The Trump Biden Situation Just Got Crazier, Insurance Denials Are Getting Worse & TikTok Resurrected
PDS Published 01/20/2025
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TikTok died and then was resurrected just 12 hours later with many rejoicing.
Let's start with TikTok. a seeing before the app went dark, creators reacting in a number of ways, including just shouting and crying at the loss of TikTok that was coming or for some. It's an entertainment source, a utility, a place to find community.
Also for others, whether they be small creators or small businesses, this has become a huge economic source for them.
Which is why after it was shut down and then brought back, you had many rejoicing, but also many very, very skeptical.
And that seeming to be connected to two main things. TikTok's repeated praise of Donald Trump, specifically by name, both in the app itself and an online statement saying, among other things, we thank President Trump for providing the necessary clarity and assurance to our service providers that they will face no penalties, providing TikTok to over 170 million Americans and allowing over 7 million small businesses to thrive. two is that was happening.
You had Donald Trump laying out a more specific plan, saying, will issue an executive order on Monday to extend the period of time before the laws prohibitions take effect, so that we can make a deal to protect our national security.
And then, saying:
I would like the United States to have a 50% ownership position in a joint venture by doing this, we save TikTok, keep it in good hands and allow it to stay up without U.S. approval. There is no TikTok. With our approval, it is worth hundreds of billions of dollars, maybe trillions.
The men continuing:
Therefore, my initial thought is a joint venture between the current owners and or new owners, whereby the U.S gets a 50% ownership in a joint venture set up between the U.S and whichever purchase we so choose.
Then had many saying it seemed like it wasn't just being loose with language, saying that it sounds like he wants it to become a state run social media platform and not just involve a US based company.
With a number of people worried that it was now going to be used as a tool against them. within a number of people arguing that that might be why we've seen so many right wing politicians and right wing influencers flip flopping their position on TikTok.
Many reporting to the likes of Charlie Kirk, Trump and others who in recent years calling for TikTok to be banned, only to now want to be praised as it saviors.
Though there I will say there is a fair share of people who have stayed firm in their stance.
With the likes of Senator Tom cotton, who has been very anti TikTok posting a statement applauding the fact that it was removed from the App Store and even arguing that there is no legal basis to grant an extension to the band's deadline. you also had House speaker Mike Johnson saying on Sunday, I think we will enforce the law.
In general, right now, the whole situation feels very messy and chaotic. we've got Rand Paul and AOC both against the band, like on the same side for different reasons.
Paul even joined TikTok on Saturday before the band, just as a few saying and opposed.
The courts may think there's an exemption to the First Amendment.
I don't.
I joined TikTok today as a form of civil disobedience to the 170 million Americans who use TikTok.
Don't give up. Don't give in. then for her part, you had AOC saying there just wasn't enough information
proving TikTok's national security threat and also slamming the way the ban was rolled out and then rolled back.
TikTok's decision to name Trump in the notification is a choice.
They are signaling that they are privately collaborating.
They have agreed to privately collaborate with Donald Trump and the Trump administration.
And for all of those concerns that people were saying that TikTok is going to be used as a propaganda tool by the Chinese, understand they're using it as a propaganda tool for the right.
Then because Trump's the one getting credit and the one who plans to take executive action protecting TikTok, you have some slamming Democrats for allowing this to happen in the first place.
With political comments is in the space like a sand picker.
Writing Democrats gave an unimaginable W to Trump by pulling this insanely incompetent and unpopular decision.
Believe that Trump, who wanted to ban TikTok initially, is now getting the most expensive free ad by being credited as its savior to 170 million Americans.
Master class.
As for where things are actually going to go from here, I mean, you had the Wall Street Journal doing a report today saying that China is open to a deal that would keep TikTok here the outlet explaining that it is a reversal of the government's previous position that it would block any for sale of TikTok.
Like with everything else we're going to talk about today.
I got to ask you, what are your thoughts as far as the whole situation now?
And what do you think is going to happen?
Let me know in those comments down below.
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With just hours to spare, Joe Biden has issued “pre-emptive pardons” to protect against potential retribution by Donald Trump.
Right, among those being pardoned?
You have General Mark Milley, Trump’s former chairman of the Joint Chiefs of Staff.
And then, you have Dr. Anthony Fauci, the former director of the NIH and the chief medical advisor to the president during the height of the pandemic.
And finally, there are all the members of the House committee that investigated the January 6th attack on the Capitol, including Liz Cheney, Adam Kinzinger, and Adam Schiff.
And actually, even beyond that, the pardon reportedly applies to not only members of Congress but also staff who served on the committee –
As well as the capitol and DC police officers who testified before the Committee.[]
And of course, many of these people? They’re folks who Trump or his allies have singled out by name as deserving of some punishment or prosecution. .
Right, for example, he’s said on social media that Cheney “should be prosecuted for what she has done to our country.” []
And in fact, he said that the whole January 6 committee “should be prosecuted for their lies and, quite frankly, TREASON!” []
And then, General Milley? He’s implied that he’s deserving of the death penalty. []
And with that, I will say, Trump has sometimes suggested he might not follow through on his threats.
Right, saying that success as president would be his “retribution.”
But then, notably, he’s also appointed people like Pam Bondi as AG and Kash Patel as FBI director –
People who have also made comments sparking concerns about who they might go after in those positions.
And with that, you had Fauci, for instance, saying he “appreciates” the president’s action and asserting that he has committed no crime.
With General Milley also thanking Biden in a statement, saying:
"After forty-three years of faithful service in uniform to our Nation, protecting and defending the Constitution, I do not wish to spend whatever remaining time the Lord grants me fighting those who unjustly might seek retribution for perceived slights.”
But notably, on the other hand, not everyone being pardoned agrees with the decision.
Kinzinger, for example, telling CNN earlier this month:
“As soon as you take a pardon, it looks like you are guilty of something.”
“I am guilty of nothing besides bringing the truth to the American people and, in the process, embarrassing Donald Trump. Because for 187 minutes, he sat there and did absolutely nothing and showed how weak and scared he truly was.”
“So no, I don’t want it.”
And then, the other Adam – Schiff – saying:
“It would be the wrong precedent to set.”
“I don’t want to see each president hereafter on their way out the door giving a broad category of pardons to members of their administration.”
Biden, for his part, reportedly considered these arguments.
Right, according to sources speaking with CNN, he's been weighing the decision for days.
With him voicing concern that pardoning could connote guilt.[]
But in the end, he clearly concluded that providing protection was more important than the potential implication of misconduct.
With him saying in a statement:
“The issuance of these pardons should not be mistaken as an acknowledgment that any individual engaged in any wrongdoing.”
And also adding:
“These are exceptional circumstances, and I cannot in good conscience do nothing.”
But of course, that hasn’t stopped fresh criticism, from both sides, but especially from Republicans.
Especially since this is after Biden’s controversial pardon of his son Hunter despite his repeated promises that he wouldn’t intervene.
And so you have people like Republican Senator Eric Schmitt, for example, writing on social media:
"The guy who claimed he would ‘protect norms’ continues to bulldoze them and the Constitution until the bitter end. Biden truly is one of the worst Presidents in American history and will only be remembered as the guy between Trump’s two terms.” []
And besides that, despite Biden’s statement, you have many taking the pardons as evidence of wrongdoing. (1, 2, 3)
But then, notably, some of the criticism?
It arguably seems to validate Biden’s decision – or at least the idea that those being pardoned might have otherwise been targeted.
Right, Senator Rand Paul, for example, repeating his claims that Fauci bears responsibility for the pandemic, engaged in a cover-up, and committed a crime. []
And notably, as far back as 2022, Fauci claimed Paul’s accusations were sparking death threats against him.
But with all that, there’s still people wondering whether Biden can even do this?
Right, the use of the pardon power to try and protect people who have not even come under investigation, let alone be charged or convicted of a crime?
It has no real clear precedent.
Right, the closest one would probably be Gerald Ford pardoning Richard Nixon in 1974 even though he had not been charged with any crimes.
And with that, according to The New York Times, for example, some legal scholars have said that he is within the boundaries of his authority..”[]
But ultimately, we’ll have to wait and see what happens.
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Donald Trump is now not only president.
He may be one of the very richest men alive.
In theory….
Right, I’ll explain.
This all has to do with Trump announcing on Friday the launch of his own personal meme coin: the $Trump meme coin.
Right, it’s technically a venture by two companies:
CIC Digital LLC, which is an affiliate of the Trump Organization..
And Fight Fight Fight LLC, which is a company formed in Delaware earlier this month.
And with that, the coin’s website said 200 million coins are currently available – with plans to issue 1 billion over the next three years.[]
And with the coin currently priced at around $50 – down from its $72 yesterday – that would make the companies’ holdings worth more than $40 billion. []
Nominally, that’d be enough to move Trump up literally hundreds of places in the Bloomberg Billionaires Index.
Now, that said, it’s unclear how much Trump actually stands to gain.
Right, as explained by the BBC:
“Meme coins are used to build popularity for a viral internet trend or movement, but they lack intrinsic value and are extremely volatile investments.”[]
And with that, it would be almost impossible to realise that amount of money by selling the tokens without dramatically affecting the price.
And in fact, as of recording, it’s still dropping.
Though, notably, that doesn’t mean there’s no money to be made for Trump. []
And the whole thing really just being an example of the power and influence Trump has accumulated and the ethical questions it raises when he uses that to grow his business.
Right, this isn’t the first time we’ve Trump leveraging his position to launch a new product.
There’s been Trump-branded sneakers, fragrances, and even special edition bibles made in China.
And in fact, this isn’t even Trump's first foray into the realm of crypto.
Right, he launched his NFT digital trading cards back in 2022.
And back in September, he and his sons lent their name to a cryptocurrency startup called World Liberty Financial –
With the deal reportedly being that they’d get a cut of the sales in exchange for helping promote the new brand.[]
But, key thing, members of the Trump family were not actually owners of the platform or officers in the company.[]
But now, with Melania Trump also launching her own meme coin last night, this seems to be the first time Trump and his relatives have become directly involved in selling cryptocurrency.
Which, notably, is an industry regulated by the Securities and Exchange Commission.
And with that, also very notable, as president, Trump is the one appointing new SEC commissioners at the end of their terms.
And he also gets to designate one of them as chairperson.
And in fact he’s named Paul Atkins, who’s a big supporter of loosening up crypto regulation, as his pick.
He’s also reportedly planning to release an executive order designating crypto as a national priority and giving industry insiders a voice within his administration
With all of this standing in stark contrast to Biden's efforts to tightly regulate the crypto industry out of a fear that the volatile market could lead to a future financial crash.[]
And of course, it’s one thing to have a different approach to a policy issue.
It’s another thing to actively pursue a direct financial stake in an industry you get to regulate.
And so, you have people like one independent crypto analyst based in Hong Kong telling Reuters:
"While it's tempting to dismiss this as just another Trump spectacle, the launch of the official Trump token opens up a Pandora's box of ethical and regulatory questions.”[]
And then, people like a former White House ethics adviser to Obama putting it more bluntly.
With him arguing that out of all of Trump’s conflicts as a businessman turned president, this “may be the most profound.”[]
And going on to say: “He’s launching a major, new multibillion-dollar venture in the burgeoning crypto industry, where he has the most profound conflict of interest between [what] he’s seeking to gain and his duties to regulate that industry — which now includes himself.”
“This may represent the single worst conflict of interest in the modern history of the presidency.”[]
And then, notably, we’ve had mixed reactions from within the crypto community as well.
For example, a former executive at Coinbase, one of the largest crypto trading platforms, on one hand celebrating the announcement as a “vibe shift” from the Biden “anti-crypto” era…
But going on to say: “Trump owning 80% and timing launch hours before inauguration is predatory and many will likely get hurt by it.” []
And now, with all that, Trump and his companies are doing their best to cover their asses.
Right, the legal disclosures, for example, say the tokens are not intended to be seen as “an investment opportunity, investment contract or security of any type.” []
With the website also saying:
“Trump Memes are intended to function as an expression of support for, and engagement with, the ideals and beliefs embodied by the symbol ‘$TRUMP.” “GetTrumpMemes.com is not political and has nothing to do with any political campaign or any political office or governmental agency.”[]
And then, also notably, the Trump family business recently released an ethics agreement.
And that agreement prohibits Trump from “day-to-day” decision making when he’s president and limits financial information about the business that can be shared with him, among other things[]
But some have claimed that it falls short in certain areas.
For example, by failing to ban deals with private foreign companies, something that was included in the one signed ahead of Trump’s first term – which was also criticized at the time.
And so now with the concerns about conflicts of interest only growing, we’ll have to just wait and see where this all ultimately ends up.
Now the coin, as I’m filming, is currently priced at around $40 – down from its high of around $72 yesterday – which means that as of right now the companies’ holdings would technically be worth tens of billions of dollars. []
Nominally, that’d be enough to move Trump up literally hundreds of places in the Bloomberg Billionaires Index.
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Insurance companies are denying essential care and life-saving treatments to cancer patients by claiming that they aren’t “medically necessary.”
That is what NBC found in a recent investigation into these allegedly absolutely amoral practices.
And, in the case of Tracy Pike, that denial of treatment may have ultimately cost him his life.
Right, Tracy was a husband and father of three who was diagnosed with Stage 4 stomach cancer shortly after his 45th birthday.
And immediately, Tracy started doing chemotherapy, which did successfully reduce the size of the tumor that had been discovered in his stomach.
But reduce is the key word here — the chemo wasn’t a permanent solution.
So his doctor told his wife Angela that his best option was to undergo a routinely practiced treatment that combined both chemo and surgery at the MD Anderson Cancer Center in Houston.
And after MD Anderson agreed to give Pike the treatment, he and his family traveled from Kentucky to Texas in 2023.
But the night before his first procedure, Tracy’s surgeon called to let the family know that the insurance he had through work — Blue Cross and Blue Shield of Illinois — it had denied him coverage of the nearly $40,000 cost of treatment.
Now, as for the reasoning, documents viewed by NBC show the insurer had ruled that the treatment Pike’s doctors had recommended wasn’t “medically necessary” because it was “experimental, investigational and unproven.”
But experts say that is totally bogus — like Dr. Ashley Sumrall (Some-Rall) a neuro-oncologist in North Carolina, who said that the treatment is a widely accepted practice, telling NBC:
“I remember when it was experimental,” but adding that today “it is routinely practiced, and for some people is a huge lifesaving procedure.”
What’s more, MD Anderson said it had been performing the procedure for more than two decades.
And even beyond all that, the denial of care also goes against the guidelines of the National Comprehensive Cancer Network — a not-for-profit alliance of leading cancer centers that publishes widely followed recommendations.
Right, the network’s guidelines explicitly state that the treatment recommended for Tracy Pike is sought for “a select group of patients after multidisciplinary evaluation and discussion as well as appropriate clinical context.”
And so with all this, Tracy Pike’s family and doctors thought the denial was just a temporary setback, and that the appeal would be easy.
But Blue Cross and Blue Shield of Illinois continued to reject the repeated appeals made by Tracy’s surgeon, even as the doctors continued to argue that it was medically necessary because it would literally save his life.
And when pressed by NBC about why it denied that life-saving treatment, a spokesperson for Blue Cross and Blue Shield — who refused to be identified — declined to comment on the case or say why the procedure was denied, citing protocol.
Instead giving only this buzzwordy, platitude-filled statement:
“We are committed to increasing access to safe, appropriate, and effective health care based on the best available information and research, and in accordance with a member’s benefit plan.”
But the fact of that matter is that Tracy never received the treatment, and in January of 2024, he passed away.
And Angela says she is still struggling to adapt to life without her husband, telling NBC:
“I cannot help but go back to that month in Texas — what would have happened if he had had that surgery? Would he have lived?”
And to make this horrible situation even more shitty, after Tracy’s death, his family couldn’t even receive a life insurance payment because his coverage had ended after he became too sick with cancer to work, leaving his family to survive on his Social Security.
Or, to sum it up in other words: Tracy lost one form of insurance because he was dying of a disease another kind of insurance refused to pay for.
And that really depicts the whole insurance industry perfectly…
Right, unfortunately, Tracy’s story is not unique — there has been a rising trend of more and more insurers denying care and treatment.
And NBC reported that one of the biggest reasons for this is the insurance industry’s system for prior authorization requests — which require doctors to get approval from the patient’s insurer before they can provide certain services.
Now, health insurance companies argue that this process helps them bring down costs because they can make sure that a given service is medically necessary or require patients to try lower-cost alternatives first.
But physicians say that there are several different common practices in the prior authorization process that actively undermine patient care.
First of all, there’s the general lack of transparency around the internal rules insurance companies have for how they approve treatment coverage or identify alternative procedures that can be approved.
Right, because insurers keep those rules private, doctors have to spend time submitting claims only to have them denied.
But that process could be avoided entirely if the insurance companies just simply TOLD doctors what they will and won’t cover instead of making them guess and waste time that cancer patients can’t afford to waste.
And often, that precious time is already being stretched thin because it can take weeks for insurers to either approve or deny certain treatments and tests.
And if the request is denied, doctors have to appeal, which is a whole other lengthy process that sucks up even MORE time.
But even for procedures that are approved, the system still works against cancer patients and their limited timelines because doctors have to repeatedly seek prior authorization for procedures that are regularly approved.
With many doctors arguing that if they have a history of receiving approvals for various treatments or tests, they should just be able to circumvent the time-consuming prior authorization rigmarole.
Beyond that, doctors also say another problem that interferes with cancer treatments is the fact that insurers require a peer review process where another doctor that THEY hire rules yes or no on a cancer procedure.
Even if it’s a procedure that the patient's own doctor recommended.
But — and this part is REALLY crazy — the insurance company doctors that approve or deny these procedures aren’t always cancer specialists.
And that’s exactly what happened with Tracy Pike — the insurance company doctor who rejected the life-saving treatment that cancer specialists had recommended was an OB-GYN.
What’s more, doctors also say that insurance companies have been increasingly requiring prior authorizations for more and more procedures and treatments.
Like, for example, the combination drugs used to combat cancer.
With a 2023 report from Journal of the American Medical Association Network finding that the number of nonspecialty branded cancer drugs that required prior approvals rose from 16% in 2010 to a whopping 78% in 2020.
And experts say all these different hurdles are especially detrimental to cancer patients — as Dr. Bruce Scott, the president of the American Medical Association, explains:
“Nowhere are the stakes higher than in cancer care where delays can literally be the difference between life and death.”
And academic research also explicitly shows that cancer patients are directly harmed by the prior authorization process.
For example, a study published last year in the JAMA Network found that nearly 1 in every 5 cancer patients didn’t receive the care their doctors prescribed for them because of authorization delays or denials.
And even just delays in approvals can harm cancer patients.
Right, a 2022 member survey by the American Society of Clinical Oncology shows that 42% of prior authorizations were “significantly delayed,” resulting in numerous different adverse effects.
With more than a third of all respondents blaming the loss of a cancer patient on prior authorizations.
And it’s not just treatments that are increasingly being denied, but essential cancer screenings as well.
Which is exactly what happened to Kay Hsu (Sue), a cancer patient who was diagnosed with metastatic breast cancer and underwent surgery and chemotherapy.
But in 2018, the cancer moved to her spine and sternum, so she began aggressive immunotherapy treatments and had quarterly PET scans to monitor the cancer’s spread.
But this past year, Cigna Healthcare denied reimbursement for two scans her doctors had ordered that cost between $10,000 and $15,000 each.
With Cigna arguing in documents that the imaging wasn’t medically necessary because it “is not supported for routine followup or to monitor your condition in the absence of symptoms.”
But Sue’s employer stepped up and paid for the scans out-of-pocket — and it was a good thing, because a PET scan in October found that the cancer had indeed spread to her liver.
With oncologists confirming that the cancer wouldn’t have been found without the PET scan.
But it’s not just private insurers that are increasing denials for care and screening.
Patient documents viewed by NBC also show that, in 2024, Medicare started denying reimbursements for ultrasounds on women at risk of breast cancer — even though they approved identical screenings the year before.
Right, radiologists say those ultrasounds help find cancers that mammograms miss, and are essential for people with dense breast tissue — which affects nearly half of women over the age of 40.
With one doctor telling the outlet this move is especially surprising because it happened the same year that the FDA started requiring mammography providers to tell patients with dense breast tissue that they might need additional screenings —
Including the ultrasounds that Medicare is denying coverage for.
But when NBC reached out to the Centers for Medicare and Medicaid Services about the reimbursement denials, a spokesperson said the coverage hadn’t changed, adding:
“The ultrasound or MRI scans you are referencing are covered by Medicare when provided as a diagnostic test. If the scans were provided as a screening test, then Medicare is unable to cover those by law.”
But a doctor explained to NBC that there’s only one reimbursement code for these kinds of ultrasounds, regardless of whether they are a diagnostic test or a kind of screening.
And Dr. Ashley Sumrall, the neuro-oncologist in North Carolina, told the outlet she has been seeing this with her patients as well.
Adding that she worries this trend will expand to private insurers because they look to Medicare reimbursement for policy.
So for now, we’ll just have to wait and see what, and I don’t really know where to end this besides saying how fucked the system is and how upsetting this whole situation is.
And on that note, I’d love to hear from you in those comments down below — especially if you or someone you know has gone through something like this.
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Right, so I feel like what we learned from that, it feels like you can almost never be sure if your health insurance is gonna cover the treatment you need.
Even when it’s fucking cancer.
And even when that treatment might save your life.
But what I wanna talk about now is how when it isn’t cancer, or some other physical condition, it can sometimes be even easier for insurers to deny treatments on the basis they aren’t “medically necessary.”
And to be clear, that’s despite the fact that a federal law existing since 2008 requires insurers to provide mental health coverage on par with coverage for other medical services.
Right, because even though that law exists, as of 2021, roughly two-thirds of Americans with a diagnosed mental health condition w ere unable to access treatment.[]
And just like with cancer, the consequences can be deadly.
And with that, we’re looking at this series of articles from ProPublica showing some of the ways insurers allegedly limit access to mental health care.
One of the most fucked up ways?
They’re known as “progress-based denials.”
Right, insurers regularly evaluate patients’ progress to see if they can be moved down to a lower and usually cheaper level of care.
Notably, they might point to a lack of progress as a reason to deny coverage.
With them labeling conditions as “chronic” and claiming the patient has reached their “baseline” level of functioning.
But then, on the flipside, if a person does make progress?
Well, insurers have also used that as a reason to deny coverage, saying that’s evidence the patient no longer needs the care they’re getting. []
And so, ultimately, in the words of ProPublica, “...doctors are left to walk a tightrope trying to convince insurers that patients are making enough progress to stay in treatment…
…but not so much that the companies prematurely cut them off from care.” []
And with mental health, as you might imagine, these types of progress-based denials, they may be more common.
Right, with something physical, you might just need an x-ray, a blood test, or some other objective measurement.
But with mental illness, it’s not always so easy to measure progress.
Not to mention progress often isn’t linear, with a patient improving slightly one day only to tank the next.
And with that, we gotta talk about the story of Geneva Moore.
Right, as she told ProPublica, depression? It’s been a near constant in her life.
In 2022, it got even worse.
But thankfully, a year later, she began an intensive outpatient program, which included multiple group and individual therapy sessions every week. []
And with that, slowly but surely, there were signs of progress.
And that’s reportedly why – just a few months into the program, her insurer – Blue Cross and Blue Shield of Texas – said it would no longer pay for it.
With the insurer’s denial letter saying the “medical necessity criteria” had not been met.
And telling Moore: “You have made progress. You are not a danger to yourself or others.”
But according to Moore’s therapist?
That wasn’t her professional opinion.
And with that, she reportedly pleaded with an insurance company doctor, telling him that Moore still had suicidal thoughts almost every day and a plan for how she would take her own life.
Also saying that while Moore had expressed a desire to stop engaging in self-harm, she still did so as often as three times a week.
And finally, explaining she was only starting to process her grief and trauma over earlier sexual and emotional abuse but still had no healthy coping skills. []
And so, the therapist said she asked for just 10 weeks.
10 more weeks, she said, and Moore would be able to leave the program. []
But the doctor? He apparently wasn’t convinced, reportedly telling the therapist that he would be upholding the initial denial.
With internal notes obtained by ProPublica claiming that Moore exhibited “an absence of suicidal thoughts;”
that her symptoms had “stabilized;”
and that she could “participate in a lower level of care.” []
And so, unable to pay the $350-a-day that it cost to stay in the program without coverage, Moore left.
And whatever “progress” she made?
It was all but erased.
Right, by her last day in the program, records reportedly show that Moore’s suicidal thoughts and intent to carry them out had escalated from a 7 to a 10 on a 1-to-10 scale. []
And within a few hours of her last session, she was driving herself to a hospital getting admitted to the ER.
With that being the start of a weeks-long downward spiral that would reportedly lead her to harming herself more frequently, drinking more often, and ending up admitted into a psychiatric hospital.
Ironically, with all this costing her insurer way more than it would’ve just to keep covering her in the first place.
Right, that stay in the psychiatric hospital?
It cost nearly $40,000.
The remaining 10 weeks in the intensive outpatient program — the treatment BCBS denied?
That would’ve cost about $10,000. []
And so, with that, two things:
First, I wanna say, at the time of ProPublica’s reporting at least, Moore was still struggling, but doing better.
Right, she had reportedly stopped drinking and harming herself. []
And second, while we can’t say EXACTLY how many stories like Moore’s there are, we can say for damn sure that it’s not the only one.
Right, ProPublica, for example, saying it’s identified dozens of lawsuits over the past decade in which judges have criticized insurance companies for citing a patient’s improvement to deny mental health coverage. []
And notably, at least a couple of them? They involved one of the doctors who denied Geneva Moore’s coverage.
A man by the name of Timothy Stock.
Right, and what you need to know with that, Stock and other insurance company doctors?
There’s guidelines they use to determine how well a patient is doing and, ultimately, whether the company should continue paying for care.
And of course, these companies, they claim these guidelines are independent and evidence-based. []
The only problem? They’re sometimes using guidelines they’ve come up with themselves.
And in interviews, several current and former insurance employees – notably from multiple different companies…
They reportedly told ProPublica that they were required to prioritize the proprietary guidelines their company used –
And that’s even if their own clinical judgment made them think differently. []
So Timothy Stock, for example, he reportedly cited a set of guidelines known as the MCG.
It’s another of the most commonly used ones, and it’s been developed by a company called Hearst Health.
And besides Geneva Moore’s coverage, in 2016, Stock reportedly referenced them to deny coverage to a teenage girl who was in residential treatment for major depression, post-traumatic stress disorder, and anxiety. []
And in another case, he upheld the denial of coverage for a girl with a long history of mental illness just a few weeks into her stay at a facility – claiming that she was “making progressive improvements” []
Less than two weeks later, according to court records, she self-harmed.
With a judge eventually ruling against the insurer and writing that Stock and another doctor, quote, “unreasonably ignored the weight of the medical evidence” showing that the girl continued to require residential treatment. []
But Stock, he’s still practicing.
And according to ProPublica, across the country, insurers continue to rely on doctors like him whose judgments have been criticized by courts.
Dr. Barbara Center, for example, she once wrote that a patient was not suicidal when, according to medical records, she was actually actively planning to kill herself.[]
With the resulting lawsuit - which was against United Behavioral Health, not Center – making it all the way up to the 9th U.S. Circuit Court of Appeals.
And there, in a unanimous opinion, the judges wrote that Center’s ‘independent’ evaluation and coverage decision were based on “obvious factual errors.”[]
With the lawyer who represented the hospital saying that after that, she didn’t think any insurance company would ever work with Center again.[]
But in fact, over the next ten years, United and other insurance companies continued employing Center even as her decisions continued to be singled out in court cases.
Right, according to ProPublica, she’s been referenced in at least 12 lawsuits alleging that insurers wrongly denied insurance coverage to patients who needed intensive mental health care.
Four of these ended in confidential settlements with no admission of wrongdoing by the insurers.
And three in judgments finding the insurance company had improperly denied coverage, one of which was appealed and then settled.[]
And of course, with that, there’s some who say the fact that big companies can so often just shell out some cash to avoid any admission of wrongdoing or real consequences is also a major problem.
But in any case, there’s a lot more even beyond that ProPublica has highlighted.
For example, one big problem?
There’s these so-called ghost networks, which basically describes when health plans list providers who supposedly accept that insurance but who aren’t actually available.
With the reality being there are often nowhere near enough available therapists in insurance networks to serve all of the people seeking care.
With notably, literally hundreds of psychiatrists speaking to ProPublica and many saying they left the network BECAUSE of problems with the insurer. []
And while the shortage of insurance-covered therapists is bad in itself, these out-of-date registries that don’t reflect the actual availability of care?
They make things even worse.
Right, one person speaking to ProPublica, for example, saying he moved to a new city knowing he needed mental health care, and thinking he’d be able to find it.
But instead, ending up trapped in the so-called “ghost network” and later being found dead.
Right, and even though some states have tried to tackle this, most reportedly aren’t, and issues are still widespread.
With part of the issue there being that even massive insurers are often regulated at the state level.
With ProPublica finding, for example, that United’s algorithm program had been deemed illegal in three states by 2021.
But saying that it hasn’t stopped it from using similar methods in other states. []
With mental health advocates claiming every single jurisdiction in which the company operates would need to be successful in bringing a case against it.[]
And so I encourage you to look at all these articles if you want every detail, they’ll be linked down below.
But in the meantime, we’re just waiting to see if anything we’ll change.
And also, you know, wondering how many cases are out there that haven’t ended up in a court case or an investigation.
Which leads me to ask if any of you have anything you wanna share in the comments to keep shedding light on this.
