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

#121

Post by downandout » Mon, Mar 26, 2018, 2:58 AM UTC

salawat wrote: post #120

downandout wrote: post #61

This story is couched in terms of how bad things were before Obamacare, but I’d like to point out that things aren’t great now either. To prevent Obamacare from bankrupting them, insurance companies are resorting to legally dubious mass-denials, one of which affected me personally. A few months ago, I woke up the next morning after eating some fast food and began vomiting. I couldn’t stop throwing up, and I couldn’t…

It's interesting that you mention that. I have Blue Cross, and I've been dealing with seemingly procedural denials every month for a chronic condition. It's getting to the point where I'm genuinely thinking there is some bad faith activity going on.

There's more likely than not some bad faith activity going on. They are essentially watering down what it means to have insurance, since they are required to sell it to people that they wouldn't otherwise have and are trying to make up the difference. One way or another, we're all paying drastically higher expenses than we would have before. If I have to pay the denied claims in my case, I'm looking at a $9800 out of pocket expense, on top of the $5K/yr premium I pay as a healthy nonsmoker.

Anthem pulled out of my state altogether for 2018, so I also had to switch providers at the beginning of the year (this claim was from late 2017). I think that's another reason they are giving me issues with this claim - they simply don't care because they no longer have to deal with my state's insurance regulator. The new insurance provider (which was the only choice I had in my area, regardless of price) so far appears to be even worse and more expensive. Something has to be done about all of this. I don't pretend to have the answer, but the ACA was apparently not it.

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

#122

Post by sykh » Mon, Mar 26, 2018, 2:59 AM UTC

pg_bot wrote: post #107

bbddg wrote: post #100

Earlier quoted context omitted.

I think there's plenty of room for innovation but we should start from the principal that everyone gets full access to medical treatment regardless of their ability to pay.

We technically have this in the United States (for emergencies). It is illegal for someone to be denied emergency services regardless of ability to pay.[0] No government system guarantees "full access" to medical treatment there is some form of rationing everywhere. https://www.cms.gov/Regulations-and-Guidance/Legislation/EMT...

Emergency rooms are required to stabilize a patient, not treat them or cure them. This is not universal care and it not giving everyone access to the medical system. One does not got the ER for things like cancer screenings.

From the link you provided:

Hospitals are then required to provide stabilizing treatment for patients with EMCs.

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

#123

Post by tptacek » Mon, Mar 26, 2018, 2:59 AM UTC

ethagknight wrote: post #117

tptacek wrote: post #32

Earlier quoted context omitted.

The rate of increase for health insurance prices went down after the ACA was enacted. The motivation for enacting the ACA was, in large part, the untenable increase in insurance prices in the 10 years leading up to it. People have a bad habit of blaming the ACA for insurance prices. The ACA failed at its goal of making individual health insurance affordable, that is true. But it didn't cause that problem, and it did…

Health insurance for my healthy young family of 4 spiraled out of control WITH ACA, so much so that I didn’t purchase proper health insurance in 2017, while also underfunding my income tax in hopes that ACA cannot legally “send me a bill” for 2.5% of my household income. (I mean shit, in a red blooded patriotic American, but that penalty made me absolutely furious) All this while paying cash for prenatal visits for o…

You have a young family of four, and can barely afford insurance premiums. Basically, without insurance, every single year you're hitting on a blackjack 17 against bankruptcy. You see the ACA penalty, and you see the insurance premium cost, but you're not factoring in the 5-digit cost of virtually any significant medical expense.

Rising insurance premiums aren't good for anyone. The ACA set out to fix the problem of rising insurance premiums and (I think) pretty much failed. But it didn't create that problem; 5-digit annual premiums for a family of four were a reality prior to the ACA --- or, at least, they were in Chicago on the small group market.

The subtext to these discussions though is whether we'd be better off without the ACA. No, we would not be. We would lose guaranteed-issue insurance, so a sizable fraction of families wouldn't be able to get insurance at all, and, from the available evidence, we would at least have the same rate problems we have now, and (according to some studies) have worse rates. Obviously, this subtext is about the GOP's health care rhetoric, and I'm not wild about opening up a political salient in this thread, but let's at least be clear: the idea that you can repeal the ACA, do nothing else, and get lower health insurance premiums for real coverage is sleight of hand.

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

#124

Post by tptacek » Mon, Mar 26, 2018, 3:05 AM UTC

madengr wrote: post #104

mobilefriendly wrote: post #27

Earlier quoted context omitted.

ACA is horrendous, unless you're receiving a government subsidy. I'm self-employed and we have one option of insurance provider, and the cheapest plan for my family last year was $18,000 a year with a huge deductible. That's after tax, out of pocket, for a healthy family with no pre-existing. Like all self-employed people I know (who aren't getting government subsidy), I moved my family to Christian Medishare, which…

That $18k was what I was quoted too. Of course no one would believe me.

I believe it completely, since it's just a small figure off what companies were paying for group coverage several years ago. The problem isn't that the figure is unbelievable; the problem is that the causal link being suggested isn't real.

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

#125

Post by ams6110 » Mon, Mar 26, 2018, 3:09 AM UTC

downandout wrote: post #81

lostlogin wrote: post #73

Earlier quoted context omitted.

The fact that this cost that much is alarming too. I get that the staff and bed bay aren’t cheap, but the consumables for the situation you describe would probably cost less than $10, and at bulk buy prices perhaps on a couple of dollars.

True, but as patients we obviously have no control over that. Also, ironically, if my insurance had simply processed the claim as they were supposed to, they would have paid far less than I'm being billed. ER cash prices are purposely inflated because insurance reimbursements are typically 1/3rd or less of the billed amount. But when the claim gets denied, they come after the individual for the full cash price.

Call the hospital and offer to settle. They will cut the price almost certainly. Almost anything they can get you to pay will be more than they will get selling the debt to a collector.

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

#126

Post by zitterbewegung » Mon, Mar 26, 2018, 3:11 AM UTC

tptacek wrote: post #40

zitterbewegung wrote: post #34

Earlier quoted context omitted.

If you want a lower payment per year go pick a really large company (the larger the pool the less you will pay). My mom pays half of what I pay and she gets family insurance while I get a single person insurance. Her pool is a large grocery store company.

$18,000 for a family is high but within the range of what insurance costs today. Family coverage on the small group market ( (I just looked it up and, weirdly, average premiums on the large group market in 2017 were higher than those in the small group market; on the small market, they're around $17,000, and in the large market, $19,000).

18k for a small business is typical. My mom pays much less than that because she doesn’t even make anything near 18k. For a small business it limits who you can hire because their take home pay would be 0.

Basically what I’m saying is the loss ratio for a bigger pool will be much lower than a smaller one. For insurance companies who charge premiums if you are in say a Bigcorp sized pool compared to a small business size pool the bigcorp pool will be larger and can have smaller premiums .

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

#127

Post by x0x0 » Mon, Mar 26, 2018, 3:14 AM UTC

tptacek wrote: post #123

ethagknight wrote: post #117

Earlier quoted context omitted.

Health insurance for my healthy young family of 4 spiraled out of control WITH ACA, so much so that I didn’t purchase proper health insurance in 2017, while also underfunding my income tax in hopes that ACA cannot legally “send me a bill” for 2.5% of my household income. (I mean shit, in a red blooded patriotic American, but that penalty made me absolutely furious) All this while paying cash for prenatal visits for o…

You have a young family of four, and can barely afford insurance premiums. Basically, without insurance, every single year you're hitting on a blackjack 17 against bankruptcy. You see the ACA penalty, and you see the insurance premium cost, but you're not factoring in the 5-digit cost of virtually any significant medical expense. Rising insurance premiums aren't good for anyone. The ACA set out to fix the problem of…

For another example: my broken ankle: tib+fib fracture, 2 severed ligaments, partially torn syndesmotic ligament, gave myself plantar fasciitis during recovery. Two surgeries, a bunch of ortho visits, a bunch more PT, 10 months on crutches.

The net bill was over $110k if I hadn't had insurance and wanted to go to one of two ankle specialists in the city I live in. With insurance, $5k-ish.

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

#128

Post by whatshisface » Mon, Mar 26, 2018, 3:16 AM UTC

tptacek wrote: post #123

ethagknight wrote: post #117

Earlier quoted context omitted.

Health insurance for my healthy young family of 4 spiraled out of control WITH ACA, so much so that I didn’t purchase proper health insurance in 2017, while also underfunding my income tax in hopes that ACA cannot legally “send me a bill” for 2.5% of my household income. (I mean shit, in a red blooded patriotic American, but that penalty made me absolutely furious) All this while paying cash for prenatal visits for o…

You have a young family of four, and can barely afford insurance premiums. Basically, without insurance, every single year you're hitting on a blackjack 17 against bankruptcy. You see the ACA penalty, and you see the insurance premium cost, but you're not factoring in the 5-digit cost of virtually any significant medical expense. Rising insurance premiums aren't good for anyone. The ACA set out to fix the problem of…

If enough people didn't have access to insurance, then there would be pressure on hospitals to find ways to reduce prices (so that their volume could go up). As it stands the medical industry is allowed to hold the poor for ransom ("accept our increased costs or they won't get treated") against the US's deep but finite pockets.

Before, we had the (very poor) demand elasticity of people paying everything they had and then maxing out every credit source, and predictably prices rose to around that point. Now, we have no demand elasticity at all, and prices can be expected to rise well above the average person's net worth + credit access.

If you look at any microeconomic equilibrium chart, you'll see that the price is held in a balance between people buying and people holding off due to price. When the good is healthcare, the human cost of "holding off" is very high, and usually involves inability to pay. Unfortunately our economic system tends to fly off the rails if this balance is disrupted, no matter how noble or urgent the cause.

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

#129

Post by x0x0 » Mon, Mar 26, 2018, 3:27 AM UTC

DoreenMichele wrote: post #72

kevhito wrote: post #65

Earlier quoted context omitted.

$18,000 doesn't sound large, relative to the high prices we all pay. I have a good solid job, and my family plan is $24k per year. That's the most basic family plan my employer offers, but it isn't a high-deductible plan. Of course, most of that is paid by my employer, so I only pay about $4k directly out of my salary. If you are self employed, then you obviously have to pay the employer part too.

For a little perspective, I supported a family of 3 on less than $18k last year and we only had partial coverage. Even though we were homeless for most of the year, the ACA penalty is pretty painful. I am in the midst of filling out my taxes. For a great many Americans, the figure you brush off as not particularly large is an unimaginable amount to come up with for insurance alone.

For 3 people, the federal poverty level is $20,160. $18k is less than that, and in California, you would have been on Medical. Even if you are on Obamacare, not Medical (in California: 138% of fpl and up), under 200% fpl the silver plans are close to free.

see eg https://www.healthforcalifornia.com/covered-california/incom...

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

#130

Post by komali2 » Mon, Mar 26, 2018, 3:44 AM UTC

whatshisface wrote: post #128

tptacek wrote: post #123

Earlier quoted context omitted.

You have a young family of four, and can barely afford insurance premiums. Basically, without insurance, every single year you're hitting on a blackjack 17 against bankruptcy. You see the ACA penalty, and you see the insurance premium cost, but you're not factoring in the 5-digit cost of virtually any significant medical expense. Rising insurance premiums aren't good for anyone. The ACA set out to fix the problem of…

If enough people didn't have access to insurance, then there would be pressure on hospitals to find ways to reduce prices (so that their volume could go up). As it stands the medical industry is allowed to hold the poor for ransom ("accept our increased costs or they won't get treated") against the US's deep but finite pockets. Before, we had the (very poor) demand elasticity of people paying everything they had and…

>pressure on hospitals to reduce prices

Elsewhere it has been said: choosing between bankruptcy for your family or cancer care for your child isn't an actual choice, it's two loaded guns pointed at your skull. One held by the hospital, the other by the insurance company.

The reason first world countries choose universal healthcare is that healthcare is a human right. Full stop. It is not an economic issue. If you want to get economic about it though you'll lose because as it turns out a healthy educated populace is more productive than one that loses productive families here and there to lances of bankruptcy from the unpredictable nest of human disease.