Comment by tombert

Comment by tombert a day ago

I don't. I have their "platinum" insurance, and they still seem to fight any claim we file.

For example, my wife got knee surgery recently, and the doctor recommended we rent a CPM machine to help her knee avoid atrophying. Renting the machine is $200 a week. Insurance said it was "optional" and refused to cover any of it. We ended up buying a used one on eBay for about $900, which is a lot but not insurmountable for us.

It kind of annoys me though, because not all their clients are yuppie software people who have disposable income. A lot of people can't afford to rent a machine for $200 a week or buy one for $900 on eBay, but they do make it much easier for the leg to heal better. Isn't "stuff that most people can't afford but would help with healing" the stated purpose for health insurance? It seems more than a little unfair that my wife's leg is more likely to heal better purely because she's married to a software engineer.

I really have no fucking idea what the difference between the cheap and expensive UHC plans. It sure seems like I'm paying many thousands of dollars more for medical stuff than I was for equivalent services with Anthem. Oh, well, at least my premiums are higher too, so that's fun.

Hopefully obviously I don't advise shooting a CEO for several reasons (both ethical and legal), but I have to say that I was unable to cry many tears when I heard it happened.

gruez a day ago

>Isn't "stuff that most people can't afford but would help with healing" the stated purpose for health insurance?

I thought the operative term was "medically necessary"? "would help with healing" can theoretically cover everything from protein shakes for knee injuries, to iPads to help with stroke recovery. A CPM machine is on the far end of this, closer to "medically necessary" than the other examples, but you have to draw the line somewhere, so some reasonable-but-theoretically-optional equipment gets excluded.

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tombert a day ago

Sure. I guess I would draw the line in a different place.
There are plenty of things that aren't strictly "necessary" but are still provided by insurance. My wife's painkiller medication isn't strictly necessary, she wouldn't die without it and the leg would probably heal the same way, but they covered that because obviously they should cover that. I feel like a piece of medical equipment like a CPM machine is more necessary than painkillers.

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- elcritch a day ago
  
  Well first question to my mind is does a CPM actually help? There's a lot of waste in American Healthcare on expensive but fairly useless treatments.
  My guess was that a CPM might fall into this category (I did PhD research in bio mechanics in MatSci). So I googled it and it returned a quote:
  > Do doctors still use CPM machines? > The machines are no longer widely used because of the multiple studies that found CPM following knee replacement surgery has minimal benefits. However, some surgeons still recommend CPM following knee surgery when the limited pros outweigh the cons in a particular case. (1)
  From an insurers perspective it makes sense not to cover a marginally useful piece of equipment. The better use of resources would probably be covering PT where there's movement and weight on the joint.
  1: https://www.verywellhealth.com/do-i-need-a-cpm-following-kne...
  
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  tombert a day ago
  
  Fair enough. It was still prescribed by the doctor and I would rather have not paid for it.
  Even if its benefits are marginal, they’re probably still more tangible than acupuncture and chiropractic, both of which are apparently covered by my insurance, and the CPM machine probably doesn’t cause a stroke like chiropractic does.
  
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danans a day ago

> Isn't "stuff that most people can't afford but would help with healing" the stated purpose for health insurance?

You are confusing "health insurance" with a "system that guarantees healthcare as a human-right". Those are different things.

The purpose of health insurance is:

- To constrain healthcare coverage to the minimum allowed by law or the plan contract, therefore maximizing profit margins.

- To provide a shared risk coverage pool to pay for treatment for catastrophic health events that are unforeseen.

- To provide a product to be used as leverage by employers over employees as part of the "benefits" of a compensation package.

Healthcare as a human-right doesn't exist in the United States unless a health situation has gotten so bad that you end up in the emergency room, which is then legally required to provide you emergency healthcare.

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