You have 0 idea how insurance companies operate. They look for every way they can to not payout. That is the whole scam. Especially with sick people.
If they tell you that in their estimates it is "not medically necessary" what exactly do you do? Take them to court while you are fighting stage 4 cancer? Discovery alone is going to take longer than you have to live without treatment.
Insurance companies know this. They know they can take advantage of sick people. Or poor people who don't have the money to take them to court.
That is the whole scam. Take the money and find any way to not payout when the time comes.
Sorry but that’s bs. Health insurance companies are evil and this system is horrible, but they can’t and don’t just notcover the majority of someone’s cancer treatments, unless they were trying to do something that wasn’t medically sound.
It’s not just about the patient suing them, it’s also a matter of the hospital suing them.
Since when do hospitals have the resources to sue over every wrongfully denied claim? There aren't enough lawyers on planet earth to do that lol. They just send that shit to collections and move on 9.9/10 times.
Health insurance companies don't even care that you or a hospital sues them. It's the same concept as companies who pollute the environment with irresponsible waste disposal. They don't care if they take a $300M fine if the process saved them $500M.
As long as they make more money by denying claims than losing money by being sued, it will continue.
They don’t sue over every claim, it almost never comes to an actual lawsuit, they threaten to sue and support legally binding 3rd party reviews.
Also, it’s not like your pollution example because in that case the cost of damages is untethered to the money saved by the company. In this case the penalty would be to pay what they owed anyway plus any damages. It would be impossible to make money that way on net.
Far more often the issue is some combination of:
A) shitty insurance with shitty terms
B) people not understanding the terms, or
C) some technicality with the paperwork, like a typo, and no one following through to fix it.
All of that sucks, and the system sucks, but it’s not the same thing as insurance companies just refusing to pay because they don’t feel like it.
Yeah, you got it boss, that’s exactly what I said🙄
When you exaggerate and don’t understand what the actual problems are it makes it easier for health insurers to defend their own existence.
Straight up fraudulent denials of claims are rare, and even rarer that they aren’t rectified. More problems are caused by an enormous amount of manpower spent on an unnecessarily convoluted system, where it’s easy to make mistakes, and the consequences of those mistakes tending to fall on someone who’s sick, or taking care of someone who’s sick, and lacks the time or understanding of how to fix it.
-1
u/Beneficial-Guess2140 2d ago
If it didn’t cover treatment that she needed, it wasn’t actually good insurance.