[HN Gopher] How a Customer Got Trapped in Ambetter's Ghost Network
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How a Customer Got Trapped in Ambetter's Ghost Network
Author : howard941
Score : 50 points
Date : 2024-09-08 19:56 UTC (3 hours ago)
(HTM) web link (www.propublica.org)
(TXT) w3m dump (www.propublica.org)
| akira2501 wrote:
| Government health care subsidies and purchasing programs have
| completely destroyed the market for services. It's an
| incomprehensible mess of products with a bloated middle layer
| that only exists to extract value out of the actual Consumer +
| Expert Care Provider equation to the extreme detriment of both of
| them.
|
| How anyone stays alive and wealthy in such a system is beyond me.
| Very few, apparently, are fortunate enough to enjoy this. We need
| to completely rethink this entire model.
| jonhohle wrote:
| It's almost as if people warned about this very thing. It's
| almost as of anything the government touches turns to crap for
| most while a few, especially those in Congress, ride off with a
| huge pay day. I'm not sure why people continue to fall for it.
| monero-xmr wrote:
| We just need to create more agencies, throw more money at the
| existing programs, establish new programs, and add more
| regulations. This time for sure
| Hnrobert42 wrote:
| I assume this is a criticism of the ACA. How, specifically,
| did it lead to this outcome?
|
| And why is your criticism reserved for the government and not
| the perpetrator of the fraud, namely Ambetter?
| Terr_ wrote:
| Hold up, how does this type of fraud require any government
| action at all? (Except for prosecuting the fraud after-the-
| fact, of course.)
|
| The core situation isn't specific to healthcare either:
| Someone's offering you a long-term contract service based on
| the strength of a menu of available services and options, but
| their offering is effectively fake.
|
| It's a similar concept to subscribing to a mostly-fake library
| of repair manuals or something, only the popular/cheap ones are
| there, and the others are permanently temporarily unavailable.
| akira2501 wrote:
| > Hold up, how this type of fraud require any government
| involvement at all?
|
| Hold up (seriously hold up and stop serially editing your
| comments), where did I say it did?
|
| > It's a similar concept
|
| The government has decided, without much input from actual
| citizens, that copyright should exist for life plus 70 years.
| Government interference in copyright has created the
| fraudulent market conditions you've just related.
|
| We can do this all day if you like.
| trollbridge wrote:
| The "problem" can be fixed relatively easily: when an "insurer"
| fails to cover a loss of one of its insureds using its own
| providers or network, the insured can simply go to anyone they
| can find and they or the third-party provider can submit the
| claim. This is how proper indemnity insurance works, and it would
| instantly fix the "technical problems" and "out of date
| directories" that this insurance company in question is suffering
| from.
|
| In any case, this company is now the target of multiple class-
| action lawsuits, including one under RICO. It would be
| interesting to find out in discovery if publishing bogus provider
| directories was intentional on the company's behalf. If it is,
| this opens a great deal of liability for them. We are fortunate
| that 11 states outright ban mandatory arbitration by insurers
| with another 3 where the courts de-facto ban it. This means
| insurers can't get away with this forever.
| brendanyounger wrote:
| While I have no love for Ambetter, I think we need to ask
| whether behavioral health services should ever be covered by
| insurance. From 10,000 feet, the behavioral health product is
| terrible. There's no clear timeline for how long it takes to
| get better, and it's nearly impossible to objectively compare
| provider quality using any publicly available data set. In
| short, it's a terrible match for insurance as a product. Which
| is why we're in this pickle.
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(page generated 2024-09-08 23:00 UTC)