Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

propublica.org

Post reply on HN
Print view View original

91–100 of 103 posts

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

#91

Post by Guvante »

mindslight wrote: post #89
Guvante wrote: post #84

Earlier quoted context omitted.

As long as it is a legitimate discount (which it legally always is) they aren't lying perse. After all the discount getting inflated by charging non-insured people ludicrous prices is the real issue but not one you can meaningfully complain about as an insured. And unfortunately if you ask for pricing they will give you the inflated pricing meaning it isn't necessarily deceptive there.

The problem is that it's framed as a payment from the insurance company, so people think the insurance is helping with the bill. What has actually happened is the insurer and pharmacy are cooperating to create sham prices/paperwork and confuse the market. It's even more glaring for post-facto bills from providers, because those prices are being presented on a cost-reimbursement basis (not contractual). The provider i…

Providing a discount to insurance companies is not fundamentally bad or nefarious.

Medicare/Medicaid tend to pay less than private insurance, however lots of places accept it because that gives them access to a bunch of potential clients.

Leveraging your user base to get a discount from a provider is normal and expected.

The problem is when insurance companies demand a particular discount and providers given them that discount by raising their prices.

Certainly a 70% discount is a sign of a bad price (assuming it isn't part of a cost normalization scheme where some services get deep discounts and others are paid with little or no discount aka "I get 70% off dangerous surgeries but I will pay 110% of simple ones")

However if instead the normal price was $200 and they accepted $150 to get access to the network that is normal.

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

#92

Post by mindslight »

Guvante wrote: post #91
mindslight wrote: post #89

Earlier quoted context omitted.

The problem is that it's framed as a payment from the insurance company, so people think the insurance is helping with the bill. What has actually happened is the insurer and pharmacy are cooperating to create sham prices/paperwork and confuse the market. It's even more glaring for post-facto bills from providers, because those prices are being presented on a cost-reimbursement basis (not contractual). The provider i…

Providing a discount to insurance companies is not fundamentally bad or nefarious. Medicare/Medicaid tend to pay less than private insurance, however lots of places accept it because that gives them access to a bunch of potential clients. Leveraging your user base to get a discount from a provider is normal and expected. The problem is when insurance companies demand a particular discount and providers given them tha…

It feels like you're just skipping the core of my points and repeating the justification that has allowed the situation to get this bad. The fake prices and 50-100% discounts are indeed symptoms of a pathological behavior that indicates it's not about true good-faith "discounts".

One straightforward healthcare reform that could be done tomorrow would be to mandate that providers must charge the same price no matter who is paying, rather than the current behavior of operating pricing cartels in league with the insurance companies. This would work even if the government kept giving itself a pass by excepting Medicare.

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

#93

Post by ceejayoz »

Guvante wrote: post #83
ceejayoz wrote: post #12

Earlier quoted context omitted.

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.

Unless you are comparing a generic to a name brand in a situation where the insurance company forces the name brand that shouldn't be the case. For better or worse in your hypothetical the uninsured price legally has to be $1,000 for medicine. They can write off part of that but no one would write off 99.8% as the insurance company would sue their pants off.

> that shouldn't be the case

Oh, I agree. But it is.

> For better or worse in your hypothetical the uninsured price legally has to be $1,000 for medicine.

No, it doesn't.

https://www.nbcnews.com/health/health-news/cost-weight-loss-...

"In March, Novo Nordisk cut the price of all doses of Wegovy by 23% for people paying in cash, dropping it from $650 to $499 per month for uninsured patients or those without coverage. (The list price of $1,349 stayed the same.)"

"It follows a similar move from Eli Lilly, which reduced Zepbound’s starter dose to $349 and higher doses to $499 through its self-pay program, Lilly Direct. The discounted doses require patients to manually draw the medication from a vial with a syringe, adding an extra step compared to the prefilled injector pens."

There are entire businesses and apps built around figuring out which is cheaper, paying out of pocket or going through insurance. https://www.healthcaredive.com/news/goodrx-benefits-check-pr...

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

#94

Post by ceejayoz »

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…

If I can reliably sell people $1 bills for $1.03, in extremely large quantities, I'll be very, very happy.

Low margin, high volume is very different than low margin, low volume. The Walton family is very pleased with their tiny margins and the wealth it has delivered them.

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

#95

Post by carabiner »

danaris wrote: post #28
carabiner wrote: post #25

Earlier quoted context omitted.

FYI the shooter has received $1.2m in donations for his defense fund, and counting.

The accused shooter. Firstly, Luigi Mangione is presumed innocent until proven guilty . Secondly, there's a fair amount of real evidence that Luigi is being set up as a scapegoat by the NYPD—a police department with a known history of planted evidence.

I agree with you 100%.

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

#96

Post by Eddy_Viscosity2 »

dragonwriter wrote: post #88
Eddy_Viscosity2 wrote: post #44

Earlier quoted context omitted.

Health insurance companies do not provide any medical services. They are the middle man between patients and the places/people that actual do provide medical services. So when they deny coverage, they just keep all the premiums paid by the patient. That money is sucked up by the middle man. So you don't need to raise premiums, you need to lower profits at health insurance companies. Every billion they make in profit…

> Health insurance companies do not provide any medical services. This is substantively not true (though literally true at the level of a company, due to separate companies within the Kaier consortium) of the nation’s largest managed core organization, the Kaiser consortium consisting of the Kaiser Foundation health plans and the Kaiser Permanente Medical Groups. > No when they deny coverage, they just keep all the p…

> requiring refund of excess premiums to members

The solution is to provide the medical services people bought the insurance to cover and not reflexively deny claims counting on at least some people to give up or die.

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

#97

Post by daft_pink »

Are they saying no to patients or are they saying no to providers?

I’ve found numerous instances where providers have billed over $5,000 for procedures that I could get for $250 if I paid cash. They do things like seperating a test panel into 100 different separate procedures, etc.

I think they need some context in the article of the interplay between providers billing practices to maximize their fees and insurer denials instead of just demonizing the insurance companies.

Every denial doesn’t result in a patient not receiving care, but is sometimes pushback against overly aggressive providers/negotiation and some of that can and probably should be automated.

Obviously them denying necessary treatment is really bad, but I find that propublica articles are often highly opinionated against certain interests and leave out a lot of context to create an extreme headline.

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

#98

Post by jmcgough »

vjvjvjvjghv wrote: post #48
jmcgough wrote: post #6

Earlier quoted context omitted.

There's a lot of problems you can point at: - Through extensive lobbying, the US passed the HMO act of 1973 which requires that all employers offer an HMO plan to employees. HMOs were created to keep costs down, but United really took this to the extreme, making it as hard to use your health insurance as possible, and creating vertical monopolies like OptumRX. United takes so long to pay providers for the work they d…

"vertical monopolies like OptumRX" This should be illegal. I have read that UNH also owns around 10% of providers so they own the whole chain.

Yes, they are even buying up therapy clinics.

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

#99

Post by Guvante »

mindslight wrote: post #92
Guvante wrote: post #91

Earlier quoted context omitted.

Providing a discount to insurance companies is not fundamentally bad or nefarious. Medicare/Medicaid tend to pay less than private insurance, however lots of places accept it because that gives them access to a bunch of potential clients. Leveraging your user base to get a discount from a provider is normal and expected. The problem is when insurance companies demand a particular discount and providers given them tha…

It feels like you're just skipping the core of my points and repeating the justification that has allowed the situation to get this bad. The fake prices and 50-100% discounts are indeed symptoms of a pathological behavior that indicates it's not about true good-faith "discounts". One straightforward healthcare reform that could be done tomorrow would be to mandate that providers must charge the same price no matter w…

And if a provider keeps charging the same amount only now they actually get it because the law requires that insurance companies pay in certain instances?

My point is just that providers raising their prices to give insurance companies a bigger discount is a problem but getting a discount isn't itself flawed.

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

#100

Post by mindslight »

Guvante wrote: post #99
mindslight wrote: post #92

Earlier quoted context omitted.

It feels like you're just skipping the core of my points and repeating the justification that has allowed the situation to get this bad. The fake prices and 50-100% discounts are indeed symptoms of a pathological behavior that indicates it's not about true good-faith "discounts". One straightforward healthcare reform that could be done tomorrow would be to mandate that providers must charge the same price no matter w…

And if a provider keeps charging the same amount only now they actually get it because the law requires that insurance companies pay in certain instances? My point is just that providers raising their prices to give insurance companies a bigger discount is a problem but getting a discount isn't itself flawed.

You keep outright ignoring my point, and then simply asserting that you don't see a problem. A bill from the provider shows a fake cost that they're demanding you reimburse them, and also a fake payment from the insurance company. Those are lies to make you think you are getting a benefit that you are not actually getting. That's called fraud.
Post reply on HN