Hacker News Reader

Comment by edgyquant | Hacker News Reader

Why in the world is the whole network thing even legal? It’s seems like a way to guarantee certain doctors and insurance companies a steady stream of cash flow without having to compete with one another. It is a hilariously corrupt system, but that’s par for the course with the medical industry. One of the only professions where you can charge people to have provided no solutions to their problems. Image a mechanic who tells you your misfiring engine and squeaky breaks are nothing and then charges you a few grand for the pleasure of them being obviously wrong.

View on HN

Aside from such a scheme dominating a particular region and being a potential playground for other anticompetitive practices, nothing about the idea in general strikes me as inherently anticompetitive.

Insurance cos can still compete on the merits of their networks and, in theory but sadly I think not in practice, these schemes could work in favor of the patients if the insurance company uses their network to balance cost with service quality.

A very dominant one could effectively rule a region as a cartel, though.

> Why in the world is the whole network thing even legal?

The answer is on some of the other comments on this page. Insurance companies make reimbursement so difficult that some doctors do not want to accept the insurance.

Doctors can be out of network and still accept the insurance.

they can accept the insurance, but if the insurance doesnt pay the bill, the doctor has rendered services w/o payment. That isnt fair to the doctor.

As many other comments point out, insurance companies pull many tricks to try to not reimburse.

I've submitted claims directly to insurance before and had the same issue.

- Your claim gets rejected for missing information, but they dont tell you what is missing

- Your claim gets rejected for being a duplicate, but the previous claim also got rejected, or both got rejected

- Your claim is "not received" there is no record of a claim

- Your re-submitted claim gets rejected because 90 days have passed, but of course, it is because you were forced to resubmit over and over

> Why in the world is the whole network thing even legal?

Lobbyists

most professions that bill by the hour work this way? squeaky brakes isn't a plausible example, but this isn't uncommon for electrical issues in luxury cars. the mechanic spends days/weeks chasing it down and eventually asks you if you want to keep paying them to look. if you say no, you still have to pay for the time they already spent. if you say yes, there's no guarantee they eventually fix it. or they come up with a root cause and give an estimate to fix. you still pay if they're "obviously wrong".

Reply on news.ycombinator.com