General Discussion

Ms. Toad

(35,704 posts)

56. First - this has nothing to do with my perception of need. It was her doctor who made that assessment - the doctor

Sun Dec 15, 2024, 05:08 PM

Dec 15

who has a specific patient in front of them, with a specific history, with which the doctor is familiar. That doctor made the assessment that she needed this surgery. My daughter has been taking medications for years against the consensus guidelines for treatment for a rare liver condition. Over that period, the guidelines have changed twice. Her medications have always been covered by insurance (at least 4 different plans).

Which brings me to the second point: The guidelines you quoted from were written in 2019, before COVID. Little is known about how COVID-related deafness is similar to (or different from) other deafness. Guidelines are not fixed in stone - they change as new information is available - and COVID is a whole lot of new information.

Finally, you linked to an anthem reference. Anthem has nothing to do with how traditional Medicare works. With few exceptions, Medicare follows the doctor's assessment of medical need.

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Outrageous reason UnitedHealthcare halted critical surgery... and LAUGHED while mocking suicidal patient [View all] vanessa_ca Dec 14 OP

Medicare would have denied $40k balloon dilation procedure too. It's a 15 minutes procedure Silent Type Dec 14 #1

She tried that. MrsCoffee Dec 14 #2

She tried that and it was painful. So let's spend $35k more because it's uncomfortable for a few minutes. Silent Type Dec 14 #4

I'm sorry but this is peripherally personal. JMCKUSICK Dec 14 #8

My life from the time I was about 12 moniss Dec 15 #53

You are a walking, talking example of insidious discrimination JMCKUSICK Dec 15 #54

Thank you. I can remember moniss Dec 15 #55

Are you fucking kidding me?! Arazi Dec 14 #15

Nope, not one of those because they aren't of questionable clinical value and government plans Silent Type Dec 14 #24

You. Are. Not. A. Medical. Expert. Arazi Dec 15 #26

Well, then, you won't like MFA because any government plan is likely going to do Silent Type Dec 15 #30

She was suicidal and needed medical care Arazi Dec 15 #39

Your lack of empathy is noted. choie Dec 15 #27

Empathy yes. Spending considerably more without looking to see if Medicare/caid guidelines Silent Type Dec 15 #32

You are not in a position to judge someone's pain tolerance Keepthesoulalive Dec 15 #35

I think I'll stick with the judgement of the attending physician.... paleotn Dec 14 #3

You mean the ones who order millions of quack treatments and tests a year to pad their bank account. Silent Type Dec 14 #5

Ah yes. ALL physicians are crooks. Is that what you're saying? paleotn Dec 14 #9

And I told you I'm not. I do work with doctors, and yes many cheat. Shouldn't be surprising Silent Type Dec 14 #11

So answer my question, do people have to die just so we ensure no grifting? paleotn Dec 14 #12

Got citations of people dying because of denials? There are plenty of cases where docs Silent Type Dec 14 #14

Hard to believe I'm having to defend this..... paleotn Dec 14 #17

Looked at Buzzfeed link, Silent Type Dec 14 #20

Words wasted on the wrong people. paleotn Dec 15 #40

Do you have a connection to the for-profit private health insurance industry? (no, not being a customer) Celerity Dec 15 #45

Bullshit choie Dec 15 #28

I work with many doctors Horse with no Name Dec 15 #44

Message auto-removed Name removed Dec 14 #16

I agree with your assessment. choie Dec 15 #29

Medicare would have paid the negotiated rate, not denied the care. Ms. Toad Dec 14 #23

American Academy of Otolarngology differs with your perception of need. Silent Type Dec 15 #50

I'm astounded you're continuing this Arazi Dec 15 #52

First - this has nothing to do with my perception of need. It was her doctor who made that assessment - the doctor Ms. Toad Dec 15 #56

So much effort to explain UHC, amazing. Passages Dec 15 #41

So much criminality is exposed in McNaughton's case. vanessa_ca Dec 15 #47

Absolutely. Passages Dec 15 #48

I just noticed your signature line. I love you lol. eom vanessa_ca Dec 15 #49

This is so painful to read that it leaves me with one question JMCKUSICK Dec 14 #6

As long as healthcare is a profit motivated "industry", the answer is to your question is yes. paleotn Dec 14 #10

Every component of our so-called health system takes a big cut. Heck, UHG donated significantly more to Dems Silent Type Dec 14 #13

As usual JMCKUSICK Dec 14 #18

Once again government failed us. While a big friggin deal, ACA is based totally upon private insurers. Why? Silent Type Dec 14 #22

Because Dems don't fight, they negotiate...with our lives JMCKUSICK Dec 15 #33

That's what I'm saying, Congress has failed us. Silent Type Dec 15 #51

"a million medical victim march on Washington" vanessa_ca Dec 15 #25

I'm sorry I can't hear you. I'm... lame54 Dec 14 #7

I hope she eventually got the surgery Meowmee Dec 14 #19

I wish they would showcase these stories Skittles Dec 14 #21

The Daily Mail? sheshe2 Dec 15 #31

Yes. I have better sources from independent outlets like ProPublica, however vanessa_ca Dec 15 #36

You don't need three OPs. sheshe2 Dec 15 #37

Because I am familiar with those three stories vanessa_ca Dec 15 #38

Since when were doctors not the authority on "medically necessary"? ColinC Dec 15 #34

Since when? Ask a woman who needs an abortion and can't get one. Autumn Dec 15 #42

Yeah, I have an old high school acquaintance, an MD who treats the LGBTQ community primarily Nittersing Dec 15 #43

Ask Greg Abbott, Ken Paxton and a host of other mostly male, GOP officials who are now overlords of the uterus. Vinca Dec 15 #46