Yeah, I think their attribution is off. Hospitals and care homes make money off of medical care for elderly and chronically ill/disabled patients from Medicare/medicaid, so there can be a perverse incentive for care providers to perform more testing and treatment than is medically necessary or advisable. Like chemotherapy for people who don’t even have cancer. Additionally, medical technology or pharmaceutical companies sometimes pay doctors for prescriptions, so there can be an even stronger incentive to provide specific treatments, even if they’re inappropriate for the patient at hand.
Insurance companies are on the opposite side of the spectrum when it comes to perverse incentives- they benefit from as few and as inexpensive treatments as possible, regardless of the reason (partially, they also sometimes have contracts with medtech and pharmaceutical companies- second link below). Whether claims for treatment are denied and the insured forgoes care, then dies; claims bounce around in the denial and appeal process for long enough that the insured dies; or the insured can be fully treated quickly and cheaply, the insurance company benefits. When they approve and pay claims for longer term or more expensive care, they consider the company to be losing money, instead of simply allocating money that they had already earmarked for general claim payments to specific insureds/recipients.
I left a job in liability insurance, which is actually very different from health insurance, but they both operate on some similar principles (and under similar bounds) of contract law, risk assessment, etc., because I didn’t agree with the ethics of it and couldn’t rationalize it to myself anymore. Even internally, at every level of interaction, we always phrased our goal as paying exactly what we owed, not as little as possible though. The concept of a company officially and openly naming a role “denial nurse” is wild to me. It feels like something I’d see as the joke answer in an hr training video about legal compliance at my old company.
The psyche often refuses to believe what it finds distasteful, abhorrent, until it simply can not. It sank in, and you took action, rather than stay for “practical reasons.” Credit where it’s due.
Yeah, I think their attribution is off. Hospitals and care homes make money off of medical care for elderly and chronically ill/disabled patients from Medicare/medicaid, so there can be a perverse incentive for care providers to perform more testing and treatment than is medically necessary or advisable. Like chemotherapy for people who don’t even have cancer. Additionally, medical technology or pharmaceutical companies sometimes pay doctors for prescriptions, so there can be an even stronger incentive to provide specific treatments, even if they’re inappropriate for the patient at hand.
Insurance companies are on the opposite side of the spectrum when it comes to perverse incentives- they benefit from as few and as inexpensive treatments as possible, regardless of the reason (partially, they also sometimes have contracts with medtech and pharmaceutical companies- second link below). Whether claims for treatment are denied and the insured forgoes care, then dies; claims bounce around in the denial and appeal process for long enough that the insured dies; or the insured can be fully treated quickly and cheaply, the insurance company benefits. When they approve and pay claims for longer term or more expensive care, they consider the company to be losing money, instead of simply allocating money that they had already earmarked for general claim payments to specific insureds/recipients.
I left a job in liability insurance, which is actually very different from health insurance, but they both operate on some similar principles (and under similar bounds) of contract law, risk assessment, etc., because I didn’t agree with the ethics of it and couldn’t rationalize it to myself anymore. Even internally, at every level of interaction, we always phrased our goal as paying exactly what we owed, not as little as possible though. The concept of a company officially and openly naming a role “denial nurse” is wild to me. It feels like something I’d see as the joke answer in an hr training video about legal compliance at my old company.
Kudos to you for not selling your ethics.
I mean, it took me a few years, but the more I learned, the worse it got.
The psyche often refuses to believe what it finds distasteful, abhorrent, until it simply can not. It sank in, and you took action, rather than stay for “practical reasons.” Credit where it’s due.
@idiomaddict @Maeve l don’t give my time and my energy to the government and to the corporate.