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.
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?
There is no law that they must refund anything. They already have the money.
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?