Re:Our fridge just emailed us to say we opened its door too ...
by lotsofpulp on Friday September 10, 2021 @06:05PM
(#28487429)
>The whole point of these things is to get them to pay for the costs of whatever the patient needs. These needs are determined by their doctor. If they're not paying, they have no reason to exist.
Per the payer's terms, whether it be government or employer or insurance company, their needs are not necessarily solely determined by a single doctor. There are teams of doctors and pharmacists at CMS, state Medicaid organizations, and insurance companies that create protocol for various courses of treatment in order to prevent mistakes, waste, and fraud.
>These companies hire experts and pay them bonuses every time they find some loophole they can use to get out of their obligation.
Source? It seems odd that a company that earns more money if it spends more on healthcare would have an incentive to look for loopholes. Of course, they have an incentive to not spend frivolously to maintain competitive prices.
But they are all using the same protocols that the government uses anyway (via CMS), since the government contracts with the same MCOs to administer taxpayer funded healthcare for 40%+ of Americans via Medicare/Medicaid/Tricare.
Per the payer's terms, whether it be government or employer or insurance company, their needs are not necessarily solely determined by a single doctor. There are teams of doctors and pharmacists at CMS, state Medicaid organizations, and insurance companies that create protocol for various courses of treatment in order to prevent mistakes, waste, and fraud.
>These companies hire experts and pay them bonuses every time they find some loophole they can use to get out of their obligation.
Source? It seems odd that a company that earns more money if it spends more on healthcare would have an incentive to look for loopholes. Of course, they have an incentive to not spend frivolously to maintain competitive prices.
https://www.healthcare.gov/glossary/medical-loss-ratio-MLR/
But they are all using the same protocols that the government uses anyway (via CMS), since the government contracts with the same MCOs to administer taxpayer funded healthcare for 40%+ of Americans via Medicare/Medicaid/Tricare.