Why Your Health Insurer Doesn't Care About Your Big Bills

[Uncle Joe]

(snip)

But Frank was startled to see that Aetna had agreed to pay NYU Langone $70,000. That's more than three times the Medicare rate for the surgery and more than double the estimate of what other insurance companies would pay for such a procedure, according to a nonprofit that tracks prices.

(snip)

Experts frequently blame this on the high prices charged by doctors and hospitals. But less scrutinized is the role insurance companies — the middlemen between patients and those providers — play in boosting our health care tab. Widely perceived as fierce guardians of health care dollars, insurers, in many cases, aren't. In fact, they often agree to pay high prices, then, one way or another, pass those high prices on to patients — all while raking in healthy profits.

(snip)

The Affordable Care Act kept profit margins in check by requiring companies to use at least 80 percent of the premiums for medical care. That's good in theory, but it actually contributes to rising health care costs. If the insurance company has accurately built high costs into the premium, it can make more money. Here's how: Let's say administrative expenses eat up about 17 percent of each premium dollar and around 3 percent is profit. Making a 3 percent profit is better if the company spends more.

It's as if a mom told her son he could have 3 percent of a bowl of ice cream. A clever child would say, "Make it a bigger bowl."

(snip)

https://www.npr.org/sections/health-shots/2018/05/25/613685732/why-your-health-insurer-doesnt-care-about-your-big-bills

[democratisphere]

1. The Entire American Criminal Enterprise Healthcare System is absolutely and totally corrupt

from one end to the other.

[Hoyt]

2. If the company spends more, its premiums are likely higher. Who is going

to knowingly pay more in premiums, especially when the rates are easy to compare on the exchanges.

No doubt, insurance companies are a drain on healthcare expenditures, as are those who profit from healthcare, some patients, some government officials, etc. But this is one criticism that is hard to believe.

Most payers who reimburse hospitals, etc., “too much,” aren’t big enough to leverage reimbursement negotiations.

[area51]

3. It's the 21st century,

long past time for a sane medical system. If you agree, please contact Speaker Pelosi and ask her to support this.

[FiveGoodMen]

4. As a recently self-proclaimed fan of capitalism, Nancy will not want to help in this way.

[earthshine]

5. Pelosi seems to want only to restore order.

She wants to get the "ship of state" back on course, but she will never attempt to steer us to better waters.

She will impeach Trump only if she has no other choice.

That's why I only support the presidential candidates who put forth policies that may improve things for the common folk. A message of anti-Trump is not enough for me.