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> Commercial insurers would be happy to sell plans that pay every claim that comes in at 100% with zero denials. It would be less work for them. But naturally employers don't want to pay for that, so the HR departments have the insurance carriers impose more restrictive coverage rules to hold down medical expenses.

This is not my experience as a buyer of health plans on healthcare.gov, or as a buyer of health plans as an employer (where the employer is not self insuring). The prior authorizations and denials happen all the same.

Additionally, the premiums are the same between employers’ self insured plans and healthcare.gov plans, so the coverage must be similar.

https://www.kff.org/health-costs/how-aca-marketplace-costs-c...

>In 2024, individual market insurance premiums averaged $540 per member per month, slightly below the average $587 per member per month premium for fully-insured employer coverage.

The idea that health insurers can simply spend more to earn more is not passing the smell test.

by nradov18 hours ago|

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Your experience is irrelevant. Insurance carriers have some standard default policies but they'll write whatever custom policy that a group buyer is willing to pay for.

by lotsofpulp17 hours ago|

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Your claim was

> Commercial insurers would be happy to sell plans that pay every claim that comes in at 100% with zero denials.

And yet I have never seen one of these after buying insurance in 3 different states.

Again, the grandparent claim was that insurance companies can increase profits simply by increasing their expenses. Yet there is no evidence of this, and the fact that everyone has to deal with approval and denial of healthcare coverage means it cannot be true.

by nradov17 hours ago|

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You're really missing the point. Have you ever been in charge of employee benefits for a large group buyer? Obviously such plans aren't available to individual consumers but commercial carriers will absolutely customize products for larger customers.

by lotsofpulp11 hours ago|

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timtim51251 wrote this:

> The actual reason commercial insurers pay more is that's the only way to can make more profits.

>Because of Obamacare requiring 80% of the money they collect to be spent, the insurance companies just get to keep 20%. So insurance companies spend more so they can collect higher premiums. That's how they make more money.

dmitrgyr wrote this:

> Ding Ding Ding. We have the correct answer. And this was a predicted consequence of that profit cap.

These statements indicate there should exist an insurance plan with a policy to pay for anything and everything. It does not matter what large self insuring employers choose to buy, as there are still significant number of people covered by non employer insured health plans.