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Which are the not-scummy ones?
I have had pretty good experiences with Premera Blue Cross Blue Shield. My employer actually just started offering a United plan to us this year, though I did not elect to use it.
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TriWest was a southwestern US insurer for veterans and their families. Valid claims just sailed through with minimal administrative overhead because their claims system was well automated and optimized.
They were good and not-scummy.
UnitedHealth bid a lower cost for the contract, won it, and promptly started denying most claims on the first pass. Only clinics which sent appeals would get paid, and almost always did.
The scummy behavior isn't just on the insurance companies: [redacted] went to a medical provider that decided to code every (scheduled!) specialist office visit with an ER facility fee, and the insurer just shrugged and said it wasn't their problem and wouldn't do anything about it until the out-of-pocket maximum, even though they would have covered such fees for a real ER visit (conveniently, this happened to save them money). Not really much you can do unless you have a competent HR department on your side, which I've been fortunate enough to personally have in the past, except pay it, call and complain until they reduce the charges, and/or leave poor reviews.
I'm not sure I'm qualified to make good suggestions about how to improve medical billing, but it's pretty clearly a mess of opaque charges. Trump in 2019 forced providers to publish price lists, which I'd have though might improve things, but it doesn't really seem to have. Active price-fixing is generally bad for all the well-known reasons even if more uniformity in prices for, say, appendectomies would make arbitrage easier. Are there any real proposals with a sound economic basis for improving things? As much as I don't like throwing up my hands in not understanding complex systems (and deferring to Chesterton on the subject of fences), I don't exactly have a better suggestion at hand.
Price transparency is always better because it cuts down on asymmetric info and makes the market more efficient, but I think the effect from these is mostly going to be behind the scenes, from the perspective of the average consumer.
For one thing, you can't pick and choose which insurance company pays for which service. If Walmart is charging less for a product that I usually buy at Target, I can just buy that one thing at Walmart and keep buying my other stuff from Target. I can't do that with medical services.
Also, even with a publicly-available price list, I can only use that list if I know exactly which line on the massive spreadsheet actually applies to me. And then, what do I do with that info? If my open enrollment period is coming up and I know I have a major procedure after that, I could do the research and switch plans, but how many people are in that position?
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looks around furtively
Yeah.
But United has a particularly bad rep.
That was actually a serious question!
Unfortunately that was a serious answer, even public options like medicare and medicaid are pretty awful.
Which puts United having an even worse reputation in an uncomfortable place.
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