5 ms·

Single payer or not but I think everybody should agree that dealing with health insurance needs to be easier and more predictable. When I read the stories of ho

Single payer or not but I think everybody should agree that dealing with health insurance needs to be easier and more predictable. When I read the stories of how people won against them, it's always mind boggling to see the giant effort they had to put into it. Hospitals and insurances should be fined if they have a high ratio of claims that get rejected first and reversed after appeal. Patients simply shouldn't have to go through this. The whole system is set up to profit from wearing down patients by attrition.

WaxProlix 2y ago
> Hospitals and insurances should be fined if they have a high ratio of claims that get rejected first and reversed after appeal They'd just invest more in not having to reverse on appeal. Handling these kinds of incentives with rules and strictures gets messy fast.
- ryandrake 2y ago
  Well, write the law to address that, too. Too often, we throw our hands up and declare legislation impossible "because companies will just get around it in ways, X, Y, and Z". The solution is to write better laws that also remove X, Y, and Z as options. And also X0, X1, Y0, Y1, Y2, Z0, Z1, Z2, Z3, and Z4. The world is complex and regulation can be complex, too. You'll never fix things by giving up and saying "We can't write the perfect law--oh well, let's just let companies do whatever they want!"
  - dylan604 2y ago
    The concept of spirit of the law vs letter of the law infuriates me to no end. I think the letter of the law should stipulate the spirit of the law (almost a TL;DR right at the beginning) so that jurists can later take that into account when deciding if the law was broken.
    - 1-more 2y ago
      US Tax law is the only place where I can think of that the spirit is the most important part of the law. There isn't much of a hard and fast definition of a home based business, but if the vibe is "this is a hobby and I'm using the business only to claim deductions, not turn a profit someday" you can be in violation.
    - kredd 2y ago
      I agree in some sense, but spirit of the law also creates very uneven playground and leaves a lot of questions. The way I see the problem, it takes way too long for us to legislate anything. By the time something passes different levels of approval, whoever has any skin in the game might figure out a way around it. That happens a lot with finding loopholes in housing related legislations. If there is a proposal that would hurt investors, they lobby against it for a while, buying time to figure out an alternative method, and by the time it passes, they don’t really care because they’ve circumvented it anyways. I see why it would also suck if we fast tracked most of the legislations though.
      - piva00 2y ago
        > I agree in some sense, but spirit of the law also creates very uneven playground and leaves a lot of questions. That happens anyway though, as much of law in Common Law systems is only settled by precedents, jurisprudence, etc. Even the US's Constitution interpretation is up to the courts when questions arise, that's the courts' job anyhow. At least working with the spirit of the law allows ways to prevent loopholes in a way that the letter of the law process only allows if new legislation is passed to cover those loopholes.
        vundercind 2y ago
        > Even the US's Constitution interpretation is up to the courts when questions arise, that's the courts' job anyhow. Judicial review of the constitutionality of laws is itself an invention of the courts, in fact. (And probably a good idea, but it’s something the courts had to decide they had, not a role or power plain in the law). So that specific thing being their job is… something they decided was their job, which is kinda funny.
  - willcipriano 2y ago
    Most of the time the "we oughta do" ideas are so simple that they wouldn't work as a law "it should be illegal to charge too high prices!" so it's sort of a non-solution as it factually wouldn't work in the real world. Real talk, the US spends more on socialized medicine per capita than all of Europe, nobody should get reelected, no foreign aid rendered nor bombs dropped until we receive what has been long paid for. They want you to focus on the former sort of "solution" than the one I provide and that's why you probably are first hearing of mine now.
    - vundercind 2y ago
      > it should be illegal to charge too high prices! Funnily enough, as far as I have been able to figure, this is basically the unifying element of all developed-country healthcare systems outside the US, which have a lot of variety but all seem to do this, one way or another. Some do it with comprehensive direct price controls that are pretty much exactly “it’s illegal to charge too-high prices” (Japan), some through state monopsony (Great Britain), some through limited price controls but the very-credible threat of adding more if providers get too greedy (Singapore), and many through some combo of the above, but the effect always boils down to price controls.
      - willcipriano 2y ago
        You misunderstand. In nations with socialized medicine (and this includes the US) there is really only one primary buyer of healthcare products and services. If that buyer decides your price is too high, you sell around 0 units. You can often receive these treatments if you wish to pay privately. Only the very wealthy do this, a small market. Drug companies in the US prefer to sell units at the prices that the buyers in those nations are allowing them VS not selling them at all. That's why they do it. Then turn around and say they can't do the same in the US as it would bankrupt them. The difference is in the US, Medicaid is quite happy to pay prices that are multiples of what other nations are paying. They sort of pretend this is all some sort of accident or due to some complexity that you wouldn't understand but it's just theft.
        2y ago
- rqtwteye 2y ago
  “ They'd just invest more in not having to reverse on appeal” That would be the goal. Get it right first time around.
  - WaxProlix 2y ago
    "Invest" here doesn't necessarily mean monetary investment, they could for instance choose to degrade their arbitration and appeals process further, understaff it, or push regulatory boundaries in that direction. And that would possibly save them money, at least in the short term. And to the extent that costs do go up for appeals processes, there's no guarantee that the resulting setup has margins that incentivize doing right by customers at all.
    - rqtwteye 2y ago
      That could be solved by proper regulation. As far as I can tell they are already making the process as miserable as possible. I don’t think it would get worse.
deleted 2y ago
[deleted]
aidenn0 2y ago
Most of the time it's not too bad to appeal a claim for smaller amounts. People go through the hoops for the larger denials because they are so motivated. I got a $150k bill for emergency care for my daughter once; it wasn't too bad because they denied it as "uncovered elective procedure" which was trivial to show it wasn't, but it was still a tense month for me waiting. The punchline, of course, is that the insurance company and the provider agreed upon $30k. Doctors' offices can't tell you what a procedure will cost ahead of time, and the amount they bill you afterwards is completely fictitious (because if you don't have health insurance you probably can't pay 5x what the insurance companies pay, so will be bankrupted anyways).
- rqtwteye 2y ago
  “ because if you don't have health insurance you probably can't pay 5x what the insurance companies pay, so will be bankrupted anyways” Or it could go the other way depending on arbitrary factors. Nobody knows.
- dimal 2y ago
  “Most of the time” in my case, it has been bad. Because it wasn’t one big bill. It was dozens of bills for $200-500. Each submission could fail in unpredictable ways. “Lost” claims forms, database “errors”, “incomplete information”, etc. And trying to deal with this burden while being sick, was too much for me. I scraped back a few dollars, but had to give up and move forward with my life.

WaxProlix 2y ago

> Hospitals and insurances should be fined if they have a high ratio of claims that get rejected first and reversed after appeal They'd just invest more in not having to reverse on appeal. Handling these kinds of incentives with rules and strictures gets messy fast.

ryandrake 2y ago
Well, write the law to address that, too. Too often, we throw our hands up and declare legislation impossible "because companies will just get around it in ways, X, Y, and Z". The solution is to write better laws that also remove X, Y, and Z as options. And also X0, X1, Y0, Y1, Y2, Z0, Z1, Z2, Z3, and Z4. The world is complex and regulation can be complex, too. You'll never fix things by giving up and saying "We can't write the perfect law--oh well, let's just let companies do whatever they want!"
- dylan604 2y ago
  The concept of spirit of the law vs letter of the law infuriates me to no end. I think the letter of the law should stipulate the spirit of the law (almost a TL;DR right at the beginning) so that jurists can later take that into account when deciding if the law was broken.
  - 1-more 2y ago
    US Tax law is the only place where I can think of that the spirit is the most important part of the law. There isn't much of a hard and fast definition of a home based business, but if the vibe is "this is a hobby and I'm using the business only to claim deductions, not turn a profit someday" you can be in violation.
  - kredd 2y ago
    I agree in some sense, but spirit of the law also creates very uneven playground and leaves a lot of questions. The way I see the problem, it takes way too long for us to legislate anything. By the time something passes different levels of approval, whoever has any skin in the game might figure out a way around it. That happens a lot with finding loopholes in housing related legislations. If there is a proposal that would hurt investors, they lobby against it for a while, buying time to figure out an alternative method, and by the time it passes, they don’t really care because they’ve circumvented it anyways. I see why it would also suck if we fast tracked most of the legislations though.
    - piva00 2y ago
      > I agree in some sense, but spirit of the law also creates very uneven playground and leaves a lot of questions. That happens anyway though, as much of law in Common Law systems is only settled by precedents, jurisprudence, etc. Even the US's Constitution interpretation is up to the courts when questions arise, that's the courts' job anyhow. At least working with the spirit of the law allows ways to prevent loopholes in a way that the letter of the law process only allows if new legislation is passed to cover those loopholes.
      - vundercind 2y ago
        > Even the US's Constitution interpretation is up to the courts when questions arise, that's the courts' job anyhow. Judicial review of the constitutionality of laws is itself an invention of the courts, in fact. (And probably a good idea, but it’s something the courts had to decide they had, not a role or power plain in the law). So that specific thing being their job is… something they decided was their job, which is kinda funny.
- willcipriano 2y ago
  Most of the time the "we oughta do" ideas are so simple that they wouldn't work as a law "it should be illegal to charge too high prices!" so it's sort of a non-solution as it factually wouldn't work in the real world. Real talk, the US spends more on socialized medicine per capita than all of Europe, nobody should get reelected, no foreign aid rendered nor bombs dropped until we receive what has been long paid for. They want you to focus on the former sort of "solution" than the one I provide and that's why you probably are first hearing of mine now.
  - vundercind 2y ago
    > it should be illegal to charge too high prices! Funnily enough, as far as I have been able to figure, this is basically the unifying element of all developed-country healthcare systems outside the US, which have a lot of variety but all seem to do this, one way or another. Some do it with comprehensive direct price controls that are pretty much exactly “it’s illegal to charge too-high prices” (Japan), some through state monopsony (Great Britain), some through limited price controls but the very-credible threat of adding more if providers get too greedy (Singapore), and many through some combo of the above, but the effect always boils down to price controls.
    - willcipriano 2y ago
      You misunderstand. In nations with socialized medicine (and this includes the US) there is really only one primary buyer of healthcare products and services. If that buyer decides your price is too high, you sell around 0 units. You can often receive these treatments if you wish to pay privately. Only the very wealthy do this, a small market. Drug companies in the US prefer to sell units at the prices that the buyers in those nations are allowing them VS not selling them at all. That's why they do it. Then turn around and say they can't do the same in the US as it would bankrupt them. The difference is in the US, Medicaid is quite happy to pay prices that are multiples of what other nations are paying. They sort of pretend this is all some sort of accident or due to some complexity that you wouldn't understand but it's just theft.
      - 2y ago
rqtwteye 2y ago
“ They'd just invest more in not having to reverse on appeal” That would be the goal. Get it right first time around.
- WaxProlix 2y ago
  "Invest" here doesn't necessarily mean monetary investment, they could for instance choose to degrade their arbitration and appeals process further, understaff it, or push regulatory boundaries in that direction. And that would possibly save them money, at least in the short term. And to the extent that costs do go up for appeals processes, there's no guarantee that the resulting setup has margins that incentivize doing right by customers at all.
  - rqtwteye 2y ago
    That could be solved by proper regulation. As far as I can tell they are already making the process as miserable as possible. I don’t think it would get worse.

deleted 2y ago

[deleted]

aidenn0 2y ago

Most of the time it's not too bad to appeal a claim for smaller amounts. People go through the hoops for the larger denials because they are so motivated. I got a $150k bill for emergency care for my daughter once; it wasn't too bad because they denied it as "uncovered elective procedure" which was trivial to show it wasn't, but it was still a tense month for me waiting. The punchline, of course, is that the insurance company and the provider agreed upon $30k. Doctors' offices can't tell you what a procedure will cost ahead of time, and the amount they bill you afterwards is completely fictitious (because if you don't have health insurance you probably can't pay 5x what the insurance companies pay, so will be bankrupted anyways).

rqtwteye 2y ago
“ because if you don't have health insurance you probably can't pay 5x what the insurance companies pay, so will be bankrupted anyways” Or it could go the other way depending on arbitrary factors. Nobody knows.
dimal 2y ago
“Most of the time” in my case, it has been bad. Because it wasn’t one big bill. It was dozens of bills for $200-500. Each submission could fail in unpredictable ways. “Lost” claims forms, database “errors”, “incomplete information”, etc. And trying to deal with this burden while being sick, was too much for me. I scraped back a few dollars, but had to give up and move forward with my life.