No, that's not how it works. Due to the ACA minimum medical loss ratio, most health plans have no direct financial incentive to deny treatment.
replyThey still do, because that's a minimum. If they have to spend 80% of premiums on medical care, then they make a lot more profit by spending just that mandated 80%, as opposed to 85% or 90%. Which they can achieve by denying claims. That's the direct financial incentive.
replyYou seem to be confused about basic arithmetic. First of all, the minimum MLR for most health plans is actually 85% (and most come in significantly above that for competitive reasons). And due to the MLR, health plans actually have a perverse incentive to approve more claims because 15% of a large number is more than 15% of a small number. This is one of the many reasons why total healthcare costs have continued to grow faster than inflation.
replyIt's nice to know they do it just for the love of the game.
replyMostly they do it because their customers (employers that sponsor health plans) ask them to in order to hold down costs.
replyThe several+ times in my life I've had to sort out billing issues, the health "insurance" agents have been helpful and friendly, stating what bills should be in no uncertain terms, even offering to conference call with billing departments to get things resolved, etc... Meanwhile provider billing departments routinely try to defraud me, even going so far as to bully me to pay those fraudulent amounts, don't follow up on things (eg filing claims) that are their responsibility and that they've said they will take care of, and generally make their problems into my problems.
replyThis certainly isn't a defense of health "insurance" companies though! I just think they're better modeled as Lovecraftian horrors animated by paperwork and compelling the creation of ever more paperwork to feed on, rather than money-grubbing cheapskates as the pop-political narrative goes. And the approaches for fixing one are much different than the approaches for fixing the other.