United Healthcare CEO killed

The Coffee Shop
102

There’s no reason for insurance companies to be entirely non-profit. But maybe it’s worth tightening the rules where the insurance companies should be getting profit from, as there’re multiple channels / options, see below:

  • Main source of insurance income is by using a margin. If your risk is 5% of losing 100 USD, you would pay 10 USD premium and if the risk materialises you get 100 USD payout. This is normal on a large scale because humans are risk averse in general. The margin can be a field of competition between the insurance companies. I have zero problem with this income channel.
  • Let’s say insurance companies just create a pool of risk, a portfolio, with no margin. If your risk is the same 5% of losing 100 USD, but you pay only 5 USD premium and if the risk materialises the insurance company pays you out 100 USD. In such a model, the main way to earn money for insurance companies is through investing. They collect the money in t=0, but they need to pay it out later in t=1, giving the company a chance to get an interest on the total fund. Every insurance company does it and I have zero problem with this income channel.
  • The problem starts, when insurance companies try to cut costs / payouts. If your risk is the very same 5% of losing 100 USD, you would pay 6 USD premium and if the risk materialises you hope to get 100 USD payout. But the insurance company finds a way to pay you only 50 USD. Sometimes also after a long fight, so extending the time when the insurance company can make money through investing. This is dirty business I don’t approve it myself.
  • Insurance companies could also be earning money through data, in a good way (e.g. advising on climate change, advising on flood-risky regions) or in a bad way (e.g. selling data for targeted patients). But I don’t know much about it, so won’t speculate.

Edit: I’m a finance / IT management consultant, so my insurance domain is limited, but I used to consult a top tier re-insurance company for years.

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103

I hate to agree with Jim but watch when the gun kicks, the victim jerks his left leg up and then hops/stumbles on his right leg

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104

Disagree, though I see the analysis. I see a person who just got shot center of mass and stumbles, and then clutches the leg only after he’s on the ground and second shot is off.

Disirregardlessly (say it in a Boston accent), to definitively say this man was shot leg first is an overstatement of the evidence.

105

I think a better alternative to paying for unproven or disproven treatments would be to charge lower premiums in the first place.

106

I don’t think anyone has mentioned this book;

https://www.amazon.com/delay-deny-defend-Books/s?k=delay+deny+defend&rh=n%3A283155&hvbmt={BidMatchType}&hvdev=c&tag=googhydr-20&ref=pd_sl_5drh44zcl3_e

Delay, Deny, Defend, Why Insurance companies don’t pay claims, and what you can do about it.

He did something about it.

2 Likes
107

Sure. Lots of ways to address this, none of which will be popular with any of the insurance companies. With the size of insurance industry lobbies, and the power they hold in DC, change will be slow and difficult to impossible.

108

I don’t understand why insurance companies and hospitals have not already been brought up on price discrimination and tying laws that exist. Limit any discount to 5%. It’s even flip flopped recently with hospitals offering cheaper “cash” prices- which in effect gives the insurers even more profit as less people hit their deductibles. If an x-ray is $100 allow them to charge $95 - $100 but any more is price discrimination. Getting it for $45 only if you have insurance should be investigated as price tying.

We have these laws on the books - but we don’t seem to use them.

This company wanted to see how much they could milk the system and the answer appears to be - not this much.

109

All of the above are currently in play to some extent. Further regulation is not likely to be received well by insurers though.

I had a data/analytic job for a large insurer in the past. Insurer was auto/home, they didn’t do medical (which has a lot of other complexities). The company I was at worked very hard to maintain a positive brand, reputation, perception. And a lot of effort going to ensure that the claims experience was positive. In order to succeed from a profit and business perspective they had to be very good at managing risk - i.e. covering “good customers”, minimizing “bad customers”. Maximizing profit by denying / reducing payouts wasn’t their strategy as that’s damaging to the brand/biz, as we’ve seen. But lot’s of other insurers don’t seem to care as much.

110

Just as the Sandy Hook massacre didn’t change anything, so too this won’t change anything. Anyone think there is any kind of “come to Jesus” moment that will change how medical treatment is handled in the US?

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111

I feel like there are a lot of issues involved here:

  • incomprehensible insurance contracts
  • Confusing billing from various healthcare providers
  • Lack of bargaining power
  • Lack of knowledge regarding recourse for claims denied or delayed
  • The need for investigation to determine actual versus fraudulent or unreasonable claims
  • AI which significantly changes the power balance in favor of whoever uses it.

Complicated Insurance Contracts: I have been very pleased with coverage and claims handling in my life. My ex’s cancer treatment was successful and timely, but he advocated for himself aggressively with the insurance company. Our homeowner’s claim for a water leak was handled well, but I worked tirelessly on that. Recently I had a theft of jewelry at my house, and I’ve felt kind of screwed. I bought $147,000 in contents coverage with $10,000 limit for jewelry, and I am not being compensated for the replacement of my stolen stuff, which is below that $10,000 limit. Why did I buy coverage that doesn’t actually reimburse my loss? I’m a lawyer, and I don’t know what recourse I have. This bolded question creates so much anger because we expect insurance to honor commitments in our time of need. Hence bad faith litigation.

I did insurance coverage work for a while, which means I read insurance contracts and wrote coverage letters. Insurance contracts are not written in plain English. I like challenges so I actually enjoyed doing that work, but most people don’t have time for that. This is a problem. I think it’s okay for people to deal with complicated contracts (home purchases, for example) every once in a while. It’s not okay to force people to deal with complicated contracts for health care, which is a monthly or yearly thing for most people.

Confusing billing: the various bills and payments from each provider or medical group are confusing, and patients are forced to bear the cost of mistakes rather than the businesses. If patients had one fee, they would not be flooded with information which has the effect of masking mistakes that costs patients money.

Lack of bargaining power: when health insurance is tied to employment, we are not able to shop around or maintain coverage independent of our employment. The market is not free, and there is no actual bargaining happening for most people.

Lack of Recourse: I’m absorbing the loss of my jewelry because I don’t have the time, energy to pursue it. I would have to file a claim with the California department of insurance, but I’m not even sure. ?

Claims adjusting: I defend medical care providers now, which means I see these healthcare systems (who are self-insured) in my current work. The process to determine reasonable claims and fraudulent claims is necessary. It is labor intensive. I can understand shifting to estimating computer programs and AI. But patients don’t have those resources. The balance of information available to the contracting parties gets more out of whack.

AI is significant issue. I have wanted to ignore it, but I can’t. It is everywhere, including my work.

112

In viewing this thread, I received that Seniors Choice ad for Life Insurance:
image

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113

Well for the record we still don’t have the reason for the shooting, only speculation. If it was personal and not business related then you are right there won’t be any change. If business related, we’ll have to wait and see (and hope).

114

That isn’t what happened. They adopted the medicare payment structure. Patient is still getting anesthesia for the entire surgery, you fell for the anesthesiologist propaganda.

115

Big Anesthesiology is like Big Pharma or Big Egg?

Or, alternatively, Medicare reimbursement is insufficient?

116

There are a lot of complicated issues, for sure. As a chronic cancer patient, I’ve had to navigate them over the last few years. Fortunately my employer and Anthem BC/BS and the specialty pharmacy have all been fantastic and easy to work with.

This podcast was timely and one of the most educational I have listened to in years. It demystified a lot of the complexity in the US medical system and is well worth the time for anyone that is interested in understanding how we got where we are.

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117

No, that isn’t what happened either. They were going to pay for anesthesia only to the surgical time limits from a Medicare/Medicade spreadsheet that very few/no surgeons use, and no one can tell where the data comes from. This was to avoid fraud from anesthesiologists, but they would not quantify that.

118

But either way patients are getting the anesthesia needed and Taylor Lorenz shouldn’t be calling for further hits as patients are getting screwed.

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119

The question isn’t if they are getting anesthesia but if they are also getting the previously popular free medical bankruptcy with anesthesia offer.

ETA: Anesthesiologists are probably the #1 type of doctor most likely to financially ruin you on the worst day of your life. It’s probably the VCs that own them. But either way it is what it is.

120

Can you expand on this?

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121

They are getting it, but the insurance they paid for isn’t covering it. Anthem Blue Cross profits $1.1 billion in 2022.