The company says it is protecting nursing home residents by curbing unnecessary hospital transfers. Whistleblowers allege cost-cutting tactics have endangered the elderly
The entire purpose of health insurance is that the patient doesn’t pay for their care entirely out-of-pocket. If the balance owed by the insurer for treatment costs more than their premiums, then the insurer is losing money on that patient. If the insurer arranges for the patient to die, then they stop losing money on that patient.
I literally just told you. Also, I have no clue what you’re imagining with this nonexistent rebate scheme. The patient won’t be paying any more premiums after they’re dead, but they won’t be costing anything, either. Insurance doesn’t have to give back any previously paid premiums.
Scenario A: The company takes in $1B in premiums. They spend $800M of it on healthcare costs. They pocket $200M.
Scenario B: The company takes in $1B in premiums. They deny coverage for $100M. They spend $700M of it on healthcare costs. They rebate their subscribers $100M. They pocket $200M.
How did those denials put more in their pocket? It’s 20% no matter how you slice it.
Because instead of a physician deciding whether or not someone is transferred to a hospital for treatment - which the insurance company is liable for - the insurers decide who goes or doesn’t go. Seems mostly doesn’t go is their first option, no matter the need.
For that one person, yes. But I’m asking how the whole “delay, deny, defend” tactic allows them to pocket additional profit that they don’t otherwise have to pay out in healthcare or rebates.
The exact same thing works for multiple people, especially when averaged out. If they avoid spending a bunch of money on 10 people the average spending overall goes down. Even if they have a limit on how much they can profit, doing this pretty much guarantees a profit while sending them to the hospital every time it is necessary means less likelihood of making a profit because it costs them more both in payments and the internal costs of processing the payments.
Is the concept of spending less means they get to keep more of what they collect too complicated?
For that patient, probably, but how does that lead to their profits increasing overall, is what I’m asking
The entire purpose of health insurance is that the patient doesn’t pay for their care entirely out-of-pocket. If the balance owed by the insurer for treatment costs more than their premiums, then the insurer is losing money on that patient. If the insurer arranges for the patient to die, then they stop losing money on that patient.
But then they have to rebate the remaining balance from the premiums they didn’t spend on healthcare costs.
How does that make them more money overall is what I’m trying to understand?
I literally just told you. Also, I have no clue what you’re imagining with this nonexistent rebate scheme. The patient won’t be paying any more premiums after they’re dead, but they won’t be costing anything, either. Insurance doesn’t have to give back any previously paid premiums.
Scenario A: The company takes in $1B in premiums. They spend $800M of it on healthcare costs. They pocket $200M.
Scenario B: The company takes in $1B in premiums. They deny coverage for $100M. They spend $700M of it on healthcare costs. They rebate their subscribers $100M. They pocket $200M.
How did those denials put more in their pocket? It’s 20% no matter how you slice it.
In scenario B they don’t rebate that money. They keep that. Where did you get this idea they rebate money?
The law? What do you mean
That does not exist.
Huh?
Because instead of a physician deciding whether or not someone is transferred to a hospital for treatment - which the insurance company is liable for - the insurers decide who goes or doesn’t go. Seems mostly doesn’t go is their first option, no matter the need.
Okay, but I’m asking how they profit from that
Because they aren’t spending their money for the ambulance service and treatment of the patient at the hospital.
They’re not profiting by increasing their bottom line. They’re doing it by not paying healthcare bills for the patient.
See my other comment
Whatever then.
¯(ツ)/¯
Whatever?
They take in the same amount of money and pay less because the person doesn’t go to the hospital.
For that one person, yes. But I’m asking how the whole “delay, deny, defend” tactic allows them to pocket additional profit that they don’t otherwise have to pay out in healthcare or rebates.
The exact same thing works for multiple people, especially when averaged out. If they avoid spending a bunch of money on 10 people the average spending overall goes down. Even if they have a limit on how much they can profit, doing this pretty much guarantees a profit while sending them to the hospital every time it is necessary means less likelihood of making a profit because it costs them more both in payments and the internal costs of processing the payments.
Is the concept of spending less means they get to keep more of what they collect too complicated?
I see you’ve downvoted all my comments here, so you know I’ve already laid out how the math works for each scenario.
Your math was bad and you seem unable to grasp extremely basic concepts of how companies work.
What part of my math was bad?
Yes.
So all of it?