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> "Essentially, the moment a customer becomes more trouble than they are worth, they are dropped [by the insurance company]." In healthcare there are many diff
by forgotmypwd 9y ago
> "Essentially, the moment a customer becomes more trouble than they are worth, they are dropped [by the insurance company]."
In healthcare there are many different models, but one popular one is the concept of an ASO. This is the case where a healthcare insurance company (think Anthem) will provide administrative services only (ASO) and not (ultimately) be financially responsible for paying claims. The group responsible, in this ASO relationship, is generally an employer.
This is actually fairly common and in it the insurance company has no incentive to drop a "customer" (member), even if/when they legally could.
There is a lot of "bad" in the health insurance industry, but there is also a lot of "good" - people working from the inside who are trying to make things better for members/individuals. Things like improving quality of care, managing coordinated care models, identifying medical risk (eg. opioid abuse), etc.
I think first people need to better educate themselves on how the industry currently works, where the problems are (there are many), and where the more positive efforts are being made in the industry. Bottom-line - don't write it off, but get better informed and try to contribute.
- socrates1998 9y agoWhat you are proposing,"get better informed and contribute", doesn't many any sense. "get better informed" about what? How insurance companies take advantage of poor people? Even if I know all the laws and regulations and details of my policy, if I don't have the money (hire a lawyer) to fight it, then I am screwed. And this has happened to me. I was in the right, but my insurance company ruled against me, I complained and they basically told me to hire a lawyer if I didn't like it. And "contribute"? what is that? Contribute money? You still don't have a solution for the problem, insurance companies having asymmetric power (via information and money and legal influence) in the customer relationship. They collude with other insurance companies to create complicated policies that you can't negotiate or understand, but are forced to have legally. It's billion dollar powerful and well connected corporations vs. one person. Not exactly a fair fight.
- forgotmypwd 9y agoMy point being that you can contribute by demanding your state or federal government officials write or support laws that change how health insurance companies are allow to operate - or - by joining the industry and fixing it from the inside. Your argument is an emotional one, and that is fine, but it does not help to _realistically_ approach this problem.
- socrates1998 9y agoI realize my argument is pessimistic, but it's much more realistic than calling "my" senator. Our system is broken. Calling or contacting our representatives is essentially futile. Honestly, the best way to change anything, would be to get rich and try to buy some influence. Which is exactly what got us here in the first place, rich people buying influence.