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I'm clueless about healthcare economics, but this sounds fishy to me. Why would insurers go along with that? In fact I would expect insurers to be in a much bet

I'm clueless about healthcare economics, but this sounds fishy to me. Why would insurers go along with that? In fact I would expect insurers to be in a much better position to bargain with a hospital than a private party. Actually it's if the hospital were billing the govt (not as motivated as a private party) where I would expect that overcharging to creep up and up.

ThunderSizzle 29d ago
Insurers can only spend 15% of premiums on admin spend (e.g. salaries, etc). That means if the CEO (and everyone else) wants more money, they need to pay more money to the hospitals, so their 15% cut grows. Also, for beyond that, unspend premiums have to be refunded, which also cuts into the potential admin spend bucket, so it's best to always ensure your paying as much as possible in claims. Plus, patients hate denied claims, because typically your forced to sign paperwork saying your responsible for anything insurance refuses to pay. And with most health insurance spending being locked to employer benefits, the big market is the group market, which means your stuck with either getting your job's option(s), finding a new job, or not getting insurance basically. In other words, you don't have a price choice as an individual in a group.
- ahartmetz 29d ago
  >typically your forced to sign paperwork saying your responsible for anything insurance refuses to pay Now that is some sick shit. Making every doctor's visit a gamble you might lose, discouraging people from seeing a doctor.
  - ThunderSizzle 29d ago
    It's even worse when they claim to be "in-network" and they make you sign that. To me, the entire point of being in network is I shouldn't have to worry about the provider filing claims correctly on my behalf, and if there is an issue, it should be on the "network" side, not my side.
- virgildotcodes 29d ago
  Hm, seems to be a bit of a contradiction between what you’re saying in terms of “insurers want to pay more” and the infamous tendency of insurers to deny claims as much as possible?
  - ThunderSizzle 29d ago
    Well, they also need to ensure they aren't spending past their premiums coming in... Alot of insurers the past few years have actually gone bankrupt from ballooning costs and claims. So, they want costs to go up, so the next year they can up the premiums, so they can then up their admin spend, but the costs still need to below the premium. And they can't just up the premium without an associated rise in cost, because groups are owed their premium money back if it isn't paid out.

ThunderSizzle 29d ago

Insurers can only spend 15% of premiums on admin spend (e.g. salaries, etc). That means if the CEO (and everyone else) wants more money, they need to pay more money to the hospitals, so their 15% cut grows. Also, for beyond that, unspend premiums have to be refunded, which also cuts into the potential admin spend bucket, so it's best to always ensure your paying as much as possible in claims. Plus, patients hate denied claims, because typically your forced to sign paperwork saying your responsible for anything insurance refuses to pay. And with most health insurance spending being locked to employer benefits, the big market is the group market, which means your stuck with either getting your job's option(s), finding a new job, or not getting insurance basically. In other words, you don't have a price choice as an individual in a group.

ahartmetz 29d ago
>typically your forced to sign paperwork saying your responsible for anything insurance refuses to pay Now that is some sick shit. Making every doctor's visit a gamble you might lose, discouraging people from seeing a doctor.
- ThunderSizzle 29d ago
  It's even worse when they claim to be "in-network" and they make you sign that. To me, the entire point of being in network is I shouldn't have to worry about the provider filing claims correctly on my behalf, and if there is an issue, it should be on the "network" side, not my side.
virgildotcodes 29d ago
Hm, seems to be a bit of a contradiction between what you’re saying in terms of “insurers want to pay more” and the infamous tendency of insurers to deny claims as much as possible?
- ThunderSizzle 29d ago
  Well, they also need to ensure they aren't spending past their premiums coming in... Alot of insurers the past few years have actually gone bankrupt from ballooning costs and claims. So, they want costs to go up, so the next year they can up the premiums, so they can then up their admin spend, but the costs still need to below the premium. And they can't just up the premium without an associated rise in cost, because groups are owed their premium money back if it isn't paid out.