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A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

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

#131

Post by zitterbewegung »

tptacek wrote: post #74
mobilefriendly wrote: post #66

Earlier quoted context omitted.

Unfortunately neither Christian Medishare nor our out-of-pocket health care payments are deductible. https://www.medishare.com/blog/is-healthcare-sharing-tax-ded...

Any HN conversation that starts out as a debate about Obamacare and ends up saving someone a few thousand dollars a year is a good conversation, so you are very welcome. Health insurance prices are a nightmare. Please don't let me come off as sounding like I don't think they are. The goal of the ACA was fix that problem, and though it fixed some very important problems, it surely didn't fix that one.

I think personally that the ACA is a great step toward affordable health care. We really need ACA++ that would address these small issues but unfortunately we probably aren't going to get it passed within the near term.

Repealing really isn't an option (due to the near impossibility of repealing an entitlement) and the public doesn't want that either. I don't know how you would fix the issue that the loss ratios will be more skewed negative since the fact that sick people pay more attention than healthy people for insurance (even when you introduce tax penalties).

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

#132

Post by aaavl2821 »

hippich wrote: post #109
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…

Note that you never mentioned person who actually receives service. IMHO problem is exactly that - none of players you mentioned truly interested in long term cost control. Some might just care about short term budgets, but otherwise all of them will pass it down to the consumer. And consumer being on their own, with little to no competition and information asymmetry has very little leverage..

I agree. The current players in the healthcare system view people as numbers, and that is terrible. Doctors are the most natural patient advocates, but unfortunately physicians' ability to influence healthcare, on a system or patient level, has decreased significantly in recent years.

I would love to see (and am hoping to build) solutions that give more power back to doctors and patients, and focus on patient experience and outcomes.

I know that a lot of consumers want to take their health decisions into their own hands, and I support that, but i think most people want help from an informed professional who is on their side (ie not controlled by a hospital or insurance company with competing interests)

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

#133

Post by pjdemers »

tptacek wrote: post #14

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 s…

Correct, anyone who plans to start their own business needs ACA. You might think "But if I own a business, I can buy insurance through it". What if you fail? What if you succeed moderately and sell it for a few million? What if your investors fire you? What if you get sick before it succeeds? What if your spouse or children get sick before it succeeds?

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

#134

Post by pg_bot »

sykh wrote: post #122
pg_bot wrote: post #107

Earlier quoted context omitted.

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.

Access is a function of cost. If medical care is affordable for people near the poverty line then we will be able to solve the access problem entirely. (this is my goal) Governments, charities, and businesses will pick up the slack as they already do.

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

#135

Post by tschwimmer »

curun1r wrote: post #102
lsc wrote: post #69

Earlier quoted context omitted.

>ACA is horrendous, unless you're receiving a government subsidy. I'm curious as to why you say "the ACA is horrendous" rather than "The income cutoffs for the ACA subsidies are way too low" - I mean, it seems obvious to me that if you make a median salary and have a family of four that you need some sort of health insurance subsidy, but I don't know where the ACA subsidy lines are, or even if they vary per state or…

My own personal "why I hate the ACA"... In 2016, I decided to take off from work and travel outside the US. I did what I thought was the responsible thing and purchased a travel insurance plan. In total, I was gone for a year...I had an amazing trip. When I got home, I wanted to sign up for insurance again. But since it wasn't a life event, I wasn't eligible to enroll until the open enrollment period. And when that t…

If your income was zero, couldn't you have gone on Medicaid?

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

#136

Post by [deleted] »

komali2 wrote: post #130
whatshisface wrote: post #128

Earlier quoted context omitted.

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 wan…

[deleted]

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

#137

Post by downandout »

ams6110 wrote: post #125
downandout wrote: post #81

Earlier quoted context omitted.

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.

Thanks for the advice. If all of my appeals are denied, I will follow it and try negotiate the price down. In any event, this won’t be a catastrophic financial event for me. But it sucks that it is happening to so many people under our current insurance regime, and not not all of them can handle it when their insurance decides not to pay.

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

#138

Post by nitwit005 »

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.

Look at how much political heat Obama, and Clinton before him, got for attempting to fix things. The other political party was more than happy to tell their constituents that their health care would be ruined, and grandma would be denied care by a "death panel".

Even though I don't like the ACA, I give Obama a lot of credit for trying. There is no political benefit to doing so.

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

#139

Post by tschwimmer »

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.

Were you eligible for Medicaid or CHIP?

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

#140

Post by DoreenMichele »

x0x0 wrote: post #129
DoreenMichele wrote: post #72

Earlier quoted context omitted.

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...

I don't really understand your point. I will note that since I could not afford housing for most of the year and struggled to get enough to eat, close to free is not cheap enough.
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