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Politics : View from the Center and Left
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To: Cogito who wrote (134802)3/25/2010 12:51:26 PM
From: Sam  Read Replies (1) of 543043
 
It is notable that the insurers don't see any need to drop people for problems on their applications before they get sick. They're willing to accept the premiums from such people for as long as they are still adding to the plus side of the ledger

Yes, they are very efficient at collecting premiums.

Someone I knew worked for BCBS for three years before becoming an actuary. He sat in a large room with many other people, all of whom were dedicated to finding reasons not to pay claims. That was their sole job.

Not that ferreting out fraud isn't important, and plenty of federal and individual company resources should be devoted to that. But--looking for reasons to deny individual claims isn't ferreting out fraud. Fraud that is worth finding is something that individual providers commit, not individual claimants. Providers' fraud is where the really big bucks are, as it happens over and over again.
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