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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

#21

Post by wyager »

maxxxxx wrote: post #7
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…

"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).

> This is the whole point of health insurance!

This is a serious misunderstanding of what insurance is. Insurance is a net benefit for society because it linearizes individual risk curves even if you have to pay in proportionally to your expected costs, not because it makes less risky people subsidize more risky people. Perhaps you should avoid calling people “stupid” for misunderstanding insurance.

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

#22

Post by maxerickson »

ModernMech wrote: post #18
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…

> 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…

The known cost isn't really insurable. A premium based on expected costs would include the full amount of the known future costs and also some amount for less predictable costs.

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

#23

Post by ModernMech »

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…

My 5 day stint in the mental hospital was billed at $14,000. With my gold plated health insurance plan, it was still $3k.

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

#24

Post by twoodfin »

ModernMech wrote: post #18
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…

> 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…

You’d pay the 99% chance of asthma * $5,000 + 1% chance of cancer * $50,000 (or whatever the probability you get cancer * the estimate of cancer treatment costs).

If you do get cancer, the other 99% of folks who didn’t get it are covering your costs.

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

#25

Post by knieveltech »

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…

Ultimately, there is no point to insurance beyond generating profit for someone.

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

#26

Post by wyager »

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.

Your EV from holding a car insurance plan is slightly lower than if you’d put that money in bonds. The benefit is that you can spread your risk across multiple parties. It’s entirely different from medical insurance, where your EV depends strongly on individual circumstances (and can be very negative). Medical insurance providers aren’t allowed to give accurate pricing, so you basically end up with a really complicated subsidy program.

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

#27

Post by mobilefriendly »

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…

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 is basically catastrophic coverage for about $3,000 year that was grandfathered in when Obamacare was passed. However it isn't truly insurance, it isn't regulated for soundness. I'm seriously considering returning to wage employment for health care benefits.

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

#28

Post by knieveltech »

ThrustVectoring wrote: post #19
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.

I don't know if this is relevant to your plan but you are aware that Texas has like the 3rd worst healthcare system in the country and maternal and infant death rates on par with most 3rd world countries, right? Good luck, don't get sick.

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

#29

Post by liveoneggs »

wyager wrote: post #21
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).

> This is the whole point of health insurance! This is a serious misunderstanding of what insurance is. Insurance is a net benefit for society because it linearizes individual risk curves even if you have to pay in proportionally to your expected costs, not because it makes less risky people subsidize more risky people. Perhaps you should avoid calling people “stupid” for misunderstanding insurance.

maybe you should avoid calling Paul Ryan "people"

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

#30

Post by csa »

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…

Many (most?) of these “losses” for Medicare and Medicare claims is due to administrative bloat at hospitals. If the fixed that, then the amount of money they receive from these types of claims would be less of an issue, imho.

US healthcare (and education as well) are massively bloated with an abundance of low value-add administrators. These bubbles need to burst.

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