I'll assume they're on company insurance. Which is often "self-insured" in that the company actually foots the bill as opposed to the insurance company.
Why don't corporations just drop insurance companies that decide to not allow cheaper medicines?
The 80% rule has a lot of loopholes. It doesn't apply to employer funded plans. There's a reason UNH is so big!
There’s an article about how a Wall St employee’s expensive care came up in C-suite meetings, as a real world consequence of this
if you punch into a chatbot questions about the employer pool insurance product, your comment is exactly how the chatbot characterizes it.
of course, "administrative sides of [health] insurance" includes requiring pre-auths and approving/rejecting claims, which is, haha, all the fucking evil parts of what they do! it's not "simply" anything. they need a huge, comprehensive, defensible model of what regulations and customers will accept as valid healthcare. apple does not need to have an opinion on ten thousand treatments and the standard of care across all these things. the insurance company does.
this is a line of investigation that the chatbots are absolutely terrible at informing people about. "administrative" is ALL the work, that is why UNH is big! you are starting from the wrong premise. you must always ask yourself, why are health insurance companies so big?
This comment chain was started to question why limiting profits to 80% of claims has to result in insurance companies denying cheaper options.
I have yet to see an argument as to why a company isn't incentived to drop a health insurer if they're forcing employees _not_ to do a $50/month option and instead pick a $1k/month option.
That definitely does happen, but companies have a lot of levers to pull around how employees select health insurance. When I bought health insurance for a small firm (~60 people), I provided a set number of dollars and workers could use these for any plan they wished (an ICHRA plan).
That's because it's the truth? I've taken graduate health policy classes from people like Don Berwick - I assure you that I did not and do not need to ask chatgpt to explain self-insurance to me.
> f course, "administrative sides of [health] insurance" includes...
How does this have anything to do with the fact that the self-insuring entity bears the risk for its insureds? The problem with the GP comment about 'giving money back to Apple' is that the money always belonged to Apple and its co-insurance / copays only exist to steer employee behavior.
apple employees say they want it, for some idiosyncratic reason apple is the party that gives it to them, and UNH is providing a uniquely cheap version of it. the gap between what employees think they are getting and what they are actually getting is huge. when you go on hacker news and people are talking about 80% medical loss ratios (that don't apply here, but that's not what you are spending your breath talking about) and "insureds" or whatever, you are enhancing the illusion.
that UNH has people carrying its water in this way: that's another reason, of many, that it is so big.