4 ms·

Is the coverage also mandated? How about the adjudication process? How about the amount of effort to successfully file a claim? As a hypothetical, consider a p

by asah 5y ago

Is the coverage also mandated? How about the adjudication process? How about the amount of effort to successfully file a claim? As a hypothetical, consider a process requiring each claim to be submitted in person, 9-10am on Mondays, down an alleyway in Toledo, 4 week turnaround, and then resubmitted 6 times before it's approved. It's not quite this bad, but everybody has a horror story and (unlike auto and home owner's insurance), I've heard nobody say anything nice about their health insurance company. (I'm working on a winning team fixing this at national scale, DM if interested)

lotsofpulp 5y ago
Yes, health insurers have to cover anyone. There is an appeal process where a third party is required to arbitrate if you feel the insurer is not approving payment for something inappropriately. I have not experienced it, nor do I know anyone who has, so I do not know what that experience is like. I do not know what nobody saying anything nice about health insurance companies means. Although, I do know from experience, that most people are not knowledgeable about many businesses, but they do like to opine on how things should be. Insurance in general is bound to have unhappy customers, whether or not justified. People interact with health insurance more than any other, so I would expect a lot more complaints. I do not doubt that managed care organizations (health insurance companies) have screwed over people. But that probably applies to any large organization. I have not seen evidence that they do so on a systemic basis, however. Note that they are often administering rules made by others, such as private employers or governments (Medicare/Medicaid). In these cases, I think part of their role is to serve as a third party who the decision maker (private employer or politicians) can point at when people get mad. > (I'm working on a winning team fixing this at national scale, DM if interested) One thing for sure is there are many improvements that can be made. Best of luck!
extraduder_ire 5y ago
I am an interested rando, where do I DM you? Is this another feature of hn that I haven't unlocked yet?
- lotsofpulp 5y ago
  It means click on their username and email them or go to whatever link is in their profile.
deregulateMed 5y ago
My insurance company gets me lower costs than the hospital would otherwise provide. It's a guarantee that I don't pay more than 8000$/yr for healthcare. Without the insurance company, I might be in debt after a hospital visit. If the medical cartels weren't so corrupt and I could get a price, I probably wouldn't use insurance.

by asah 5y ago

lotsofpulp 5y ago

Yes, health insurers have to cover anyone. There is an appeal process where a third party is required to arbitrate if you feel the insurer is not approving payment for something inappropriately. I have not experienced it, nor do I know anyone who has, so I do not know what that experience is like. I do not know what nobody saying anything nice about health insurance companies means. Although, I do know from experience, that most people are not knowledgeable about many businesses, but they do like to opine on how things should be. Insurance in general is bound to have unhappy customers, whether or not justified. People interact with health insurance more than any other, so I would expect a lot more complaints. I do not doubt that managed care organizations (health insurance companies) have screwed over people. But that probably applies to any large organization. I have not seen evidence that they do so on a systemic basis, however. Note that they are often administering rules made by others, such as private employers or governments (Medicare/Medicaid). In these cases, I think part of their role is to serve as a third party who the decision maker (private employer or politicians) can point at when people get mad. > (I'm working on a winning team fixing this at national scale, DM if interested) One thing for sure is there are many improvements that can be made. Best of luck!

extraduder_ire 5y ago

I am an interested rando, where do I DM you? Is this another feature of hn that I haven't unlocked yet?

lotsofpulp 5y ago
It means click on their username and email them or go to whatever link is in their profile.

deregulateMed 5y ago

My insurance company gets me lower costs than the hospital would otherwise provide. It's a guarantee that I don't pay more than 8000$/yr for healthcare. Without the insurance company, I might be in debt after a hospital visit. If the medical cartels weren't so corrupt and I could get a price, I probably wouldn't use insurance.