[fiftyfifty]

Why can't they just put this money towards rejecting fewer claims?

[sega_sai]

The company's goal is to satisfy share-holders, not some pesky sick people.

[wesselbindt]

I don't understand, why would they do that?

[hypothesis]

For same reason any other insurance company doing it? Those guys are statistically the worst, with no one else being close.

Like if your argument being fiduciary duty to rob everyone blind health outcomes be damned, then why say Kaiser is not being sued in to the ground?

[ceejayoz]

> Their profit margin is 5.5%.

Sure, except they own the pharmacy (https://en.wikipedia.org/wiki/Optum), the payments solution (https://en.wikipedia.org/wiki/Change_Healthcare), the outpatient surgery centers (https://en.wikipedia.org/wiki/SCA_Health), the in-home care providers (https://en.wikipedia.org/wiki/Amedisys), and a whopping 10% of the country's doctors - the nation's single largest employer of them (https://www.statnews.com/2024/07/25/united-health-group-medi...).

(Oh, and they pay their doctors higher rates. https://www.statnews.com/2024/11/25/unitedhealth-higher-paym...)

Those are "expenses" for that margin calculation.

[johnduhart]

> Their profit margin is 5.5%.

5.5% of what, dmm?

https://www.healthcaredive.com/news/unitedhealth-unh-2024-re...

> the Minnesota healthcare behemoth reported adjusted profit of $25.7 billion — an all-time record.

[throwway120385]

Isn't profit what the board keeps after they pay for everything including the people in the board's employ? So in that sense the profit margin doesn't mean terribly much because you can always pay more to your senior managers and less to your patients.

[darth_avocado]

If they deny less claims, they’ll need fewer adjusters, admin and customer care staff. They will still have 5.5% profit margins but the CEO will get paid less because the net profit won’t perpetually grow and Wall Street doesn’t like that.

[NewJazz]

We should up that threshold until these companies start posting consistent losses, then ease up.

I tried researching this, but couldn't come up with an answer: if an insurance company pays doctors to review and dent claims, does that doctor salary count as "quality improvement activities", or administrative?

[7952]

Surely the entire point of insurance is that the provider takes the financial risk. That is what they have been paid to do. If they cannot afford to do that through premiums then they should make a loss.

[StormChaser_5]

Depends what their costs are but if all claims would take 85.5 of their premiums with the rest their overhead costs then I think most of their customers would be happy

[franktankbank]

They bloat the overall health care system to increase the absolute value of that 80% premium. Efforts to human health are overburdened by exercises of human bureaucracy and frankly obviously intentional bad service.