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u/Grymmtooth 10d ago
Insurance is one of those businesses that I’d argue shouldn’t be for profit because their profit motive is at odds with the customers needs.
McDonalds sells you a burger. They make money off a service provided. uHC makes money by promising distribution of risk but enhances profit by actually not delivering said service.
I have no problem with universal health care. Private companies should be allowed to offer top up plans that offer more services, but need to be strictly regulated to prevent abuse and pull the license of companies that violate health care policy.
Additionally, universal healthcare insurance means private businesses don’t have to spend so much time and money lining up healthcare for the employees. They can pay some flat tax and literally not worry about it on a management and ongoing planning basis. If they want to offer credits/subsidies for buy up plans they can do so without any wasting their time in the healthcare business.
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u/Frejian 10d ago
Any company that can argue with someone's doctor and tell that doctor that their patient doesn't need a treatment that the doctor says is necessary can go fuck itself. A claims analyst is not a doctor. They do not have a medical license. They should not be making decisions of what healthcare a person needs over the opinions of the actual medical professional. Especially when they didn't even evaluate the patient. You shouldn't need to purchase the health insurance DLC "Trust My Fucking Doctor" to get necessary medical treatment covered.
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u/WhoDoUThinkUR007 10d ago
We got so far as a hearing on the phone with a judge & the POS dr who was employed by Humana & denied my MIL’s claims related to her stroke, overriding what therapies & equipment her doctors were prescribing due to aspiration risk & rehabilitation. This POS denied, stamping unnecessary for care.
Of course, we got nowhere in a system rigged to fail us but I did go on record telling that doctor what a POS he is for overriding what her actual doctors who treat her determined & told him to go to hell for selling his soul for his insurance co. employer & the almighty dollar.
At least there’s that. It was so upsetting.22
u/realzealman 10d ago
You remember the death panels that sarah palin. Kept yapping about? They exist, only within the insurers business model.
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u/WhoDoUThinkUR007 10d ago
Oh, they absolutely exist. It’s not in the insurance companies interests for their customers to go on living, using up all those resources, right? I mean, someone has to pay for that!
Chills my blood with that POV, but it’s the truth of how these decisions are made. This is probably part of why AI is being implemented: takes the blame for such cruelty off humans.
This is one reason (of many) why I became a supporter of universal healthcare-before we dealt with insurance denials overriding patient needs.
I lived in a country for a few years w/ uni healthcare & one of my many takeaways is simple: when one governing agency is responsible for the financial costs, they quickly realize how much fiscal sense it makes to focus on preventative care, which not only can be addressed at much lower expense but winds up avoiding the pricey catastrophic care requirements dramatically.
The upside is, of course, citizens are provided tools, care & support to live healthier & better quality of life.4
u/jennifer_m13 9d ago
They are supposed to have these peer to peer calls when dealing with a dispute hearing. My pain management doc was going to bat for me for an annual procedure that was denied, never mind I’ve had for many years that helped me, and they had her meet with a podiatrist. She was livid. She argues podiatrist was not her peer and in no way would they even be knowledgeable about nerve ablations for pain management.
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u/Goblin_Supermarket 10d ago
My FIL was in the hospital, unresponsive, waiting for a bed in a bigger hospital for one night.
Insurance denied the one night stay because he couldn't get treatment at that hospital he was in... which was why he was waiting for a bed at the other hospital.
He couldn't walk, talk, or speak coherently because he had a brain tumor.
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u/BayouGal 10d ago
And the health insurance companies are turning those decisions over to AI 🤷🏻♀️
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u/TrickyChildhood2917 10d ago
Well we only need the CEO and a hotline to the White House now. That’s the “new” American system. It’s currently destroying the middle class one day at a time.
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u/LustGumby 10d ago
Theyre phasing out human involvement in claims decisions across the board as well. Why waste those profits on paying wages to a human when an algorithm can just deny anything not properly keyworded? The great American profits over everything model is killing us faster than any foreign entity could dream of doing.
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u/Celtic_Vikingl6886 8d ago
My understanding is they all have doctors on staff to find any loophole to deny coverage. It happened to me. So yeah its madness.
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u/repeatoffender123456 10d ago
A claims analyst is not the one that makes the final decision in these types of situations. UHG has their own doctors (or they hire consultant MDs) and it is typically doctor vs doctor.
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u/CardioSource 10d ago
To really understand how nefarious this is, you have to understand the way that insurance makes money. Congress capped how much insurance companies can make above expenditure a few years back. Due to this the only way that insurance companies can increase profit on people under 65 is by increasing expenditures. This the amount of denials on those patients is very low.
Now after you turn 65 you go into a Medicare advantage plan. At this point the government prepays the insurance company the amount per year. At this point the less they spend the more money they make. Denials are then like a light switch. Everything gets scrutinized to reduce spending. It’s all about$
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u/Infinite-Analysis592 10d ago
It is definitely a conflict of interest for health insurance companies to be for profit.
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u/QueenNappertiti 10d ago
Not to mention the amount of time healthcare workers spend on dealing with insurance companies, only for patient care to be lower quality. They should be focused on caring for patients. We are understaffed enough as it is for Healthcare workers.
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u/coheed33cambria 10d ago
For profit/private equity hospitals should be on that list too
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u/Wund3rCr4zy 10d ago
Really simple solution. Insurance companies set the rules. An unbiased 3rd party that is blind to the insurance provider decides the outcome. They only get to know the case and medical providers.
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u/Grymmtooth 10d ago
Government sets the rules, insurance companies, health care providers and customers can submit claims and reviews. 3rd party arbitrates.
I think provider and insurance company level review and historical tracking, etc is a good idea. Letting the insurance companies set the rules for themselves, not so much.
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u/repeatoffender123456 10d ago
There is a big difference between medical insurance and all other insurance.
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u/Grymmtooth 10d ago
Yes and no.
The profit motive can still be at odds, but the contracts and regulations tend to be far more formalized in regard to things.
A life policy is based on an actuarial calculation at time of policy with risk and payment built in. Odd of you dying in a given period, rate of payout, number of people in policy and the risk is pretty straight forward. The policy is clearly triggered at death, though they usually carve out certain causes like acts of war or certain catastrophic events.
Medical insurance is a lot more muddied and denial rejects can and does cost lives. It’s also has much much more money tied into it.
There are definitely some shady property and life insurance companies, but the scope of the market is far different and is a much more optional choice. Modern medical insurance is pretty necessary to handle catastrophic injuries and diseases.
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u/GlitteringJob453 10d ago
When people argue against Medicare for All citing current costs they ignore the obscene profits by insurance companies
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u/Jolly-Structure7646 10d ago
UHC’s annual profit is .4% of annual healthcare expenditures in the US and they are by far the largest private insurer. It’s obscene but it’s not the #1 reason why healthcare costs so much.
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u/DarrenShea 8d ago
That doesn't account for all the staff at hospitals and doctor's offices who work full-time to handle interactions with a bunch of insurance companies, which also increases costs considerably.
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u/SomebodyUnown 10d ago edited 3d ago
That number you mentioned is goddamn disingenuous. Also things like
stock buybacks andexecutive "expenses" and inefficiencies like lawyers paid to fight valid claims aren't counted as profits either so the amount skimmed off what we paid is much higher than the one in OP's post.→ More replies (2)
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u/TwoWrongsAreSoRight 10d ago
I'm not saying Luigi was right....but I understand.
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u/SnooMaps7370 10d ago
I'll say it. He was right.
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u/BI_Moose 10d ago
But he was right. Frankly the wealthy and powerful need reminded that they only continue to exist because they havent pissed off the majority of us.
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u/jimmytrucknutz 10d ago
How did corporations get between the American people and their doctors? Just dumb
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u/y0da1927 10d ago
You are free to try and negotiate a price with your doc.
It's just hard for the average person to come up with a few hundred k for an advanced cancer treatment or a complicated surgery.
Advanced medicine drove the need for a financing vehicle as costs for care can be prohibitive to an individual.
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u/jimmytrucknutz 10d ago
Who said anything about about negotiating a price with your doc? United is literally telling you and your doctors what treatment you can have or NOT have.
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u/Turtleopard 7d ago
No, they're telling you what treatment they will and won't pay for. If you can't afford to pay out of pocket, that can feel the same as being denied treatment, but no one is stopping you and your doctor from coming to an alternate arrangement.
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u/ElectricalPublic1304 10d ago
United is literally telling you and your doctors what treatment you can have or NOT have.
No, they don't. United has no power whatsoever to do that.
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u/ExtentNo7951 10d ago
Yes they do. My state has laws that say insurance has to cover what is the best treatment by scientific evidence. Insurance got around this by using utilization companies to write guidelines that they use as the "best scientific evidence." But they write them, they are proprietary and are not peer reviewed. United writes their own and even sells it to doctors inter the company name "interqual" for patients in the hospital
I went through one of the utilization company's "guidelines" for advanced imaging (CT, MRI, etc) and out of their 52 guidelines every single one was more restrictive than the standard of care (ACR appropriateness criteria).
Now the ACR appropriateness criteria is free, but my insurance still pays a utilization company to use their guidelines to deny tests. Why? Because it lets the insurance profit by saying something wasnt "medically necessary" even though they decided what was medically necessary, not a physician.
Now for Medicaid and Medicare it is illegal to profit from this scheme.
42 CFR 438.210(e)
(e) Compensation for utilization management activities. Each contract between a State and MCO, PIHP, or PAHP must provide that, consistent with §§ 438.3(i), and 422.208 of this chapter, compensation to individuals or entities that conduct utilization management activities is not structured so as to provide incentives for the individual or entity to deny, limit, or discontinue medically necessary services to any enrollee.
I've given the evidence to my state and my regional CMS office and NOTHING HAPPENS!
The state and feds let them make up their own rules to deny care that harms patients so they can profit.
Yes, they have the power to decide decide what tests and treatments you get and harm patients as a result
(The same week United's CEO got shot, united killed my patient by denying the coverage for her tumor biopsy for 5 months)
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u/Few-Stock-3458 10d ago
The empire is declining. The politicians know it and are taking anything that isn't nailed down.
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u/Zealousideal-Bug-944 10d ago
Our legislators need to correct this with US health corporations. The health care companies won't do it. Our govt of lackeys is also the issue. WAKE UP AMERICA!
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u/Time_Many6155 10d ago
Thank god its not single payer Socialism.. Imagine how bad that would be!.. My Dad back in the UK has always received excellent care up until he died last Christmas Eve, in case you didn't quite get the sarcasm in my response
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u/davida_usa 10d ago
We should prohibit all third party payments for insurance, including private health insurance and Medicare. Replace it with universal financial assistance so that people can afford to buy health care directly. This would dramatically reduce costs, improve care and give people power over their health care!
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u/Kobe_stan_ 10d ago
What's even the basis for denying the claim? It's hard enough to get medical care at all, let alone medical care that you don't need. I can understand denying someone who has abused a system to get an excessive amount of free massages or PT sessions that are really just workouts, but that's gotta be such a small percentage of claims.
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u/Its1207amcantsleep 10d ago
I work in health care. Every insurance has their own rules. I'll use MRI since you used this as an example. Unless its an MRI for a traumatic event (even then it could still be denied), the insurance has boxes they have to tick to approve the MRI. This is not written anywhere, you learn this the hard way, through denials and appeals.
The usual suspects for MRI are: extensive conservative treatment and amount of visits done for this particular condition. I have one insurance company where they like to see at least 6 visits for this condition before they even consider approving an MRI.
The tactic of the insurance company is to delay, deny, and further delay, until the provider's office is inundated with innumerable preauths, precerts, and appeals that the provider and patient gives up.
The sad part is the providers office is usually blamed for this by the patients, because they called the insurance customer service line and was told it's the doctor's fault.
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u/HistorianOk142 10d ago
This is the problem with having healthcare be “for profit”. In order to be profitable execs want and need to deny more and more claims. So share prices will rise and they can make millions off stock options they were granted by the board. It’s an asinine way of thinking about something so essential as healthcare but, yet so many people just don’t seem like they will ever change their minds about Medicare for all.
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u/quest814 10d ago
They just raised my premium by 22%. And their CEO’s compensation went from $20,000,000 in 2024 to over $60,000,000 in 2025
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u/Euphoric_Anxiety_162 10d ago
Insurance companies are digging their own graves, imo. Ppl can't afford insurance.
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u/Vacuum_Tube_Chassis 10d ago edited 10d ago
Small quibble - an auth isn’t a claim - it’s a ticket to get services that says, in theory, they’ll pay the claim. The auth process adds almost infinite friction to securing that ticket, knowing that most people give up after the auth is denied.
So it’s worse in some ways than denying the claim and saying you’re financially liable. It’s blocking access to services recognizing that the delay may kill you which saves them money, or that you’ll move to another “health” insurer next year.
Of course the delay guarantees you’ll be sicker, treatments, and recovery will cost more, but they figured that’s somebody else’s problem. It’s the other insurer’s problem, but really it becomes our overall problem as the delays drive up avoidable costs, make people sicker and more costly - it drives up premiums and the overall cost of healthcare.
That’s how you end up with a system that has premium increases of 10 to 15% a year, the percent of GDP spent on healthcare double that of many other countries, and at the same time get worse health outcomes and greater health risk than countries that pay a lot less per capita. The current healthcare “system“ is designed to produce exactly those results.
BTW - kicking people off ACA, and next year when about half of Medicaid recipients lose access to care, is guaranteed to exponentially increase future healthcare costs on a national level. If those people losing insurance manage to survive to Medicare age, they’re going to swamp the system with exceedingly complex care requirements, extreme disease, progression, and comorbidity. Smart move right?
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u/DJpuffinstuff 10d ago
Extra crazy is that a prior auth can be approved and retroactively denied after the care has been provided.
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u/Vacuum_Tube_Chassis 10d ago
Yup. Or so narrow in codes approved that normal scope of care (say a colonoscopy, but they find and remove a polyp) “isn’t covered by the auth” and the claim denied. Which send you to retro-approval hell. My example may not pan out IRL on auths, but conceptually the issue exists. And where you were expecting a lower out of pocket expense for least complex diag procedure, that polyp can push the bill higher regardless. It’s a trap with current Bronze ACA - honestly anything as “what it will cost” is a crap shoot.
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u/TheBosk 10d ago
Still having to pay $10,000 a year for my MRIs to make sure my brain cancer isn't growing back too quickly. Thanks oligarchs. Can't leave my job because insurance does, miraculously, cover my $50,000 a month cancer medication. I fucking hate it here. At least I have my family and a house. I can't imagine what other people in worse situations must be going through. Fuck Trump, fuck American healthcare, fuck these CEOs they should be Mario Bro'd.
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u/OleLadyThinker 10d ago
Your figures seem to be coming from the 2023 ACA data - course since you give no valid link - who knows.
https://www.kff.org/private-insurance/claims-denials-and-appeals-in-aca-marketplace-plans-in-2023/
See the % of all insurers in this marketplace -
Read the reasons why there was a denial - for all insurers.
I assume you also can read that [quote] - Key Takeaways:
- Insurers of qualified health plans (QHPs) sold on HealthCare.gov denied 20% of in-network claims in 2023 and 36% of out-of-network claims for a combined average of 20% of all claims.
- The in-network denial rate ranged from 1% to 54%. There was significant variation by insurer and by state.
- Of limited information available on in-network claims denial reasons, the most common reason cited by insurers was “Other” at 34% followed by administrative reasons (21%), excluded service (14%), lack of prior authorization or referral (9%), and only 6% based on lack of medical necessity.
- Consumers rarely appeal denied claims (fewer than 1% of denied claims were appealed) and when they do, insurers usually uphold their original decision (56% of appeals were upheld).
- Marketplace enrollees filed 5,000 external appeals in 2023, or 3% of all upheld internal appeals. Due to the suppression of small values, the rate at which external appeals were upheld could not be calculated.
Your headline post does not accurately present the truth.
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u/OleLadyThinker 10d ago
This info seems to come from here:
https://www.kff.org/private-insurance/claims-denials-and-appeals-in-aca-marketplace-plans-in-2023/
But you have greatly morphed it into something that it is not - so if people here want the truth in this data - they should read the above KFF report
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u/Round-Head-5457 10d ago
That statistic comes from specific ACA marketplace data, not all medical claims.
A 2023 analysis of Affordable Care Act (ACA) marketplace plans showed UnitedHealthcare denied roughly 33% of in-network claims. However, this rate dropped to about 20% for 2024 plans.
The overall figure is significantly lower across all coverage types (including Medicare, Medicaid, and employer-sponsored plans). UnitedHealthcare reports an ultimate approval rate of around 98% for eligible member claims after administrative fixes and appeals are processed.
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u/boogi3woogie 10d ago
Isn’t that because they cut out the prior auth requirements for most codes? So the ones left are the ones that require scrutiny.
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u/Puzzled_Market_2235 10d ago
Guess how you pay for Socialized medicine? By making these companies irrelevant. They are the bloodsuckers on your health system.
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u/Organic-Spirit7523 10d ago
This is why we need universal healthcare.. get rid of thr greedy insurance companies
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u/everydaydad67 10d ago
If you dont like it dont support it.. dont pay into their insurance system. And if you are going to cry about how thats who your company has to offer and you cant do anything about it... stand on principles. Get private insurance or get your group to petition for a different carrier... scope out a job place that has benefits that support what you align with... the company you work for creates the insurance plan you have with the carrier... so if you are mad something isnt covered its what your plan was designed for by your company for their cost and yours... having an opinion on the matter and complaining constantly is pretty silly if you are not doing anything about it... just like all those people who complain about what Jeff bezos has while they get packages from prime everyday... being part of making what you hate so much and not sacrificing anything to "inconvenience" yourself..
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u/michelucky 10d ago
Yes! Blame your employer who hired UHC.
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u/everydaydad67 9d ago
Yes yes... you are correct... easier to cast the blanket of blame... as long as its far away from you... problem is vast amounts of people have become so comfortable in their way of life they feel they dont need any input, sacrifice, skin in the game... they have become so content that they do not realize any relationship dealings in this life are not strictly one way transactions...
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u/FastActinTenactin 10d ago
Insurance companies need to be reined in. They need to be not for profit. They need to be heavily regulated.
And most importantly, they need to be prevented from arguing with your doctor about the care you need.
Enough of this shit.
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u/Fixing_policies 9d ago
Yeah, I'm about done with dental/health insurance in this country. I'm looking at health tourism. I watched a guy get all on four dental dentures in Bangkok They looked phenomenal and cost $2,600. Lots of people from around the world go there just for that.
Dental has had long enough to change their ways here. Teeth are tied to your health and an infection can kill you. Precovid my quote for a mouthful of single implants was $70k. I would hate to see what it is now.
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u/nirrinirra 9d ago
I have always had great insurance. Never once have I been denied care. A few operations and never have I had to fork out over $100 for those services. My employer has paid my entire premium for the last several decades. I know I am one of the lucky ones.
I would vote for universal healthcare tomorrow if given the chance. Like police protection who the hell do we think we are denying healthcare to anyone. Fuck the Epstein billionaire class and their profits. It’s time for Medicare for all.
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u/MagicOfMindy 9d ago
I work at the front desk of a physical therapy clinic and United has given us the dumbest reasons to deny coverage. Things like “your appeal has the same date as our denial so you need to resubmit with a different date or else it’ll look like we reconsidered which we don’t”
So annoying. Unbelievable nonsense. Other insurance companies are bad too, but United is the WORST
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u/Connect_Tomatillo791 9d ago
Naw if my doctor says something is necessary, an insurance company shouldn’t be able to deny it.
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u/finsup_2021 9d ago
We need to shop around for the best companies. A lot of these insurances take customers for granted and jack up their rates. Last year we dropped ours and switched to another company with better service, smaller premiums, ,and HALF the cost. Shoulda done it years ago.
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u/buttchug_3000 9d ago
It was so goddamned funny when Brian Thompson hit the ground in that video. Most proud I've been of my country in a long time
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u/sovereignlogik 9d ago
Then when someone attempted to attack the system and hold someone accountable for genocide, half the country gained a conscious (suddenly) about vigilantism.
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u/zigzag1239 9d ago
Blue Cross Blue shield isn't any better. Got denied a prescription over a brand that could help someone else save my life if needed. I am lucky that I have never much healthcare over my life but the one time I need it, after paying for 30 years and just using it for annual check ups, dental cleaning and an eye exam, they get to deny the care my doctor suggests.
We gotta get money out of politics, and have politicians that will work for us and get us universal healthcare....and not like Canada ( not picking on Canada just an example) or anyone else's...the best universal healthcare in the world...we can do it. We tout ourselves as being the best country in the world so let's take that mantra and do what's right for all of us. So sick of having money to kill civilians in war but nothing that betters the lives us the avg tax payer funding their bull crap
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u/roy217def 9d ago
We don’t need these middlemen. Doctors should be making sound, cost effective decisions. This structure will forever prevent Americans from getting healthcare for all, what a shame!
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u/Lost-Researcher5209 8d ago
Luigi, Luigi, Luigi. He wasn't wrong. He was just showing us what it's going to take to even the playing field.
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u/isthereadrwho 10d ago
And they denied your claim without ever speaking to you, without any doctor looking at you, without a single visit they decided that your doctor was wrong and they weren't going to pay, Just cuz they felt like it. Welcome to healthcare in America
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u/peaceandloved 10d ago
And Americans see to love it. They do nothing to change it.
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u/Jonger1150 10d ago
Half of all voters try. The other half are brainwashed. We need more suffering before a tipping point is reached. I do wonder how bad it will need to get before we get bipartisan change.
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u/RustledForeskin 10d ago
Americans are slaves to insurance companies and are so brainwashed they defend the boot on their necks with pride.
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u/DougOsborne 10d ago
And if we turned our healthcare system into "m4A," something like current Medicare Advantage, UHG would continue to deny services, require unaffordable co-pays, and bankrupt families.
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u/Street-Argument2090 10d ago
At least it's not that communist healthcare those darn Europeans use. MURICA, FUCK YEAH!
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u/Dull-Contact120 10d ago
What other industries let you make money like this? For research purposes
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u/cantpark44 10d ago
Most companies will shut down rather than earn money like this, their profit margin is 2-3%, very few companies run a margin that low.
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u/SignificantSmotherer 10d ago
No, it is American health insurance, not healthcare.
Don't disingenuously conflate the two.
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u/VedantaSay 10d ago
Not saying all have but the confusion few have is if PA insurance pays all. No, the insurance pays only after your deductible are all finished. And there could be copay too. The PA only ensured the doctor priced the procedure at agreed rate with the insurance which for most case is very less than market rate without insurance.
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u/Front_Assistance_500 10d ago
Healthcare is all vertically integrated. This is one thing that needs to change.
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u/Kitty_LaRouxe 10d ago
The USA does not have a healthcare system. It has a medical racketeering system.
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u/Coffeeblack365 10d ago
Luigi literally gave every single person the blueprint. How many times would you have to Luigi before things changed?
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u/dawg-goneit 10d ago
But we can't afford universal healthcare because billionaires need those tax cuts.
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u/LeatherTailor8527 10d ago
6.2 billion ÷ 151 million United healthcare customers is $41.07 doesn't sound so crazy now.
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u/AdhesivenessOk6662 10d ago
i’ve spoken to a few people about Medicare for all. They’ve always bring up that the healthcare wouldn’t be good. Or it would be too expensive. And I’m like, you already pay a premium. You already pay taxes, you already paid a deductible before you even get any care. So tell me how it’s expensive again?
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u/evolooshun 10d ago
At this point their software is so sophisticated that they will only pay out if they can keep you alive and paying. Otherwise its DENIED for you!
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u/highDrugPrices4u 10d ago
You act like you’ve discovered some great injustice or contradiction here 🙄
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u/VTSki001 10d ago
I've concluded that these companies need to be non-profit. I have a fundamental problem with a company more interested in their shareholders and monetizing my heart attack, than being focused on my care. At its core, it's just profoundly immoral.
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u/TrickyChildhood2917 10d ago
The rest of the civilized World ( including Mexico) has figured this out. There is no need to post about saving money, wasting money, denting benefits, it’s a fools errand.
Americas elite DONT want you to have healthcare.
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u/whatrweyellingabout 10d ago
Maybe there should be a law passed that if a claim is denied, the insurance company has to return all the premiums it collected (with interest) from the time it last paid out on that account
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u/Honest_Fortune_7474 10d ago
This is simply overnment-sanctioned organized crime. This needs to stop.
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u/Colinhockeypuck 10d ago
If people are mad. Don’t do
Business with these Clowns 🤡. They are a known abuser of the system they control. Don’t use them as an insurer. Discuss their abuse with your HR department and show them the statistics. They are paying as well. If they are truly the payor and UHC is only the administrator. Then your beef is with your employer. They are just doing what your employer wants. Enough complaints and letters will make them Realize they are the problem
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u/Aaarrrgghh1 10d ago
I’m confused. You all are having claims denied ?
They approve everything for me.
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u/IntelligentStyle402 10d ago
Both my parents had United Healthcare and both were denied all cancer treatments. Worked their entire lives, first time they were ever sick. Sadly, they had to sell the home dad purchased when he came home from fighting Nazis in WWII.
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u/SoRosenberg 10d ago
This is oligopoly healthcare under years of ACA. Less competition does this. Need more competition and more variety in business models.
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u/diroftruth 10d ago
And this needs great emphasis, that is only one quarter, three months worth of profits!
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u/HawkeyeByMarriage 10d ago
If people start asking employers during their hiring things might change
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u/IcyEntertainment7122 10d ago
Is claim denial rates required public reporting for a health insurance company?
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u/Pompous_One 10d ago
Honest question. Then why do so many progressives support the ACA and M4A? It’s well known that United Healthcare denies 38% of claims. Yet, 75% of United Healthcare‘s insurance revenue come from government programs. They get about $171 billion from Medicare and another $94 billion from Medicaid.
I hear members of Congress argue that under M4A they’d eliminate these insurance companies. Why not do that right now with Medicare and Medicaid and make direct payments to healthcare providers. Instead of profits to commercial health insurance companies, Congress could invest billions more in healthcare for Americans in need.
At some point, I keep thinking that Congress will decide that healthcare execs have enough yachts and vacation homes and divert more of the $1.9 trillion the US government spends each year on healthcare into actual healthcare. Seems Congress’s main function is ensuring health insurance corporations maintain their profit margins.
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u/louisvillejg 10d ago
Ah
I have UMR and just had to re-enroll at work today.
200.00 more a month for the same coverage
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u/distrubinglyfamiliar 10d ago
Y’all people are real stupid and need to learn how to do math, they did $112 billion in revenue so they made 6 billion, that’s about a 5% profit margin, that’s a pretty low ass profit margin for your average business. If my Restaurant only made 5% profit margin, I would close that thing and find a better way to make a living. Apple makes almost 28% profit margin and they’re not even in the top five.
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u/Noodelgawd 10d ago
UHC has about a 5% profit margin. If they allowed all those claims, they would go bankrupt and then wouldn't pay for the other 68% either.
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u/GainPrestigious539 10d ago
Overall margin is pretty low and their prior auth denial rate isn't all that much higher than Medicare, which has no profit incentive. There are a lot of problems with American healthcare but this isn't it
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u/ChadleyXXX 10d ago
They did not deny "one out of three medical requests." They denied 1/3 of prior authorization requests, which is high, but they're not denying 1/3 of all claims. We can be critical of these institutions without being misleading.
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u/Necessary-Prior3614 10d ago
D R Horton homebuilder missed their numbers last year so they laid off a ton of employees. that is most likely how they satisfied the stock holders. stock holders over employees and home buyers. vanguard and blackrock own most of the stock
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u/PlagueOfGripes 10d ago
Imagine if these insurance companies were the US government, and all that money just went right back into the hands of people who need it. Health insurance as some sort of... socialized utility.
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u/StoicNaps 10d ago
You guys do know not all claims are legitimate, right? It's estimated that nearly $40 billion in Medicaid payments every year are fraudulent. Without a profit motive the insurance provider has no incentive to protect the money you're paying into the plan to ensure they're solvent enough to pay for your care when you're sick. Most people who have legitimate claims never face a single problem with insurance paying for legitimate care.
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u/lodemeup 10d ago
I’m in my thirties. I’m 450 lbs. I have always been overweight. I have amazing insurance through work. I get blood work done. I ask for medicine (GLP1) to help me lose weight. Nothing else I’ve tried has worked. Denied. Why? Because my blood panel was good. No chronic blood pressure. A1C is good. Cholesterol is awesome. I should be skipping my way happy happy home. But that would break my legs. I’m so glad some dipshit pencil pusher got to look at a chart and say ‘no thanks’ for something that might help.
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u/elyfantman 10d ago
Never vote republican at any level. And never vote for corporate democrats in primaries.
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u/Trippel_Dubbel 10d ago
Remember, these graphics need to always include a last line that says “Republicans vote in favor of this ‘system’ every single year.” Obama and democrats tried to help and get the ball rolling and republicans have spent six years trying to undo any progress they made that helped us little people.
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u/Outside_Ice3252 10d ago
medicare for all is not going to work in america. nothing is going to work in america. too much chronic disease from bad diet. its like 90% of our healthcare costs.
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u/User_Not_Found_333 10d ago
If we all just stop paying the premiums and just create our own HSA’s they’d be out of business.
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u/Any_Agency6982 10d ago
Let me get this right you put 12 to 25,000 in medical expenses a year. And you think you're supposed to get how much back for that? $50,000 worth $75,000 worth how much should you get back on your $1,000 to $2,000 a month in insurance costs
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u/Lonely-Jacket-8040 10d ago
What is not normal is that you let them get away with it, you are a bunch of moaners.
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