3 ms·
This is the kind of thing that confuses me. When insurance companies deny claims I actually understand that; I'm honestly open to the idea that they might be d
by hackeraccount 2y ago
This is the kind of thing that confuses me. When insurance companies deny claims I actually understand that; I'm honestly open to the idea that they might be doing it for good reasons. That there are some procedures which might be done and should not be.
The $300 breast pump and $79 Tylenol is harder to understand. Why can't insurance companies step in and say this is crazy we're not paying for it?
Is it like the $3000.00 hammer? i.e. we want the jet fighter to come in under a certain cost so there are bundled items that are ridiculously expensive. The hospitals or some other 3rd party somehow put the insurance company in a posistion where they can't say no even though they want to?
Or is there some perverse incentive? Insurance companies benefit from an expensive breast pump / Tylenol? If that's the case why do they ever deny claims?
Is the amount too small in grand scheme of things?
Do they get some kick back for some types of care that make eating this cost still worthwhile?
- foxyv 2y agoThor explains this a little in this short: https://www.youtube.com/shorts/b43iUJI4_Ms https://www.youtube.com/shorts/b43iUJI4_Ms
- spyckie2 2y agoThe article makes a claim that it is in the insurance companies best interest to make the overall cost of healthcare to go up so they can get a bigger profit. While I somewhat agree with that claim, I suspect that there are many systemic policies designed into healthcare by policy makers that create these inefficiencies in the first place. 1) why can’t an insurance offer a lower cost option? It’s because of the policy of what they are required to provide. 2) why do hospitals charge so much markup for everything? It’s probably because there is a lot that they can’t charge you for, they can’t charge you by hour by doctor and nurse quantity. So they have to charge arbitrary markups on random items. This allows for hidden profits esp by savvy financial data people. 3) what incentives are there to give cost effective services in the medical field? There are none. Customers will pay regardless, and insurance will cover regardless. Game theory wise, it is in the best interest for insurance companies a to cooperate with with medical service companies to push larger and larger bills to consumers.
- nradov 2y agoSome hospitals certainly engage in abusive billing and collections practices. But most of the stories you see about a $79 Tylenol are based on a misunderstanding of how institutional claims work. Those are typically billed based on DRG codes with negotiated rates so the line items have no relationship to the actual amount paid by insurers or patients. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software https://www.cms.gov/medicare/payment/prospective-payment-sys...