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Started By
Message
Question about interstate competition amongst insurance companies...
Posted on 12/5/16 at 1:21 pm
Posted on 12/5/16 at 1:21 pm
The theory sounds solid, I just have serious questions about the details of such an arrangement. I believe the only way this works is if your insurance carrier is required to pick up your tap in another state. In the event you need services outside your insured state.
Example 1: Most people don't realize Blue Cross Louisiana (Francise) is separate from other states as for as policy, procedures and coverage. This helps them build a corporate shield in case of litigation. Now if I need to see a doctor in Colorado and must have XRay, Blood Test, See the Doctor and have Meds my bill could be in $2,000 range. Same goes if I break my leg skiing. The policy in Louisiana should have to help cover those expenses, right.
Example 2: Here is another problem because I deal with this all the time. Inside a physicians office it's already insanely tough to 1) find if this person is insured, has Medicaid or Medicare etc 2) to know if the policy in place and if the insured has changed companies 3) Because I know and can imagine how time consuming it is all going to be dealing with various insurance companies outside the state makes me worried.
The number of insurance companies allowed to sell across state lines must be somewhat limited or else doctors might just reject all or most of them. You can't just have an endless exchange of companies trying to get into the state. Maybe you allow a cut off for a year and after 9 months begin reopening bids and proposals.
Example 1: Most people don't realize Blue Cross Louisiana (Francise) is separate from other states as for as policy, procedures and coverage. This helps them build a corporate shield in case of litigation. Now if I need to see a doctor in Colorado and must have XRay, Blood Test, See the Doctor and have Meds my bill could be in $2,000 range. Same goes if I break my leg skiing. The policy in Louisiana should have to help cover those expenses, right.
Example 2: Here is another problem because I deal with this all the time. Inside a physicians office it's already insanely tough to 1) find if this person is insured, has Medicaid or Medicare etc 2) to know if the policy in place and if the insured has changed companies 3) Because I know and can imagine how time consuming it is all going to be dealing with various insurance companies outside the state makes me worried.
The number of insurance companies allowed to sell across state lines must be somewhat limited or else doctors might just reject all or most of them. You can't just have an endless exchange of companies trying to get into the state. Maybe you allow a cut off for a year and after 9 months begin reopening bids and proposals.
This post was edited on 12/5/16 at 1:24 pm
9
Posted on 12/5/16 at 1:26 pm to Rakim
cant be done without getting rid of state standards, state controlling authorities and moving up to a national standards and control
which means more government.
but Trump has a secret plan to get it done.
which means more government.
but Trump has a secret plan to get it done.
Posted on 12/5/16 at 1:27 pm to Rakim
quote:
Example 1: Most people don't realize Blue Cross Louisiana (Francise) is separate from other states as for as policy, procedures and coverage. This helps them build a corporate shield in case of litigation. Now if I need to see a doctor in Colorado and must have XRay, Blood Test, See the Doctor and have Meds my bill could be in $2,000 range. Same goes if I break my leg skiing. The policy in Louisiana should have to help cover those expenses, right. Example 2: Here is another problem because I deal with this all the time. Inside a physicians office it's already insanely tough to 1) find if this person is insured, has Medicaid or Medicare etc 2) to know if the policy in place and if the insured has changed companies 3) Because I know and can imagine how time consuming it is all going to be dealing with various insurance companies outside the state makes me worried.
There's so much wrong with 1 and 2 I just stopped reading.
Posted on 12/5/16 at 1:28 pm to Rakim
quote:
The policy in Louisiana should have to help cover those expenses, right.
Yes. Even now I accept out of state insurance payments for our patients. I take BCBS Louisiana, in Texas, right now.
quote:
. Inside a physicians office it's already insanely tough to 1) find if this person is insured, has Medicaid or Medicare etc 2) to know if the policy in place and if the insured has changed companies 3) Because I know and can imagine how time consuming it is all going to be dealing with various insurance companies outside the state makes me worried.
No different then verifying any other patient. Not a big deal.
The big deal is what the earlier poster mentioned. Uniform regulations from state to state that will more easily allow insurers to comply with each state's regulations.
Posted on 12/5/16 at 1:32 pm to Cruiserhog
quote:
rid of state standards
This would be great. Then individuals can work out what policy they want with the insurer. The only item the states would need to set up is an arbitration board which handles disputes between citizens and insurers...it should have zero business saying what is and isn't covered.
Posted on 12/5/16 at 1:34 pm to Rakim
Hope this can be an serios discussion.
My thoughts on it would be competition is good but what it could create is one small carrier after another simply vying for covered lives via a lowest quoted premium model. The idea may seem good to a consumer but the fine print of the policy would dictate - in all likelihood - huge donut holes, gaps in care or network coverage or even long claim reimbursement payouts to the networks.
If either, the patients could face unknown OOP not realized until care has been given and driving debt or default. Same idea with hospitals in terms of them not getting quick payout which could drive some service price hikes. In either case, the only winner would be the Insurance carrier(s) who are benefitting from a big infusion of out of state deposits without advancing their precious small population business model.
Posted on 12/5/16 at 1:43 pm to Sao
quote:
My thoughts on it would be competition is good but what it could create is one small carrier after another simply vying for covered lives via a lowest quoted premium model. The idea may seem good to a consumer but the fine print of the policy would dictate - in all likelihood - huge donut holes, gaps in care or network coverage or even long claim reimbursement payouts to the networks.
Exactly, insurance companies are still insurance companies and those donut holes are there to further reduce risk of paying out. Question will always be "how do you eliminate these hole and keep premiums/ deducbibles from skyrocketing? More competition is the fallback response but every carrier will have them, it's just not a perfect system. But that's okay imo
Posted on 12/5/16 at 1:47 pm to Rakim
quote:
Example 1: Most people don't realize Blue Cross Louisiana (Francise) is separate from other states as for as policy, procedures and coverage. This helps them build a corporate shield in case of litigation. Now if I need to see a doctor in Colorado and must have XRay, Blood Test, See the Doctor and have Meds my bill could be in $2,000 range. Same goes if I break my leg skiing. The policy in Louisiana should have to help cover those expenses, right.
My BlueCross already does---it is simply an out of network provider. Yours does too I suspect.
quote:
Example 2: Here is another problem because I deal with this all the time. Inside a physicians office it's already insanely tough to 1) find if this person is insured, has Medicaid or Medicare etc 2) to know if the policy in place and if the insured has changed companies 3) Because I know and can imagine how time consuming it is all going to be dealing with various insurance companies outside the state makes me worried.
Why do you worry???? What makes it harder to send an email or make a phone call to an out of state firm?
quote:
The number of insurance companies allowed to sell across state lines must be somewhat limited or else doctors might just reject all or most of them.
BS. Why not? Who is going to buy insurance from a company that will not pay the doctors they want???
quote:
You can't just have an endless exchange of companies trying to get into the state
GOSH I hope we have hundreds. Who wouldn't??? If they can financially meet their obligations I want them. Why do you make such assumptions?
quote:
Maybe you allow a cut off for a year and after 9 months begin reopening bids and proposals.
Why?????
Your post is an example of the narrow thinking that our current health care system has cultivated.
Posted on 12/5/16 at 1:48 pm to Cruiserhog
quote:
cant be done without getting rid of state standards, state controlling authorities and moving up to a national standards and control
which means more government.
Explain how getting rid of 50 state standards and authorities is more government.
Posted on 12/5/16 at 1:49 pm to Rakim
Where do you come up with this stuff? Which liberal came up with donut hole? That's a ridiculous analogy.
The problem isn't insurance company greed. The problem is that claims are too high. Claims are too high mainly because we are an unhealthy, fat and lazy and lack personal responsibility.
You can't hide from claims. Claims are claims. They must be paid. You want lower healthcare costs start fat shaming again for starters. Obesity is worse for you than smoking.
The problem isn't insurance company greed. The problem is that claims are too high. Claims are too high mainly because we are an unhealthy, fat and lazy and lack personal responsibility.
You can't hide from claims. Claims are claims. They must be paid. You want lower healthcare costs start fat shaming again for starters. Obesity is worse for you than smoking.
This post was edited on 12/5/16 at 1:50 pm
Posted on 12/5/16 at 1:51 pm to I B Freeman
quote:
Explain how getting rid of 50 state standards and authorities is more government.
I would love to hear this too. Hell, I bet we could get rid of 20 staffers alone by not having to address 50 states and each of their different regulations and laws. We are just a $1B company that doesn't even do health insurance.
Posted on 12/5/16 at 1:51 pm to Rakim
I do think the bigger insurers would collude to a certain extent
Posted on 12/5/16 at 1:52 pm to tke857
quote:
I do think the bigger insurers would collude to a certain extent
Why do you think that? Do you think there would be collusion across the board or just some particular size market like small, medium or large size groups?
Posted on 12/5/16 at 1:53 pm to roadGator
Hate to tell you this but donut hole isn't a liberal design, nor a republican one. It's a sustainable business model based upon total pool, utilization, risk and ultimately profit to an underwriter.
Posted on 12/5/16 at 1:55 pm to roadGator
quote:
The problem is that claims are too high. Claims are too high mainly because we are an unhealthy, fat and lazy and lack personal responsibility.
Why that may contribute to more use of health care it is not the reason cost have risen faster than inflation.
Cost have risen--for the most part--higher than the cost of inflation because the biggest purchaser of health care services---the US government---is a very poor shopper.
It is really simple---a provider can not charge LESS than they charge medicare for a service if they are to be a medicare provider. SO--drug companies and providers beg for increases from the bureaucrats and get them because of lobbying $$$$. When they get another $2 for a pill or something from the government then the cost of that pill goes up to everybody else.
The only way to lower the cost of healthcare is to get the government out of the business of direct purchasing of healthcare services and make the consumers the shopper. We could reimburse poor people if need be.
Posted on 12/5/16 at 1:55 pm to tke857
quote:
I do think the bigger insurers would collude to a certain extent
Or better put, acquisition. Swallowing smaller private carriers and folding them into their own population... Cycle continues.
Posted on 12/5/16 at 1:55 pm to tke857
quote:
I do think the bigger insurers would collude to a certain extent
What do you think they do now???
Posted on 12/5/16 at 1:56 pm to Rakim
quote:
cant be done without getting rid of state standards, state controlling authorities and moving up to a national standards and control
which means more government.
but Trump has a secret plan to get it done.
NY has high standards to protect the consumer.
Delaware is all in for the company.
I am sure that if all companies were required to come up to NY standards this idea would pass Dem Congress easily.
Posted on 12/5/16 at 1:56 pm to Sao
I've been in the insurance industry for 20 years and the only time (recently) I've heard the term donut hole is when folks are talking about Part D of Medicare.
When I was in underwriting we never used the term while developing rates either.
I'll look into it more.
When I was in underwriting we never used the term while developing rates either.
I'll look into it more.
Posted on 12/5/16 at 1:59 pm to Sao
quote:
Swallowing smaller private carriers and folding them into their own population... Cycle continues.
This would most certainly happen.
Small company A would grow their business so that large company B would purchase them. Small company A execs make bank.
Rinse, repeat. Nothing wrong with it but it would happen over and over and over. I'd try to get involved at the stock holder level of a for profit if this ever became a thing again. I've always worked for not-for profits.
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