New Yorker: A Man Was Murdered in Cold Blood and You're Laughing?

[Prairie Gates]

53. There's also slipperiness in attributing initial denials to minor errors and "lazy doctors"

The high number of initial denials is a result of a deliberate policy designed to create more final denials by making the process of achieiving a successful claim extremely difficult. It's a bit like saying "Sure, you get mugged 30% of the time that you go outside, but they only successfully grab your money 9% of the time." Well, fuck me. That's nice!

The various strategies that they start in on with initial denials are part of the overall problem. Claiming that their relentless claim-denial tactics are only successful 10% of the time ultimately is quite the prancing bit of sophistry, but most people see through this nonsense as a result of their own experience. If I have to fight tooth and nail for six months for a claim that should have been paid immediately, I have still been harmed. It is a thief and a liar who would counter with "well, you got your money eventually, no?" Especially since many don't, even with that terrible fight that is a fight made by deliberate policy.

Ultimately, these are all dishonest tactics made to obscure the overall point: health insurance companies should not be very profitable. The basic principle is that those who are healthy help pay for those who are sick, but everybody gets sick at some point, and some are very sick and require a great deal of care. A health insurance company can surely increase efficiencies and pull a small profit from that overall scheme. The only way they could possibly amass the massive profits they're taking is by disrupting the orderly running of a "healthy pay for the sick" agreement. They take money from the healthy and the sick, and return as little as they can. This company made $16 billion in profit. That's not possible under an orderly operation of a health in surance company. It is only possible when they are rapacious murderers, and that's the end of that.