Completely agree. Just had to vent.
Comment on Why do we have to do the health insurance company's job for them?
thurstylark@lemm.ee 5 months ago
They get paid when the least amount of people they insure use their services. They’re not incentivized to help those they’ve insured. The less they have to pay out to providers, the better the executive bonuses. Thus, they are diligent in collecting premiums, but can just sit on their hands when it comes to paying out.
The more the system denies and delays a claim, the fewer insured people are willing or able to put themselves through the bureaucracy gauntlet, the fewer pay outs.
They’re not in the business of insurance, they’re in the business of making money from the business of insurance. It’s over-complicated on purpose.
Klanky@sopuli.xyz 5 months ago
UltraMagnus0001@lemmy.world 5 months ago
They actually use algorithms to deny claims. Also, remember the scene when Mr incredible was an insurance salesman?
grue@lemmy.world 5 months ago
You’d think that the doctor’s office would at least be motivated to fix the problem so they get paid, though, 'cause I sure as Hell aren’t going to do it!
AA5B@lemmy.world 5 months ago
But you probably signed that you are liable for all bills regardless of insurance, and before you got any treatment. Read through all the paperwork sometime: it may not be reasonable or fair and you don’t have a choice but somehow it’s legal
admiralteal@kbin.social 5 months ago
And what might be the most important part cannot be elided over: market capitalism is HIGHLY efficient at solving optimization problems, but it only responds to incentives.
So if you can create the right incentives to reward the result you want and punish results you don't want, a market solution is going to do a marvelous job. It's great at, say, price discovery. But if the incentives do not align with the desired result, it's going to grind you under heel.
The incentives the insurance companies are responding to, frankly, are the ones you have outlined and essentially no others. Collect more premiums, make fewer payouts. There's no "breaking point" here because they have an absolutely vast customer base that has no choice to opt out of the system for a variety of reasons (ranging from the ACA individual mandate to the fact that it is not possible for an individual to make fully-informed financial decisions about their health even WITH advanced knowledge and training that nearly no one has).
Health insurance is pretty much a textbook example of a service that the free market is ill-suited to provide.
So over time, market capitalism is going to make them collect endlessly-increasing premiums and pay out less and less. It is going to continue to get worse. Period. It will eventually get nationalized. Period. All the argument in the meantime is just over how long we want to continue to let people be sick and broke before we apply the only fix.
captainlezbian@lemmy.world 5 months ago
Also it’s not like you can change insurers when they do this. First it almost certainly didn’t happen during open enrollment but also your insurance provider is probably decided by your employer.