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Excessive is knowingly denying someone necessary medical coverage solely for financial gain. If private insurers want to play that game then they can register

Excessive is knowingly denying someone necessary medical coverage solely for financial gain. If private insurers want to play that game then they can register as a non-profit organization or be an optional layer on top of a public backstop, such as medicare-for-all, an arrangement they've lobbied against for deacdes. Sadly, they want to retain the ability to deny you coverage for any reason. Their maximum profit happens when they pay out as few claims as possible. The only reason they don't already operate that way is legal enforcement, so let's take that to it's logical conclusion

lotsofpulp 1mo ago
If you were in charge of denying or approving claims (millions of them), would you expect to make errors? Would you expect every insured without sufficient medical knowledge to understand which denial was appropriate versus which was an error?
- pc86 1mo ago
  You know the answer, they would just steal money from people they don't like the pay for everything, and when that runs out almost immediately they'll implement rationing and waitlists. Tale as old as time.
  - scottLobster 1mo ago
    Raising taxes to pay for the public welfare isn't stealing. Rationing and wait-lists are a problem in some countries, and they're preferable problems to the ones existing in our current system. You don't want to help, and you need a fairy tale to reframe your selfishness so you can lie to yourself in the mirror. Many such people, you aren't insightful.
- scottLobster 1mo ago
  They don't have to believe the insured, they can believe the doctors, plural. Also, their "errors", even when innocent, are on you to solve. I'm currently working to get my 2nd autistic child covered for ABA services, been fighting insurance for 2 months now with 4 qualified professionals, 2 MDs, a PhD Nurse and an ABA Supervisor, from multiple providers saying she qualifies. Insurance's own in-house doctor agreed that they followed state recommendations, up until another internal doctor just some days ago contradicted them and said there's one part that they don't, which just so happens to invalidate her entire diagnosis (which took 3 separate appointments over the course of a month and was more thorough than most). The doctors who diagnosed here are livid, as they have a major insurer essentially telling them that their entire program and every diagnosis from it is invalid, while other programs are not held to the same scrutiny. I know first hand, because her older sister is also autistic and she got approved by this same insurer on a much less stringent examination from a different provider. We'll get it solved, in the worst case we're fortunate enough to be able to hire lawyers. Not everyone has that kind of savings. Oh, and in the meantime this is 2 months my kid is going without therapy, and a bunch of wasted time for all involved. You want more? Earlier this year my father in law died in part because his private medicare advantage plan denied him coverage for in-patient rehab after brain surgery, which the surgeon, doctor and every medical professional who looked at him said he needed. We appealed, they denied the appeal. Later that week he tried to get up at night to use the bathroom, couldn't support his own weight and fell, suffering a skull fracture that necessitated a second brain surgery. That second surgery was fully covered, but they still refused to cover in-patient rehab. He died some weeks later, have never received more than rehab 2 days a week and whatever improvised rehab the family could cobble together between our work schedules. And that's just my personal experience in the last year. I have stories from previous years and more still from relatives. Anyone who's had to make extensive use of the medical system will have many such stories of various severity, it's just a given that when you file a claim you must be ready to fight and hope you don't have to. These are not innocent mistakes, and if they are than the insurers making them should be shut down for negligence and those in charge held responsible for resulting damages.
  - lotsofpulp 1mo ago
    >They don't have to believe the insured, they can believe the doctors, plural. Also, their "errors", even when innocent, are on you to solve. You misinterpreted what I wrote. I was referring to people who believe they were wronged, but do not have the knowledge to understand they were not wronged, due to healthcare being extremely complicated. I understand your frustrations, and there certainly are errors that managed care organizations should not be making, but the financial figures indicate the root of the problem is insufficient supply of healthcare. In this comment, you write: https://news.ycombinator.com/item?id=49211264 https://news.ycombinator.com/item?id=49211264 >For-profit claim denials should be abolished unless there's a public backstop. There is little to no profit in managed care. There are 7 publicly listed managed care organizations (UNH, Elevance, Cigna, CVS, Humana, Centene, and Molina). There are myriad non profit managed care organizations (Kaiser Permanente, Cambia, HCSC and other various Blue Cross Blue Shield). All of their financials are open, so go read their 10-K and 990 and see for yourself that almost all the revenue goes out the door as healthcare expenses. It has nothing to do with profit or non profit. The root problem of insufficient supply of healthcare is not in the wheelhouse of managed care organizations to supply, no matter how many executives are assassinated.

lotsofpulp 1mo ago

If you were in charge of denying or approving claims (millions of them), would you expect to make errors? Would you expect every insured without sufficient medical knowledge to understand which denial was appropriate versus which was an error?

pc86 1mo ago
You know the answer, they would just steal money from people they don't like the pay for everything, and when that runs out almost immediately they'll implement rationing and waitlists. Tale as old as time.
- scottLobster 1mo ago
  Raising taxes to pay for the public welfare isn't stealing. Rationing and wait-lists are a problem in some countries, and they're preferable problems to the ones existing in our current system. You don't want to help, and you need a fairy tale to reframe your selfishness so you can lie to yourself in the mirror. Many such people, you aren't insightful.
scottLobster 1mo ago
They don't have to believe the insured, they can believe the doctors, plural. Also, their "errors", even when innocent, are on you to solve. I'm currently working to get my 2nd autistic child covered for ABA services, been fighting insurance for 2 months now with 4 qualified professionals, 2 MDs, a PhD Nurse and an ABA Supervisor, from multiple providers saying she qualifies. Insurance's own in-house doctor agreed that they followed state recommendations, up until another internal doctor just some days ago contradicted them and said there's one part that they don't, which just so happens to invalidate her entire diagnosis (which took 3 separate appointments over the course of a month and was more thorough than most). The doctors who diagnosed here are livid, as they have a major insurer essentially telling them that their entire program and every diagnosis from it is invalid, while other programs are not held to the same scrutiny. I know first hand, because her older sister is also autistic and she got approved by this same insurer on a much less stringent examination from a different provider. We'll get it solved, in the worst case we're fortunate enough to be able to hire lawyers. Not everyone has that kind of savings. Oh, and in the meantime this is 2 months my kid is going without therapy, and a bunch of wasted time for all involved. You want more? Earlier this year my father in law died in part because his private medicare advantage plan denied him coverage for in-patient rehab after brain surgery, which the surgeon, doctor and every medical professional who looked at him said he needed. We appealed, they denied the appeal. Later that week he tried to get up at night to use the bathroom, couldn't support his own weight and fell, suffering a skull fracture that necessitated a second brain surgery. That second surgery was fully covered, but they still refused to cover in-patient rehab. He died some weeks later, have never received more than rehab 2 days a week and whatever improvised rehab the family could cobble together between our work schedules. And that's just my personal experience in the last year. I have stories from previous years and more still from relatives. Anyone who's had to make extensive use of the medical system will have many such stories of various severity, it's just a given that when you file a claim you must be ready to fight and hope you don't have to. These are not innocent mistakes, and if they are than the insurers making them should be shut down for negligence and those in charge held responsible for resulting damages.
- lotsofpulp 1mo ago
  >They don't have to believe the insured, they can believe the doctors, plural. Also, their "errors", even when innocent, are on you to solve. You misinterpreted what I wrote. I was referring to people who believe they were wronged, but do not have the knowledge to understand they were not wronged, due to healthcare being extremely complicated. I understand your frustrations, and there certainly are errors that managed care organizations should not be making, but the financial figures indicate the root of the problem is insufficient supply of healthcare. In this comment, you write: https://news.ycombinator.com/item?id=49211264 https://news.ycombinator.com/item?id=49211264 >For-profit claim denials should be abolished unless there's a public backstop. There is little to no profit in managed care. There are 7 publicly listed managed care organizations (UNH, Elevance, Cigna, CVS, Humana, Centene, and Molina). There are myriad non profit managed care organizations (Kaiser Permanente, Cambia, HCSC and other various Blue Cross Blue Shield). All of their financials are open, so go read their 10-K and 990 and see for yourself that almost all the revenue goes out the door as healthcare expenses. It has nothing to do with profit or non profit. The root problem of insufficient supply of healthcare is not in the wheelhouse of managed care organizations to supply, no matter how many executives are assassinated.