While much of the country is the in the health insurance bashing mood, let’s keep this in mind.
A health insurance carrier that pays $8 in claims for every $10 in premiums collected has a medical cost ratio (MCR) of 80%.
Under the Affordable Care Act (ACA), health insurance carriers were mandated to allocate a significant share of the premium to clinical services and the improvement of healthcare quality.
Health insurance providers are required to divert 80% of premiums to claims (85% for large groups) and activities that improve the quality of care and offer more value to the plan’s participants. If an insurer fails to spend the required 80% on health care costs, it will have to rebate excess funds back to the consumer.
Source: Investopedia
Profits for insurers are driven by enrollment volume and managing administrative expenses, not by intentionally denying claims.
QUINNSCOMMENTARY 
https://www.statnews.com/2024/12/11/wall-street-unitedhealthcare-ceo-shooting-brian-thompson/
LikeLike
I must be out of the loop because I haven’t heard or seen much write up bashing healthcare or more specifically healthcare insurance. Other than the annual renew or change policies questions I haven’t noticed it. There is always complaining about the ever increasing costs and that is baked in for as far in the future as we can see.
LikeLike
Check social media
LikeLike
As in most any business the amount of customers as well as managing expenses (administrative and other) do contribute to profits. But profit is also gained by denials and by requiring pre-authorization for some procedures. According to the U.S. Senate Permanent Subcommittee on Investigations (Octobert 17,2024) found thaT:
“. . . UnitedHealthcare’s denial rate for post-acute care — health care needed to transition people out of hospitals and back into their homes — for people with Medicare Advantage plans rose to 22.7% in 2022, from 10.9% in 2020.”
Healthcare insurers also count on a very low rate of appeals of these denials.
LikeLike