This article first appeared at ProPublica and was co-published with The Capitol Forum. ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.
Capitalism and medicine is not a match made in heaven; the USA version is less felicitous than that.
The data here should be really easy to assemble.
The insurance companies can look this stuff up and summarize it with a few keystrokes.
Part of shining a light on this issue is showing how very simple it is for those who have the data to produce it.
As with many matters of this type, they won’t do it until they must.
Just fuck the motherfuckers. The most useless parasites in the history of humanity.
…and yet Americans seem content to pay double for half.
…having lived in other, more reasonable countries, I’m just gobsmacked by this.
“Denial rates are not directly comparable from one health plan to another and could lead consumers to make inaccurate conclusions on the robustness of the health plan,” Kelly Parsons, director of media relations for the Blue Cross Blue Shield Association, said in an email.
Translation: Consumers would be shocked if they knew just how bad their health plans were.
We will likely never see such data, because as soon as we do it would become apparent that the insurers will deny the claim to some of their customers but not to others. I would be totally shocked if that were not the case.
The business model of a health insurer is to collect premiums. Paying out claims is overhead, along with staff and marketing and all the rest. So they do everything to increase the amount of premiums they collect while reducing overhead. If that means letting people die, so be it.
We found Palin’s death panels. But they work for private insurance companies. Ask any one of these customers, or the survivors who had to bury a child because some nobody piece of shit in Omaha decided a cancer treatment was “too expensive.”
Americans are among the stupidest imbeciles on the planet. The average American IQ is 100. “Mentally challenged” begins at 80 (I would prefer to use the “R” word but there are too many 20year old bedwetters policing this site) and genius at 135. Simple math tells you that far more Americans are closer to being “mentally challenged” than geniuses. That explains a lot.
From the article:
…hope that one day there will be enough public information to rank insurers by their denial rates and compare how reliably they provide different services, from behavioral health to emergency care.
“There’s a name and shame function that is possible here,” she said. “It holds some real potential for getting plans to clean up their acts.”
I have a better solution for this problem.
Universal Health Care. Not Medicare for All, not ACA. Nothing less than Universal Health Care. Birth to death. Medical people can concentrate on what they were trained to do. Patients can concentrate on their health and recovery. Insurance Companies can fuck themselves. Agents can try to find service jobs that have merit and worth to humanity. We can do this.
I work in HR for a large non-profit organization. The organization pays roughly 80-90% of each employee’s monthly premiums. Employees pay quite a lot too, especially if they get family coverage. Most of the employees I work with have no idea of the real cost of their insurance. When they complain, not unreasonably, about their premiums, I show them the numbers - what they pay plus what the organization pays. It’s an eye opener for them.
My point is that many Americans may not have a clue about the real costs of their health insurance. What astonishes me is that employers don’t get behind serious reform of the American health insurance racket! Payroll is usually the biggest expense category for any business, and insurance is a significant portion of that expense. Businesses could really boom if they could unload the burden of providing health coverage for people.
The American model is grossly outdated. American health insurance is one of the driving factors in our decision to move back to Canada after we retire.
One of the questions just hinted at in the article is how many claims were denied initially and then paid after resubmission. Those initial denials particularly hurt people who are poor, or busy, or don’t have good access to a lawyer, because some significant fraction will decide to eat the cost rather than spend time and money they don’t have fighting the case (on top of the money they pay to providers, who typically won’t wait for resolution of a wrongful denial).
Back in the 90s there was a health insurance company in New York that grew very fast and was briefly very profitable until it got mired in legal and cash-flow problems and (iirc) went belly-up. One of their financial techniques, according to people who signed up with them, was simply to deny every claim the first time it came in. Gained them months of float, and every subscriber who gave up and didn’t refile was pure profit.
DIL just had to change OB five months into pregnancy because insurance dropped Dr. Turns out practice was bought out by Hedgefund that decided to play hardball with insurance company. Son says they were able find another practice they like & same hospital for delivery. My thoughts, what do hedgefunds know about medical practices???
“Denial rates are not directly comparable from one health plan to another and could lead consumers to make inaccurate conclusions on the robustness of the health plan,” Kelly Parsons, director of media relations for the Blue Cross Blue Shield Association, said in an email.
ha ha ha ha ha haah…oh my goodness, how did he keep from laughing himself after making that statement I’ll never know
I’m looking forward to being hooked up with AI voice chatbots the next time I wait on the hold line for half an hour.
They count on this. I also don’t appreciate that I am talking to a secretary about my personal health issues and then that person gets to decide whether to clear my claim or not.
Here’s what most people don’t understand about private health insurance:
The U.S. Department of Labor regulates upwards of 2 million health plans, including many in which employers pay directly for workers’ health care coverage rather than buying it from insurance companies. Roughly two-thirds of American workers with insurance depend on such plans, according to the Kaiser Family Foundation.
What that means is that health insurance companies, for the most part, don’t actually pay for the vast majority of healthcare services they oversee!
Let that sink in. The insurance company almost never pays the bill; the employer pays it instead. It’s called administrative service only insurance (ASO) and it accounts for about three in four employer sponsored policies in this country.
With these policies, the money never passes through the insurance company and so, they’re never really directly responsible for what happens to it. Instead, individual employers are directly responsible for the payments to healthcare providers and the insurance company is only responsible for the the “paperwork” (administrative services).
This system, effectively, insulates the insurance companies form the consequences of any of their decisions. If they approve a service, it’s not their money. If they deny a service, that’s just their advice. They have no reason to keep track of any of these decisions either since thee decisions never involve money they actually posses at any time. In fact, the insurance companies themselves often farm out the actual administrative work to third parties and never ask about it.
The vast majority of revenue to health insurance companies now has little to do with commercial health insurance. They collect a small fee (about $30 per month per employee) to provide these administrative services but, in reality, the main focus of almost all health insurance companies now is to “insure” Medicare and Medicaid recipients well ignoring, for the most part, the rest of us.
Same with the auto insurance industry, the only industry in America whose mandatory purchase is enforced by the police and the courts.
There was a study done at UC Berkeley years ago on the benefits of insuring every car for minimum liability (the lowest level of insurance mandated) through pay at the pump. It found that, because all the insured would be in a single pool, it reduced the cost of auto insurance to pennies on the dollar. Moreover, the amount people paid was now directly proportional to how much they drove.
For some reason insurance companies were unanimously opposed the idea. Imagine that.
OT response: I feel the same way about the tax code. Simply it so tax accountants and attorneys have to transition to services that have merit and worth.