Aetna creates new obstacle to care for seniors, highlighting need for prior authorization reform

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    • #441161
      • Total Posts: 9,978

      It has become common practice for health insurance companies to create new obstacles for patients, in hopes of not having to provide essential health care to those who need it. The reason for these types of obstacles is simple: Fewer surgeries performed translates to larger insurance company profits.

      Like other insurance companies, Aetna has enjoyed record profits through the COVID-19 pandemic. The company, which was acquired by CVS Health in 2018, saw its operating income increase from $1.06 billion in 2019 to $3.07 billion in 2020.

      Prior authorization requirements can be challenging for patients, creating barriers to care and increasing administrative burdens for physicians who must spend time and resources to get approvals as insurance companies design and administer increasingly complex prior authorization systems.

      The time delays and administrative burdens also continue to undermine health care outcomes. Most startlingly, in a 2020 American Medical Association survey, 30% of physicians reported that prior authorization led to a serious adverse event for a patient in their care such as hospitalization, medical intervention to prevent permanent impairment, or even disability or death.

      Comment by Don McCanne o PNHP: Creating barriers to care in order to increase profits is a prime function of private insurers. To them, it is more important than taking measures to be sure that patients receive the care that they need. Prior authorization is a method designed to prevent patients from receiving the care that has been recommended.

      How would a public insurance program, such as single payer Medicare for All, differ? Such programs are structured to enable everyone to obtain the care that they need, whereas insurer profits don’t even exist.

      Why do our national policies continue to support private insurers through ACA insurance exchanges, Medicare Advantage plans, tax preferences for private employer-sponsored plans, and other government support of private insurance entities?

      Health care justice for all is a primary goal of a universal public insurance program. That has to be preferred to the more expensive, inequitable, profit-driven system that we now have that leaves so many without the care they need while driving others into medical debt, not to mention the potential for disability or even death. Doesn’t our government care about us, the peopl


      Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

    • #441182
      • Total Posts: 6,436

      but need a separate referral for each thing, and  a specialist will ONLY consider what is on the referral form (and sometimes that is wrong, too, wrong knee, wrong hip.  So fucking much for the primary coordination bullshit.) .  Basic message – you are 75, no matter that a year ago none of this was happening, take an Aleeve and shut up.  Oh, and have you had a mammogram and a flu shot?  Honestly, if all the care I am gonna get is “take an Aleeve” – what’s the difference what kills me?  Looks like that is profit-based now.

      America is not a country, it's just a business. (Brad Pitt, Killing Them Softly)

      Everything I post is just my opinion, and, honestly, I would love to be wrong.

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