The company says it is protecting nursing home residents by curbing unnecessary hospital transfers. Whistleblowers allege cost-cutting tactics have endangered the elderly
Well for starters, in your breakdown, isn’t the insurer paying some baseline amount to the nursing home? So if they don’t bring you to the hospital, aren’t they still paying out some portion of that to the home by default?
But okay, let’s say it would cost the insurer $1000 per month when regular hospital transfers are involved, and $500 per month to keep them there (just for easy numbers). Then, throw in the $100 bonus to the homes that do it, that’s $600 of the initial $1000 premium that the insurer spends instead of the full amount.
But after rebates, the insurer gets to pocket $200 of that thousand. The other $200 they’re either using to pay out other claims, or sending it back as a rebate (which they obviously want to avoid).
So I’m definitely seeing how the nursing home profits, but what’s the incentive for the insurer?
Well for starters, in your breakdown, isn’t the insurer paying some baseline amount to the nursing home? So if they don’t bring you to the hospital, aren’t they still paying out some portion of that to the home by default?
But okay, let’s say it would cost the insurer $1000 per month when regular hospital transfers are involved, and $500 per month to keep them there (just for easy numbers). Then, throw in the $100 bonus to the homes that do it, that’s $600 of the initial $1000 premium that the insurer spends instead of the full amount.
But after rebates, the insurer gets to pocket $200 of that thousand. The other $200 they’re either using to pay out other claims, or sending it back as a rebate (which they obviously want to avoid).
So I’m definitely seeing how the nursing home profits, but what’s the incentive for the insurer?
I feel like there is enough for you to work it out. Which insurance company do you work for? ;)
Just a downvote? That’s a shame, you seemed like the most good-faith one here.
I don’t have voting enabled in my client. So, it wasn’t me.
https://lemvotes.org/comment/piefed.nullspace.lol/comment/922611
Oh swiping is downvoting. Hmm. That’s also “back”
Poor interface.
Fixed 😇
What do you mean, “there is enough for you to work it out”?
For real – what am I missing?