[specialp]

One thing lost on people is the "for-profit" motive is not solely with insurers or plan providers. Medical practitioners in my experience are extremely motivated to provide as many services as the insurer will pay for regardless of how medically useful they are.

This results in often legitimate procedures being denied. But make no mistake, the care providers billing insurance are just as likely or more likely to try to grab money in any way possible.

I was once involved in a company that would place laboratories and other diagnostic machinery in physician's offices. They would always be very interested in what the insurance reimburses and how many patients they can run it on. There would always be some gimmick like Oh, homocystine we can run on every patient for $5 and be reimbursed $30, and then you would see that ran on every single patient they could to make that money. Eventually insurers would have to shut it down. High sensitivity CRP was another one until medicare locked it to being run once in a patient's lifetime.

[maerF0x0]

> Medical practitioners in my experience are extremely motivated to provide as many services as the insurer will pay for regardless of how medically useful they are.

I've personally found this particularly common and suspect within the Dental industry.

https://health.sunnybrook.ca/navigator/too-many-dental-x-ray...

[pc86]

> Medical practitioners in my experience are extremely motivated to provide as many services as the insurer will pay for regardless of how medically useful they are.

The shitty ones, maybe. I know many physicians who acknowledge that unnecessary tests lead to unnecessary interventions, which is proven to reduce quality of life and decrease outcomes.

[ryathal]

A lot of this is also cat and mouse about reimbursements. Medicare has cut payments for a lot of visits to the point they aren't profitable, BUT if you fill out a form and e-file and do X for a visit, then you get a bonus payment and can bill a higher code so the net return is about the same.

[maxerickson]

All the people complaining that they went in for an included annual checkup and got billed for asking a question are running into this, it's the provider that changes or adds the billing code.

(Maybe not the practitioner directly, the providing organization)