“As I mentioned earlier, they cannot raise premiums at their whim and 80% or 85% of premiums must go to providers, any additional premiums collected are returned.”
Percentage alone isnt everything
The Ceo’s and Presidents of insurance companies get paid multiple millions of dollars At one Point Mark Bertoloni received almost 28 million dollars in one year. while running a company that denies claims that could have saved lives. That year I had spent months trying to get a CT scan approved for a patient wit ha suspicious lesion. Renal cell carcinoma is essentially curable if caught early enough before it spreads. by the time it was approved it had spread. (Admittedly there is no way to know for sure if it spread during that delay). The patient is dead now. the few thousand dollars his company should have spent in timely error is a rounding error in his salary. This is but one story I have dozens my colleagues have more.
The truth is I don’t fault him or the company. that is their job they profit by denying healthcare that is there entire business model. I fault the business model.
“As far as the story you mentioned is concerned- I hope that’s the exception and not the norm”
Thanks for reading it.
What I was most outraged about whas the physician who just rubber stamps what nurse had previously denied. what is the poitn of having a physician reviewer if he isnt actually reviewing it?
You say you hope its the exception . It is a lot of exceptions close enough to being the norm . It is their business model . Yes they have t pay 85% that still leaves millions and million and millions for their top executives .