1–A constant battle is underway between insurance companies that do not want to pay any claims, even legitimate ones, and doctors and hospitals incentivised to rip off patients, insurers, and taxpayers with unnecessary surgeries and Medicare fraud.
2–Insurance companies demand massive amounts of paperwork out of rational fear of fraud and unnecessary treatments. Doctors perform for-profit (as opposed to for-patient) procedures that guarantee more explanations and more paperwork.
3–Doctors and hospitals have direct personal contact with patients, but insurance companies don’t. In cases where doctors put patients at huge risk with needless procedures and surgeries, it’s easy for hospitals and doctors to point their finger at insurance companies. On the other hand, many sincere, honest doctors have difficulty getting patients the care they should have because insurers believe they are getting ripped off by unnecessary procedures, even when they aren’t….
Mr. Shedlock’s six points sound like a child complaining. Take the first three.
Pt 1. Insurance companies that don’t want to pay any claims? Let’s dispense with “want”, since that is irrelevant issue. I don’t care if my cable company wants to provide me with a service as long as they in fact provide the service for which I pay. With that modification, his phrase “any claims” is false in my experience. Aetna, UHC, BCBS, Humana have all paid my family’s claims, largely without quibbling.
Insurers have a strong incentive to pay genuine claims because customers will stop paying for a product that they never receive and hospitals and doctors will start refusing a promise of payment that never materialize. In the latter case, consider the Medicaid payment backlog in Illinois.
Pt 2. Insurance companies have a duty to guard against fraud. If they do not then they will run at a loss every year. As a paying customer, I pay them in part to be solvent so they can successfully insure me against health risks.
Pt 3. is inconsistent with Pt. 1. Evidently, he now admits that there are “many sincere, honest doctors” who are concerned about “getting patients the care they should have”. Either the incentives to rip off patients and others are not that strong, or many doctors have stronger incentives to be honest.
Having had direct experience of point #1, I think I can comment on it.
My wife had an operation on her hand which the insurance company assured
us was covered. However, the doctor refused to send the
paperwork to the insurance company, telling us to pay him directly,
and that we should ask for re-imbursement from the insurance company.
The insurance company refused to pay unless the doctor
sent in the supporting paperwork. After much pointless wrangling,
neither the insurance company nor the doctor would help us,
and I was left to pay the entire cost of $3,000, although I did
“have coverage” – whatever that means !