Comment by droopyEyelids

Comment by droopyEyelids a day ago

6 replies

Here's a point about all the insurance companies: UHC administers the medical plan on behalf of your employer. For all practical purposes, they are a whipping boy for the real 'man behind the curtain' (your employer).

Your company (for self-funded plans) actually decides what’s covered and what isn’t, sets copays and deductibles, and ultimately saves or spends money on healthcare costs. UHC’s role is to apply those rules, maintain the provider network, and handle the billing and customer service.

If your company offers insurance, there is someone who can tell the "insurance company" to cover the service they are not covering. Usually the HR Benefits Administrator, or 'plan sponsor'. And they do it all the time! If you have a sad story and the budget is ok for the quarter, they will help! If you are a company officer, you can also have whatever your company can afford.

kiratp a day ago

This only applies to large employers. Smaller ones are just presentef a limited list of plans to pick from, and the plans change every year. Most of the time, as a startup, you can’t buy a Mag7 equivalent health plan for any amount of money off the marketplace

  • meetingthrower 20 hours ago

    Mag7 surely is self insured. They have an amazing risk pool of young people. Probably biggest cost is babies. So in this way employer sponsored health insurance screws the rest of the market, as it "hordes" the best risks. The insurance companies then wail about the cost of the risker pool of those of us stuck in the smaller plans...

    • vjvjvjvjghv 19 hours ago

      There should only be one risk pool which is the whole country. Unfortunately the republicans want to go the other way and push sick people into high risk pools which will be unaffordable for a lot of people

  • tombert a day ago

    Yeah, I work for a smaller company. I'm not sure which options they omitted but I don't think have the same bargaining power as a BigCo.

  • droopyEyelids a day ago

    It depends. If your employer is part of a self-funded group of other employers, then there is a group of trustees from all the employers that can approve.

    If it's a 'fully insured' group plan then the insurance company is technically in charge, but your company can do an Employer-paid exception (aka carve-out reimbursement) to cover something thats getting rejected. They also have the option to purchase add-on policies to add coverage for upper class stuff like fertility treatments, weight loss drugs, or gender-affirming care.

silexia 21 hours ago

Insurance companies are a whipping boy, but for doctors not your employer.

Doctors charge massively high prices, which is why insurance bills are high. Doctors have the most powerful trade union on the planet and strictly limit residencies, thus limiting new doctor supply and keeping prices super high.