293
you are viewing a single comment's thread
view the rest of the comments
view the rest of the comments
this post was submitted on 13 Jan 2026
293 points (100.0% liked)
News
36118 readers
3261 users here now
Welcome to the News community!
Rules:
1. Be civil
Attack the argument, not the person. No racism/sexism/bigotry. Good faith argumentation only. This includes accusing another user of being a bot or paid actor. Trolling is uncivil and is grounds for removal and/or a community ban. Do not respond to rule-breaking content; report it and move on.
2. All posts should contain a source (url) that is as reliable and unbiased as possible and must only contain one link.
Obvious biased sources will be removed at the mods’ discretion. Supporting links can be added in comments or posted separately but not to the post body. Sources may be checked for reliability using Wikipedia, MBFC, AdFontes, GroundNews, etc.
3. No bots, spam or self-promotion.
Only approved bots, which follow the guidelines for bots set by the instance, are allowed.
4. Post titles should be the same as the article used as source. Clickbait titles may be removed.
Posts which titles don’t match the source may be removed. If the site changed their headline, we may ask you to update the post title. Clickbait titles use hyperbolic language and do not accurately describe the article content. When necessary, post titles may be edited, clearly marked with [brackets], but may never be used to editorialize or comment on the content.
5. Only recent news is allowed.
Posts must be news from the most recent 30 days.
6. All posts must be news articles.
No opinion pieces, Listicles, editorials, videos, blogs, press releases, or celebrity gossip will be allowed. All posts will be judged on a case-by-case basis. Mods may use discretion to pre-approve videos or press releases from highly credible sources that provide unique, newsworthy content not available or possible in another format.
7. No duplicate posts.
If an article has already been posted, it will be removed. Different articles reporting on the same subject are permitted. If the post that matches your post is very old, we refer you to rule 5.
8. Misinformation is prohibited.
Misinformation / propaganda is strictly prohibited. Any comment or post containing or linking to misinformation will be removed. If you feel that your post has been removed in error, credible sources must be provided.
9. No link shorteners or news aggregators.
All posts must link to original article sources. You may include archival links in the post description. News aggregators such as Yahoo, Google, Hacker News, etc. should be avoided in favor of the original source link. Newswire services such as AP, Reuters, or AFP, are frequently republished and may be shared from other credible sources.
10. Don't copy entire article in your post body
For copyright reasons, you are not allowed to copy an entire article into your post body. This is an instance wide rule, that is strictly enforced in this community.
founded 2 years ago
MODERATORS
The point of delaying and denying is so that they can collect the insurance money but never pay out. For someone in a retirement home who needs hospital services, their insurance would pay for this… But if the retirement home just simply doesn’t take them to the hospital… Then the insurance company will give the retirement home a small bonus that is significantly less than the overall hospital bill would have been.
I do not think any of us are surprised to hear which particular insurance company is being accused of doing this…
But how do they finesse the "never pay out" part? How do they avoid paying out through healthcare or rebates?
In arrangements like this, an insurer (often through Medicare Advantage) pays nursing homes a fixed monthly amount per resident, then layers on incentives tied to cost and utilization: (1) bonus payments if the facility meets targets such as lower hospital transfer rates or quality scores, (2) shared-savings payouts where the nursing home gets a portion of the medical cost savings if overall spending drops, (3) sometimes penalties or clawbacks if targets are missed, and (4) care-management support (e.g., insurer-employed clinicians embedded in the facility) that influences how care is delivered and measured — the controversy arises when these financial incentives may unintentionally discourage medically necessary hospital transfers.
Okay, so I think I follow -- if the nursing home keeps patients there instead of transfering them to a hospital, the insurance company pays them more, so the nursing homes are incentivized to keep patients there, even at their detriment.
Do I have that right?
Yes. So, they are dying of a heart attack and the nursing home says, “old man, you have heartburn, go back to bed” and then they keep their bonus check.
And this is on top of all the horrible things that nursing homes do even without insurance companies giving kickbacks and bonus checks
Okay, I'm with you so far. Go on.
You seem very agreeable tonight… it’s suspicious.
Well I'm trying to understand how that translates into more revenue for the insurer.
If I live in a nursing home and I pay $1000 per month to the insurance company (via Medicare and out of pocket, etc), and they have to pay $1000 per month for my medical bills, they get no money.
So, if they make a deal with the nursing home to stop bringing me to the hospital, they won’t have to pay my medical bills and they keep the $1000.
As a reward, they will pay the nursing home $100.
$900 profit.
Well for starters, in your breakdown, isn't the insurer paying some baseline amount to the nursing home? So if they don't bring you to the hospital, aren't they still paying out some portion of that to the home by default?
But okay, let's say it would cost the insurer $1000 per month when regular hospital transfers are involved, and $500 per month to keep them there (just for easy numbers). Then, throw in the $100 bonus to the homes that do it, that's $600 of the initial $1000 premium that the insurer spends instead of the full amount.
The insurer gets to pocket $200 of that remaining $400. The other $200 they're either using to pay out other claims, or sending it back as a rebate (which they obviously want to avoid).
So I'm definitely seeing how the nursing home profits, but what's the incentive for the insurer?
I feel like there is enough for you to work it out. Which insurance company do you work for? ;)
What do you mean, "there is enough for you to work it out"?
For real -- what am I missing?
Just a downvote? That's a shame, you seemed like the most good-faith one here.
I don’t have voting enabled in my client. So, it wasn’t me.
https://lemvotes.org/comment/piefed.nullspace.lol/comment/922611
Oh swiping is downvoting. Hmm. That’s also “back”
Poor interface.
Fixed 😇
Because they're banking on the patient dying before they actually get the care they need. And to ensure this they pay the nursing homes to not take patients to the hospital to get the care they need.
You've read the rest of this discussion, yeah?
Not before I commented, but I did after and decided to leave it up. No one actually answered your question fully until pretty far down the chain.