Health insurance companies aren't incentivised to fight this kind of thing.
Clearly falls into mandatory coverage (if claims are accurate), so all companies are going to have to pay it. Raises costs. Insurance gets to have overhead (profit) based on claims paid.
There's more incentive to deny marginal claims, because some insurance companies won't and then you may attract more customers with a lower price and maybe you get more money that way.
Patients are unlikely to complain to insurance to tell them the treatment/confinement was unjustified... because the patient will then need to pay the bill.
> Patients are unlikely to complain to insurance to tell them the treatment/confinement was unjustified... because the patient will then need to pay the bill.
Honestly, you buried the lede here. This is the horrifying and broken part. Under no circumstances should someone have to be afraid of paying for their involuntary commitment.
Like is Acadia really going to sue so they can have the insurance company and the patient testify under oath that Acadia management is guilty of kidnapping at scale, and in this particular case?
As someone who went through this with a child and Acadia’s competitor UHS, yes. Yes, they do. The number of parents in our support group who fought in court to get their kids or relatives out of one of these hospitals only to be presented with a back-breaking bill for their commitment is genuinely nauseating.
This is one of the prime examples of the utter failure of the US for-profit healthcare model.
I wholeheartedly attest to this.
I had to stay in an Acadia facility due to a bipolar flare-up.
The bill was so bad... I think if I hadn't been in a better place, the bill would have sent me right back in!
The last time I checked, you can simply dispute a bill to get it off your credit report.
If they actually kidnapped you (as is apparently common practice there), I doubt they’d be dumb enough to sue you.
If they were, you can countersue in California, and the civil damages they owe you for kidnapping you will be deducted from whatever court judgement they win (probably making it negative).
Patient was treated. If insurance refuses to cover, the hospital bill the patient. If the patient refuses to pay, they'll end up in collections or bankruptcy, depending.
Insurance company profits are capped as a percentage of expenses, so saving money means they make less money. There are bad incentives all over the place in healthcare regulations.
If you're referring to the minimum medical loss ratio provisions in the ACA, most insurance companies are above the minimum, which means any marginal fraud reduction is pure profit for them.
Insurance executives' pay is limited by a pool of money that is calculated as a % of total expenses. If expenses are higher due to this sort of fraud, have an incentive to ignore it to keep that pool of money available for compensation as large as possible.
For health plan executives the financial incentives run both ways. Most medical "insurance" companies no longer provide much insurance and primarily act as third-party administrators for self-insured employers. In the short term, health plans can make more profit by approving more claims. But in the long term they have to compete for the business of those group buyers and so they try to block waste/fraud/abuse that drives up customer costs.
Clearly falls into mandatory coverage (if claims are accurate), so all companies are going to have to pay it. Raises costs. Insurance gets to have overhead (profit) based on claims paid.
There's more incentive to deny marginal claims, because some insurance companies won't and then you may attract more customers with a lower price and maybe you get more money that way.
Patients are unlikely to complain to insurance to tell them the treatment/confinement was unjustified... because the patient will then need to pay the bill.