I work in insurance. It’s hard for me to believe that CEOs have much of any effect on how these large institutions operate. It’s all regulations and overdetermined market dynamics. All these CEOs inevitably herd towards whatever the most viable strategy is.
Everyone is talking about UHC denying 1/3 of claims, which is absurd (in the same chart everyone else is denying huge % of claims too). I think they are mixing up “we aren’t going to pay for this code / gross billed amount, but please resubmit with this code and you’ll get the negotiated rate” with “denial”. Denying claims is a huge deal and companies do basically anything they can to avoid doing it.
Look, we’ve all got stories. But none of them are going to get solved by shooting CEOs. If we outlawed claim denials and premiums skyrocketed people would complain about that too.
>>>I think they are mixing up “we aren’t going to pay for this code / gross billed amount, but please resubmit with this code and you’ll get the negotiated rate” with “denial”.<<<
Yeah. Something isn't right with that graph. My other thought is the customer spread is far different than other large insurance companies somehow (more Medicaid/Medicare members?).
A great article, thank you for sharing. I especially hate the snide responses to the "elite backlash". It's not that pearl clutching elites are scared the masses are waking up; it's just that some of the population still has enough humanity in them to feel horrible that a kid will one day watch their father be executed on CCTV footage. Like you said, "murdering people is bad".
Most people will never care to understand how insurance works as a financial product. Forget healthcare if it’s too emotional. Look at viral videos of people raging over higher car insurance premiums after a crash. To them, it’s cosmic injustice and racism. The insurance company, the government—it all blurs into one faceless force of “systemic discrimination.”
Yea, I have one personal example. I was denied coverage for Adderall (I in fact have United Healthcare insurance), but they said they would cover vyvanse or ritalin.
Of course I was mad. My doctor prescribed me Adderall, but they wouldn't cover it. What a miscarriage of the system!
But the reality is more complicated. The DEA implemented caps on Adderall production, which decreased the supply which of course raises the price. So insurance companies are more likely to reject claims for adderall, given that the government has made it much more expensive to pay for. https://www.additudemag.com/adderall-shortage-dea-stimulants-adhd-medication/
Framing things through this "healthcare" lens allows people to launder their socialist impulses into something that sounds less bitchmade. "I'm mad that I'm poor/that rich people exist" doesn't sound nearly so good as "people are literally dying because of the greedy insurance companies!" What the person actually wants is the same in both cases--they want rich people to give them stuff for free.
Could you elaborate on the issue of regulations on Insurance companies by goverment getting in the way? From my understanding a lot of uncompetitive regulations are the result of insurers purposefly lobbying goverment to prevent new competition, but maybe I'm wrong.
The number of regulations in medicine is enormous and I wouldn’t know where to start. At a minimum you have numerous agencies that set rules related to medicine and healthcare, such as:
FDA
CDC
NIH
CMS
DEA
But it's not just insurance regulations. All medical regulations can push up costs. For example, in my other comment - the DEA reduced the supply of Adderall. This increases costs, but isn't directly related to insurance, but the increased cost will push insurers like United to deny claims (they denied my Adderall claim and suggested Vyvanse instead.)
I work in insurance. It’s hard for me to believe that CEOs have much of any effect on how these large institutions operate. It’s all regulations and overdetermined market dynamics. All these CEOs inevitably herd towards whatever the most viable strategy is.
Everyone is talking about UHC denying 1/3 of claims, which is absurd (in the same chart everyone else is denying huge % of claims too). I think they are mixing up “we aren’t going to pay for this code / gross billed amount, but please resubmit with this code and you’ll get the negotiated rate” with “denial”. Denying claims is a huge deal and companies do basically anything they can to avoid doing it.
Look, we’ve all got stories. But none of them are going to get solved by shooting CEOs. If we outlawed claim denials and premiums skyrocketed people would complain about that too.
>>>I think they are mixing up “we aren’t going to pay for this code / gross billed amount, but please resubmit with this code and you’ll get the negotiated rate” with “denial”.<<<
Yeah. Something isn't right with that graph. My other thought is the customer spread is far different than other large insurance companies somehow (more Medicaid/Medicare members?).
Preach it brother.
A great article, thank you for sharing. I especially hate the snide responses to the "elite backlash". It's not that pearl clutching elites are scared the masses are waking up; it's just that some of the population still has enough humanity in them to feel horrible that a kid will one day watch their father be executed on CCTV footage. Like you said, "murdering people is bad".
Yea, the reaction is freakish, but ultimately the average person is satisfied with their healthcare. Old people are especially well taken care of.
So it goes.
“Taylor Lorenz is wrong about abso-fucking-lutely everything”
#fify
It’s one thing to not be sad about it (Literally don’t even know who this man is), but the gleefulness about this man’s death is disturbing.
I think this piece works so much better for saving the obvious "murder is bad" point until the end, after a whole bunch of nerdy graphs.
Impressed that you put this together in an hour!
Lorenz retardposting is fuel to me
Impressive that you wrote all this in one hour!
Most people will never care to understand how insurance works as a financial product. Forget healthcare if it’s too emotional. Look at viral videos of people raging over higher car insurance premiums after a crash. To them, it’s cosmic injustice and racism. The insurance company, the government—it all blurs into one faceless force of “systemic discrimination.”
Yea, I have one personal example. I was denied coverage for Adderall (I in fact have United Healthcare insurance), but they said they would cover vyvanse or ritalin.
Of course I was mad. My doctor prescribed me Adderall, but they wouldn't cover it. What a miscarriage of the system!
But the reality is more complicated. The DEA implemented caps on Adderall production, which decreased the supply which of course raises the price. So insurance companies are more likely to reject claims for adderall, given that the government has made it much more expensive to pay for. https://www.additudemag.com/adderall-shortage-dea-stimulants-adhd-medication/
Framing things through this "healthcare" lens allows people to launder their socialist impulses into something that sounds less bitchmade. "I'm mad that I'm poor/that rich people exist" doesn't sound nearly so good as "people are literally dying because of the greedy insurance companies!" What the person actually wants is the same in both cases--they want rich people to give them stuff for free.
I think a lot of people don't even understand insurance at the most basic conceptual level.
At least she’s consistent, she’s wrong about almost everything :)
Could you elaborate on the issue of regulations on Insurance companies by goverment getting in the way? From my understanding a lot of uncompetitive regulations are the result of insurers purposefly lobbying goverment to prevent new competition, but maybe I'm wrong.
The number of regulations in medicine is enormous and I wouldn’t know where to start. At a minimum you have numerous agencies that set rules related to medicine and healthcare, such as:
FDA
CDC
NIH
CMS
DEA
But it's not just insurance regulations. All medical regulations can push up costs. For example, in my other comment - the DEA reduced the supply of Adderall. This increases costs, but isn't directly related to insurance, but the increased cost will push insurers like United to deny claims (they denied my Adderall claim and suggested Vyvanse instead.)