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This is from be ACA but I think it gives the general idea of the tactics insurance companies use: https://health.usnews.com/health-news/articles/2008/08/25/how

This is from be ACA but I think it gives the general idea of the tactics insurance companies use: https://health.usnews.com/health-news/articles/2008/08/25/how-crafty-health-insurers-are-denying-care https://health.usnews.com/health-news/articles/2008/08/25/ho... Here's one from after ACA passed and was implemented: https://www.cbsnews.com/news/mental-illness-health-care-insurance-60-minutes/ https://www.cbsnews.com/news/mental-illness-health-care-insu... The ACA attempted to make things more fair in terms of appealing denials and mandating certain coverages. It's not reasonable to believe that Aetna's profit comes from offer better preventative care. I'd need to see some evidence to believe that. Certainly before ACA health insurance companies let people die in the name of corporate greed. They have an economic incentive to deny care. Evidence of this is in the fact that the CEO is getting a $500 million bonus. Yes the $500 million comes from stock price increase. But that comes from profit and the profit, at least partly, comes from denying care. EDIT: https://twitter.com/RoseAnnDeMoro/status/922627477553397761/video/1 https://twitter.com/RoseAnnDeMoro/status/922627477553397761/... It happens often enough that there is a market for lawyers to help out when insurance claims are denied. https://scottglovsky.com/practice-areas/health-insurance-denial-lawyer/ https://scottglovsky.com/practice-areas/health-insurance-den...

rukittenme 9y ago
> profit, at least partly, comes from denying care. This is the same as saying Dole makes part of their profit by selling rotten bananas. A factual statement but the implication of it is incorrect. The bulk of Aetna's business is to sell health insurance to healthy people. Its cheaper to never provide service than to deny payouts. > Yes the $500 million comes from stock price increase. But that comes from profit Stock prices rise and fall without any consideration to profit. See Amazon. Aetna's valuation can be based on a thousand different factors. The fact that an offer has been made to purchase Aetna can increase its stock price.
- yequalsx 9y ago
  Revenue comes from selling policies. The company has a financial incentive to deny care because that increases the profit. It's one way they try to control expenses and thereby increase profit. After Katrina State Farm famously denied coverage to many people on the grounds that it wasn't storm damage but rather flood damage. Companies that have an incentive to get out of spending money generally try to do so. Health insurance companies hire people for the express purpose of looking for loopholes and ways to deny coverage. This is well documented. You have in the comment above and in other comments spoken in terms of what could be. Do you have evidence that Aetna's valuation was not based on profitability? Do you deny that Aetna has a financial incentive to deny coverage or to look for ways to get out of paying for coverage? Do you believe that the $500 million for one person is money well spent in the U.S. healthcare system?
  - rukittenme 9y ago
    > Do you have evidence that Aetna's valuation was not based on profitability? No. But if you read the comment of the person I originally responded to, you'll see that this discussion is irrelevant to the overall point. Any clarification of Aetna's valuation has been for your understanding of stock valuations in general. Not to pursue some point about Aetna's ethical or unethical valuation. > The company has a financial incentive to deny care because that increases the profit. > Do you deny that Aetna has a financial incentive to deny coverage or to look for ways to get out of paying for coverage? Yes, categorically. If Aetna signs an agreement to pay health expenses and fails to follow through they face three major consequences: - They can be sued for breach of contract. - They can lose market power as their brand loses public trust. - They can face fines from government regulators. If Aetna is denying claims that they were never contractually obligated to pay in the first place, then I see that as fraud prevention. > Do you believe that the $500 million for one person is money well spent in the U.S. healthcare system? Why should I even have an opinion on the subject? I have never given Aetna or CVS my business. It's not my money they're swapping. CVS is in a highly competitive market segment. If they were ripping off their customers they would have never acquired the market power to pay this CEO a bonus of $500m.
    - yequalsx 9y ago
      Yes, categorically. If Aetna signs an agreement to pay health expenses and fails to follow through they face three major consequences: - They can be sued for breach of contract. - They can lose market power as their brand loses public trust. - They can face fines from government regulators. I think you are ignorant about how things work in the U.S. There haven't been strong regulators for quite some time. The average person has neither the money, time, or willpower to fight an insurance company. The legal costs can be quite high. The time required to get a favorable ruling that actually gets enforced is often times quite long. Witness Exxon and the time required to get them to pay for the Valdez accident. In an ideal world your point would be relevant. We do not live in a truly free market. We live in an environment of regulatory capture. An era of force arbitration which is well known to favor the corporation. We do not live in an environment where corporate malfeasance is properly punished. Look at the fines banks had to pay for knowingly laundering drug money. It was far less than the profit. BP famously has leaky oil pipelines in Nigeria because it can get away with it. Comcast has virtually no public trust and yet it continues to profit greatly. Your view is not justified by reality. It is well documented that health insurance companies hire people to look for loopholes. To delay and ultimately try to deny coverage. This is not disputable.

rukittenme 9y ago

> profit, at least partly, comes from denying care. This is the same as saying Dole makes part of their profit by selling rotten bananas. A factual statement but the implication of it is incorrect. The bulk of Aetna's business is to sell health insurance to healthy people. Its cheaper to never provide service than to deny payouts. > Yes the $500 million comes from stock price increase. But that comes from profit Stock prices rise and fall without any consideration to profit. See Amazon. Aetna's valuation can be based on a thousand different factors. The fact that an offer has been made to purchase Aetna can increase its stock price.

yequalsx 9y ago
Revenue comes from selling policies. The company has a financial incentive to deny care because that increases the profit. It's one way they try to control expenses and thereby increase profit. After Katrina State Farm famously denied coverage to many people on the grounds that it wasn't storm damage but rather flood damage. Companies that have an incentive to get out of spending money generally try to do so. Health insurance companies hire people for the express purpose of looking for loopholes and ways to deny coverage. This is well documented. You have in the comment above and in other comments spoken in terms of what could be. Do you have evidence that Aetna's valuation was not based on profitability? Do you deny that Aetna has a financial incentive to deny coverage or to look for ways to get out of paying for coverage? Do you believe that the $500 million for one person is money well spent in the U.S. healthcare system?
- rukittenme 9y ago
  > Do you have evidence that Aetna's valuation was not based on profitability? No. But if you read the comment of the person I originally responded to, you'll see that this discussion is irrelevant to the overall point. Any clarification of Aetna's valuation has been for your understanding of stock valuations in general. Not to pursue some point about Aetna's ethical or unethical valuation. > The company has a financial incentive to deny care because that increases the profit. > Do you deny that Aetna has a financial incentive to deny coverage or to look for ways to get out of paying for coverage? Yes, categorically. If Aetna signs an agreement to pay health expenses and fails to follow through they face three major consequences: - They can be sued for breach of contract. - They can lose market power as their brand loses public trust. - They can face fines from government regulators. If Aetna is denying claims that they were never contractually obligated to pay in the first place, then I see that as fraud prevention. > Do you believe that the $500 million for one person is money well spent in the U.S. healthcare system? Why should I even have an opinion on the subject? I have never given Aetna or CVS my business. It's not my money they're swapping. CVS is in a highly competitive market segment. If they were ripping off their customers they would have never acquired the market power to pay this CEO a bonus of $500m.
  - yequalsx 9y ago
    Yes, categorically. If Aetna signs an agreement to pay health expenses and fails to follow through they face three major consequences: - They can be sued for breach of contract. - They can lose market power as their brand loses public trust. - They can face fines from government regulators. I think you are ignorant about how things work in the U.S. There haven't been strong regulators for quite some time. The average person has neither the money, time, or willpower to fight an insurance company. The legal costs can be quite high. The time required to get a favorable ruling that actually gets enforced is often times quite long. Witness Exxon and the time required to get them to pay for the Valdez accident. In an ideal world your point would be relevant. We do not live in a truly free market. We live in an environment of regulatory capture. An era of force arbitration which is well known to favor the corporation. We do not live in an environment where corporate malfeasance is properly punished. Look at the fines banks had to pay for knowingly laundering drug money. It was far less than the profit. BP famously has leaky oil pipelines in Nigeria because it can get away with it. Comcast has virtually no public trust and yet it continues to profit greatly. Your view is not justified by reality. It is well documented that health insurance companies hire people to look for loopholes. To delay and ultimately try to deny coverage. This is not disputable.