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> Much of what insurers do is preventing waste, fraud, and abuse Medical insurers are the waste, fraud, and abuse.
by bugglebeetle 3y ago
> Much of what insurers do is preventing waste, fraud, and abuse
Medical insurers are the waste, fraud, and abuse.
- lotsofpulp 3y agoUS government employees would be doing the same things for Medicare and Medicaid and Tricare. Outsourcing that work to “insurers” helps keep the heat off the politicians.
- coredog64 3y agoNot true for Medicare. How it works is that Medicare splits the US up into regions (can’t remember if it’s currently 5 or 7). For each of these regions, a private medical insurance company handles all of the claims paperwork and the money for said claims comes from Uncle Sugar. This is also why it’s disingenuous when folks trot out the “claim dollars per Federal employee” argument for Medicare. Note: I’m not talking about Medicare Advantage which is a separate program whereby Medicare pays the premiums for private health insurance plans.
- lotsofpulp 3y agoIt seems like we are in agreement.
- nradov 3y agoI'm not sure what you mean there. Even Medicare in the US and single payer systems in other countries have strict rules to prevent waste, fraud, and abuse. They will refuse to pay claims that don't comply with coverage rules. In many cases those are even more strict than US private medical insurers.
- bugglebeetle 3y agoWhat I mean is that what insurers do is try to screw people out of money and receiving necessary treatment to line their own pockets. Here’s a fairly concrete example: https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis https://www.propublica.org/article/unitedhealth-healthcare-i...
- nradov 3y agoInsurers do deny some claims and authorization requests, but in most cases this doesn't line their own pockets. Rather the opposite. Most large employers are now self insured, and the medical "insurance" companies just administer claims. Due to the 85% minimum medical loss ratio imposed by the Affordable Care Act (Obamacare), insurers actually make more profit when they approve more treatments. When claims or authorizations are denied it's generally because large employers have been pushing back to control their own costs. Unfortunately, many consumers don't understand this market dynamic and direct their blame in the wrong direction.
- bugglebeetle 3y agoApologies, but this is complete bullshit. They make money by denying expensive claims, regardless of whether or not people actually need the treatment, and optimize for this despicable behavior.
- nradov 3y agoI have given you accurate information. If you choose to remain ignorant then that is your affair. The reality is that payers that offer health plans to self-insured employers don't make money by denying claims.
- bugglebeetle 3y agoNo, you’ve intentionally tried to deflect and deceive across this entire thread, as is obvious from all the downvotes and comments you’ve received. It’s quite bold to lie and say insurance companies don’t deny claims to make money, since there are only myriad news stories, court cases, books, films, etc about them doing so, but you do you.