Just so tired of almost every time a doctor submits stuff to insurance, we have to be the ones to make multiple phone calls to both the doctor’s office and insurance to iron everything out, figure out what the issue is (it’s always a different issue), and basically be the go-between for the office and insurance. What am I paying $500+/month for?! It’s like paying for the privilege of having an exhausting part-time job.
And yes, I understand that insurance wants to weasel out of paying anything, but this isn’t even shadiness, just straight up incompetence and lack of communication/following procedures. The amount of emotional energy we have to spend untangling this stuff leaves us drained.
They get paid when the least amount of people they insure use their services. They’re not incentivized to help those they’ve insured. The less they have to pay out to providers, the better the executive bonuses. Thus, they are diligent in collecting premiums, but can just sit on their hands when it comes to paying out.
The more the system denies and delays a claim, the fewer insured people are willing or able to put themselves through the bureaucracy gauntlet, the fewer pay outs.
They’re not in the business of insurance, they’re in the business of making money from the business of insurance. It’s over-complicated on purpose.
And what might be the most important part cannot be elided over: market capitalism is HIGHLY efficient at solving optimization problems, but it only responds to incentives.
So if you can create the right incentives to reward the result you want and punish results you don’t want, a market solution is going to do a marvelous job. It’s great at, say, price discovery. But if the incentives do not align with the desired result, it’s going to grind you under heel.
The incentives the insurance companies are responding to, frankly, are the ones you have outlined and essentially no others. Collect more premiums, make fewer payouts. There’s no “breaking point” here because they have an absolutely vast customer base that has no choice to opt out of the system for a variety of reasons (ranging from the ACA individual mandate to the fact that it is not possible for an individual to make fully-informed financial decisions about their health even WITH advanced knowledge and training that nearly no one has).
Health insurance is pretty much a textbook example of the kind of service that shouldn’t be on private markets.
So over time, market capitalism is going to make them collect endlessly-increasing premiums and pay out less and less. It is going to continue to get worse because the incentives of the system have defined ‘worse’ as being the optimal result. Period. It will eventually get nationalized. Period. All the argument in the meantime is just over how long we want to continue to let people be sick and broke before we apply the only fix.
You’d think that the doctor’s office would at least be motivated to fix the problem so they get paid, though, 'cause I’m sure as Hell not going to!
