Just because you paid for insurance doesn't mean you should get it

They are making medical decisions.

I'm launching my burger insurance company

Oblige them

So well worded. I struggle to get this concept out when discussing the concern about grocery prices and why homesteading / community gardens are the only protection we can reasonably have right now

Oh no, each claim is a new loan application. You pay in your premium to have the right to apply.

Related https://projects.propublica.org/claimfile/

From personal experience, the vast majority are practicing out of scope. It would cost them a ton of money in overhead to have a cardiologist deny a claim for cardiology related testing or treatment so they just wing it. In some cases it's not even a physician, it's a nurse, NP or PA.

This is where government needs to step and regulate but we all know that isn't going to happen.

And the guy who proved that their bio:

I say unpopular things but never something I know to be untrue. Always open to hear good-faith counter arguments. My goal is to engage in dialogue that seeks truth rather than scoring points.

Was a lie yesterday.

Well, what about the contract? Traditionally, contracts have three main elements: Offer, acceptance, and consideration. That is, one party offers something, the counter-party accepts the offer, and there's an exchange of something of value between them. It ought to be obvious to even the most casual observer that there's a lot to unpack about acceptance. Clearly, the party accepting the offer should understand the offer in order for the contract to be valid.

If I offer the neighborhood cats treats in exchange for not digging up my plants, and they accept, that doesn't give me a cause of action to sue them (or their owners) for breach of contact when they still dig up my plants. A cat cannot lacks the understanding of the offer, and cannot accept, and therefore no contact exists.

Similarly, if a human lacks the mental capacity to understand an offer—say, a person deep in dementia agrees to a reverse mortgage without knowledge of their legal guardian—a court can rule that no contract existed, because the person did not understand the offer.

Health insurance contracts are anything but clear. In fact, the Byzantine details surpass the ability of most people to understand. (Part of my job in the past was getting paid to read and interpret health benefit statements for other people. Quick— what's ERISA, and what are the legal implications of health insurance vs. health benefit plans?) Is it really a valid contract, if people can't even begin to understand the offer?

One might say that people should get an attorney to look it over. Yeah, and then what? Counter-offer? We don't have much leverage to do so, because the terms of all of the offers are bad, and opting out of health coverage entirely is not a good option. (Even the healthiest person could get hit by a car and be financially ruined for life.)

That's the source of the anger. We can understand how insurance is supposed to work: Pay premiums to mitigate risk. Instead, these companies hide all manner of gotchas in contract terms we have no hope of understanding. Traditionally, that would not be a valid contract, but the legal system seems to exist to serve the powerful, so it enforces them anyway. (Even then, the insurance companies try to avoid fulfilling what seem like their clear obligations because sick people lack the wherewithal to fight them.)

Liberals are right wing. They're comparatively further left than conservatives but both ideologies favour capitalism as the economic system which is inherently on the right -- in opposition to a more controlled market.

Liberals are right wing.

Liberalism is a right wing ideology.

Like this guy has a point they dont have a duty of care, they didnt take an oath, they are a private for profit company with shareholders. They will absolutely take as much as they can, give you as little as they can and be as cunty about it as they can get away with.

Its fucking WRONG but its not surprising.

To be honest, I hadn't interpreted the quoted toot (man I do hate that they are called toots) as trying to educate people on how insurance works. In that light I do agree with what you are saying, people should be aware of how these systems actually work.

Apologies if this post is coming off as overly 'smug liberal'.

You misunderstand. The service that insurance companies provide is one that is for shareholders. It's a way of allocating and rationing medical care while also keeping business going.

Poor people don't own hospitals. Poor people can't develop medicines and medical equipment. Can't train and hire doctors. That stuff is extremely expensive. The capital class owns that stuff, right?

They aren't just going give it away are they? But they do need a labor force that, though desperate, isn't too sickly that their labor can't be exploited.

The service that health insurers provide to their actual customers, the capital class, is to reallocate the aforementioned expenses back onto workers by way of premiums and limiting care to the bare minimum.

This is why health insurance is tied to employment in America. You (most likely) didn't hire your health insurer and negotiate your insurance contract, your employer did. It's not for you, it's for them, and really, for their owners, who extract the value of your healthy labor from your employer.

And this isn't come an-cap or communist hot take, this is just the economics of how healthcare works in America. You're getting the care, sure, and if you're covered hopefully you're in the road to recovery and won't become insolvent due to medical debts, but this system is not for your benefit. It's not out to save you money. You are at best an afterthought, a concept of a customer. More of a number.

The OOP described is, in different terms, as if health insurer was nothing more than a risk pool cooperative.

Here are the customers of UNH:

They also own the hospital groups, the device makers, and the pharmaceuticals.

Yeah that's what I was getting at. For some reason I'm being downvoted for saying how things actually work?

Exactly.

Generally speaking, uninsured medical costs and medication are cheaper than what the insurance company pays. SOURCE

Hospitals and Insurance companies do this because it's a write-off for the insurance company and it makes the patients feel better about their coverage plan.

You likely could get the treatment without the authorizations if you pressed, I sincerely doubt the hospital would try to stop you, but that would put you into debt so obviously don't do that.

Insurance companies deny payments for treatments. Hospitals deny treatment.

Insurance companies shouldn't exist, I would never simp for them, but as a personal policy I always call out lies. The lie in this case being "insurance companies are murderers."