[bigchewy]

>>The problem with the "can't negotiate" argument is that insurers have every incentive to negotiate on behalf of the patients they cover. And they have scale—United Healthcare covers more lives than the NHS.

No, they don't. With ACA, insurance companies must spend 85% of their revenue on medical. This means that their profit margin is effectively capped and the only way for the industry to increase profits is to increase the amount they pay out to providers, pharma, etc. so, no, the insurance company does not have every incentive to negotiate. In fact, sadly, most of the time it's the opposite.

[replicatorblog]

Interesting hypothesis, but if it's accurate, have we seen a change is pricing pre/post ACA implementation? Theoretically, insurers would have been more active negotiators prior to the ACA. If so, wouldn't that suggest that rising drug prices are more a problem of heavy-handed regulation than private profit motive?

[uberduber]

25-50% of my 60-100 claims used to be denied every single year, I'd fight all of them and win. I had no claim denials in 2014 and a handful in 2015 with the same insurer. Pre-authorizations which used to be denied or delayed all now magically go through in 1-2 days.

For example, I needed a specialized MRI, doctor orders it at the hospital, approved in one day. Before I do it, I find out that the allowed amount is $30k, insurance will pay $27k and I will be responsible for $3k. Before insurance would've fought me tooth and nail on this. I eventually find a place that that tells me they'll bill $1.2k to insurance but can't tell me what insurance will allow. It takes them three times and two weeks to get the insurance approved. My final copay ends up being $55.

While healthcare has always outpaced consumer inflation, I have noticed a massive increase in the rate for hospitals and pharma, while my doctors are all actually being paid less than 5 years ago. In 2010 my doctor would get $100-120, now he gets $55-75 for the same visit. Meanwhile a simple blood test that would be $2 at my doctor or would have been $15 at hospital is now $50 at the hospital after the ACA. I think there's a lot more kickbacks and bribery going on.

[subhobroto]

Would very much appreciate if you could share this very thought here: https://www.quora.com/Has-the-ACA-removed-the-incentives-for...

> In 2010 my doctor would get $100-120, now he gets $55-75 for the same visit.

While not incorrect, the rates doctors get just for being in your insurance's network has gone up as well (doctors actually get paid to be in-network). A doctor might very well take a loss per visit but they get paid thousands (if they are in a very populous area with a big insurance company) to be in-network.