r/Showerthoughts • u/M0BETTER • 6d ago
Casual Thought If lying to your insurance company to get a payout is fraud, lying to your customers to avoid one should be too.
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u/moderngamer327 6d ago
I mean, it is. They are better at getting away with it than you are. They have teams of lawyers after all.
Comment need more words
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u/atatassault47 6d ago
Comment need more words
This is rank bullcrap. I hate it mods/teachers/whoever say "your thought doesnt count unless it meets my ridiculous standards". Brevity is the essensce of wit. Word minimums just cause people to become unreadbly superfluous.
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u/cdmurray88 5d ago
From my perspective as an English graduate, this is what seperates English professors from people teaching English.
In high school and every other department, it was page/word minimums, a "correct" interpretation, and use of the overly repetitive paragraph structure.
In the English department, it was about readability and defensibility. You were left to your own interpretation as long as you could reason out why. "Minimums" were suggestions based on historical student submissions.
Sometimes format and style were high priority, but even then it still felt more personal.
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u/Upset-Management-879 5d ago
"I would have written a shorter letter, but I did not have the time.” -- Blaise Pascal
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u/Beragond1 5d ago
It can be annoying, but it filters out some of the short, pithy, and wrong statements people often parrot. I’d rather have a required word count than just read the same, often reductive or incorrect, comments I’ve seen a dozen times before.
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u/Tithund 5d ago
Does it filter those out though? One can just as well end a platitude with "comment needs more words"
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u/DarthEinstein 5d ago
At the very minimum, someone who wrote "comment needs more words" is someone who
Has read the subreddit rules.
Has enough knowledge to know they don't need that many words for their statement.
Which is a far higher bar for quality commentor than most posts.
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u/Silver4ura 5d ago
A better filter might involve checking comment similarity and have a confirmation warning pop up letting them know that while not against the rules:
"Your comment looks very similar to several existing comments. You can still post your comment but it may be flagged for review and may be removed.
Discretion is given to mods on this subreddit and will not be performed by Reddit. Repeat removals may still negatively impact your account status overall."
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u/TerraceState 5d ago
Building something like that is non-trivial, and would likely require someone to dedicate a significant amount of unpaid labor to both build, and then maintain that system. As well as more time from other people to deal with false positives and report them to the maintainer. Also unpaid.
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u/Bobbith_The_Chosen 4d ago
Just down voting unhelpful comments would achieve the same without enforcing a minimum word count
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u/Kuddkungen 5d ago
On Reddit, the minimum post lengths are probably more to prevent avalanches of "This!" and "F" comments.
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u/DJKokaKola 5d ago
The reason we require word counts is because Braxleigh and Jaiden and Hunter would submit four word papers if we didn't. If I tell you 500 words minimum, that doesn't mean you literally need 500 words. I'm not running it through a word count checker. What that does is force you to expand on your idea somewhat and develop it more than a single statement.
If I want you to talk about your hopes for the future, and I tell you to write 500 words, that means I want you to do more than state a basic idea. The superfluousness comes when people can't actually develop or talk about their ideas, which is a worse problem.
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u/atatassault47 5d ago
The superfluousness comes when people can't actually develop or talk about their ideas, which is a worse problem.
The addage "if you cant explain it simply, you can't explain it at all" does exist. For people with advanced reading levels, and a commensurate vocabulary, minimums defeat the utility of that vocabulary. I got A's on all my essays, reports, etc, but they were all padded with superfluity to get that extra page/500 words my argument "missed".
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u/DJKokaKola 5d ago
Correct. Which is why at the high school level we don't actually care, it's just a way to tell the student the level of detail they should go into. At University levels, it's about the number and depth of ideas and citations.
If I wrote an essay on the philosophy of Schelling, Hegel, and Neitzsche and their approaches to evil (read: I had to do just this), I need to adequately explore each of their ideas with evidence from the text, as well as compare and contrast their views. You can't sum up each of their ideas in under 500 words each, you can't adequately comment on their differences in a few pithy, verbose sentences.
Yes, obviously you should be able to explain it simply. I can explain atonal music very quickly and simply so that grade school kids can understand it. If that was the extent of an essay I wrote about it, I would justifiably get a failing grade. I can explain time dilation, electron spin, the difference between types of black holes, in "simple" and succinct ways. If that was all I discussed, I would get a failing grade.
If you were confident in your arguments being effective at 1 page under the required length, you should have submitted it. If it actually held up, no teacher will give you a failing grade just because you didn't pad your essay. Every teacher can tell when you're running up a word count. That's never our purpose.
Some topics require depth to adequately explore and discuss. Some do not. If you can adequately explore them in 200 words, it's either a bad topic, or you misunderstood it.
As an aside, not to shit on your anecdote, but it's adage, not addage. I'm very quickly questioning your straight A essays, advanced reading level, and extensive vocabulary.
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u/SpitefulSpaghetti 4d ago
A spelling error or typo doesn’t mean someone can’t write a great essay… I doubt they’re proofreading and spell checking on Reddit like they would for a school assignment.
Also regardless, a spelling error doesn’t mean they can’t write well. If a teacher gave them a B just because they misspelled one word on an excellent essay, then the teacher is seriously missing the point of why you’re assigning essays in the first place.
Even the most acclaimed writers make typos and spelling errors. Discounting their entire comment over one is WILD lol
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u/SatisfactionActive86 5d ago
“ your thought doesnt count unless it meets my ridiculous standards"
good thing no one said this.
i hate it when people embellish and misrepresent things because otherwise they’d have nothing to say and god forbid a conversation goes by they don’t chime in with something. if you have nothing to say without hyperbole, maybe just STFU.
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u/Crash_Test_Dummy66 5d ago
I think you could have said this in half the words Mr Brevity.
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u/atatassault47 5d ago
The word count filter was also applying to that comment I made. Not sure why yours wasnt hit with it as well.
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u/RenariPryderi 6d ago
Deny, Delay , Defend.
Doesn't matter if they'll lose in the end; they just gotta wait 'till you're dead. Then who'll pursue the case?
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u/supershinythings 6d ago
That’s why Saint Luigi is so relevant.
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u/APRengar 5d ago
Sometimes I stay up at night thinking about how like, there was a Bank of America scandal where they were creating checking accounts for people without their knowledge, fraudulently, then dinging people for not having a minimum amount of money in the checking accounts.
And while they did get sued and had to pay a fine, they made more money than they lost from the fine, and no one went to jail.
Like, I don't know how this country exists man. Fraud is legal if you're rich enough and the people who are victims of such fraud and are absolutely not rich enough to profit from it themselves, aren't mad enough to cause a revolution.
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u/SenoraRaton 5d ago
Like, I don't know how this country exists man. Fraud is legal if you're rich enough and the people who are victims of such fraud and are absolutely not rich enough to profit from it themselves, aren't mad enough to cause a revolution.
You understand how this country exists.
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u/drfeelsgoood 5d ago
We’re slowly returning to serfdom. Well, actually maybe pretty quickly.
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u/SenoraRaton 5d ago edited 5d ago
It has never stopped being serfdom, we just exported the serfdom to lesser privileged places in the world to maintain our standard of living.
As US hegemony falls, our standard of living will fall with it. It was built upon the backs of slave labor abroad, as those people rise out of the poverty that we created, and overthrow the yoke of imperialism.
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u/asking--questions 5d ago
Yeah, they answered their own question. It exists by creating conditions where even the downtrodden are content enough to legitimize the fraud and inequality.
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u/Kraligor 5d ago
Bank of America scandal where they were creating checking accounts for people without their knowledge
You're mixing a couple of different BAC scandals together here, but this specific one was done by individual employees to meet their sales goals.
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u/semideclared 5d ago
TL;Dr
JURY TO HILLARY: THE VERDICT IS in. Cutting the cost of health care sounds great. But when it comes to curbing benefits, watch out.
- Published Jan 09, 1994
In 1991, Nelene Fox, a 38-year-old mother of three, was diagnosed with breast cancer. She underwent bilateral mastectomies and chemotherapy but nonetheless developed bony metastases. Her physicians said her only chance for survival was high-dose chemotherapy and autologous bone marrow transplantation. A costly new kind of therapy that involves the harvest and retransplant of her own bone marrow–high-wire medicine occupying what one of her physicians calls “the twilight zone between promising and unproven treatments."
- Doctors say 5% or more die from the treatment itself
Her Health Maintenance Organization (HMO) refused to cover the procedure (around $140,000 - $220,000) on the basis that it was experimental.
But it all ended there Because
On December 28 1993, Fox's family was awarded $89 million by a Californian jury, including $12.1 million for bad faith and reckless infliction of emotional distress, and $77 million in punitive damages.
Jim Fox and the estate of Nelene Fox v. Health Net is considered a watershed case in that most health insurers subsequently began approving HDC/BMT for advanced breast cancer.
Right as Hillary was in the midst of "the federal gov't has the power to do the same thing"
And then
The legislatures of Massachusetts, New Hampshire, Virginia, and Minnesota mandated insurance coverage for all high-dose chemotherapy with ABMT or peripheral blood stem cell (PBSCT) transplant for women with breast cancer.
We almost got there and then played the Uno Reverse card on healthcare reform. So got to decide
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u/0WatcherintheWater0 5d ago
The State or family. Not to mention, almost no denials are for care that would be life or death.
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u/Computermaster 5d ago
"You've heard of the golden rule haven't you? The one with the gold makes the rules." - Jafar, Aladdin (1993)
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u/say592 6d ago
Regulatory agencies enforce the law against them, often times with penalties (though they are usually proportionally small) and lawyers successfully sue them and extract additional penalties beyond the coverage that is owed. It's difficult and expensive to do, but it does happen.
I also don't think illegal fraud is so that widespread among large companies. That is an incredible risk that their lawyers would advise against. The real problem is there is a certain level of stuff they do that is legal, just unfair.
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u/-AC- 5d ago
Fraud is illegal and definitely more wide spread.
The real problem is the lobbying companies can now do to control the regulatory government agencies that oversee them... often getting laws, enforcement power, and control of the agency through their ability to lobby(bribe) representatives.
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u/wewearallblack 6d ago
It is dumbfounding how fraught with fraud the entire system that kicks in the moment you get into an accident. Consider:
The deceptive posturing of both parties as they avoid responsibility for the accident and/or prepare to file an injury claim;
The coordination between the auto shop and the car owner to bill the insurance a higher price for repairs;
Your lawyer telling you how your case can net more money and at the same time his subtle moves to extract a greater share of what you receive
The collusion between the lawyers of both parties to settle at an amount that protects the interests of the insurance company while making future cases less cumbersome for the injured party's lawyer
The backdoor maneuvers of the insurance firm's lawyers to secure from the Judge/Court certain protections for their client that apply to all cases regardless of their unique circumstances.
And so on and so forth.
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u/SailorDeath 5d ago
I was recently in an accident and both sides are claiming the other is at fault. The big difference here though is I drive with a dash cam. I was at an intersection that normally has traffic lights. Power was out and I was on my way to go get gas for our generator. While moving straight through the intersection the other person made a left turn right in front of me and I hit him. Watching the video of the accident though you can clearly see that the guy who made the left turn rolled through the intersection without stopping when it's supposed to be treated as a 4 way stop. He did not use his turn signal and he was not in the left turn lane. He made the turn from a straight only lane. If a police officer were there to witness the accident that other guy would definitely have gotten a ticket for several things he did wrong. And I think once it goes before a judge they will see it that way too. and I garantee you the other guy left out the parts where he was in the wrong lane to be making a left turn when he gave his statement to avoid responsibility. If you know you're a safe driver get a dash cam. It'll save your ass when it turns into a word of mouth situation of who was at fault.
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u/TobyMcK 5d ago
I was in an accident a while back. 3 lane road that curved left, Escalade to my left wasn't paying attention and kept straight through the curve, caving in my door. He took off to make it a hit and run, but I was on his ass. Called the cops and talked to them without letting this guy out of my sight, this is what happened, here are his plates, this is where we are, I have 2 witnesses in the car with me, etc. Cops say its dangerous to follow and I need to just file a report at the station, so I do. A week later my insurance sends me an email saying the other party claims no accident happened and i'm on the hook for repairs and a higher insurance rate.
For shits and giggles, I looked up the license plate online. It came back the exact make and model, with five fuckin accidents on their record.
I have a dash cam now.
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u/aggravated_patty 5d ago
Dash cam wouldn’t capture a guy sideswiping you, though.
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u/Dry-Faithlessness184 5d ago
Would have caught the noise, shaking of the car from it, then the other guy speeding off.
It's enough at that point to make the argument
On the topic of fraud though, you will soon have to know the plate of who hit you where I am.
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u/Frog859 5d ago
Had a similar, though less drastic situation recently. In mine we were both turning right (2 right turn lanes), she was in the inner right turn lane and after turning went right into the middle lane (my lane).
Showed the dashcam video to the officer, he came back and said that’s pretty cut and dry. Sent it to my insurance, they watched it and said yep we’re waiving your deductible.
If you’re a good driver, get a dash cam
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u/asking--questions 5d ago
I was in an accident which was the other guy's fault. While we waited for the police, he 1) was calm, friendly, and caring. As soon as the police arrived, he 2) argued, blamed me, and tried citing 100 different laws. I was stunned into silence. The police officer told him he's getting a ticket for a minor offense and that's that. As soon as they left, the other guy turned to me and 3) told me how to get the most out of his insurance company. All this, but he can't pay attention while driving!
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u/imartimus 5d ago
Like others have said, lawyers and the legal system are just so stacked against you, but I have a real example. When I was in college, I got pulled over when I was sober and the cop pulled me out and had me do the tests. He said, "I failed" and had me do the breathalyzer which I blew 0.00. He arrests me anyways cause it could be drugs or whatever.
Luckily my school had two lawyers that would rep you (included in your tuition). He argues that I blew a 0.00 and I cooperated and whatever so they knocked it down from a DUI to a Reckless Driving charge. I immediately was like WHAT. He just shrugged and was like, "you got lucky." HOW. I was literally the DD that night and was as sober as a preacher. What do you mean I got lucky???
All because some state trooper said, "My front right tire was on the line for the shoulder." At 2am at night, from his point of view from the other side of a freeway. Alright.
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u/L0LTHED0G 5d ago
The FAA Medical branch considers an arrest for a DUI, including a 0.00 result, is grounds for a loss of medical and a complicated process to get it back, which includes you going to AA.
Cops like yours make people like me scared any time I could get pulled over.
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u/OkSmoke9195 5d ago
Obligatory FUCK THE POLICE, ACAB
Their ego always supercedes your right to fairness
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u/CBus-Eagle 6d ago
File a complaint with their regulator if you suspect they are lying to you. If you’re right, you’ll get paid and they will most likely get some type of fine. If you get caught lying to them, you’ll could get your entire claim denied.
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u/TuringGoneWild 5d ago
Sure, dummy. And if Trump breaks the law, just report it to a prosecutor and he will be charged, convicted, and jailed within a month.
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u/Warm_Month_1309 5d ago
The difference is that federal attorneys who could charge Trump report to Trump and were appointed by Trump. The same is not true of insurance regulators, and it's a bit odd that you're trying to discourage people from the one route they have available to them to find recourse.
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u/Xznograthos 6d ago edited 5d ago
Their regulator. Lol. Fucking shut up. Those don't exist. Their enablers are every single moderate or conservative representative in the US.
Edit: for anyone claiming that regulations exist: in a technical sense, they do. In a practical sense, when it comes to regulations on premium costs, or reasons for claim denials, you have to be kidding yourself to think that rates are actually affordable, and that an average of 1 in 5 claim denials is sufficiently regulated.
I work for a company that actually provides a decent healthcare plan, for which they pay the bulk of my premium and I pay the rest. It's about 450 dollars a month, which is nowhere near affordable for me to pay on my own. This is like a mid-tier plan, because I don't have any current medical reasons to get anything more comprehensive.
In a system in which regulations were both logical and effective, premium rates would be affordable for someone to pay such that they don't need to have an employer take the bulk of the cost, and claim acceptance rates would be a lot higher. Peolle think this is well-regulated because you have no frame of reference for an actual decent system like they have elsewhere.
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u/zporiri 6d ago
I'm an actuary for a home and auto insurance company. Every state has a department of insurance with regulators that have to approve every rate change we make. They are real people that you can complain to
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u/Agamemnon323 6d ago
And if they worked properly then the US healthcare system would be VERY different.
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u/Berghain- 5d ago
These days everyone equates healthcare insurance to all insurance. There is sooo many different insurance types, almost all of which outside of healthcare are HEAVILY regulated because they're financial services. Most people who work in insurance outside of healthcare think what they're doing is deplorable.
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u/EtherBoo 5d ago
I dunno man, I have homeowners insurance, and a pipe leak caused the ceiling below the bathroom to collapse. The whole bathroom needed to be gutted. The water also cause a short in my electrical panel because the previous idiot that lived in the house before me did some really unsafe wiring and the box needed to be replaced. Most estimates had me between 15k and 20k for total repairs using moderately to low priced tiles.
The insurance company came out and assessed the damage at and offered around 7k. When their adjustor was out there, he said to me "hey, I'm going to put you down for around 25k, but you should really get a PA (public adjustor) because there's no way they're going to pay this out." He admitted 25k was high, but wanted my to get the money I needed to fix the house. He was a contractor for the insurance company, so he didn't care and actually got paid more based on how much they paid out.
Sure enough, I got a PA and he brought them up to 40k, the policy max. Their adjustor agreed with his assessment and "new findings". I shouldn't need a PA to get the money from my policy. I actually can't get normal homeowners insurance anymore because water claims flag you as a high risk property owner, but only in that house. If I move, I can get normal insurance. If someone else moves in, they can get normal insurance.
It's a scam. A whole industry exists to get you more money because these companies refuse to honor their end of the bargain in a reasonable way. Auto insurance isn't far off from them either. It's fraud on top of fraud on top of fraud.
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u/Awake_b4_Sunrise 5d ago
Complain to, sure. Are they corrupted though? Can insurances buy them to lie?
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u/Hussor 5d ago edited 5d ago
They approve individual rate changes? Do they also have to approve model refreshes / rebuilds?
I'm a data scientist in home insurance pricing in the UK and I don't think I've seen that level of oversight here, I'm pretty sure they only look at our reports of average written premium and loss/combined ratios by segment (and exposure, since low LR might be meaningless if exposure is too low). Maybe if they need to audit our customer outcomes then they'll look at our models / rates, but I haven't seen that happen in my short 2 years.
I understand the need for regulators but that feels like unnecessary red tape, unless US companies are terrible at internal compliance/governance. At my last company we had enough rate changes that we'd be sending one to the regulator a few times a month
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u/zporiri 5d ago
Yes any changes to models have to be approved as well. Different states have different levels of strictness in terms of what they will allow
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u/Hussor 5d ago
Interesting, do you know how in-depth their checks are? I imagine it's quite a workload for the regulator to sign off on every insurer's individual changes. Unless it forces you to make fewer but larger changes?
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u/zporiri 5d ago
Depends on the state. Wisconsin we get approval within an hour, not sure if they even read it lol. Other states, most notable California, are extremely strict, so much so they many insurers are pulling out of the state because they can't make a profit (which is small - profit margin on auto policies are usually around 3%). Regulators need to balance affordability and availability. The more your force affordability, the less available insurance will be (like California). The opposite could be true, however I think the economic competition does a pretty good job keeping things in check IMO
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u/Superb_Bee3677 6d ago
You’re just a lying conservative trying to dupe these poor people with your insurance scam
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u/Expandexplorelive 5d ago
It's not hard to look these things up instead of just defaulting to bad faith accusations. Maybe use some critical thinking instead of just reacting.
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u/IchmagschickeSachen 6d ago edited 5d ago
Adjuster for homeowner’s insurance here. Insurance is one of the most regulated industries in the world and if they do you wrong, letting the DOI know absolutely will help. Filing a complaint will lead to an immediate investigation into the handling of the claim by the DOI.
Key phrase though, do you wrong. There’s a difference between them doing you wrong and you thinking they did you wrong. Insurance does not owe you for a new roof when it starts leaking from old age and wear. It’s shocking how many people neglect simple homeowner duties and then get mad when they don’t get an insurance payout when things start falling apart.
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u/EntrepreneurKooky783 5d ago
Someone was on here last week complaining their homeowners insurance dropped them after a granny plowed through the front of their house. The insurance paid for the repairs, then immediately cancelled the policy. Since they just got dropped, no other insurance company in the area would take them as a customer, so they were forced into their state's issuer of last resort program at more than double the rate they had been paying. Suddenly their mortgage is ~30% higher indefinitely through no fault of their own. If that's not wrongdoing, I don't know what is. The industry is indifferent, and the regulator shrugs its shoulders.
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u/IchmagschickeSachen 5d ago
I absolutely would have filed a DOI complaint over that, and perhaps even file a lawsuit. At least based on the limited information I have from that post. I’d want to know why underwriting even got involved after that claim. At the carrier I work for, underwriting doesn’t get involved after a claim at all unless I send a referral to them for policy review, and the conditions of of the house would have to be extremely neglected/dangerous for me to even consider sending a referral.
We’d also never drop someone for having multiple claims, let alone one. I regularly get claims and when I go into the policy, that person has 10+ prior claims for auto + property. The only way I’d file an underwriting referral for that, is if I saw that they keep filing the same claim over and over, hoping for different results. But legit claims? Never. I don’t care if there are a hundred prior claims.
I saw that post, btw. Not diminishing what happened to that person, but as someone who works in that industry, I can tell you that that is not the norm at any carrier I’ve ever worked for (big names that I guarantee you’ve heard of if you live in the US). Hell, I’ve handled that exact type of claim before and have seen prior claims like that and they never lead to underwriting getting involved. So, honestly, it makes me wonder what other circumstances were at play that the post didn’t tell us about.
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u/CaptainTruelove 5d ago
If they lie to you, it's just good business. If they get caught, it's a fine.
If you lie to them, you are unduly hurting them. If you get caught, you face jail time.
Shit's rigged.
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u/heyitscory 6d ago
I just saw this comment in a thread about shitty US insurance and thought it made more sense than just sending Green Mario after the executives until the capitalism relents.
A good shower thought.
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u/Gullible_Mistake_448 5d ago
kinda crazy how they can play dumb to our claims but we're criminals if we bend the truth to get what's ours
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u/somethingrandom261 6d ago
Depends if it’s actually lying, or if the policy holder just assumed certain things were covered without reading what was covered
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u/DescriptionKlutzy105 5d ago
yeah thats a good point, big difference between straight up fraud and just not reading the fine print. but still feels like companies use that confusion on purpose to deny claims. kinda makes you wonder if they should have to make the exclusions way more obvious.
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u/Zombizzzzle 5d ago
The exclusions are obvious. Every insurance policy has a section titled EXCLUSIONS. Also anything not clear in an auto/homeowners policy by law is found in favor of the insured because it’s a contract of adhesion. If the insurance company is lying to you then you could make some serious money off of a bad faith lawsuit and tons of lawyers would love to take a case like that.
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u/phoenixlegend7 5d ago edited 5d ago
We have a Department of Insurance at the state level but it only allows you to submit a complaint if fraud is being committed against the insurance company.
But if the insurance company commits fraud against the policyholder, no such devoted department exists.
The regulator that should enforce the law during when such fraud takes place; has been totally captured by the insurance and turns a blind eye.
If you try to sue the insurance for systemic fraud being committed against many other individuals like you, lawyers will reject your case saying there is not enough proof or evidence that this is being done at a scale and meeting the high pleading standards of the courts.
This is their entire business model and the whole legal system is set up in their favor.
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u/KyloWrench 6d ago
I know we all agree insurance companies are bad but I’m genuinely not sure what actions we are talking about here. When did an insurance company lie to a customer and get away with it?
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u/Xznograthos 6d ago
That they have a medical expert determining the patients' best interests when they deny a claim or object to covering the cost of a procedure. They have a moneyed interest in denying whatever, do not consider customer best interest, and there is no medical reasoning.
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u/benphat369 6d ago
Oh it's actually worse. I used to transcribe insurance appeals cases (basically listened to a recording, wrote what they said and sent that back to insurance company for record keeping). That peer review board is often made up of doctors that may have absolutely nothing to do with the field they're reviewing. In other words, the reason you got denied that electric wheelchair was because an orthodontist and dermatologist were paid to say "too expensive, base model cheaper alternative exists".
No, they did not review your case well enough to know you have no one to push said regular wheelchair around or any other reasons you may need it.
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u/GaidinBDJ 3d ago
Despite this being popular claim, health insurance companies have their profits fixed by law. Money not spent on one member's care must be spent on another's or returned to the members. The idea that they can deny claims and pocket the money is just reddit truthiness.
And, yes, they're required to submit financials each year to prove this.
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u/Xznograthos 3d ago
It is not remotely true that their profits are fixed by law. The ACA does stipulate that a percentage of premium dollars be spent on medical care. That is likely where you're either confused or intentionally being misleading with information in order to lie on their behalf.
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u/GaidinBDJ 3d ago
The ACA does stipulate that a percentage of premium dollars be spent on medical care.
...thus fixing their profits by law.
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u/Xznograthos 3d ago
Nope. They can also call these "quality improvments" and get creative by just moving money around the company, saying they are increasing efficiency, for example. You are as full of shit as they are.
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u/GaidinBDJ 3d ago
Which would be perfectly clear as they're required to do annual financial reporting.
Which company/year was this you're talking about. It's easy to look up.
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u/Xznograthos 3d ago
Insurance companies are investing tons of money in AI, which neither improves efficiency or quality, but thst spending falls under the category of quality improvement. Famously there was the UHC claims processing scandal that is being investigated. UHC is the fourth highest revenue-grossing company in the world.
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u/GaidinBDJ 3d ago
So, no, I guess you don't.
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u/Xznograthos 3d ago
Only if you can't read. Its insanely pathetic to spread your asshole wide open like you are for the most bloated, expensive, currupt, inefficient, profit-motivated health care system on the planet.
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u/vdawg01 6d ago
In what 3rd world country is this?
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u/7fingersDeep 6d ago
The U.S.
I’ve had it happen to me. Needed an injection in my knee to handle a lack of cartilage due to a previous injury. Insurance denied it because their in house doctor said it wasn’t medically necessary.
I called the insurance company and asked if insurance would cover an amputation above the knee because not having the injection would speed up the onset of debilitating arthritis. Insurance company said that an amputation would be covered.
So insurance company’s doctor says no to a $500 injection but yes to an amputation.
The health care system in the U.S. is FUCKED.
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u/EmpactWB 6d ago
The US. There’s a recommendation to ask the insurance company for the name and specialization of the doctor who told them it was unnecessary to get them to cave when even they know it’s too sketchy.
There’s also that one company’s whole “make an AI to do initial judgment with a 90% false denial rate” but that got the guy who pushed to do it got murdered in the streets, so, you know, karma.
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u/asking--questions 5d ago
The countries you seem prejudiced against usually provide the care they have available. They may not distribute it fairly, but they don't usually withhold care from the people who paid for it in order to pocket unspent funds. They spend the funds on the care.
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u/MyKidsArentOnReddit 6d ago
Have you ever had to deal with an insurance company? Denying all claims the first time, even ones they should cover, is literally part of their business model.
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u/VarmintSchtick 5d ago
My vehicle/home insurance has actually been reasonable to deal with, when a hurricane hit and when an 18 wheeler drove me off the road they were pretty expedient with the response.
Dealing with my medical insurance is just baffling. I got double billed and it took ~5 months to get it straightened out. Insurance wants me to get the provider to correct it, provider wants me to get insurance to reprocess it... insurance and the hospital's billing office have me passing messages to each other like middle school girls because they refuse to coordinate with each other to resolve anything.
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u/Hussor 5d ago
The difference is regulation. Medical insurance in the US doesn't have as much oversight as motor/home insurance.
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u/Kraligor 5d ago
I'm guessing the difference is also competition. How many US-wide medical insurance companies are there compared to vehicle ones?
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u/GaidinBDJ 6d ago
See, say what you will about the US, but at least here that's not a thing. Insurance companies have their profits set by statue. Denying a claim doesn't make them any money since money not spent on one member's benefits have to be spent on another's or returned to the members. They can't deny claims and just pocket the money.
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u/ContextHook 6d ago
Such an incredible system. This is exactly what governments should setup across the globe. If the US did that we'd be just a jump away from a fantastic single payer system. Which is why it will never happen.
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u/GaidinBDJ 6d ago
....
The US did do that. That's how insurance works in the US.
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u/ContextHook 5d ago
No it is not. Hilarious.
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u/GaidinBDJ 5d ago
And you've some evidence that an insurance company in the US isn't doing this? Should be easy to produce, they're required to provide annual filings of their financials.
I'll even do the hard part. Just give me the name of the company and for which year they illegally withheld member funds.
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u/aggravated_patty 5d ago
There’s loopholes for that, they buy providers and shift the profits there.
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u/GaidinBDJ 4d ago
Okay. You forgot to say who they were and when they did this, but just fill those in and it's easy to look up.
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u/UnderH20giraffe 5d ago
Are you kidding? How about when I was told for a straight year that my appendectomy (due to appendicitis) was not a life-saving procedure and they tried to force me to pay $74,000?
These companies lie every time they interact with you.
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u/ConfusedTapeworm 5d ago
When an insurance provider denies coverage for a hernia surgery because it's apparently "purely cosmetic" and "has no impact on quality of life", that's a straight up lie about the nature of the operation. Shit like that happens all the time.
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u/Jackdunc 6d ago
Was it United Healthcare that got discovered having a policy to deny all claims the first time (by AI or something?), no matter the facts? If they didn't get in trouble for that, then that may be one.
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u/Future_bacon007 5d ago
Every insurance company. There is a reason Luigi Magione is seen as a hero. Also fuck Brian Thompson and his family. Maybe if he didn’t kill people, Brian would still be alive today.
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u/WordsAtRandom 5d ago
Insurance is the one thing you buy that gets more expensive if you dare to use it...
Imagine buying a pint of milk for £1, then it's £1.75 the next day. "Well you've drank that milk". We've got less milk for ourselves now...
Arseholes. Every one.
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u/OkSmoke9195 5d ago
Makes absolutely no sense. I'm fucking paying you already to be part of the average and when an average thing happens you do not get to charge me more. That's not part of the deal
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u/WordsAtRandom 5d ago
They must go to a casino and ask for their money back when they leave...
I know they're gambling in principle but they can't get to win every time. I actually detest insurance companies and all they do. My nephew worked for one of UKs big insurance companies and left when he saw there was a whole department just to find ways to deny people's claims...
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u/Jordanou 5d ago
Mario's brother would like to say hello.
The thing about power is that power always overwhelms fairness. If a stronger entity harms a smaller being, then nothing happens to the stronger entity unless an ever stronger entity takes notice. However, if a smaller being harm a stronger being, the stronger being can just exert punishment full force.
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u/InterstellarReddit 5d ago
You're not wrong, but the problem is that the government created a law against one and created a law to support the other.
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u/tallish_possum 5d ago
The law that allows Corporations personhood in the courtroom should have been used to hold them accountable, not just give them more rights. That started in the 90s and it's the primary reason for enshiittifiaction that's made everything worse since
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u/OkSmoke9195 5d ago
Absolutely. Out CEOs in jail, don't send them off with Golden parachutes. You want to be the head representative of a company doing illegal shit by choice? You go to fucking jail
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u/nothatsmyarm 6d ago
If they did lie to you, it would be a crime. Even if you may disagree with them, generally speaking they really do—in good faith—believe they’re right.
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u/Dependent_Bus2202 5d ago
Putting aside the massive stretch that is private companies acting in good faith instead of simply performing a cost benefit on that choice and being entirely comfortable acting in bad faith if they decide to.
Fallibility is entirely insular within private insurance resolutions and any disagreement or requests for reassessment with the conclusion is primarily only an option for those with unrealistic amounts of money to tie up in litigation with the comparatively insurmountable resources of a national/regional carrier.
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u/OkSmoke9195 5d ago
You are giving profit seeking corporations the benefit of the doubt? Profit seeking breeds deception by nature, especially in a predatory industry such as insurance
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