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How often do health insurers say no to patients? (2023)

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Re: How often do health insurers say no to patients? (2023)

#61

Post by mattnewton »

eviks wrote: post #58
SamoyedFurFluff wrote: post #31

Earlier quoted context omitted.

How can we have a competitive marketplace? I’m not a doctor (and therefore cannot informed evaluate the services) and even if I was I can’t search for my preferred cardiologist when I’m having a heart attack.

You're not a mechanic, how can you evaluate the services be certain that they didn't oil your breaks instead of your engine? > can’t search for my preferred cardiologist when I’m having a heart attack. You can't search for your preferred mechanics when your breaks failed on a highway. Yet somehow that didn't kill the competitive marketplace.

I can call a cab or get a replacement car from my insurance to drive around in, and I understand my body a whole lot less than my car. Demand for a car mechanic is nowhere near as inelastic as most of healthcare, so I don’t think this analogy really fits. At most it suggests that private markets can handle ambulances as well as we handle roadside towing.

Re: How often do health insurers say no to patients? (2023)

#62

Post by kstrauser »

eviks wrote: post #58
SamoyedFurFluff wrote: post #31

Earlier quoted context omitted.

How can we have a competitive marketplace? I’m not a doctor (and therefore cannot informed evaluate the services) and even if I was I can’t search for my preferred cardiologist when I’m having a heart attack.

You're not a mechanic, how can you evaluate the services be certain that they didn't oil your breaks instead of your engine? > can’t search for my preferred cardiologist when I’m having a heart attack. You can't search for your preferred mechanics when your breaks failed on a highway. Yet somehow that didn't kill the competitive marketplace.

That’s a bad analogy. If my brakes fail, once I come to a stop there’s no urgency in getting them fixed. I can abandon the care if it’s a lemon. I can have it towed home. I can use Yelp to find a reasonable mechanic. I can rent another car until this one’s fixed. It’s the opposite of “every second counts”.

Meanwhile, this is the only heart I have, and if it’s in danger of stopping, I have approximately seconds to call 911 to get someone to come take me to the repair shop of their choosing.

Re: How often do health insurers say no to patients? (2023)

#63

Post by avalys »

kstrauser wrote: post #43
firesteelrain wrote: post #41

Earlier quoted context omitted.

How would it all be paid for if not by increasing premiums (like what happened with ACA)?

The sheer amount of overhead induced by insurance is staggering. For example, the sum of the net profits of all insurers represents money extracted from the system without contributing to health. And the amount of time doctors spend documenting patient care over and above what’s medically necessary purely to make insurers happy is time not spent seeing patients. Clinic staff spending hours on the phone each day argui…

Have you actually checked any of these numbers?

What do you imagine is the profit margin of a health insurance company?

According to this report by the national association of state regulators, the profit margin of the health insurance industry in 2023 was 3%, or $25 billion.

Compared to over $1T of premiums, and over $4T of total healthcare spending in the US, that doesn't seem "staggering" to me.

https://content.naic.org/sites/default/files/topics-industry...

Re: How often do health insurers say no to patients? (2023)

#64

Post by mindslight »

ceejayoz wrote: post #12
Guvante wrote: post #7

Earlier quoted context omitted.

You are on a high deductible plan. With those plans you pay the first $X and after that a percentage of costs (coinsurance) up to $Y. Sometimes certain things are covered before you hit your deductible other times not.

Yes, but you'll often find that in a high-deductible plan the insurance company gets a "discount" of your $1k med down to $200, which they brag about in your EOB… but the medication's cash price for uninsured people would be $20. You're out of pocket $180 more than you should be, and paying the $20 cash price out of pocket means your deductible doesn't budge.

It's straightforward fraud. Both the providers and insurers goal is to mislead people into thinking the "adjustment" represents a payment from the insurance company.

The pattern is even more flagrant when done with post-facto billed services, since the price hasn't even been assented to. The whole medical industry has essentially normalized many different types of fraud against patients, and yet the industry is so entrenched that state/county AGs don't bother going after them.

Re: How often do health insurers say no to patients? (2023)

#65

Post by hippo22 »

arwhatever wrote: post #22
kstrauser wrote: post #14

All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300. The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. I was raised a die-hard ca…

1. A properly competitive marketplace 2. Socialized medicine 3. What we have now I would like to see #1 tried but at this point I’ll gladly accept #2

I think the outcome we're witnessing in the U.S. is simply an outcome of an insurance-backed industry. All the market forces conspire for prices to be higher. Insurance companies actually don't care how much healthcare costs because they earn a fixed percentage on premiums. If healthcare costs are higher, then premium costs are higher, so the insurance companies earn more money.

Naturally, hospitals also wants prices to be higher so they can earn more money.

I would expect this dynamic to play out whenever all the buyers in the marketplace are insurance companies.

Re: How often do health insurers say no to patients? (2023)

#66

Post by kstrauser »

avalys wrote: post #63
kstrauser wrote: post #43

Earlier quoted context omitted.

The sheer amount of overhead induced by insurance is staggering. For example, the sum of the net profits of all insurers represents money extracted from the system without contributing to health. And the amount of time doctors spend documenting patient care over and above what’s medically necessary purely to make insurers happy is time not spent seeing patients. Clinic staff spending hours on the phone each day argui…

Have you actually checked any of these numbers? What do you imagine is the profit margin of a health insurance company? According to this report by the national association of state regulators, the profit margin of the health insurance industry in 2023 was 3%, or $25 billion. Compared to over $1T of premiums, and over $4T of total healthcare spending in the US, that doesn't seem "staggering" to me. https://content.na…

Yes. I owned a medical practice. These numbers affected how much money we took home every month, and I know them with far more personal interest than almost anyone else weighing in here.

Re: How often do health insurers say no to patients? (2023)

#67

Post by refurb »

kstrauser wrote: post #37
avalys wrote: post #34

Earlier quoted context omitted.

If it’s not up to health insurers to limit healthcare spending, then which organizational role in the healthcare system do you think is appropriate to place this responsibility with?

Elected representatives answerable to their constituents would be a vast improvement in health outcomes.

Elected representatives should determine what healthcare I get?

Really?

Re: How often do health insurers say no to patients? (2023)

#68

Post by refurb »

Do Americans think they are special? Do they think that everything gets paid for no matter what? An endless pool of money?

As a Canadian I had the pleasure of my insurer (Canadian government) denying my treatment. Multiple appeals, still a no. My doctor said it was the only thing that would treat my disease. So my only choice is paying for it in cash at $10,000+ per month, which I can't afford.

Re: How often do health insurers say no to patients? (2023)

#69

Post by jaredklewis »

mattnewton wrote: post #27
arwhatever wrote: post #22

Earlier quoted context omitted.

1. A properly competitive marketplace 2. Socialized medicine 3. What we have now I would like to see #1 tried but at this point I’ll gladly accept #2

I just don't think #1 is possible, how can you have a functioning marketplace for a good when the demand is hard to forecast for an individual, almost completely inelastic and often extremely time sensitive. I'd say the US really tried and the incentives just aren't there for a stable system.

I don’t think we tried.

For a market to work, the buyers have to be exercising their discretion. But most health insurance in the US is provided through employers (whose interests are different from those of the employees). There are a thousand other ways that the US healthcare markets are not free or poorly designed, but this is the original sin that (I would argue) causes most of the issues: the insured don’t choose their insurer, so the insurers are not competing for members, they’re competing for employers.

See Singapore for a place that actually tried. They have a public healthcare but also a well functioning private healthcare market.

Re: How often do health insurers say no to patients? (2023)

#70

Post by NuclearPM »

refurb wrote: post #67
kstrauser wrote: post #37

Earlier quoted context omitted.

Elected representatives answerable to their constituents would be a vast improvement in health outcomes.

Elected representatives should determine what healthcare I get? Really?

Yes. Indirectly.
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