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I would question the incentives for an insurance company to reject claims arbitrarily or to not make the process for submitted claims at the very least adequate for two reasons: 1. If you insure a bunch of people against, in short, stuff that can kill them, then it's really in your best financial interests to be making sure that as many of those people as possible are seeing a doctor as regularly as possible (within reason) because that's how you avoid situations where someone makes shitty healthcare decisions for 3 decades then suddenly needs every imaginable treatment for every imaginable ailment that said person, who is obviously not a healthcare professional, would have never seen coming because they weren't regularly attending to their health in a low cost consistent kind of way, instead they just let their health deteriorate until it was an emergency. Which, from my understanding, especially in America, is where the vultures pounce to ensure your insurance companies pays top dollar for critical drugs and treatment. 2. On a purely accounting note, wouldn't this just fuck up your cash flow figures? I mean, if someone needs to get their insurer to pay for something because they don't have another option and they try and claim for that thing, isn't it in your best interest to make sure you pay out the amount at least reasonably quickly because, especially if you're acting in bad faith, their going to eventually break their way through the system to the "submit claim button" through sheer hours of trying, or their going to end up in court because they don't have other options. Then you've suddenly got a massive lump sum payout that probably wasn't in your forecasted expenses. To me, that just sounds like unpredictable silliness. But then again, I live in a country with free health insurance so I genuinely could be entirely missing the mark here and it could genuinely be more profitable to pinch your pennies as an insurer. |