I've wondered this for a while: Insurance is a contractual obligation on the insurer's part, right? What's stopping me from just suing them for breach of contract rather than going through their appeals process if they illegally deny my claim?
this post was submitted on 03 Sep 2025
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What’s stopping me from just suing them for breach of contract rather than going through their appeals process if they illegally deny my claim?
Medicaid is a government provision that has no contract that underpins it. With something like United Healthcare, there is a bargained for exchange of mutual consideration (you give $ and UHC provides insurance subject to all the terms and conditions in the contract).
That is not something in Medicaid because Medicaid isn't getting anything in exchange for its health coverage. The government can put whatever restrictions on it that it wants. The benefit comes from the government having one more contribution to the ecconomic system. However, that is too attenuated of a benefit to say that there was a bargained-for exchange.
Probably some terms and conditions you signed as part of the contract
What's stopping me from just suing them for breach of contract rather than going through their appeals process if they illegally deny my claim?
The cost of a lawyer that can hope to match theirs. They don't care if it loses them money as long as it deters others from trying the same.
Here's your head of Medicare.
Good Ol' Doctor Oz.
Big profile you should be able to track him down easy in the wee hours of the morning to ask some questions as any good citizen of someone representing their interests.
I'm still incapable of fully accepting that's real.
ok, as a non american, that's not a real government site, right? this is a good joke?
So they will approve more claims to avoid paying, right... Right?
Yes, I said, lying.
The machine won't let me get treatment for the thing that makes me narrate my actions, I explained with a weary sigh.
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I didn't know I still had any faith to lose in the insurance industry. At this point anyone in a management position is undeniably evil, in all senses of the word. I wish nothing but the worst for them.
If it makes anyone feel better, they denied everything when it was humans running the show too
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ID every executive who works for the company. Nothing is gonna happen unless we know who they are.
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Garbage humans in, garbage AI out
That's a fucking idiotic idea.
No, it's fine and makes total sense if your goal is to incentivize your company's suppliers and affiliates to KILL PEOPLE.
what the fuck kind of country looks to save billions of dollars spent on healthcare for their own citizens instead of waste fraud & abuse by the uber wealthy, or the military?
you can have an insanely strong military without the waste & fraud that exists in the US
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What’s the fucking point of paying for it anymore? Might as well not even have it at this point…
This is FUCKING enraging.
The term 'perverse incentive' springs to mind, except there'll be nothing unexpected about the consequences.
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Gross
So what's the point of having insurance if you can't claim what you need?
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