"Slow Pay, Low Pay or No Pay": Blue Cross Approved Surgeries Then Refused to Pay

I wish more people were asking “why does the hospital charge such absurdly high fees?” instead of “why is Blue Cross trying to not pay those absurdly high fees?”

This. Even if you eliminated all profit margins of insurers you only decrease medical costs in the US by a tiny fraction, still leaving you far worse off than in other countries. They suck, but they're a cheap scapegoat for simpleton populists who don't know or don't want to fix the actual problems.

https://www.noahpinion.blog/p/insurance-companies-arent-the-...

Many reasons, one of which is "insurers refusing to pay for things they authorized".

Consider their business model. A lot of highly educated employees, a lot of very expensive equipment and furnishings, a high risk of customers dying in their care, and injury lawyers hovering around the exits telling sick and injured people that if they aren’t 100% cured they have a lucrative claim.

Except the insurers increasingly own the cost centers.

The big insurers own the PBMs, the specialty pharmacies, the doctors, the urgent care networks. United Healthcare is the country’s single largest employer of physicians. https://www.statnews.com/2025/03/07/unitedhealth-surgery-cen...

They pay their controlled ones higher rates, even. https://www.statnews.com/2024/11/25/unitedhealth-higher-paym...

Why not both?

Everyone angry about Big Tech and the like need to know that healthcare was patient zero for the monopolization and enshittification cycle that seems to have consumed everything in the world economy.

Once one industry consolidates, their vendors and customers need to consolidate too, or they don't have any negotiating leverage. If you don't consolidate, you're the deal taker, and that deal will be incredibly garbage. This cycle continues until it reaches the one place where you can't consolidate: end customers. There's no such thing as a "customer union" that can fight back against this bullshit. This turns business into a conspiracy to screw the customer, purely through normal, logical business actions that were already illegal but unenforced.

The problem with merely pinning the blame on one entity is that it doesn't fix the system. You don't care about whether or not it's the hospital's fault or the insurer's fault, you just want the problem fixed. Law enforcement actually has a solution for this: joint and several liability, which is a way of saying "I don't care who did it, someone either fixes it or I'm punishing both of you". Pin the blame on both entities if you want the shenanigans to stop.

In today's episode of things Americans claim they are the first to encounter/solve... hospitals?

I have a very long and maybe ill-formed in-person rant about medical costs in the USA and the cost of higher education in the last 30 years and how these issues are are n-sides of the same n-sided coin but it takes about 8 beers to get through and isn't something I ever have the nerve to put down in an HN comment.

The "customer union" is supposed to be the government

But of course that has been captured as well

I've lived in multiple countries with customer unions in the form of a health board that negotiates a single charge master with providers.

Does it lead to wait times? Sure! So does the US system!

This.

Why can the hospital in France (even the private one) tell me ahead of time how much something will cost, while American providers will scream that this is absolutely impossible to do?

> Even if you eliminated all profit margins of insurers you only decrease medical costs in the US by a tiny fraction

This is completely wrong.

A general practicioner doctor is unlikely to be making much more than 300K, or $144/hr. But my visit to said doctor costs $450 for 15 minutes, or $1800/hr.

Many people are making a fortune out of the system, the money is not going to the person doing useful work, the doctor. Where is the other $1656/hr disappearing?

Eliminate all those grifters from the loop and I could go see this doctor for $36 per 15min visit. Heck I wouldn't even need insurance, I can pay that out of pocket.

Sure, I'm ignoring rent/utilities/supplies, so it'd be a bit more than $36 but those costs are a tiny percentage. In any case it'd be less than $50, far below the current $450.

You say it's wrong but then don't do your working properly. The $1656 isn't going to the insurer. Read the article.

You're mixing up which way the money goes. The doctor's practice or hospital gets the extra $1656, from the insurer. That's the problem.

Then the solution is obvious. The government can pay this doctor their 300K salary directly out of taxes and we cut out everyone else. Win/win for everyone who matters.

Massachusetts is trying essentially this and should have the initial results by the end of they FY. I'm hopeful.

> The doctor's practice or hospital gets the extra $1656, from the insurer.

No, they don't.

Insurance pays out their negotiated rate of like $100 for that 15 minute appointment. (Which likely has some pre- and post-appointment work involved. My doc has clearly at least skimmed my chart prior, and I get a written note later. I'm also seen by a nurse initially.)

The rates have to be obscenely high on paper so the insurer gets their big win negotiating.

The rest just... evaporates. https://imgur.com/a/X5oLXgr