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The Affordable Care Act requires that "Insurers must spend at least 80–85% of premium dollars on health costs; rebates must be issued if this is violated." So i

The Affordable Care Act requires that "Insurers must spend at least 80–85% of premium dollars on health costs; rebates must be issued if this is violated." So insurers bought hospital networks, inflated the bills, and took their profit from the other side of the equation. Before you forgive your insurance company and blame your pharmacy and doctor, check first that they aren't owned by the same corporation.

bpodgursky 2y ago
Do you have any examples? I am quite confident I have never been in this situation, I have never heard of anyone except Kaiser patients (who are FWIW very happy with their service) getting this.
- tmpz22 2y ago
  My extended family has been Kaiser for decades and it has plenty of faults (Bay Area region). I’ve personally had multiple severe misdiagnosis by tired over worked doctors. I’ve had massive ER bills with trivial operations. I’ve gotten damagingly inaccurate mental health care, and at times long delays to see various specialists. The partnership of Kaiser and Reagan are largely responsible for the healthcare system America has today. Do not give them a pass.
- timschmidt 2y ago
  United Health Group is covered in "What Happens When Your Insurer Is Also Your Doctor and Your Pharmacist" - https://www.wsj.com/health/healthcare/what-happens-when-your-insurer-is-also-your-doctor-and-your-pharmacist-8df727af https://www.wsj.com/health/healthcare/what-happens-when-your... There's also https://en.wikipedia.org/wiki/Centene_Corporation https://en.wikipedia.org/wiki/Centene_Corporation You mentioned Kaiser Permanente who acquired Geisinger Health System's network of hospitals: https://en.wikipedia.org/wiki/Kaiser_Permanente https://en.wikipedia.org/wiki/Kaiser_Permanente See also: https://pahealthaccess.org/promises-made-promises-broken-what-really-happens-when-local-hospitals-are-acquired/ https://pahealthaccess.org/promises-made-promises-broken-wha... https://www.kff.org/health-costs/issue-brief/ten-things-to-know-about-consolidation-in-health-care-provider-markets/ https://www.kff.org/health-costs/issue-brief/ten-things-to-k...
- solarpunk 2y ago
  I think the term used to describe the imposed cost regulation is 'Medical Loss Ratio (MLR)', and the providers that own both ends of the claims transactions can use inflated costs to artificially manipulate their MLR.
- dumbmrblah 2y ago
  Kaiser is great, until you get sick. Then it’s a nightmare, especially if you have anything complex going on. I’m a physician that works at an ultra specialized hospital.
  - Brian_K_White 2y ago
    And I saw some chart of percentage claims denied that said KP denied the least at 7% while UHG the most or almost, at something like 39%. Even if that were true that KP deny the least, it ends up meaning nothing if they also own the hospital who they graciously never deny claims from. Ugh.
    - dumbmrblah 2y ago
      The gunman etched ‘Delay, Deny, Defend’ in those bullets. UHG denies. KP delays. Both can lead to disastrous consequences. Edit: And by delay, I don’t mean delay in seeing a specialist, I mean delay getting the most modern and up-to-date care. They have a tendency to practice population based treatment (and fiscally responsible), which may not be what is the most up to date. I understand it as an hospital administrator, but I can see the consequences as a physician.
      - inemesitaffia 2y ago
        Population based treatment is where nationalized care ends in
TheNewsIsHere 2y ago
I would also add that those of us on HM are probably more likely to have good insurance versus what most Americans have access to. Insurance carriers like low risk and thrive on people not fighting adverse decisions either because of a lack of time and resources or knowledge. The variables matter. My insurance carrier has also never denied a claim, but I’m in more or less good health for my age, have an HSA (at a bank owned by the insurance company) with a significant annual contribution from the issuing employer, and I don’t have anything going on (at the time I write this) that would end up in medical review. And if I did have to deal with that, theres financial cushion available to me to rely on while I fight it out with insurance.

bpodgursky 2y ago

Do you have any examples? I am quite confident I have never been in this situation, I have never heard of anyone except Kaiser patients (who are FWIW very happy with their service) getting this.

tmpz22 2y ago
My extended family has been Kaiser for decades and it has plenty of faults (Bay Area region). I’ve personally had multiple severe misdiagnosis by tired over worked doctors. I’ve had massive ER bills with trivial operations. I’ve gotten damagingly inaccurate mental health care, and at times long delays to see various specialists. The partnership of Kaiser and Reagan are largely responsible for the healthcare system America has today. Do not give them a pass.
timschmidt 2y ago
United Health Group is covered in "What Happens When Your Insurer Is Also Your Doctor and Your Pharmacist" - https://www.wsj.com/health/healthcare/what-happens-when-your-insurer-is-also-your-doctor-and-your-pharmacist-8df727af https://www.wsj.com/health/healthcare/what-happens-when-your... There's also https://en.wikipedia.org/wiki/Centene_Corporation https://en.wikipedia.org/wiki/Centene_Corporation You mentioned Kaiser Permanente who acquired Geisinger Health System's network of hospitals: https://en.wikipedia.org/wiki/Kaiser_Permanente https://en.wikipedia.org/wiki/Kaiser_Permanente See also: https://pahealthaccess.org/promises-made-promises-broken-what-really-happens-when-local-hospitals-are-acquired/ https://pahealthaccess.org/promises-made-promises-broken-wha... https://www.kff.org/health-costs/issue-brief/ten-things-to-know-about-consolidation-in-health-care-provider-markets/ https://www.kff.org/health-costs/issue-brief/ten-things-to-k...
solarpunk 2y ago
I think the term used to describe the imposed cost regulation is 'Medical Loss Ratio (MLR)', and the providers that own both ends of the claims transactions can use inflated costs to artificially manipulate their MLR.
dumbmrblah 2y ago
Kaiser is great, until you get sick. Then it’s a nightmare, especially if you have anything complex going on. I’m a physician that works at an ultra specialized hospital.
- Brian_K_White 2y ago
  And I saw some chart of percentage claims denied that said KP denied the least at 7% while UHG the most or almost, at something like 39%. Even if that were true that KP deny the least, it ends up meaning nothing if they also own the hospital who they graciously never deny claims from. Ugh.
  - dumbmrblah 2y ago
    The gunman etched ‘Delay, Deny, Defend’ in those bullets. UHG denies. KP delays. Both can lead to disastrous consequences. Edit: And by delay, I don’t mean delay in seeing a specialist, I mean delay getting the most modern and up-to-date care. They have a tendency to practice population based treatment (and fiscally responsible), which may not be what is the most up to date. I understand it as an hospital administrator, but I can see the consequences as a physician.
    - inemesitaffia 2y ago
      Population based treatment is where nationalized care ends in

TheNewsIsHere 2y ago

I would also add that those of us on HM are probably more likely to have good insurance versus what most Americans have access to. Insurance carriers like low risk and thrive on people not fighting adverse decisions either because of a lack of time and resources or knowledge. The variables matter. My insurance carrier has also never denied a claim, but I’m in more or less good health for my age, have an HSA (at a bank owned by the insurance company) with a significant annual contribution from the issuing employer, and I don’t have anything going on (at the time I write this) that would end up in medical review. And if I did have to deal with that, theres financial cushion available to me to rely on while I fight it out with insurance.