this helps no one. You dont understand what can cause a person to take someones life out of anger? I can think of many hypotheticals that could lead to somebody to get so mad that they want to kill a ceo of a morally corrupt company. I dont condone it, but i can certainly understand and even accept it.
Why isn't Chuck Foreman in the Hall of Fame?
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I guess revenge is a dish best served cold.
Rich execs live in a world where their continuously robbing the average person has no consequences outside of making them even richer. You live by the sword, sometimes you die by the sword.
He spent years telling people who paid premiums "Too bad for you." Today it's too bad for what's left of his family.
Living in a world where instrumentalities divorce actions from consequences leads to this. He likely never had a face to face with anyone his actions hurt until yesterday.
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12-05-2024, 02:02 PM
(This post was last modified: 12-05-2024, 02:06 PM by purplefaithful.)
Nice timing from Anthem BCBS
On the table? You're on the clock...
=============================================
Anthem Blue Cross Blue Shield says it won't cover anesthesia after certain time limits in 3 states
A leading anesthesiologists' group called the change "a cynical money grab."Anthem Blue Cross Blue Shield has announced it will no longer cover the full length of anesthesia during surgery if it exceeds a specific time limit, leading to outrage across social media, from average users to government officials.
The change will affect those receiving coverage in New York, Missouri and Connecticut, according to the American Society of Anesthesiologists.
The insurance provider said that starting on Feb. 1, 2025, it will begin using the CMS Physician Work Time values to "target the number of minutes reported for anesthesia services."
If a claim is submitted where the reported time for anesthesia services exceeds the established number of minutes, it will be denied, according to Anthem.
People under the age of 22 and maternity-related care will be excluded from the change, Anthem Blue Cross Blue Shield said.
For people who disagree with claim reimbursement decisions, Anthem said in its announcement that it's possible to dispute claim denials using the process outlined in its provider manual.
"Documentation to support your request will be required," the announcement explained.
The American Society of Anesthesiologists said in a press release the move was "unprecedented" and based on "an arbitrary time limit."
"Anesthesiologists provide individualized care to every patient, carefully assessing the patient’s health prior to the surgery, looking at existing diseases and medical conditions to determine the resources and medical expertise needed, attending to the patient during the entire procedure, resolving unexpected complications that may arise and/or extend the duration of the surgery, and working to ensure that the patient is comfortable during recovery.
"Payment for anesthesia services is based on several factors, including the exact amount of time for anesthesiologists to deliver care preoperatively, during the operation, and when transitioning the patient to the recovery unit afterwards."
Dr. Donald E. Arnold, president of the society, added in a statement: “This is just the latest in a long line of appalling behavior by commercial health insurers looking to drive their profits up at the expense of patients and physicians providing essential care,” Dr. Donald E. Arnold, president of the society, said in a statement.
“It’s a cynical money grab by Anthem, designed to take advantage of the commitment anesthesiologists make thousands of times each day to provide their patients with expert, complete and safe anesthesia care,” Arnold continued. “This egregious policy breaks the trust between Anthem and its policyholders who expect their health insurer to pay physicians for the entirety of the care they need.”
The society called on the insurance company to reverse the proposal immediately.
Anthem did not immediately respond to a request for comment from TODAY.com.
Government leaders across New York and Connecticut responded to the news in early December.
"Outrageous. I’m going to make sure New Yorkers are protected," New York Gov. Kathy Hochul wrote in a post on X.
Sen. Chris Murphy (D-Conn.) also weighed in.
“This is appalling. Saddling patients with thousands of dollars in surprise additional medical debt. And for what? Just to boost corporate profits? Reverse this decision immediately,” Murphy said in a post on X.
Source: Today
Newly released photo...
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(12-05-2024, 01:11 PM)JimmyinSD Wrote: You dont understand what can cause a person to take someones life out of anger? I can think of many hypotheticals that could lead to somebody to get so mad that they want to kill a ceo of a morally corrupt company. I dont condone it, but i can certainly understand and even accept it.
Agreed. Not condoned, but not understanding how this might happen anecdotally or situationally is not grasping the world we live in. Or how insurance affects life and death everyday.
Hear, hear.....
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(12-05-2024, 01:11 PM)JimmyinSD Wrote: You dont understand what can cause a person to take someones life out of anger? I can think of many hypotheticals that could lead to somebody to get so mad that they want to kill a ceo of a morally corrupt company. I dont condone it, but i can certainly understand and even accept it.
No actually I was referring to the comments about his death on various platforms. I said I understand the anger and frustration at the system, reforms are needed. I understand the anger, fear, desperation and frustration. It's hard when there are so many barriers to care. There are a wide range of motivators for people's actions. A lot of lives are lost to anger no doubt and this is clearly another example of that
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Now our rates will go up to pay for protecting these robber-barons.
Any excuse to SQUEEZE another farthing..
Water Companies in CA. were the same....There's a drought....rates go up.....
There's too MUCH water in reservoirs.....money needed to improve infrastructure.
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