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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

#51

Post by jjoonathan »

mobilefriendly wrote: post #27
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…

How do you make sure you're actually getting catastrophic coverage for $3k? The information asymmetry between insurance providers and customers heavily incentivizes the creation of "value" plans that achieve their "value" by appearing to cover more than they actually do. Since only a tiny fraction of customers ever make catastrophic claims, most people will be unaware that they are buying garbage even if a policy were to never pay out (100% lemon-drop rate). Is your due diligence sensitive enough to pick up even a severe 50% lemon-drop rate (affecting, say, 0.5% of customers)?

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

#52

Post by mobilefriendly »

snuxoll wrote: post #47
tptacek wrote: post #40

Earlier quoted context omitted.

$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).

That’s still roughly the case, I work for a medical billing company owned by a physician group, we have a pretty large group and are essentially self-insured. I pay ~$220-ish a month for my family of three, the company pays $800+/mo. Boy am I glad to work for a company that pays such a large chunk of my benefits, many other places cover maybe 50% of your dependent costs.

The injustice of the system is that self-employed have to pay with after-tax dollars while your employer can deduct the cost of providing those benefits.

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

#53

Post by bobcostas55 »

snuxoll wrote: post #47
tptacek wrote: post #40

Earlier quoted context omitted.

$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).

That’s still roughly the case, I work for a medical billing company owned by a physician group, we have a pretty large group and are essentially self-insured. I pay ~$220-ish a month for my family of three, the company pays $800+/mo. Boy am I glad to work for a company that pays such a large chunk of my benefits, many other places cover maybe 50% of your dependent costs.

You're still the one paying the $800, the only benefit is you get to do it with pre-tax money. It's not like that money comes out of the aether, it's part of your compensation.

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

#54

Post by ThrustVectoring »

knieveltech wrote: post #28
ThrustVectoring wrote: post #19

Earlier quoted context omitted.

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.

I plan on picking up solid health insurance coverage as well, of course. This is just so that my insurance company and health care provider can't screw me over through balance billing.

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

#55

Post by oh_sigh »

maxxxxx wrote: post #39
oh_sigh wrote: post #11

Earlier quoted context omitted.

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.

How well does that system work for a generation that produces fewer adults than are present in the generation?

Instead of paying for other peoples health insurance and then other people pay for mine, why can't I just save the money that I would be paying in premiums above and beyond what the rational amount would be and then pay for my own health care when I get older(or, pay for the higher premiums when I get older)?

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

#56

Post by tptacek »

mobilefriendly wrote: post #52
snuxoll wrote: post #47

Earlier quoted context omitted.

That’s still roughly the case, I work for a medical billing company owned by a physician group, we have a pretty large group and are essentially self-insured. I pay ~$220-ish a month for my family of three, the company pays $800+/mo. Boy am I glad to work for a company that pays such a large chunk of my benefits, many other places cover maybe 50% of your dependent costs.

The injustice of the system is that self-employed have to pay with after-tax dollars while your employer can deduct the cost of providing those benefits.

As I understand it (I hope I understand this, because I rely on it), LLC principals are allowed to deduct the cost of health insurance.

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

#57

Post by aaavl2821 »

Spooky23 wrote: post #31
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…

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 be…

> 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

this is not true. check out the annual financial reports for the UC hospital system as an example [0]. the majority of revenue comes from commercial payers. looking at data from HCA (largest public hospital company in US) tells similar story [1]. this is despite the fact that medicare patients are more costly overall

the bigger issue, however, are the margins. in 2010, UCSF, UC Davis and UCI had 3.5% profit margin for medicare, -27% margin for medicaid, and 21.8% margin for commercial. for UCLA they had -30% profit for medicare, -36% for medicaid, and 34% margin for commercial. private insurance literally subsidizes public insurance here. without private insurance, those hospitals die [2]

looking at other hospitals id imagine it is similar, though dont have data offhand

as to the reimbursement rates being squeezed bc of glut of beds, i dont think that is true and have seen data in the past to refute it, though i dont have the sources offhand.

[0] http://regents.universityofcalifornia.edu/regmeet/nov13/a4at...

[1] https://www.sec.gov/Archives/edgar/data/860730/0001193125180...

[2] https://www.oshpd.ca.gov/HID/

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

#58

Post by oh_sigh »

robbiep wrote: post #17
oh_sigh wrote: post #11

Earlier quoted context omitted.

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

No, that is not how insurance works. Insurance works well when you group people with similar risk profiles together, not by grouping people with dissimilar risk profiles together.

Imagine a world where a 20 year old would be able to buy a 10-year term life insurance policy for the same amount that a 90 year old can. That is essentially what the ACA attempted to provide.

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

#59

Post by tptacek »

DoreenMichele wrote: post #48
mobilefriendly wrote: post #36

Earlier quoted context omitted.

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…

A little data that agrees with your impression: https://www.forbes.com/sites/theapothecary/2016/07/28/overwh...

That article, aided and abetted by the terrible writing in the Brookings article it's criticizing, is comparing apples (the rate of increase) and oranges (the actual increase). There's no controversy that health insurance rates are increasing; they've been increasing dramatically since the turn of the century.

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

#60

Post by twoodfin »

ModernMech wrote: post #37
twoodfin wrote: post #24

Earlier quoted context omitted.

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.

It’s the asthma for which you are near-guaranteed to need $5,000 worth of treatment for that’s the issue, not the small chance you get cancer.

You’re not looking to insure against the chance you get asthma: You have asthma, and you’re looking for someone healthy to help pay for it. If too few healthy people sign up for Obamacare relative to the sick (and remember, all else equal, they have to be charged the same regardless of their health) those healthy folks will get an increasingly bad deal as their premiums are covering the costs of more and more sick enrollees and more and more healthy folk drop out of the exchanges. That’s the “death spiral”.

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