[monocasa]

They do both to carefully approach the 20% overhead allowed by the ACA. Denying claims wholesale, and allowing the claims they do approve to increase in cost year over year greater than inflation so that they can make the total pie that they take 20% of greater each year.

[lotsofpulp]

Then why do some of them exceed the minimum medical loss ratio by quite a bit? Why did Elevance simply not deny more claims so it could get closer to 80% rather than 90% and book more net income?

https://www.oliverwyman.com/our-expertise/insights/2023/mar/...

> MEDICAL LOSS RATIO TRENDS

>Reported loss ratios are 89.4% for Elevance (fka Anthem), 86.0% for CVS Health (Aetna), 83.8% for Cigna, and 82.8% for UnitedHealthcare. Loss ratios have been impacted by seasonal patterns and the return to more stable utilization than seen in 2020.

Seems like an unsubstantiated conspiracy theory.