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"Anthem has begun denying coverage for emergency room visits that it deems “inappropriate” because they aren’t, in the insurance plan’s view, true emergencies."

"Anthem has begun denying coverage for emergency room visits that it deems “inappropriate” because they aren’t, in the insurance plan’s view, true emergencies." Story of America. It is sad and pathetic. Insurance companies have too much power and even the doctors/hospitals are helpless for the most part. Yes, it is an entire system that needs to be overhauled. The game is rigged against the consumer right now. You are never sure what the actual cost of your visit will be until you start receiving the bills which could be months after your visit. How dare you ask how much the visit could cost ? The "Admins" in the ER/hospital/clinic wouldn't even know at that time. Yes they won't.

FireBeyond 9y ago
Not to mention the defensive tone they take. "It's not fair that we are having to "massively overpay" (interesting phrasing) for what could have been handled by routine care". The insurer takes the view that it's _their_ money, that they earned. When it's their customers that are paying, in the insurance pool, after, and only after, Anthem has already taken its cut. Yes, it's not as black and white as that, and part of that administration cost is ensuring efficient use of the pool's money, but nonetheless, to read insurers defense of these policies, you'd think they were just trying to defend against lazy/greedy customers and ERs trying to milk them out of their money (and with good reason, because they absolutely do view it as their money once your premiums are paid, and the less they pay out, the less they get to keep - pop quiz, say a pool of 1M people pay $5,000/yr for insurance, with a pool of $5B for benefits, and an insurer takes 10% administration costs. Say this insurance pool only pays out $4B that year. What are the odds that the insurer pays out that $500M back to the pool, or as a dividend/rate reduction? Of course you know the answer. Of course the reality is that in theory such money could be kept in the pool "for a rainy day", leaving aside concepts of reinsurance, etc., but that often doesn't happen either, not when there's bonuses to be paid...).

FireBeyond 9y ago

Not to mention the defensive tone they take. "It's not fair that we are having to "massively overpay" (interesting phrasing) for what could have been handled by routine care". The insurer takes the view that it's _their_ money, that they earned. When it's their customers that are paying, in the insurance pool, after, and only after, Anthem has already taken its cut. Yes, it's not as black and white as that, and part of that administration cost is ensuring efficient use of the pool's money, but nonetheless, to read insurers defense of these policies, you'd think they were just trying to defend against lazy/greedy customers and ERs trying to milk them out of their money (and with good reason, because they absolutely do view it as their money once your premiums are paid, and the less they pay out, the less they get to keep - pop quiz, say a pool of 1M people pay $5,000/yr for insurance, with a pool of $5B for benefits, and an insurer takes 10% administration costs. Say this insurance pool only pays out $4B that year. What are the odds that the insurer pays out that $500M back to the pool, or as a dividend/rate reduction? Of course you know the answer. Of course the reality is that in theory such money could be kept in the pool "for a rainy day", leaving aside concepts of reinsurance, etc., but that often doesn't happen either, not when there's bonuses to be paid...).