Mullin's recent activity
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Comment on How has your career changed you? in ~life
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Comment on How has your career changed you? in ~life
Mullin Link ParentIt's not surprising, if you're only working on denials then you'd expect to be on the cases where it occurred not because it wasn't or isn't medically necessary but that either administrative or...It's not surprising, if you're only working on denials then you'd expect to be on the cases where it occurred not because it wasn't or isn't medically necessary but that either administrative or prior authorization or utilization management or some other reason occurred. The point I always try to make, and what that commenter doesn't say: hospitals could always treat if they wanted to, they could out of the goodness of their hearts deliver care on these denials. An insurance company doesn't stop a medical treatment from happening, it only stops payment. There's an underlying thought that insurance companies should be financially liable for all of this but none of that financial burden should fall on the providers, who are equally money seeking. There's no way to cheat the economics on this.
When I worked for a Medicaid plan, the goal of CM/UM all of this was to save money, yes, but it's because if you don't save money you will have to cut services, it's a misconception that every health plan runs in the black. There's also significant work (this is my domain really) around patient outcomes. The patient is not actually better served being at acute care for 20+ days, they have better outcomes if you moved them to a SNF or an LTC or an AIR...so you deny the extension of the LOS for acute care, it isn't going to help the patient but then you're the bad guy, and the hospital loves to paint you as the bad guy. All the while if you're the patient your risk of adverse outcomes might be increasing despite it costing more.
My main point is you'll find very few people who have worked on all sides of it offering nuanced opinions, it's always black and white. I've mentioned in other threads that people fundamentally misunderstand why insurance exists and what the value add even is, again, why I'm so jaded about the whole thing
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Comment on How has your career changed you? in ~life
Mullin Link ParentRealistic pricing and a shift away from networks and charge masters that change on a contract to contract basis. I think patients should know what they (or their insurance) is paying for up front.Realistic pricing and a shift away from networks and charge masters that change on a contract to contract basis. I think patients should know what they (or their insurance) is paying for up front.
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Comment on How has your career changed you? in ~life
Mullin LinkPresently, I work for a health insurance company (sort of) and have for the past 11 years, before that I worked 6 years at hospitals and providers. You will get a sense here that health insurance...Presently, I work for a health insurance company (sort of) and have for the past 11 years, before that I worked 6 years at hospitals and providers.
You will get a sense here that health insurance are always the bad guys, that really isn't true. There are bad guys everywhere, and nowhere, in the US health apparatus. One of the biggest changes over my career is being involved in something everyone both cares about, has opinions of, is highly political, and everyone knows someone who has a story. To a certain extent, I am empathetic and try to convey and assist where I can, but it also makes me jaded when people don't want to learn or accept reality of the situation, or are quick to point blame or expect solutions that aren't realistic (financially or politically or practically).
I really can't even begin to describe all my thoughts on my career. I started out and still abide by trying to help people. I saw the waste and cost disease at hospitals and providers, and I see it as well here. It's also very...complex, I have held 7 different positions in 6 departments, which has been across medicaid pharmacy, medicare care delivery, finance, state health plan, and now I'm in our consultancy wing, working with providers once more. Genuinely, the people working at a health insurance company spreads a pretty broad spectrum, and most people are not evil or malicious, but the US system and literal financial reality means that there's always some ghoulish scenario someone has encountered. And it's always the fault of the insurance. Despite the majority of cost drivers being from the provider side, which is increasing with AI tools.
It just feels mostly hopeless that I'll ever see any meaningful change in my lifetime to how healthcare in the US is structured so I just do what I can to at least push things in a positive direction. Sometimes that's expanding programs to populations that need it, sometimes it's cutting off vendors that aren't actually helping, sometimes it's reducing fraud. Right now I'm working on a cancer project as well as some provider scoring pieces. Nobody here wants a patient to have a bad time, but it's almost impossible to have nuanced discussions about it in any online space, since as I mentioned it's such an inflammatory topic.
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Comment on Our AI midwife in ~health
Mullin Link ParentAs someone who has been through the IVF process (and have a healthy 3yo) as well, it's absolutely insane to me they never got a hysteroscopy, at least with us, even without a history of cysts or...As someone who has been through the IVF process (and have a healthy 3yo) as well, it's absolutely insane to me they never got a hysteroscopy, at least with us, even without a history of cysts or fibroids or similar, our fertility doctor wanted to make sure that the uterine wall was ideal prior to transfer. I think all in all we had two hysteroscopies done, one before our first transfer, and one as well as some removal of scar tissue years after in preparation for another transfer, I cannot believe they wouldn't have done one in 6 years of fertility treatment when it was one of the first things they looked towards in idk, maybe the first 6 mo of the process?
Incidentally, it was after the second hysteroscopy, that whoops! my wife got pregnant naturally. Turns out she mostly had "sticky" fallopian tubes. So our son(3mo now) jumped queue.
All in all I'm happy this couple got the child they wanted. Fertility struggles are really, really really really stressful and costly and generally a lot of sadness and disappointment, I'd have been gutted if we'd done 5 transfers without a live birth....we didn't even have 5 viable embryos.
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Comment on Deciding whether (or not) to have a child in ~life
Mullin LinkYou've already gotten a lot of advice, but I'll still add my own experience to give another data point. We have two kids now, 3 and 2mos, and the only thing I regret is not having them sooner, as...You've already gotten a lot of advice, but I'll still add my own experience to give another data point.
We have two kids now, 3 and 2mos, and the only thing I regret is not having them sooner, as others have already stated, having kids is a unique joy that's incredibly rewarding every single day, I won't rehash.
Something I want to say is that having kids isn't just for you, but it's so much for your family/community that people don't realize. I can see how much it impacts my own parents, how much better it makes their life. My mom's had a tough time the last few years with a lot of her siblings dying, and honestly, I had this thought at the last funeral that if nobody has kids, you only ever have deaths, you're only ever at funerals and it's depressing as fuck. Not to mention losing a partner, if you don't have kids, sure you have family but they have their own lives, so that sense of loneliness is just astronomical. With kids you still have your partner with you, in a way. I know it doesn't have to be biological, but it's that you raised someone with them. We had our daughter first in our friend group and having her around quickly encouraged my other friends to get off the fence and have kids themselves, and I'm automatically closer to them because we have this shared experience, and our kids will see each other, likely their whole lives. The efforts I spent cultivating friends and community that share my values get reinforced in our kids, that's the most hopeful I can be about the world.
I think I'm rambling a bit, let me clarify:kids are also a lot of work, and you will be tired, and stressed, but! People will be accommodating, you will experience so much goodwill just from being a parent because well, other parents have been there, they see it, they've lived it. At work if you have to pick up a kiddo from daycare, or take them to an appt, everybody understands. Everyone gets it, and that feels both relieving and validating.
So yeah, I think it's fine to be optimistic, and even though life may be harder for my kids than it was for me, and my parents had an easier time than I did, at no point did I think I shouldn't have been born or that I'd wished they didn't have me. Maybe the climate or political instability or whatever else isn't fixable now, but it'll be fixable eventually, and we'll need humans who care to do that, so I try to do my small part, and honestly I get rewarded for it far more than I'm inconvenienced
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Comment on What are the genuinely worst films of all time? in ~movies
Mullin LinkJesus Christ Vampire Hunter Yes, it's a B movie, it might be satire idk, I couldn't get through even 30mins. It's obviously low budget, like college project level, but I could not find any...Jesus Christ Vampire Hunter
Yes, it's a B movie, it might be satire idk, I couldn't get through even 30mins. It's obviously low budget, like college project level, but I could not find any redeeming qualities and we quickly turned it off, my cousin had gotten it out of some bargain bin based on the name alone and even campy-ness could not save it.
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Comment on What are the genuinely worst films of all time? in ~movies
Mullin Link ParentOk, but battlefield Earth is kind of great as a comedy. I regularly quote the "we've decided not to keep you here for a other 5 cycles.......but for another Fifty cycles! With endless options for...Ok, but battlefield Earth is kind of great as a comedy. I regularly quote the "we've decided not to keep you here for a other 5 cycles.......but for another Fifty cycles! With endless options for renewal endless options for renewal endless options for renewal..................................hahahahahahha" it's just so goddamn goofy
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Comment on Help me choose a small electric car in ~transport
Mullin LinkOk so, the biggest constraint problem you have here is size, but it's not insurmountable. If something like a Hyundai Ioniq 5 is too big, then that kind of leaves I think the Volvo EX30? Which...Ok so, the biggest constraint problem you have here is size, but it's not insurmountable. If something like a Hyundai Ioniq 5 is too big, then that kind of leaves I think the Volvo EX30? Which have their own weirdness being basically a Chinese EV, but also, Chinese EVs are pretty reliable hey, so I think that's probably your best bet. You can find deals on the weird Nissan/Honda/Toyota crossover EVs, because they sold like shit, but I'm sure they are fine cars, there's also the similar Suburu version or whatever, the Japanese manufacturers kind of half-assed crossover EVs, but I've not heard anything particularly bad about them, just that the Hyundais were better equipped. I think it will be tough to find anything smaller.
As far as PHEVs, yeah there are a few options that are still small, prius namely, or the Ford C-max before it was discontinued (I have a 2015 chugging along just fine), but I agree with you. I think in 2026 you can commit to full EV and be happy
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
Mullin Link ParentI'm well aware of lobbying, as I stated. The majority supporting something and that thing being politically likely to occur are also, unfortunately, not the same thing at all in the US. I am not...I'm well aware of lobbying, as I stated. The majority supporting something and that thing being politically likely to occur are also, unfortunately, not the same thing at all in the US. I am not even sure what would need to occur to get medicare for all, but it's extremely possible that even if we did, it would be a marketplace situation like MA/ACA/medicaid(in markets like NY). So it's not even a given that the insurance companies would even fundamentally change. Pretty grim, I try to focus myself on improving patient outcomes or at least not spending money wastefully.
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
Mullin Link ParentI was perhaps needlessly hostile, in retrospect. Believe me when I say that I am always malding about healthcare, it's my hobby horse everywhere. Providers love that they can push all the blame to...I was perhaps needlessly hostile, in retrospect. Believe me when I say that I am always malding about healthcare, it's my hobby horse everywhere.
Providers love that they can push all the blame to insurers, especially to patients, but they could just as easily lower costs or increase care if they wanted to. I understand that if you've been interacting with the healthcare system, especially for someone who is dual, and if it's not strict Medicare but MA, and not sure the Medicaid situation, but yes, it can be astronomically annoying when you just want to receive care, but providers made this bed. At no point in their finance meetings are they thinking "how can we treat more patients more cheaply" and I've seen what I would describe as hostile negotiations where they'll threaten not to treat Medicaid or indigent population to get better rates from the state.
Sorry I got heated, I have enough rage for everyone involved XD
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Comment on Moving US to Japan: Things to bring? Things to leave behind? in ~life
Mullin Link ParentI think, I mean any of them are fine default/Ryobi/Milwaukee/home Depot brand etc, but Milwaukee has the best of the mini sized ones, the case would be easy enough to throw in a suitcase. I'd get...I think, I mean any of them are fine default/Ryobi/Milwaukee/home Depot brand etc, but Milwaukee has the best of the mini sized ones, the case would be easy enough to throw in a suitcase. I'd get one of those to hedge and then if you need larger tools just buy them in Japan. I helped my brother move/assemble furniture and he had one he'd gotten for work and it was a godsend. It's like the Ikea gun screwdriver on steroids.
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
Mullin Link ParentHow it typically works is there are criteria for anything not automatically approved, and then beyond that a doctor is tasked with being the final adjudicator of claims approval, and beyond that...How it typically works is there are criteria for anything not automatically approved, and then beyond that a doctor is tasked with being the final adjudicator of claims approval, and beyond that there is still appeals and grievances. But IME it doesn't take much to meet the threshold for medical necessity. All the doctors have access to the same information on what treatments are effective or not. It isn't so cut and dry that one avenue is better than another.
In the same vein that one doctor is paid by the insurance the other doctor is paid by the hospital, he has exactly the same perverse incentive to get that MRI approved as the medical director does to deny it, per your own admission
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
Mullin Link ParentI don't want to hound you, so tell me if you'd rather just not have further discussion about it. But insurance companies exist to manage risk, and to collectively bargain. That is the service they...- Exemplary
I don't want to hound you, so tell me if you'd rather just not have further discussion about it. But insurance companies exist to manage risk, and to collectively bargain. That is the service they provide, and health insurance provides more and takes less profit than basically every other type of insurance in existence. Your bills are lower because the health insurance negotiates for you. You can afford to have a catastrophic medical event because the insurance spreads your costs over a greater risk pool. Your premiums pay for someone else's catastrophic event, so on and so forth.
Whether you believe this should be the government's job or not has no bearing on the application or value add of insurance. Also both Medicare and Medicaid are often managed by insurance companies as a health plan, and have to make the exact kinds of decisions about coverage, utilization management, etc in order to maintain profitability. That means denying care, it also means giving only certain members additional care. I worked for a Medicaid health plan in New York, when the budget bill passed, we had to reduce membership because NY was losing federal dollars and had no way to compensate. You either deny care to maintain profitability or you no longer cover unprofitable members. The dollars truly are zero sum. Health plans can only lobby, they otherwise have no bearing on the funding situation or laws at a federal level. I absolutely assure you that nobody wants patients to be sicker, everyone wants them to get high quality care, but it's a difficult problem to solve. Recently I evaluated a vendor we were paying for the sole purpose of helping patients get into their PCP, they got an extra community based healthcare worker to get them in, remove barriers, facilitate transportation, plenty of extra care and cost because getting them in and then being healthier would reduce costs. And it had zero ROI over three years of program!
Until the government gets off their ass, which they seem uninterested in doing, insurers are unfortunately a solution rather than a problem. We could also get the AMA to stop fucking restricting residency slots and reduce education requirements so we could have enough doctors to service our population, too!
I'm just tired of misinformed opinions on this. I've worked in healthcare for 17 years, I've worked at hospitals, doctor's offices, pharmacies, insurance plans, health service providers, it is insanely stupid and reductive to think you can point to any one actor as "the problem" and I would seriously consider educating yourself on the details before spouting nonsense. For the record, the CEO of UHC was not the CEO of UHG who dictated many of the overall policies around increased usage of AI in prior auth, or increase in denials without using actual clinicians, things I very much disagree with. I just think Thompson's murder..... accomplishes nothing, it changes nothing. I think it was better that CEOs take the subway or walk the streets instead of taking an armored van or flying only by helicopter anywhere, I don't think whatever this was in service of actually improved anyone's life, and I was just as incensed about the response here when it happened as I (apparently) am right now. And I never met the guy or anything, I have no personal stake in it
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
Mullin Link ParentYou do realize that the people denying care at the health insurance company are also doctors right? I think in terms of denying care it doesn't matter who does it, an insurance company declining...You do realize that the people denying care at the health insurance company are also doctors right?
I think in terms of denying care it doesn't matter who does it, an insurance company declining to pay, and a doctor declining to treat without being paid. If you believe that healthcare systems and providers aren't also profit seeking then you have a very misunderstood idea of how broken US healthcare is and who the bad actors are (it's not really anyone tbh, it's just perverse incentives the whole way down)
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Comment on AI data center developers begin suing local jurisdictions behind bans and moratoriums — claims range from officials exceeding authority to violations of due process and equal protection laws in ~tech
Mullin Link ParentI think it's whether you can block specific businesses provided they meet the zoning requirements, right? It's one thing to zone something commercial but try to restrict which commercial entities...I think it's whether you can block specific businesses provided they meet the zoning requirements, right? It's one thing to zone something commercial but try to restrict which commercial entities can build there. I don't think communities themselves have carte blanche to unilaterally stop a business from building provided they bought the land and pay taxes, no?
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Comment on Moving US to Japan: Things to bring? Things to leave behind? in ~life
Mullin LinkI think power tools are pretty cheap in the US but not as available elsewhere? But if you're limited on packing may not be a good fit. But I assume if you're in a rural area having like a...I think power tools are pretty cheap in the US but not as available elsewhere? But if you're limited on packing may not be a good fit. But I assume if you're in a rural area having like a Milwaukee cordless impact may be nice, Amazon.jp doesn't seem to stock them or ship them there, but no clue on if hardware stores or anywhere else would have them. I remember not really seeing any in any electronics stores in Japan.
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Comment on Tokyo, yeast, and expectations in ~travel
Mullin Link ParentHonestly Michelin stars are a bit of a crapshoot these days, it's a bit disconcerting, but they definitely drive people to go there.Honestly Michelin stars are a bit of a crapshoot these days, it's a bit disconcerting, but they definitely drive people to go there.
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Comment on Hitoner | Chapter 11 in ~anime
Mullin LinkSpoilers Haruko is the AI(suspected) on his ship correct? So I'm guessing we are going the direction of misaligned computer, which I fear is a bit played out, but we'll see where it goes. I'm...Spoilers
Haruko is the AI(suspected) on his ship correct? So I'm guessing we are going the direction of misaligned computer, which I fear is a bit played out, but we'll see where it goes. I'm guessing the human army is just robots. I've been enjoying the mystery of this series, whether humans seeded the planet in the first place, and that's how he knew to come here. Whether Hito is a modified human beyond just being able to cryo sleep, and if the animal world is truly as war-free as it appears. I love that they went the direction they did with the "cowardly lion" trope, when he's totally right to be afraid.
Really enjoying this so far, glad to see discussion for it here on tildes
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Comment on Any significant changes to Tildes are extremely unlikely in ~tildes.official
Mullin LinkFine by me, I'm very happy with the minimalist structure. I don't need or want more than Tildes offers: users submitting and commenting, like the forums of old.Fine by me, I'm very happy with the minimalist structure. I don't need or want more than Tildes offers: users submitting and commenting, like the forums of old.
This also tends to happen even with universal and single payer systems, unless the hospitals are also state owned, you just see less of it because it's more streamlined. I would be shocked if the NHS for example didn't have length of stay or levels of care standards complete with threats of non-payment if facilities are incapable of following them.
Treatments don't always have such a clear cut efficacy, especially in complex conditions, I assure you that someone, somewhere, is making an executive judgement on who gets what, whether that be a transplant, a knee or hip replacement, how long a patient should stay inpatient after surgery etc. You need standards otherwise cost overrun and over-utilization(to speak nothing of fraud) runs amok.
Also, doctors make mistakes, and if not mistakes they may have their own independent ideas of what treatment for a condition should look like, even if that doesn't align with current best practices, or there is a comorbidity or risk they didn't consider. I have myself, as the absolute last line, stopped a pediatric IV order that was egregiously wrong, when I was about to make it under the hood. The MD ordered it wrong, the pharmacist approved the order when they shouldn't have, the compounding pharmacist didn't notice grabbing the drugs and it came to me to say something was up. That was 16 years ago, and that was only one I'm aware that I caught. A single doctor shouldn't be (and often isn't) the sole point of failure for a patient.
There's no free lunch. A single payer system would save us money on administrative bloat and is the right solution, but it doesn't preclude the types of problems that people tend to have with insurance, and it won't stop there ever being a denial of care or a prior authorization or a preferred treatment or facility.