No one will answer my question, Please someone help me understand.
Scenario:
If person is on a lot of Medication for several medical problems and the medical bills are +/- $500,000 a year. One of the medications (Prednisone) has caused another medical problem that is not reversible and will be very expensive in the future, but can be slowed up considerably. Possibly not have to be dealt with because of the age of the person. And there is an operation that would slow up the progression, cure many of the other medical problems and drop the medication cost in half. Giving a savings to the insurance company and a better life to the person.
Response for Physicians:
Insurance will turn down the operation because of their shareholders. It has nothing to do with medical reasons.
My view and wanting to understand the Math:
If the insurance co pays for one procedure that will cut cost of this person overall medical cost and the still charging the person the same premium for the insurance, won’t their stock be worth more. Because of the money they are saving? Making shareholders happy.
By denying the procedure, they are allowing medical cost to go up, premiums to go up and share values to drop. Driving the stock market down.