this post was submitted on 20 Aug 2023
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Technically insurance only works if everybody pays in. Wouldn't work as a concept if every tom dick and harry could pay them $100 then a week later need $100,000. They'd basically be out of business right quick with nothing to provide for anyone. Maybe as some believe it should just be provided through taxes, but it's certainly not a scam.
The scam part comes when you are forced to fight tooth and nail to get money from them even when you are clearly covered
This. For non trivial claims they basically won't lift a finger until you take them to court.
This. I got a detailed bill for a minor surgery, every single value was under the value of their own detailed coverage, and they still didn't pay back around 12% of the value and never justified what the difference was about. They did it because they know I won't fight them on it and they do it to everyone. That objectively and legally makes their detailed coverage a scam.
I’ve always said that insurance companies will spend dollars to figure out how to cheat you out of dimes.
It’s true insurance companies need to take in adequate premiums in order to have the money the money to pay claims. And when done in balance, insurance is a great thing. Not all insurance in a scam, no doubting that.
But the current state of insurance, especially health insurance in the US, shows that these companies are making massive profits. How does this happen? Literally one way: They take in more premiums than they pay out in coverage. How? By either knowingly overcharging people or skirting out of paying covered claims through other means (such as baseless rejections).
That’s the problem with the entire insurance industry and why it must be properly regulated in any industry: It is a race to the bottom. The worse the insurer treats the people that buy insurance from them, the better the company does financially (charge a lot, pay out a little). Mix in the fact that (1) you cannot shop around at the time you need a claim and (2) the contracts are so intensive only a sophisticated legal team can interpret them, and it’s a recipe for disaster.
So you’re right that all insurance isn’t necessarily a scam. But if you can’t see that the US health insurance industry raking in profits shows serious dysfunction that could be considered a scam, it’s worth taking a second look.
Nobody works for free. In order to be a large effective and not out of business business you need to have a profit to cover overhead like staff.
Profit is revenue minus expenses
Did someone say people should work for free? No where am I saying that. Massive profits are not necessary to cover overhead - expenses like overheard and salaries are paid for by revenue - what’s leftover is profit.
This thread is about whether the current US healthcare insurance industry is a scam or not. Scam means “a dishonest scheme” and insurance saying it’s going to provide healthcare coverage but actually just takes your money, doesn’t provide coverage, and only pays investors/executives could be considered a dishonest scheme by many.
Insurance companies have a natural tendency to become worse and worse over time. This is called the race to the bottom and is an incredibly well-known phenomena in insurance. Like monopolies, insurance is one of the rare situations where experts are in damn-near universal agreement that heavy regulation is necessary.
Right now, insurance companies are objectively very bad to the people they provide coverage for. This isn’t an opinion, this is a fact that’s easily verified and well understood. They are not being effectively regulated and as such, are racing to the bottom by providing absolutely terrible coverage while taking in massive premiums. This is not good for anyone and is not fixed by a free market in any way. You cannot effectively shop for insurance and their behavior is not rectified, unless prohibited by law (regulation).
I only posted what I did because your post read like you expected insurance to run by paying out 100% of what they get in. The thread started with general insurance but many zeroed in on health insurance. Yes there are problems, obviously, but certain things like denying claims comes about from many people trying to scam payments and the insurers tightening security too much without enough oversight.
Everybody seems to think there's huge payments going to investors and C level executives but that comes from market confidence. So the stock price rises and those bonuses of stock options appreciate without the company paying a dime.
United Healthcare pulled in $20 BILLION dollars in PROFIT in 2022. The ceo was given $24 million in compensation for that year. Denying claims because of scams? They can afford it.
How was that compensation structured? Was it cash or stock? And how much money would they spend if they didn't act paranoid about false claims? Would that dissolve the 80 billion because it's possible.
Aside from that, did you notice this is a 2 month old post?
About $4 million was non-equity pay. Around $19 million was vested shares. He had a 331 : 1 ratio to the average employee. They can afford to pay people’s urgent medical bills without denying claims. If we are required to have insurance to be able to get BASIC needs met, that insurance better meet those basic needs. It’s especially rough for people with less money and less opportunity. Some people live paycheck to paycheck and their claim being denied means that hospital bill now forces them to choose between rent or food.
I do realize this is a 2 month old thread. There’s like 15 posts in my feed. Normally, I tend to lurk and not comment. Lemmy has a bit of a content drought, and I figured people would be happy with more comments or discussion, even on slightly older threads. If your opinion has changed I’d be happy to discuss that as well.
The point of my stance wasn't to say the world is perfect and nothing should change. Only to try and point out the potential reasons for how things are beyond "they're evil".
But the problem is that medical costs are only as high as they are because of insurance. Hospitals started making up fake, artificially high prices because insurance companies wanted a discount for referring patients to their hospital.
I've heard many a tale of contacting the billing department and telling them you don't have insurance and either they can get what money they actually need or none of it. They end up getting a much smaller bill.
I'm not in the US, but one of the issues I have with medical insurance is that, say you need medication, the doctor will provide you with a prescription, requiring a specific brand due to the efficacy compared to other brands. The insurance providers would reject claims for the prescribed brand, and suggest an inferior brand that doctors warned to avoid.
This happened to my older folks, and is baffling why insurances feel the need to override a doctor's recommendations.
They were the same drug. The generic version is made after the original patent runs out and is an exact copy.
Perhaps, but this is what was advised by the doctor, so I don't know
Not necessarily. I'm on a daily medication that has a generic but is available in both extended release and immediate release forms. The extended release provides a more consistent dosage and has historically prevented me from getting sick. The immediate release causes inconsistent spikes and I have a history of getting sick on it. Insurance refused to pay for the extended release type for about 2 years before it made it onto their "formulary." In the meantime I was using GoodRx and paying $100/mo instead of my paid health insurance pharmacy plan to make sure I wouldn't get sick. The person I spoke to at the pharmacy management wing of the insurance company literally told me "you can get an app on your phone which will tell you when to take the immediate release medication."
Hold up don't forget that in the US, healthcare providers base their pricing on what they will receive after insurance discounts. This creates a massively overinflated market where most of the value is made up and a large portion of actual payments goes to insurance and corporations
Insurance policies are many and varied, covering different types of risk.
Many policies are potentially scammy in some circumstances.