[todfox]

I once had an insurance plan with a grossly inaccurate provider directory. This cost me a bit as the doctor they suggested to me, verbally on the phone, turned out to be out of network. They later told me it was the doctor’s responsibility to remove themselves from the directories and they often fail to do that. If they’re so incapable of maintaining an accurate list of providers on their own, how did the insurance company know to reject that claim so quickly? They are simply liars and fraudsters.

I began calling random doctors in the directory and one even told me he tried to get his name removed for three years. Anybody at the insurance company could clean up the directory once a quarter. They know the directories are inaccurate. It makes their network look bigger.

Health insurance middlemen need to be eliminated already.

[LorenPechtel]

Yup, I've seen it also.

None of the snail mail garbage, but I couldn't pry anything out of the portal. The first attempt with the insurance company produced an e-mail that was utterly useless. The second attempt, when I spelled out the problem with the first, produced a completely different list when it should have been a subset except with a greater distance. Of that list I could reject some based on their websites, some were utterly wrong based on calling the office (and in one case a "never heard of them") one had been in an accident and wasn't currently accepting new patients and that left one. And it was the closest one I had looked at, the distance bit was most certainly not relevant.

They need to put a much shorter timeline on the insurance coming up with a suitable practitioner. Say, maybe a day rather than 60 days. And maybe a month to actually get an appointment. And, for an existing situation the clock is set by any important scripts the patient might have. (My hunt was triggered by my getting dumped by the system--I had been grandfathered in when the practice changed. Then the doctor left and the grandfathering ended.)

[Projectiboga]

Simple solution is if the insurance directory says a provider is "in network" than they should be on the hook to honor that and pay the provider and collect the in network deductible from the patient directly. I'd bet that issue would be fixed in a very short time. It is basically fraud for them to have inflated list of supposedly active providers.

[LorenPechtel]

While I do agree with the issue of an inflated list I didn't find anyone on their list that actually existed (at least at the office listed) and wasn't actually in network. I found doctors that didn't cover the whole field of their specialty.

[underlipton]

The political cowardice of the Obama administration and congressional Democrats to not just deep-six the private health insurance industry as we knew it when they had the chance, Republican (and Blue Dog) whining be damned, cannot be overstated. It's been 15 years. Think how different our country could be today, how much better off people could have been, if we'd established an American NHS with even half of the money we spend.

It's a little crazy how quick we are to fire individuals who have a negative effect on a given organization, while being so loathe to "fire" the organizations who have a negative effect on our society.

[Projectiboga]

Yep campaign finance laws really feed this mess. Both parties love to blame the Senate Filibuster, but no one want's to eliminate it. This specific problem would end rapidly if the insurance companies were on the hook for having to honor their 'in network' lists, they should be liable for any inaccuracies on that list, and any fighting about money should be between the providers and the insurance companies, both have money to litigate. Patients do not have the time or money to fight effectively.

[underlipton]

One thing: both parties have done their part in changing cloture votes for nominees to simple majorities (though, of course, with the distinction that Democrats were frustrated with years of filibuster abuse, whereas Republicans used it simply to get their SCOTUS nomination through).

But whether its the filibuster or private entities caught in massive controversies (medical insurers wrt TFA, banks wrt the GFC, Big Pharma wrt the opioid crisis), the hemming and hawing over in government incremental change and any sort of real accountability, in the face of clear abuse and exploitation, is infuriating.

I'll add another wrinkle: all of this was predictable, because these issues that have become of concern for the entire country have analogues that weren't dealt with correctly when they were mostly affecting marginalized groups (LGBT folk accessing care, people of color accessing mortgages and dealing with the crack epidemic). Did we inadvertently build ourselves a framework for failure with those? I tend to think so. They're not new diseases, we just let old ones spread.

[prepend]

It seems like insurance companies don’t care about things that burden the customer or provider. Lots of onerous forms and weird processes that are wrongly documented.

I had infuriating situations where their directory showed a provider, their phone service confirmed they were in network, but the claim was rejected as out of network. They said they made a mistake and the only way to know is to try to submit a claim. I asked the same thing “if you know to review a claim why don’t your reps or your web site know?”

[mindslight]

What I don't get is why people seem to just take it? Just because someone sends you a bill does not mean there is a valid debt you actually owe. This goes double in the medical extraction industry where the default behavior is sending bills with large fake amounts "due" and hoping victims don't examine them too closely.

I'm dealing with a similar thing right now where the "insurance" company says something is covered and they will "adjust" it any day now, while the "provider's" billing agent continues sending us fraudulent bills with fraudulent charges. The services were actually provided in a hospital and the hospital's bill was already paid, making these charges baseless for two separate reasons. It's like if you bought food at a supermarket and then a few months later the cashier themselves sent you a bill for several hundred dollars.

So every few months I call them up, tell them that there are fraudulent charges on their statements, and if they send me a payoff statement or corrected bill I am willing and able to pay it in full. They respond that they cannot do that, but emphasize it's really important for me to pay the other charges by their fabricated "due date". I reiterate that I'm not going to pay part of their bill only to have the matter not resolved when they keep sending me fraudulent statements, and that presenting a correct statement is their responsibility. There are certainly better uses of my time, but at this point this medical shakedown cartel is so out of control it's all of our responsibility to hold the line.

[telchior]

The problem seems much less simple than people just "taking it".

The first line of defense against these shenanigans is provider choice. If you've got employer insurance, you have no choice. If you are unemployed or have the kind of poorly paying job that has no insurance, you must prioritize one of a few cheap plans, all of which have bad reputations. The number of people who can really choose is likely quite small.

The second line of defense is knowledge of your rights. However... these rights are quite squishy. The insurance company has quite a number of methods, and people trained in using them, for creating and assigning debts. The customer typically has no knowledge, no time to obtain that knowledge, and nowhere to turn for help. Most people also know that if they're in a situation like yours, the company can very quickly make it MUCH worse by sending the imaginary debt on to a collector; this may be "illegal" but that's a nasty swamp to dive into for a regular person with time constraints.

The third line is just... persistence. This is most accessible, but you're probably underestimating the number of people who either flat out don't have the time / mental bandwidth for it, or have a fear of going against authority which more or less prevents them from repeatedly pushing back.

The insurance industry is an evolved parasite, and it has taken its current form after decades of evolutionary pressure in the system. You may not believe that people should "take it", but it is nevertheless specifically evolved to have the maximum number of ordinary people do exactly that.

[mindslight]

I do know why the fraud succeeds so much of the time, and I agree your comment does a good job of explaining many of the dynamics. I really meant my lead in more in the context of why relatively informed people discussing this on message boards and in news articles brush past having paid fraudulent bills in such fatalistic terms, rather than stating they were bullied/tricked or they consciously decided it wasn't worth their time to fight. It lends an air of legitimacy to the shakedowns.

I had a durable medical equipment supplier send me a fully "adjusted" and paid by "insurance" bill that I had already paid the correct copay on, but they were still demanding more. I double checked with the "insurance" company, then called the supplier and told them how their bill was wrong. They responded with some nonsense like "that is their price, this is our price. Don't you want to pay what you owe?". I asked them if they liked referrals to the attorney general and they just flat out hung up on me. Never heard another word. These people are shameless.

[prepend]

Every doctor I visit makes me sign a financial agreement before performing services. It says something like “you owe whatever we bill you and if insurance doesn’t pay, you must”

Good luck holding the line, what usually happens is we get stuck with a bill no matter what.

[mindslight]

I generally cross out such nonsense and nobody has ever even commented.

But note that even if you haven't crossed it out, it's still not a valid contract - "whatever number we might pull out of our ass later" isn't defining consideration, plus there is no counterparty signing it.

Such documents are really just part of stage managing the victim for a later shakedown.

[Reason077]

It sounds like something that would be very easy to fix if the government mandated that insurance companies have a responsibility to keep their provider directories up-to-date. Software should be able to very easily identify providers that have not accepted any claims in a given time period, so that they can be flagged for removal.

[mu53]

You are giving me flashbacks back to 2008.

"THeY aRe Gonna KILL GrandMA"

Healthcare companies are entrenched politically with expansive lobbying efforts and advertising dollars.

[0xcde4c3db]

This has been the case for a long time. If you don't believe me, why not break out the old phonograph and spin up the classic 1961 album "Ronald Reagan Speaks Out Against Socialized Medicine", in which Ronald Reagan (the actor?) warned us that Medicare is just a "foot in the door" toward becoming an authoritarian dystopia where the government tells everyone which town they're allowed to live in? Just ignore the fact that it was produced as part of a stealth campaign by the AMA [1].

[1] https://en.wikipedia.org/wiki/Operation_Coffee_Cup

[trilbyglens]

This is the real issue. The rest of the developed world solved health insurance long ago.

[musicale]

> They are simply liars and fraudsters.

Systematic fraud is very profitable.