The Sutter Health Network / Palo Alto Medical Foundation routinely get caught committing widespread insurance fraud.
They also offer products that seem to be junk insurance to me, but I’m not a lawyer.
Here are three examples of their alleged widespread insurance fraud:
https://allaboutlawyer.com/claim-your-sutter-health-settleme...
https://www.sfgate.com/bayarea/article/sutter-health-accused...
https://www.justice.gov/archives/opa/pr/government-intervene...
Some of those suites involve other big providers, like KP. Not sure if any of the healthcare providers around here are reputable at this point.
I was gonna bring up Franz but you said "rarely" not "never".
I think people are wising up to the fact that at scale modern forms of insurance, all forms not just health, is not a real product that delivers value to both parties, it's a contrived way to use government force to lighten everyone's pockets to the benefit of a few while paying out only as needed to justify the pretext and the only thing it really shares with it's free-ish market equivalents from 50+yr ago is the name. So there will probably be more murders before things change.
You can call things inevitable and on some level they likely are but +/-5yr makes a huge difference in the exact turns of events and the form that history takes because at the very least it determines who the parties involved are and/or affects the circumstances they are balancing. Do we still get Hitler if WW1 starts later or goes slightly differently? You don't get the modern world without Hitler.
Us typing this here and now with the world as it is is necessarily predicated on a ton of things who's details came down in large part to chance. And it goes back way, way, way further than that.
A friend had his life wrecked by Kaiser, and none of the attorneys he consulted wanted to touch the case because according to the attorneys they had an army of lawyers and he'd already agreed to arbitration when getting the insurance. The max they claimed could be won wouldn't even cover the legal fees.
You definitely don't want insurance from the same team you're getting the insured services from. It's the conflict of interests to end all conflict of interests, especially in the context of health care.
To me the latter is an alignment of interests. The insurer will happily pay for preventive screenings and care to save itself costs on treatment later.
No, the actual problem is that the insurer and provider want to screw over the paying customer. Binding arbitration is just one convenient method they've taken advantage of to accomplish that. Getting rid of binding arbitration is still a good idea, but you can bet they'll find some other way to screw over their customers because they clearly care more about profit than people. The actual solution would be to reform the healthcare system so that its goal is focused more on healing people than stuffing pockets with cash and so companies that only care about money are forced out of it entirely.
Since it's unlikely that anyone with the power to fix the deeply broken healthcare system will do it any time soon, the least people can do is avoid this insurer and healthcare provider since they've demonstrated themselves to be hostile to their own paying customers.
I don't see a big profit motive for Kaiser because it's a non-profit. And because the same company owns the insurance provider and hospitals, they're incentivized to keep overall costs down. As long as they can't arbitrarily throw people off their plans, this means investing in preventive care and doing it cheap.
Traditional insurance providers don't care about that. They actually like it when hospitals raise prices because it allows them to charge higher premiums. Since they can only take up to 10% in premiums (or some other number, but it's a fixed %) as profits, higher costs and higher premiums are good for their bottom line.
Kaiser is how single-payer healthcare would look if it wasn't run by the government.
> reform the healthcare system so that its goal is focused more on healing people than stuffing pockets with cash and so companies that only care about money are forced out of it entirely.
What does that actually mean? What concrete steps would you take to accomplish this? Without specifics this is wooly, idealistic nonsense.
Again to take Kaiser's example: their doctors are salaried (at least the ones that work in hospitals). They have no incentive to overbill you or make you take unnecessary tests. The doctors make the same money no matter what procedures they do on you. And Kaiser owns the insurance company that's paying those bills. They also have no incentive to skip necessary tests. If they miss a problem it'll cost Kaiser more money later to treat you. Do you have a better way to "focus [only] on healing people" than that?
We've been through cancer and diabetes (so far).
As someone with a little experience with the 'advertiser side' of Google, they also push junk to their paying clients, using every opportunity to sell terrible, worthless placements to advertisers. Which is to say that the problem is not that 'searchers' are the product, the problem is that Google is not focused on creating value for its counter-parties.
Advertisers are selected based on being palatable for the content and the audience. It’s common for content licensing deals to has stipulations about which advertisement is acceptable. Virtually all platforms — even Google Search — has rules about the type of advertisements you see. There are of course laws that prohibit the advertising of certain types of products in certain places.
Even if these scams had the money for a full page NYT article, they wouldn’t had gotten it.
This discrepancy is always there for everything we see and get advertised for.
The problem is that these things exist at all.
Omnienshittified: May go down as the most hilarious - yet prescient - new word this century. (In the USA of course.)
We're looking for a newspaper publisher being liable for the ad it published. Not a story it published.
You can't cancel google. They make sure of it
Seems worth noting that "sleazy" and "suck their co-religionists into" are (unfounded, as far as I can tell) opinions, "cost the world" is flat-out false and the exact reason why they are an appealing option, and "and leave you high and dry when you or your kids get hurt or sick" is also an unfounded claim. His only citation for any of this is talking about someone who doesn't like morality clauses, but...picked it anyways, presumably because it didn't cost the world?
Some are better than others. I picked the one that looked the most like real insurance and has a >30 year track record of not leaving people high and dry. I've been on it for almost seven years and it's worked out well so far.
And if it's "like the old days", then it must not be some some uniquely sleazy thing.
I'll also add:
>these plans do not comply with the Affordable Care Act, which requires comprehensive coverage, and bans exclusions for pre-existing conditions. These plans only exist because of loopholes in the ACA, designed for very small-scale employers or temporary coverage...
He lumps sharing ministries in with this, but it's worth noting that the company I'm with was explicitly exempted by the ACA from the outset. It's not a loophole. Health sharing ministries that existed before the year 2000 could be used to satisfy the individual mandate. So he's being misleading here as well.