[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.