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A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

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31–40 of 211 posts

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

#31

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…

As with all things healthcare, yes and no.

Private, for profit insurance is almost certainly always evil. Their margins are dictated by how much they can delay or avoid coverage. That pretty much defines evil.

Medicare is why hospitals exist, period. Private insurers make it as difficult as possible to stay in a hospital, because they are more expensive and usually result in worse outcomes.

Reimbursement rates are being squeezed because there is a glut of hospital beds. As a result, hospitals, designed to operate with higher overheads, are losing money.

There’s a whole web of bullshit where the lack of universal coverage and rational allocation of resources results in strange behaviors.

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

#32
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…

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 something extremely important to mitigate it.

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

#33
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…

[deleted]

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

#34
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…

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.

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

#35
post #26
post #10

Earlier quoted context omitted.

" 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 complicat…

" Medical insurance providers aren’t allowed to give accurate pricing, "

Why are they not allowed to do so? I think it's more likely that they don't want to so they can make up prices as they wish.

"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)."

This is exactly the same as health insurance. Spread risk over many people. EV depends on individual circumstances (driving skills or health). If health insurance is healthy people subsidizing sick people, then car insurance is good drivers subsidizing bad drivers. I don't see the difference.

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

#36
post #32

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…

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…

No it didn't, it reduced choice and drove up insurance costs by mandating that all private insurance cover everything + kitchen sink. My single brother's cheap catastrophic plan was OUTLAWED to force him onto the ACA exchange. The only thing ACA has done on prices is pass rising costs to taxpayers (more than 80% of ACA participates are subsidized) and the exchanges are in a death spiral because anyone who can escape them is doing so.

Another thing-- the data on prices are a flat out LIE, the government is also making massive payments to the insurance companies directly -- their prices don't reflect their actual costs.

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

#37

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. 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.

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

This is exactly my point, but it's this mechanism Paul Ryan said wasn't working. @powera claimed this is not the point of insurance. These things seem like exactly the same thing to me, so help me understand the nuance.

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

#38

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. 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.

Okay, now we're getting somewhere. Let's stay with the example of asthma. I pay a premium based on that condition, and the expectation that maybe one day I'll get cancer. Sure, I can understand that.

So then I get cancer, and the bill is more than I can afford. Where does the money come from? Not my premiums, because I've only been a subscriber for 3 months, and my premiums won't even cover the cost of treatment for a week of cancer treatment. If someone else isn't paying for me, and I'm not paying for me, who is paying for my treatment?

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

#39
post #11

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…

Young people also will get old and not all of them will be multimillionaires so it makes sense that one generation pays for the previous because one day they will be in the same place.

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

#40

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…

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).
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