Would like various opinions on the following please. What is yours?

Question

Who sits down and makes up the laws for insurance regulations as to who is or is not eligible for surgery?

My friend has a lot of severe illnesses. The medication for one of these has eaten away at a lot of cartiledge in her body. She needs a total knee, which the ins co will not authorize bcause she is onoly 43. She may not live to see 44 as it is. Each day on this knee just makes it and her other ailments worse.

Another lady we know has carotid stenosis and a brain aneurism. Neither of these operations will be authorized by the ins co becuse they do not meet their criteria of percentage of blockage in the case of the carotid stenosis and severity in the case of the aneurism. An aneurism has degrees of severity in their eyes? What a crock. Let's wait until the person has a stroke and then fix it.

They pay for people to go have reversals of their tubal ligations or vasectomies so they can have more welfare kids but put the cabash on someone with a life threatening illness.

And before someone gets their knickers in a twist about the welfare remark, I worked in the O.R. for 17 yrs. We had people come in all the time for these reversals. Most were Medicaid patients - welfare. Most already had a few kids, were not married but wanted another child with their new partner. Insurance paid pronto.

Answer 1

Right now, there really aren't any Federal laws (besides medicare and medicaid), and very few state laws in the US that deal directly with medical insurance. Medical insurance is generally covered by laws governing contracts. Medical insurance can provide as little or as much coverage as the company decides, as long as the coverages and limitations are specified in the contract.

As far as the government is concerned, you agree to the contract terms when you buy the insurance, and theoretically, competition between companies ensures that there will be a wide choice of coverage available at the best possible cost. In reality, insurance companies don't seem to compete, and risky and expensive procedures are seldom covered.

Thousands of people die each year in the US becasue they can't afford medical care that could save their lives - either because they cannot afford insurance or because their insurance coverage is limited.

Pay attention to the coming presidential election in the US - this is an issue that Hillary Clinton is pushing and it may become a major deciding point in the election.

Answer 2

Its all bottom line with the ins co. & making sure that it show a big profit. They aren't concerned about ppl or the effect of their decisions. Therefore, they pay for reversals on tubal ligations & vasectomies. They put criteria on carotid stenosis, aneurism & other life threatening surgeries. Who makes these rules? The number crunchers, that's who. Who else would be able to decide how these decisions would affect the bottom line. With the reversals it is a yes or no question. There is no way to put a criteria to it. You can't say we will do your reversal if the tube is 85% obstructed. With the life threatening conditions you can put a criteria on it & they put the criteria as high as possible to limit the number of surgeries as much as possible without opening themselves up to lawsuits. They even look at the likelihood of lawsuits & the amount of settlement vs how much they would have to pay out in the increased number of surgeries for a lower criteria. Is this not the most inhumane thing you have ever heard? That's why we need health care reform.

Answer 3

unfortunately its the law makers who make these laws, and how they come about is they get lobbied for in congress etc. and voted on . the insurance company's hire people to lobby for them to get the laws to work to their benefit as much as they can, basically boils down to money, the more money you have the easier it is to get what you want. and the insurance companies have a Hugh pocket book to work with.