Comment by lesuorac
1 day ago
> So, no, paradoxically, it is not in the interest of people paying for the treatment to save money. Quite the opposite.
I'll assume they're on company insurance. Which is often "self-insured" in that the company actually foots the bill as opposed to the insurance company.
Why don't corporations just drop insurance companies that decide to not allow cheaper medicines?
UNH is so big because its customer Apple has its own pool. Apple deducts $24k/y for your healthcare. Healthy 29 year old male doesn't use anything. UNH denies the claims anyway. It gives that money back to Apple, which doesn't give it to you.
The 80% rule has a lot of loopholes. It doesn't apply to employer funded plans. There's a reason UNH is so big!
Employer funded plans are not all the same. Large entities with a lot of money (like universities, big firms) self-insure. Thus the insurance company in those cases is simply managing all the administrative sides of insurance while the plan owner is the actual insurer of risk.
There’s an article about how a Wall St employee’s expensive care came up in C-suite meetings, as a real world consequence of this
> simply managing all the administrative sides of insurance
if you punch into a chatbot questions about the employer pool insurance product, your comment is exactly how the chatbot characterizes it.
of course, "administrative sides of [health] insurance" includes requiring pre-auths and approving/rejecting claims, which is, haha, all the fucking evil parts of what they do! it's not "simply" anything. they need a huge, comprehensive, defensible model of what regulations and customers will accept as valid healthcare. apple does not need to have an opinion on ten thousand treatments and the standard of care across all these things. the insurance company does.
this is a line of investigation that the chatbots are absolutely terrible at informing people about. "administrative" is ALL the work, that is why UNH is big! you are starting from the wrong premise. you must always ask yourself, why are health insurance companies so big?
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