News for hackers. Stuff that matters.

A comment on "Not Medically Necessary": Helping America's Health Insurers Deny Coverage. Parent comment

Re:"Not Medically Necessary": Helping America's Health Insur... by jmspamerton on Wednesday May 13, 2026 @04:21PM (#48126977)
Physician and Hospital resources is a real zero sum game, how do you fairly regulate the medical landscape so those who's lives will benefit most from a procedure will receive the procedure?

Who decides this? You?

Should we allow everyone in the world who needs a procedure to receive one free and get ahead in line for Americans who need the same procedure? That's what the current climate looks like with unbridaled immigration under progressives.

These are hard questions. What's the answer?

[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by throwway120385 on Wednesday May 13, 2026 @06:02PM (#48128194)
Why not pay for these things out of taxes? I don't think you'll be so quick to defend the system if you ever find yourself needing care beyond a checkup once a year. It's designed to make the insurance carrier money by constantly having little costs slip through the cracks that should be covered. Get a dental checkup? Sorry one of your X-Rays wasn't covered but the other ones were. Now you get to spend hours fighting for a $13.00 cost. Oh you're at the max for this service for the year because we accumulated the estimated cost when you started calling doctors about what the after-insurance cost will be. Wait a minute this out-patient consult is actually a surgery because you saw a surgeon so it must have been a surgery, and it's not medically necessary to have the surgery without the consult.
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by ben-johnson on Wednesday May 13, 2026 @06:04PM (#48128220)
Because there are a finite number of doctors and hospital beds and you can't create either by throwing more money at the problem. You didn't actually read the content did you
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by freeone3000 on Wednesday May 13, 2026 @07:04PM (#48128781)
The doctor has already managed to find time for the service - she’s seen you. Potentially even done the procedure. The hospital has made room for you. The resource is already consumed by you, like a restaurant meal. The question is who is picking up the check, when you already have a subscription service paid for.
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by tt24 on Wednesday May 13, 2026 @07:24PM (#48128996)
The service is not “free healthcare for any procedure ordered by a doctor all the time without limits”, they have the right to refuse something they feel is unnecessary
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by freeone3000 on Thursday May 14, 2026 @03:02AM (#48132027)
Why isn’t it “any procedure performed by a doctor all the time with no limits”? Do you think there’s a cabal of doctors doing medical procedures for funsies? And that if such a thing did exist, it would be a bigger problem than some company who has never seen you, never examined you, and you’ve already paid money to, denying the claim because they judge it “unnecessary” when the doctor who did see you claims it is?
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by ceejayoz on Wednesday May 13, 2026 @07:25PM (#48129006)
And the doc is also spending a shocking amount of their time on the phone yelling at the insurance company flacks, as a bonus.
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by array_key_first on Wednesday May 13, 2026 @09:57PM (#48130240)
You can most definitely create both hospitals and doctors using money.
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by AlotOfReading on Wednesday May 13, 2026 @07:00PM (#48128729)
I guarantee you that the insurance company has zero clue or consideration for any physician and hospital resource constraints.

Gating access to medical care is the job of the patient's PCP and or other doctor. If the care is truly, meaningfully rationed (like transplant organs and blood banks), there are triaged priority lists managed by medical organizations.

[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by singleshot_ on Wednesday May 13, 2026 @05:48PM (#48128069)
These are actually pretty easy questions as long as you’re not an asshole.
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by tt24 on Wednesday May 13, 2026 @07:24PM (#48129002)
Dang, can we take a look at this one please? It’s not a productive, helpful, or interesting comment. Thanks!
[ Parent | on HN ]
[dead]
Re:"Not Medically Necessary": Helping America's Health Insur... by singleshot_ on Sunday May 17, 2026 @10:08AM (#48169057)
Did you know you spelled "unbridled" wrong because you are an idiot?
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by hdgvhicv on Wednesday May 13, 2026 @05:53PM (#48128120)
Every other country seems to solve it
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by ben-johnson on Wednesday May 13, 2026 @06:02PM (#48128199)
Do they? Which countries have solved it? In Canada, the wait is so long for free specialized procedures that many patients choose euthanasia instead. Can't imagine it's better anywhere else. Which countries have solved it?
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by throwway120385 on Wednesday May 13, 2026 @06:04PM (#48128214)
> In Canada, the wait is so long for free specialized procedures that many patients choose euthanasia instead.

This claim is so outlandish that I'd like to see some sources for it.

[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by ben-johnson on Wednesday May 13, 2026 @06:42PM (#48128556)
https://www.pbs.org/newshour/world/some-health-care-workers-...

This is pbs. In Canada they euthanasia an option for healthcare.

[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by ceejayoz on Wednesday May 13, 2026 @06:51PM (#48128646)
https://en.wikipedia.org/wiki/Assisted_suicide_in_the_United...
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by BeetleB on Wednesday May 13, 2026 @07:00PM (#48128738)
Where in the link does it say they're opting for euthanasia due to long wait times?
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by nonfamous on Wednesday May 13, 2026 @06:52PM (#48128657)
Sources do not support claim.
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by nick__m on Wednesday May 13, 2026 @06:31PM (#48128460)
I live in Québec, Canada and the longest I had to wait was 3 months for a gallbladder ablation. And my wife, who is on her fourtht year of ribociclib to prevent her spinal metastasis (breast cancer) from coming back, have timely periodical CT-PET and IRM scans.

MAID is popular not because of lack of care but because Québécois values their autonomy and quality of life above being simply alive for the longest time possible.

[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by ben-johnson on Wednesday May 13, 2026 @06:40PM (#48128541)
In the US nobody waits three months for a simple gall bladder ablation. What's crazy is you think that's normal. She has 'timely' scans because they are made months in advance.
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by ordersofmag on Wednesday May 13, 2026 @08:11PM (#48129428)
In the US around 26 million people have no form of health insurance. These same people are unlikely to be able to afford a 'simple' gall bladder ablation out of pocket. Which implies an effectively infinite wait time. What's crazy is that some people think this is normal.
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by ceejayoz on Wednesday May 13, 2026 @06:47PM (#48128608)
My dermatologist books nine months in advance. My wife’s neurologist books six months out. Long waits are absolutely a thing in the US. A surgery she needed took 18 months to go through.
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by nick__m on Wednesday May 13, 2026 @06:58PM (#48128705)
But it was truly not urgent, I would have been ok with waiting 6 months!

And the scans are not scheduled months in advance. We complained that we were only informed of the date and time of the next scan a few days before it... The explanation was that they have a must not be done before and a must be done after dates but the actual scheduling is done just in time so urgent case are prioritized before routine care.

[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by kelseyfrog on Wednesday May 13, 2026 @06:38PM (#48128525)
If I used my imagination as an epistemic authority, I'd often be wrong. Why not gain knowledge through experience? Visit Canada and report back.
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by analog31 on Wednesday May 13, 2026 @06:47PM (#48128607)
Wait times in my region are 12-24 months. My "annual" appointments with generalists occur roughly 18 months apart, and usually involve being seen by a PA or NP.
[ Parent | on HN ]
Re:"Not Medically Necessary": Helping America's Health Insur... by jghn on Wednesday May 13, 2026 @07:04PM (#48128780)
I'm in the US. I have 4 different appointments that are in 2027 because the relevant specialists book that far out.
[ Parent | on HN ]