Also, for beyond that, unspend premiums have to be refunded, which also cuts into the potential admin spend bucket, so it's best to always ensure your paying as much as possible in claims.
Plus, patients hate denied claims, because typically your forced to sign paperwork saying your responsible for anything insurance refuses to pay.
And with most health insurance spending being locked to employer benefits, the big market is the group market, which means your stuck with either getting your job's option(s), finding a new job, or not getting insurance basically.
In other words, you don't have a price choice as an individual in a group.
Now that is some sick shit. Making every doctor's visit a gamble you might lose, discouraging people from seeing a doctor.
Alot of insurers the past few years have actually gone bankrupt from ballooning costs and claims.
So, they want costs to go up, so the next year they can up the premiums, so they can then up their admin spend, but the costs still need to below the premium. And they can't just up the premium without an associated rise in cost, because groups are owed their premium money back if it isn't paid out.