Tag Archives: insurance

UHC, Denials, and Wrongful Death Revisited

Posted on by under EVS Journal, Health Care Series, moralism

The questions you ask determine the answers you get. If you ask the right questions, you have some hope of reaching the right answers. If you ask the wrong ones, you’ll likely reach the wrong answers. If you give up on asking, you get nothing but what you started with, so that if you begin in ignorance, you end there.

The debate about the killing of Brian Thompson threatens to begin and end either in misdirection or reinforced ignorance or both. Stuck between two competing brands of outrage–one exulting in Thompson’s death, the other outraged at the exultation–we’re in danger of losing the denials/reimbursement plot altogether. I know I’ve posted on this issue already, but think I’ve found a better way of saying what I was trying to say in that post, one that does a better job of asking the right questions than my last post did.* So here is UHC, Denials, and Death, Take 2. Continue reading →

UHC, Denials, and Death

Posted on by under Big Data, Health Care Series, Palestine

This post has been superseded by a new and improved version written a few days later (Dec. 18, 2024). 

Let me just get straight to the point: I have a real worry about how people are reacting to the UHC killing. It’s not the usual worry that we’re being mean to Brian Thompson. It’s that a lot of what people are saying shows a misunderstanding of how the health insurance denials process works. I work in health care denials management on the provider side, and have in fact dealt with UHC‘s denials reps. I have no sympathy for them or for the insurance industry generally. UHC is the apex predator in an industry of predators. But on the whole, I don’t think it makes sense to say that insurance denials kill people. I’ll grant that excess mortality and morbidity are possible through an insurance denial, but death-through-denial is not the modal case of premature death or even close to it, and it’s a mistake to suggest otherwise. Continue reading →

How Not to Cover Coverage

Posted on by under Uncategorized

From an article in yesterday’s New York Times, about the closing of the enrollment period for Obamacare health insurance policies in New Jersey. The couple, Ana Gonzalez and Celso Morales, had earlier been described as coming to a health center in Plainfield, New Jersey in order to “sign up for a subsidized health plan.”

Ms. Gonzalez and Mr. Morales, who moved to New Jersey from Puerto Rico, came to sign up for coverage on the advice of one of his co-workers after Mr. Morales was told he has diabetes. The couple — she is 54 and he is 58 — qualified for Medicaid in Puerto Rico, but in New Jersey, their income is too high. They earn about $35,000 a year between her job at Target and his work laying stones for a construction company. With the Affordable Care Act tax credit, they will pay just under $200 a month to cover the two of them, a sum that seemed to please Ms. Gonzalez.

How useful is this information if we don’t know how high their deductible is or what their coverage is like? No middle- or upper-middle class person that I know would be content to know that their health insurance premium was $200/month without knowing anything else about their policy or coverage. But for some reason, seasoned reporters for The New York Times seem to think that we’re to judge this couple’s insurance situation knowing just that. Continue reading →