I recently had a procedure denied (after the fact) because the price charged was apparently "excessively above the average" price for that procedure, leaving me on the hook for the full amount. It felt like the opposite of being insured.
I also couldn't wrap my head around why they didn't just pay whatever they thought it was worth and let me cover the rest.
> I also couldn't wrap my head around why they didn't just pay whatever they thought it was worth and let me cover the rest.
Because nothing is forcing them to do so. If you don’t like it, what are you going to do about it? Shoot their CEO or something? They have all the leverage.
Insurance is a terrible name for what we have, its not insurance, its blackmail.
You dying and zero being paid out by the insurance company is the best profit margin they can ask for, that's the entire goal of an insurance company at this point.
If there are no payouts, then they have to return all premiums. They only get paid a percentage of covered care.
This presents it's own set of tradeoffs, namely between decreasing premiums to attract subscribers, and what is covered, to keep subscribers happy.
> I also couldn't wrap my head around why they didn't just pay whatever they thought it was worth and let me cover the rest.
Because insurance would then just lowball the cost of everything.
Insurance needs to either do what they say they do, cover x% of procedure cost with a maximum yearly deductible or we need to be talking about why we have insurance in the first place.
We need new regulations around health and insurance. Ideally, public insurance.
> Because insurance would then just lowball the cost of everything.
They do. Many, many billable items are priced to the limit that insurance will pay. Insurance and providers have agreements on the prices they can charge for certain procedures or supplies.
It used to be the norm that insurance would pay their maximum and leave the rest to you. Sometimes the provider would waive the difference, sometimes it was billed to you.
The cost of healthcare is 100% an artefact of insurance price fixing and absolutely nothing else.
Doing that would make sense, and we can't have that now, can we?
Related:
Feds help health insurers hide their dirty secret: denials on the rise
Related:
Doctors Say Dealing with Health Insurers Is Only Getting Worse
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