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Hmmmm, what's the explanation/incentive for their wildly shittier business practices then? They must be making money somewhere off of the sky high denial rates, no?
They make money off of denied claims, but the strategy can only go so far without falling afoul of ACA profit caps. They certainly aren't incentivized to pay out much more than 80%, it's just that even with high denial rates they can hit that target due to the difference in what they pay providers vs what they charge customers.
I mean I didn't realize it was premiums and not profits that's a my b, but there has to be some explanation for why their behavior is so much more obnoxious than providers and way their denial rate and so on is so different (30% more I think?)
Are you sure you don't find them more obnoxious because you are a provider yourself? I find it pretty obnoxious when nobody at the hospital can tell me what a procedure will cost, or when they charge me over $500 for some saltwater.
I mean a 30% higher rate of random denials seems pretty assholish no?
There exists staff in the hospital who can tell you how much the "charge" (but not necessarily the "cost") is for a given thing but they don't interact with patients because our healthcare system is based around patients not paying for things themselves directly, these staff interact with the people who are paying (insurance companies).
Depending on the details of the specific complaint, your bag of saline costs a shit-ton of money because it was made and stored in a sterile setting with a restrictive expiration date and was handled by a large number of staff, all of which as per government regulations, or because the number is completely made up in a weird voodoo dance that exists to get insurance to pay for things.
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