1. Profits are capped as a percent of health care expenditures.
2. Employers (and people in the Marketplace) purchase insurance mostly based on price, which incentivizes lower prices.
3. (I'm guessing) Medicare advantage pays a flat annual rate to insurers.
4. Insurer denies large claims on Medicare Advantage accounts, turning annual rate directly to profits.
5. Insurer's denial of claims for other classes of policy lowers the price of the policy, increasing competitiveness.
6. Providers fight with insurance policy and fall back to billing patients, who can only pay pennies on the dollar.
7. The providers raise future rates to compensate for the costs and losses incurred by denials.
7. Increasing prices for all customers yields the desired absolute profits, without penalizing the company doing the denials.
1. Profits are capped as a percent of health care expenditures.
2. Employers (and people in the Marketplace) purchase insurance mostly based on price, which incentivizes lower prices.
3. (I'm guessing) Medicare advantage pays a flat annual rate to insurers.
4. Insurer denies large claims on Medicare Advantage accounts, turning annual rate directly to profits.
5. Insurer's denial of claims for other classes of policy lowers the price of the policy, increasing competitiveness.
6. Providers fight with insurance policy and fall back to billing patients, who can only pay pennies on the dollar.
7. The providers raise future rates to compensate for the costs and losses incurred by denials.
7. Increasing prices for all customers yields the desired absolute profits, without penalizing the company doing the denials.