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Comment by jliptzin | Hacker News Reader

I don't understand why the insurance company is the one to decide when and how to cap the costs. If a doctor says I need X drug or Y procedure the insurance company shouldn't be allowed to just deny paying for it simply because they want to pad their margins. I have had doctors prescribe a certain drug for me, insurance denies it, then they switch me to something else which they say is inferior because it might cause other issues/side effects but that's what I have to do if the first option won't be covered. If someone smashes into the passenger door of my car can my car insurance company just say they don't feel like paying for it because I can still get into the car through the driver side?

Sure premiums will go up, but the conversation should then shift to why does a 15 min ambulance ride cost $5,000 instead of fighting about whether or not an insurance company is going to cover it.

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>I don't understand why the insurance company is the one to decide when and how to cap the costs.

Because the insurance company is basically the only entity who has skin in the game.

>Sure premiums will go up, but the conversation should then shift to why does a 15 min ambulance ride cost $5,000 instead of fighting about whether or not an insurance company is going to cover it.

And the response if this is all covered would be "who cares? my insurance is covering it anyways". The patient doesn't have any incentive to choose a cheaper hospital, because he won't see any of the savings.

This is a straw man argument. Yes they shouldn't deny a prescription if your doctor says you need it.

What I'm talking about is capping the costs of a supporting doctor for a surgical procedure. From my quick research, there is no significant cost basis for surgery running longer than planned besides the anesthesiologist's time. So the doctor would make $400k instead of $500k per year.

Here is some perspective. The anesthesiologist's bill for my wife's colonoscopy in 2023 was $2k. This is a routine procedure that takes less than an hour. Also, the place was just filled with patients and there was one guy handling them all.

I agree. I'm just saying that instead of reducing healthcare costs by having insurance companies deny necessary procedures and medications seemingly randomly, there should be serious regulations capping healthcare costs. Generally speaking I am against any form of government-set price controls, but healthcare costs are so completely out of control that I don't know of any other way to deal with it. It's also a unique situation where the customer has no way of shopping around for a competitor - if you're having an emergency, your only choice is the nearest hospital - they should not be taking advantage of that situation and making you pay through the nose.

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