A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims • Hacker News Board

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#11

Post by oh_sigh » Sun, Mar 25, 2018, 11:14 PM UTC

ModernMech wrote: post #4

maxxxxx wrote: post #2

It's hard to believe that the country is putting up with a system that can bankrupt you any time you get sick and there is pretty much nothing you can do other than being lucky or having a lot of money already. The actual medical care is fine but the billing practices are just ridiculous. I would call them fraudulent in a lot of cases.

Is it really hard to believe though? The ones who are lucky and have the money are fine with the situation. The unlucky ones with no money are too busy fighting diseases, insurance companies, and bill collectors, they don't have time to change the system. Dealing with insurance when you have a serious illness is a full time job. The people who need change most are literally fighting for their lives. Meanwhile, health…

Why should young people subsidize the health care of old people who almost certainly have a higher net worth than the young people?

Remember with Obamacare about how there was a huge push to get young people to sign up for it, because without healthy young people paying too high premiums, the system would fall over with the costs of the elderly? Maybe that is why young people didn't want to sign up for the ACA, and they needed to enforce 'penalties' for not having health care.

If young people were actually charged a fair market rate for their health insurance, they would sign up in droves because it would be dirt cheap. But when you make them pay far more than is reasonable, because old people need health insurance too, then that is how you get a system where no one wants to sign up for it until they are legally forced to.

The ACA in this sense completely subverted the point of insurance. So, maybe the right doesn't understand insurance, but neither does the left.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#12

Post by aaavl2821 » Sun, Mar 25, 2018, 11:16 PM UTC

This is a good article, but it only shows a few parts of a much more complex whole, and extrapolating from these anecdotes to a broader system is not really accurate

Many hospitals lose money on every Medicare and Medicaid patient. The only reason they survive is because they can charge private insurance companies more. So hospitals and health systems have been consolidating to strengthen their negotiating position against insurers

This article paints Medicare as the good guy, private insurance as evil, and hospitals as mixed. The reality is more complicated, and more regional, but overall healthcare is a zero sum game today between payers and providers fighting for dollars, and power comes largely from scale. In geographies where payers are bigger and stronger, they push hospitals and force many to consolidate or die. In areas where hospitals are stronger, they basically dictate price and rates can skyrocket

There's a lot of bad stuff happening on all sides, and it isn't clear that private insurance is always evil. If we become a single payer society, small providers that are struggling to survive will probably be the first to die, and providers will probably consolidate much more aggressively into massive national chains, like the Walmart of healthcare

The cause of a lot of healthcare issues is not one particular party (insurance, Medicare, hospitals) but a system that encourages monopoly seeking behavior without any good mechanism for regulating this

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#13

Post by maxerickson » Sun, Mar 25, 2018, 11:20 PM UTC

maxxxxx wrote: post #10

powera wrote: post #8

Earlier quoted context omitted.

That is the whole point of socialized medicine . The point of insurance is that you pay slightly more than the expected value of your claims. So if you know you need $5000 worth of medical treatment for asthma, your insurance premium should be definitely more than $5000. This bizarre obsession with using the phrase "insurance" and insisting on a product that is not at all insurance is probably why the US health-care…

" The point of insurance is that you pay slightly more than the expected value of your claims. " Not true. Car liability insurance is very similar to health insurance. A lot of people never get anything out of it.

They are using expected value in a technical sense.

In a pure contract between equally informed parties, it's exactly how insurance would be priced.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#14

Post by tptacek » Sun, Mar 25, 2018, 11:21 PM UTC

If you're a tech entrepreneur, it's the first story in here that should alarm you the most. It's about denying coverage altogether, not about denying individual claims. Outside of the "guaranteed issue" ACA market, there is virtually no due process for coverage denial. You can be denied on a whim, with little recourse.

The list of conditions for which insurance outside the ACA will be denied is long and opaque. The story makes it sound as if they're looking for reliably diagnosed conditions like diabetes. No. They're looking for indicators of a long list of potential conditions. If you or your spouse has a functioning female reproductive system, the chance of your family being denied is high, even without a diagnosed or treated condition. We were denied for something like that, and also because my daughter had an unexplained seizure when she was 4 (she's now 16 and just fine). To get insurance for the first couple years of Matasano, my wife had to take a crappy full-time job with group coverage.

Without insurance, a typical working family is one major medical incident away from zeroing themselves out. My daughter has never met a pickleball net that didn't break her ankle (she has met one pickleball net). Even with insurance, the cost of that injury was high single-digit thousands of dollars. Without it? The cost of a pretty decent car. Find a friend who's had an appendectomy some time and try to find out how much the insurance company was (nominally) billed for it. A down payment on a house.

If you work in this industry, intend ever to start your own business and potentially have a family at the same time, you should be extremely alarmed at the prospect of guaranteed issue regulated health insurance (the ACA) being replaced.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#15

Post by owyn » Sun, Mar 25, 2018, 11:23 PM UTC

maxxxxx wrote: post #10

powera wrote: post #8

Earlier quoted context omitted.

That is the whole point of socialized medicine . The point of insurance is that you pay slightly more than the expected value of your claims. So if you know you need $5000 worth of medical treatment for asthma, your insurance premium should be definitely more than $5000. This bizarre obsession with using the phrase "insurance" and insisting on a product that is not at all insurance is probably why the US health-care…

" The point of insurance is that you pay slightly more than the expected value of your claims. " Not true. Car liability insurance is very similar to health insurance. A lot of people never get anything out of it.

You don't have to own a car. Everyone gets sick at some point, and everybody dies of something. Whether that's cripplingly bankruptingly expensive or not is partly the point.

Although I suppose if the singularity happens, that will also solve the health care crisis in this country. (sarcasm)

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#16

Post by maxerickson » Sun, Mar 25, 2018, 11:23 PM UTC

aaavl2821 wrote: post #12

This is a good article, but it only shows a few parts of a much more complex whole, and extrapolating from these anecdotes to a broader system is not really accurate Many hospitals lose money on every Medicare and Medicaid patient. The only reason they survive is because they can charge private insurance companies more. So hospitals and health systems have been consolidating to strengthen their negotiating position a…

I think it'd be a good sport to make hospitals eat denied claims. If two giant institutions want to argue about whether something is covered, the patient should not be the loser.

We should also better fund Medicare and Medicaid. Taxes should be apparent.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#17

Post by robbiep » Sun, Mar 25, 2018, 11:24 PM UTC

oh_sigh wrote: post #11

ModernMech wrote: post #4

Earlier quoted context omitted.

Is it really hard to believe though? The ones who are lucky and have the money are fine with the situation. The unlucky ones with no money are too busy fighting diseases, insurance companies, and bill collectors, they don't have time to change the system. Dealing with insurance when you have a serious illness is a full time job. The people who need change most are literally fighting for their lives. Meanwhile, health…

Why should young people subsidize the health care of old people who almost certainly have a higher net worth than the young people? Remember with Obamacare about how there was a huge push to get young people to sign up for it, because without healthy young people paying too high premiums, the system would fall over with the costs of the elderly? Maybe that is why young people didn't want to sign up for the ACA, and t…

You realise that is literally how insurance works though, right? If you tranched age groups or risk profiles then you would have those needing to use insurance unable to afford coverage. Which defeats the purpose

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#18

Post by ModernMech » Sun, Mar 25, 2018, 11:32 PM UTC

powera wrote: post #8

maxxxxx wrote: post #7

Earlier quoted context omitted.

"The whole idea of Obamacare is...the people who are healthy pay for the...sick" This is the whole point of health insurance! What a stupid idiot (I am overly nice to Paul Ryan. His budget plan was the most ridiculous thing I have ever read).

That is the whole point of socialized medicine . The point of insurance is that you pay slightly more than the expected value of your claims. So if you know you need $5000 worth of medical treatment for asthma, your insurance premium should be definitely more than $5000. This bizarre obsession with using the phrase "insurance" and insisting on a product that is not at all insurance is probably why the US health-care…

> That is the whole point of socialized medicine. The point of insurance is that you pay slightly more than the expected value of your claims. So if you know you need $5000 worth of medical treatment for asthma, your insurance premium should be definitely more than $5000.

How does that make sense? If I knew I needed $5000 worth of medical treatment for asthma, and I pay an appropriate premium based on that, but then I get cancer..... well then someone else is going to have to pay for that, because my premiums certainly won't cover the cost of cancer treatment.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#19

Post by ThrustVectoring » Sun, Mar 25, 2018, 11:33 PM UTC

maxxxxx wrote: post #2

It's hard to believe that the country is putting up with a system that can bankrupt you any time you get sick and there is pretty much nothing you can do other than being lucky or having a lot of money already. The actual medical care is fine but the billing practices are just ridiculous. I would call them fraudulent in a lot of cases.

My long-term plan is to get something like a million dollars in retirement accounts and a home and retire in Texas, where your retirement accounts have unlimited protection against creditors. If any random incident can bankrupt you, then your best bet is to ensure that you cannot be forced into bankruptcy.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#20

Post by sykh » Sun, Mar 25, 2018, 11:33 PM UTC

Every health care system rations care since no current system has enough resources to care for everyone without some form of waiting. The U.S. health care system rations care in the most immoral way of the advanced nations. A person should not profit by denying care to someone else.

As a nation we should try optimizing for a more moral, just system. As I see it that would be something like Medicare for all but I'm open to suggestions/solutions.