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UnitedHealth reduced hospitalizations for nursing home seniors. Now it faces wrongful death claims
(www.theguardian.com)
this post was submitted on 13 Jan 2026
188 points (99.5% liked)
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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? ;)
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 😇
What do you mean, "there is enough for you to work it out"?
For real -- what am I missing?