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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 br

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
> 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. Everything you said before this point is irrelevant. It's trivial to find the list of lawsuits lost and fines paid[1]. Read this excerpt: > In 1999 a California jury awarded $116 million in punitive damages to the widow of a man whose death from stomach cancer was alleged to have been caused by the refusal of an Aetna subsidiary to approve treatment approved by its own doctors. $116 million for failing to pay what would have been $100k max for treatment. Aetna certainly has a financial interest in upholding their agreements. They would have to deny 1160 identical cases before breaking even. Assuming that none of those 1160 sued for damages. 1. https://www.corp-research.org/aetna https://www.corp-research.org/aetna
- yequalsx 9y ago
  The case was then settled out of court for an undisclosed amount that was reported to be around $20 million. I know a medical malpractice attorney. He only takes cases he is absolutely sure to win. The gray areas he leaves alone. It is in these gray areas that insurance companies mostly try to get away with paying claims. What I wrote prior was not irrelevant. You have a naive view of how markets work in the U.S.
  - rukittenme 9y ago
    It is irrelevant. You're talking about oil spills in Nigeria. I'm talking about one specific health-care company in America. I don't care to hear your opinions on the market and how it operates. I also don't care to hear anecdotal testimony about your friend's business practices. It is a matter of public record when Aetna has been fined and when Aetna has been sued. It is trivial to research the subject. I'm not sure why we're still having this conversation. Aetna's P/E ratio is 50% higher than the market average which means its price (and therefore CEO bonus) are driven by future growth potential. Not profit "extracted" in the here and now.

rukittenme 9y ago

> 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. Everything you said before this point is irrelevant. It's trivial to find the list of lawsuits lost and fines paid[1]. Read this excerpt: > In 1999 a California jury awarded $116 million in punitive damages to the widow of a man whose death from stomach cancer was alleged to have been caused by the refusal of an Aetna subsidiary to approve treatment approved by its own doctors. $116 million for failing to pay what would have been $100k max for treatment. Aetna certainly has a financial interest in upholding their agreements. They would have to deny 1160 identical cases before breaking even. Assuming that none of those 1160 sued for damages. 1. https://www.corp-research.org/aetna https://www.corp-research.org/aetna

yequalsx 9y ago
The case was then settled out of court for an undisclosed amount that was reported to be around $20 million. I know a medical malpractice attorney. He only takes cases he is absolutely sure to win. The gray areas he leaves alone. It is in these gray areas that insurance companies mostly try to get away with paying claims. What I wrote prior was not irrelevant. You have a naive view of how markets work in the U.S.
- rukittenme 9y ago
  It is irrelevant. You're talking about oil spills in Nigeria. I'm talking about one specific health-care company in America. I don't care to hear your opinions on the market and how it operates. I also don't care to hear anecdotal testimony about your friend's business practices. It is a matter of public record when Aetna has been fined and when Aetna has been sued. It is trivial to research the subject. I'm not sure why we're still having this conversation. Aetna's P/E ratio is 50% higher than the market average which means its price (and therefore CEO bonus) are driven by future growth potential. Not profit "extracted" in the here and now.