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This doesn't explain why the insurance companies don't have an incentive to fight back. If Acadia is engaged in insurance fraud, the insurance companies have e
by archgoon 2y ago
This doesn't explain why the insurance companies don't have an incentive to fight back.
If Acadia is engaged in insurance fraud, the insurance companies have every incentive to stop that.
- deleted 2y ago[deleted]
- nickff 2y agoInsurance company profits are capped as a percentage of expenses, so saving money means they make less money. There are bad incentives all over the place in healthcare regulations.
- gruez 2y agoIf you're referring to the minimum medical loss ratio provisions in the ACA, most insurance companies are above the minimum, which means any marginal fraud reduction is pure profit for them.
- sulandor 2y agounless there's a cut to be had
- loeg 2y agoWhy? Insurance providers have capped profit margins. The only way to grow their revenue is to grow covered expenses (and correspondingly, premiums).
- ericjmorey 2y agoInsurance executives' pay is limited by a pool of money that is calculated as a % of total expenses. If expenses are higher due to this sort of fraud, have an incentive to ignore it to keep that pool of money available for compensation as large as possible.
- deleted 2y ago[deleted]
- nradov 2y agoFor health plan executives the financial incentives run both ways. Most medical "insurance" companies no longer provide much insurance and primarily act as third-party administrators for self-insured employers. In the short term, health plans can make more profit by approving more claims. But in the long term they have to compete for the business of those group buyers and so they try to block waste/fraud/abuse that drives up customer costs.
- toast0 2y agoHealth insurance companies aren't incentivised to fight this kind of thing. Clearly falls into mandatory coverage (if claims are accurate), so all companies are going to have to pay it. Raises costs. Insurance gets to have overhead (profit) based on claims paid. There's more incentive to deny marginal claims, because some insurance companies won't and then you may attract more customers with a lower price and maybe you get more money that way. Patients are unlikely to complain to insurance to tell them the treatment/confinement was unjustified... because the patient will then need to pay the bill.
- LordDragonfang 2y ago> Patients are unlikely to complain to insurance to tell them the treatment/confinement was unjustified... because the patient will then need to pay the bill. Honestly, you buried the lede here. This is the horrifying and broken part. Under no circumstances should someone have to be afraid of paying for their involuntary commitment.
- hedora 2y agoDo the patients have to pay in that case? Like is Acadia really going to sue so they can have the insurance company and the patient testify under oath that Acadia management is guilty of kidnapping at scale, and in this particular case?
- castillar76 2y agoAs someone who went through this with a child and Acadia’s competitor UHS, yes. Yes, they do. The number of parents in our support group who fought in court to get their kids or relatives out of one of these hospitals only to be presented with a back-breaking bill for their commitment is genuinely nauseating. This is one of the prime examples of the utter failure of the US for-profit healthcare model.
- amy-petrik-214 2y agoI wholeheartedly attest to this. I had to stay in an Acadia facility due to a bipolar flare-up. The bill was so bad... I think if I hadn't been in a better place, the bill would have sent me right back in!