It took a New Orleans civil jury only 2 hours to unanimously decide that the state's largest health insurance provider committed fraud and abused rights of doctors.
it is absolutely disgusting how much power these frikkin insurance companies have. where did they get off deciding what & where a patient will have medical procedures done. they are not doctors, they are paper pushers. beyond despicable, bottom line is greed and it needs to stop
I remember when they said they would NEVER get between the patient and their doctor. BALONEY. They control the purse strings. I have been told that if I didn't like their decision, I could pay out of my own pocket. It's their way or the highway, every time. We can't let our stupid government do this for us, we have to MAKE these companies live up to their promises.
Health insurance companies practice medicine without a license and commit malpractice. I have BC/BS and despite my neurologist, one of the leading experts in my problem, telling them that recovery will take upwards of a year of physical therapy, the insurance company cut off my benefits after just 3 months because they said I wasn't improving fast enough. I hate BC/BS.
!! doctors are very greedy people. if this woman has a real cancer , not just fake one ( 50 % by statistics), surgery will not help her to stay alive...
Correct. All forms of insurance should be abolished, and everyone should pay their own bills. I should be responsible for my own health bills only, not everyone else's.
@@DistrustHumanz You are entitled to have your cynical selfish 3rd grader-level opinion, but not everyone wants to flush their retirement down the drain for medical bills. I'm sure you have plenty leverage to negotiate your prescription costs against Big Pharma? Apparently you don't believe in education either smh.
I have had many problems with health insurance companies over the years. Medical billing and insurance has become a scam. It needs to be reeled in and reformed.
They own Congress and the State legislatures, so it won't happen as long as people elect career politicians in either of our fake professional parties.
Health insurance companies are not interested in your health. Their interest is in their bottom line and to their share holders. That’s what publicly traded corporations are obligated to do. When people start buying into insurance companies that are not publicly traded then you’ll start to see HEALTH care.
It's a vicious cycle. Once people start buying into companies that are not publicly traded, they become more valuable and get bought out by venture capitalists or go public because every business is incentivized by profit, not the well-being of our people.
I used to work in the Business Office of a long term care hospital in OKC. We filed insurance for our patients. Two of the hardest insurance companies to get payment from were BCBS and Champis/ChampVA. We worked hard to get charges paid for our patients. I worked about 6 months to get a $50,000 payment from Champus, having to file and refile for payment. But a coworker was a hero to a patient. She worked for one full year to get a $500,000 insurance payment for a patient. The hospital was so grateful and, to make sure the payment was received promptly, our employer FLEW her from OKC to, I believe, Atlanta to pick up the actual check. Not bad for a business office that was originally located in the basement of the hospital!
More hospitals need to do this, people complain about the high fees a hospital can charge, but they don’t know that the insurance denys claims for bogus reasons. The insurance will charge outrages premiums, low ball hospitals and doctors for reimbursement.
As someone who works in healthcare, I fantasize about this a lot lol. It's not a long term solution though. Just like with banking there's only a handful of companies that own most of the market. Getting fines are just another cost of doing business.
My BCBS rates go up every year and I’m sure I’m one of millions who are paying BCBS’s legal costs ! The government needs to start regulating these companies!
You’d like more government regulations? Government regulations are a nightmare. We citizens ban together and put these companies out of business by building a better mousetrap. Government ALWAYS sides with big pharma, big oil, big banks and big insurance.
@@mushroombird9400 The government is ALREADY in bed with these companies! So you’d rather have no medical insurance than a corrupt one that still provides some? Putting them out of business doesn’t help! Look at the banking industry- the country went into a depression because there was no regulation of corrupt people taking our money and doing whatever they wanted with it! Educate yourself about history!
The problem is the money will come from the people paying the premiums, not the multimillionaire CEO. So insurance will just charge more for premiums, so they care pay for even more lawyers.
Of course, if there were actually free markets, BCBS couldn’t just raise premiums. But, since much of the economy is controlled by oligopolies, no “market forces” exist.
@@timdowney6721 If there were actual free markets, insurance companies could deny coverage for pre-existing conditions. Oligopolies are a natural market failure resulting from lack of regulation. There's a reason libertarian countries don't exist.
The biggest issue is the amount medical facilities bill to health insurance companies for absolutely everything. It’s asinine, I mentioned the rate charged to Medicare for simple refill appointments to an RN and she said, “that makes me want to leave healthcare.” Additionally, the joke of a neck surgery I went through here for ridiculous money- which was outpatient above a dang plastic surgery office, cost more than a proper surgery done in Germany which is followed up with a week stay in a hotel so they ensure you are doing well and recovering appropriately. Here, I was sent out same day with an ill fitted neck brace and my neck violently whiplashing. Our entire healthcare system needs to be brought to its knees. It’s nothing but greed and corruption.
BCBS causes problems often, starting with simple prior authentications. They've been asking to get sued these days after the stories I've heard. They don't want to pay for anything. They'll go out of the way to try to not pay - makes me ask what us patients are paying THEM for??
If you've ever called in to dispute a claim, those automated messaging systems say there's no guarantee of payment even with an authorization. It's bonkers.
BCBS tried to deny payment for my prosthesis after breast cancer. They denied payment because no “services” were rendered. The jerk I was talking to had no idea what a mastectomy was and couldn’t even grasp the concept that “services” provided by a salesperson would be considered prostitution. Especially since they flatly refused to explain what kind of “services” they expected the salesperson to perform. I made it clear I was hanging up and calling the authorities. The person that owned the medical supply business was appalled and said I was correct that it would be considered prostitution as they aren’t medical professionals. Before I could call the authorities the jerk’s supervisor called and approved the payment!
I’m on United Healthcare, they’ve refused me having a diagnostic mammogram. 😡 Makes no sense! I’m sick of paying into these companies when they don’t care if you’re ill!
@@YaYaPaBla It has something to do with split billing Medicare A and B. Louisiana billing used to always make me question. Florida and New York Split billing used to always make me question when I did billing.
This is ridiculous I had a neighbor who needed a hysterectomy because they found pre- cancerous cells during a routine Pap smear. The insurance company didn’t want to pay for it because they felt the Dr didn’t have a legitimated claim. So the Dr personally got on the phone and really had it out with them after speaking to several people. They agreed to cover the procedure then he scheduled the surgery and told my neighbor he didn’t go to medical school to fight with insurance companies about what they are going to cover and what they are not going to cover.
The issue with what that doctor told his patient is the doctor is the one that has to inform the insurance company [that] a procedure is necessary. My husband's coworker was diagnosed with pancreatic cancer. We told him to apply for disability so he could stay home once he started chemo, etc.. The doctors told him he has to apply himself but disability said they had to hear from the doctors. They went back and forth, he never got onto the program, and died in the interim. These insurance companies require proof from 'the doctors' in these situations but the doctors claim they don't have time to deal with the companies__and to boot, many doctors are now moving to "concierge" care(patient pays extra so they don't have to wait to see a doctor, etc.) which means more $$ for them. So, it's actually a twofold problem with these insurance companies stalling to cover payouts, and doctors crying they don't have time to do what the patient needs. 😬
Yet ANOTHER example of an insurance company practicing medicine without a license. These shark insurance companies need to stick to paying the bills and leave the medical decisions to the qualified LICENSED DOCTORS.
Hate crime. Cause big insurance companies need to get fined more often, and heavily to keep them transparent and honest. Too big to touch is used way too often by insurance companies.
They are awful! I am battling them to get therapy for my daughter with ASD. They tried to send me to an "in-network" doctor who turned out to be an OBGYN. I am so frustrated.
I Trust the oil companies more than I trust Blue Cross Blue Shield. I trust anybody more than I trust Blue Cross Blue Shield. More lawsuits need to be taken against them.
I'm so happy to hear about this! For far too long the insurance company has dictated to the doctor who, what, when, and where. That has NEVER been okay! Doctors go to school for many years to know what's best for their patient's health. Insurance companies know how to count cash. They do not know what's best for my health! I'm hoping this is the beginning of the end for HMOs. They've been too powerful for too long.
My late wife was diagnosed with breast cancer n 2010 and we had Blue Cross Blue Shield of Louisiana. Throughout her treatment BCBSLA second guessed or denied authorization for medication and procedures and required our doctors to constantly write letters of appeal. Every damn month we had to argue over her medication or just pay for it out of pocket. Finally I switched employers and because they were based in Texas, my coverage was under Aetna. It was like night and day between the two companies. Sadly, Aetna was not writing policies in Louisiana so when I retired early I had to switch back to BCBSLA and we were back to the game of my doctors being second guessed or medication I was prescribed not being covered in their damn formulary! The health insurance/healthcare system is broken and needs a major overhaul just like the prescription drug industry.
Who is the leader with the power to disband, penalize, or rewrite the insurance companies' role in medical care? Wherever that guy is, we need to be pushing for that person to change this broken, exploitive system. Companies should not be able to profit off the population being unwell.
They know they will win on appeal because they donate to the appropriate political party. It's all a game to them. People, patients are NOT in their equation.
Off topic question to ask here-but I’m not American (am Kiwi), and so hearing this reporter pronounce New Orleans “New Or-lee-ins" threw me off a lil having only known it to be said as "New Or-leans". Can any NOLA folk pls clarify pls & ty! Stoked to hear about this ruling otherwise, hope it costs them that 'hundreds of millions'! People's health should *not* be treated as business, glad it only takes a court 2 hours to rule that in essence, people (in a medical sense) are not profit!
Just as these women should get reconstructive surgery, so should reconstructive dental procedures be covered as well. Dental insurance covers very little. People need healthy teeth and gums.
Now imagine instead of Blue Cross, it was the government you were fighting to get your healthcare. You would send in a request to a faceless bureaucracy, and one unnamed person could halt the whole process. There would be very little recourse (“You can’t fight city hall!) unless large advocacy groups were on your side. For the average person, you would simply have to accept their verdict. Insurance corporations are crappy, but government bureaucracy is that times ten!
That’s what is wrong insurance companies tell you and Dr what to do they have most clients over a barrel and it’s shameful many people have died waiting for test they want treat our children for PANS disease when it’s been proven over and over I salute these Dr and wish all Dr would have the ability to do same 😢
Prior authorization means you will pay for the procedure with the provider. $420 MILLION wasn't paid to doctors. That's why you get autoionization BEFORE the procedure. BC/BS fragrantly violated even their own procedures here.
hope you all heard that right: "Blue Cross/Blue Shield found guilty of FRAUD" - if you have this insurance, ask yourself why are you supporting felons?
Insurance used to be a safety net for anyone who got sick, needed surgery or treatment... now it's just an old fashioned shell game. Disgraceful. I pray the victory lasts through any and all appeal challenges.
Blue Cross and Blue Shield in my opinion is one of the worst insurance companies for just this reason I changed from them to other insurance companies because of the paperwork and having to call and see if they would cover my surgery with certain doctors
Insurance makes sense for certain avenues of life, mainly ones that are reasonably objective and cost limited, for example, cars, homes, etc. It just doesn't appear to work for healthcare. That doesn't mean you won't still have issues with a single payer system, or single payer hybrid system, but there will be less, and less complexity.
Looks like I just (accidentally) found the answer to my question as to why the largest hospital/hospital system in my midwestern city just dropped Blue Cross/Blue Shield about a month ago
Take the profit out of healthcare. Providing healthcare in the U.S. should not be based on whether they can profit off people's misery. You don't have to pay bills for police or fire services because you pay taxes for them. Medical should be the same.
In my eyes he biggest issue with insurance companies is that they have "in-network" setup in the first place. All that rhetoric is just a way to nickel and dime every aspect of healthcare, from the doctors and hospitals, to the patients. Just BS! 😡
Did y'all actually pay attention? Insurance didn't decline coverage. They just recommended going into in-network surgeons. But patient wanted to go to a specific surgeon.
