3 ms·

I never understood why insurers get all the flack while the providers get a pass.

cogman10 1y ago
Because the common interaction people have with their insurers is "We are denying this because of <REASON>" which they have to fight to get healthcare. When a provider rips off an insurer it's invisible to the general public. Also, incidentally, when people talk about fraud in Medicare/Medicaid, the providers are almost always where that happens (yet that's often not pointed out).
- deathanatos 1y ago
  > Because the common interaction people have with their insurers is "We are denying this because of <REASON>" Of the multiple times my insurance has declined to cover one thing or another, not once have I ever gotten a reason. The claim is just billed to the patient, directly. I'm then left wondering things like "Hey, your plan documentation says 'preventative care is 100% covered'. This was preventative care. Why is it being declined?" If I want to know, it's an hour of my time, at least, going back & forth with insurance to learn "Oh, '100% covered' … except in these cases."
walkabout 1y ago
FWIW I hate most medical billing departments (and hospitals are the worst) about as much as I hate insurance. They're at least as likely to fuck something up (curiously, always in their favor, not yours) as insurers, from what I've seen. And they're almost as unpleasant to deal with—at least they don't generally keep you on hold for literal hours, but it's still not great. And one of the ugliest public-facing roles in all of American medicine has to be the insurance-vultures whose job is to hover about emergency rooms pestering very-sick people for their billing information. Fucking gross.
potato3732842 1y ago
Every party at every point in the system is various shades of complicit in fleecing us. That's the magic of the system. It's all divided up in so many ways and so many of the feedback loops touch through the people getting screwed that it's impossible to build a "these guys might not be wholly responsible, but they're responsible enough things will get better if we push them off a cliff or legislate them into poverty or whatever" consensus you need to build to change things 17% of the US GDP is healthcare, now obviously there's a lot of nurses and random courier drivers and all sorts of other stuff in there, but they would all need to take some amount of haircut for us to get fleeced less. The GDP contribution of slavery was ~13% just preceding the civil war and credible moves (i.e. electing Lincoln) to make them take a haircut caused, you know, the civil war. There is likely no "clean" way to fix this problem other than a century long frog boiling exercise
- nocoiner 1y ago
  You think nurses and couriers are the ones who need to take pay cuts to get healthcare expenses under control??? Lm, and I cannot stress this enough, fao.
  - potato3732842 1y ago
    The size of the haircut the whole industry needs to take is so large that in all likelihood nobody will be unscathed.
unyttigfjelltol 1y ago
Because it’s only human nature to complain about the people who aren’t in the room. Insurers are not only absent, they are economically adverse to the two parties making decisions in the room.
myko 1y ago
In years of working in the medical industry it is rare for health systems to purposefully upcode a patient's visit (this is taken extremely seriously) while insurers attempting not to pay the bill and sticking it to the patient and health system is standard practice

Because the common interaction people have with their insurers is "We are denying this because of <REASON>" which they have to fight to get healthcare. When a provider rips off an insurer it's invisible to the general public. Also, incidentally, when people talk about fraud in Medicare/Medicaid, the providers are almost always where that happens (yet that's often not pointed out).

deathanatos 1y ago
> Because the common interaction people have with their insurers is "We are denying this because of <REASON>" Of the multiple times my insurance has declined to cover one thing or another, not once have I ever gotten a reason. The claim is just billed to the patient, directly. I'm then left wondering things like "Hey, your plan documentation says 'preventative care is 100% covered'. This was preventative care. Why is it being declined?" If I want to know, it's an hour of my time, at least, going back & forth with insurance to learn "Oh, '100% covered' … except in these cases."

walkabout 1y ago

FWIW I hate most medical billing departments (and hospitals are the worst) about as much as I hate insurance. They're at least as likely to fuck something up (curiously, always in their favor, not yours) as insurers, from what I've seen. And they're almost as unpleasant to deal with—at least they don't generally keep you on hold for literal hours, but it's still not great. And one of the ugliest public-facing roles in all of American medicine has to be the insurance-vultures whose job is to hover about emergency rooms pestering very-sick people for their billing information. Fucking gross.

potato3732842 1y ago

Every party at every point in the system is various shades of complicit in fleecing us. That's the magic of the system. It's all divided up in so many ways and so many of the feedback loops touch through the people getting screwed that it's impossible to build a "these guys might not be wholly responsible, but they're responsible enough things will get better if we push them off a cliff or legislate them into poverty or whatever" consensus you need to build to change things 17% of the US GDP is healthcare, now obviously there's a lot of nurses and random courier drivers and all sorts of other stuff in there, but they would all need to take some amount of haircut for us to get fleeced less. The GDP contribution of slavery was ~13% just preceding the civil war and credible moves (i.e. electing Lincoln) to make them take a haircut caused, you know, the civil war. There is likely no "clean" way to fix this problem other than a century long frog boiling exercise

nocoiner 1y ago
You think nurses and couriers are the ones who need to take pay cuts to get healthcare expenses under control??? Lm, and I cannot stress this enough, fao.
- potato3732842 1y ago
  The size of the haircut the whole industry needs to take is so large that in all likelihood nobody will be unscathed.

unyttigfjelltol 1y ago

Because it’s only human nature to complain about the people who aren’t in the room. Insurers are not only absent, they are economically adverse to the two parties making decisions in the room.

myko 1y ago

In years of working in the medical industry it is rare for health systems to purposefully upcode a patient's visit (this is taken extremely seriously) while insurers attempting not to pay the bill and sticking it to the patient and health system is standard practice