Opinion | I Was a Health Insurance Executive. What I Saw Made Me Quit.
www.nytimes.com
Shareholders, not patient outcomes, tend to drive decisions at health insurance companies.

One story that we couldn’t keep out of the press and that contributed most to my decision to walk away from my career in 2008 involved Nataline Sarkisyan, a 17-year-old leukemia patient in California whose scheduled liver transplant was postponed at the last minute when Cigna told her surgeons it wouldn’t pay. Cigna’s medical director, 2,500 miles away from Ms. Sarkisyan, said she was too sick for the procedure. Her family stirred up so much media attention that Cigna relented, but it was too late. She died a few hours after Cigna’s change of heart.

Ms. Sarkisyan’s death affected me personally and deeply. As a father, I couldn’t imagine the depth of despair her parents were facing. I turned in my notice a few weeks later. I could not in good conscience continue being a spokesman for an industry that was making it increasingly difficult for Americans to get often lifesaving care.

One of my last acts before resigning was helping to plan a meeting for investors and Wall Street financial analysts — similar to the one that UnitedHealthcare canceled after Mr. Thompson’s horrific killing. These annual investor days, like the consumerism idea I helped spread, reveal an uncomfortable truth about our health insurance system: that shareholders, not patient outcomes, tend to drive decisions at for-profit health insurance companies.

  • chicken@lemmy.dbzer0.com
    2·
    7 days ago

    Every time I have gotten denied, I get a letter. They list what gets paid for and what doesn’t.

    Spending years putting up with a company is a pretty steep price to pay to learn the basics of how they do business. Consumer choices can’t effect change very well if they are largely kept in the dark is my point, and they are.

    From the book Delay, Deny, Defend:

    Companies could report on how many claims are filed with them, how long it takes to process the claims, how many claims are denied, how many policyholders have to resort to suing the companies to have their claims satisfied, and how those suits turn out. They could report the information to state regulators or use it in their advertising. Then the scope of the problem nationally would be easy to determine, and consumers would know who the worst offenders are. In fact, some states require insurance companies to report these numbers, and the NAIC has begun to collect the data. But the reporting and collection are secret, at the insistence of the insurance companies. If they wanted to refute the existence of delay, deny, defend, they could do so. Their silence speaks louder than any numbers.

    Which is why we need a third party. When I mentioned that and supported third parties before the election, the .world instance permabanned me! LMAO

    Yeah I also voted third party, they don’t really like it. Idk how much good it will do, or what the best solution would be, but the people calling for more murders I think are generally falling for the “something must be done, this is something, therefore this must be done” fallacy.