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Message
re: Question about interstate competition amongst insurance companies...
Posted on 12/5/16 at 2:00 pm to CelticDog
Posted on 12/5/16 at 2:00 pm to CelticDog
quote:
Delaware is all in for the company.
The good people of Delaware should be up in arms about their terrible coverage and greedy companies then, right?
0
Posted on 12/5/16 at 2:03 pm to roadGator
Worked for Caremark/AdvancePCS during the 2004 Med D rollout and I guess you're right, the term was coined then due to the DED OOP gaps.
Now, MEDIGAP has been around among time I think... meaning gaps to cover DED, copay, other. Gap insurance has been a popular necessary long before Part D's term donut hole just by different ways of recognizing said gap.
Posted on 12/5/16 at 2:05 pm to Sao
I mean if you have to bet on who creates a moniker like donut hole don't you bet on Dem? 
Posted on 12/5/16 at 2:06 pm to roadGator
It was Bush's HHS
Posted on 12/5/16 at 2:07 pm to I B Freeman
quote:
Explain how getting rid of 50 state standards and authorities is more government
I thought the idea was to devolve power down to the states. This seems like more centralized federal power.
Posted on 12/5/16 at 2:08 pm to Sao
Yeah, but who would you bet on.
Just found this...I'll have to look closer. Of course I understand what it represents but theorems? Holy shite. Who has been writing theorems on donut holes?
Just found this...I'll have to look closer. Of course I understand what it represents but theorems? Holy shite. Who has been writing theorems on donut holes?
quote:
he Second Theorem of Doughnut-Hole Economics
Posted on 12/5/16 at 2:09 pm to I B Freeman
quote:
Why do you worry???? What makes it harder to send an email or make a phone call to an out of state firm?
Generally you don't find out until that patient arrives at your office. Response times and customer service are not the forte of this industry. It's a pain in the arse. I'm sure some smart person can improve the lag time but it's problematic.
quote:
BS. Why not? Who is going to buy insurance from a company that will not pay the doctors they want???
You don't deal with this obviously. You know how many people buy insurance and never think to ask or find out if their doctor is in network? A bunch
quote:
Your post is an example of the narrow thinking that our current health care system has cultivated.
Well, your post reminds me of the thoughtless morons that didn't think Obamacare through. Again, I support the system proposed but god forbid someone question if it's feasible to providers.
Posted on 12/5/16 at 2:10 pm to Rakim
quote:
You know how many people buy insurance and never think to ask or find out if their doctor is in network? A bunch
This couldn't be more wrong. It's often the question they ask before they buy.
I spend a lot of time on answering this question for buyers. I'm not making this up.
This post was edited on 12/5/16 at 2:11 pm
Posted on 12/5/16 at 2:11 pm to roadGator
I can only tell you the problems we face with 5 physicians offices we work for.
This post was edited on 12/5/16 at 2:13 pm
Posted on 12/5/16 at 2:17 pm to Rakim
Are you seeing a bunch of people on individual policies through Celtic or something?
Posted on 12/5/16 at 2:21 pm to Cruiserhog
quote:This gives me pause as well. I don't think it's the panacea many believe it will be.
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
The real problem is the cultural belief that insurance is a way to get an unlimited amount of goods and services for a very low "premium" monthly payment.
There is no magic. And until "the people" understand and accept that... medicine will continue to be f*cked up.
This post was edited on 12/5/16 at 2:22 pm
Posted on 12/5/16 at 2:23 pm to Rakim
i think it was a reasonable restriction put in place that is now outdated.
with that said, its going to do next to nothing to solve our insurance problem.
with that said, its going to do next to nothing to solve our insurance problem.
Posted on 12/5/16 at 2:23 pm to Rakim
Many insurance companies are technically franchise conglomerates.
BCBS of California is run and managed by different folks than BCBS of Georgia. Totally different boards of directors. Totally different plan designs. Totally different costs. And totally different In-Network cost coded rating systems.
One of the big changes that will happen is to In-Network cost coding for CPT/procedural codes.
Like CPT code 64105 may be a 45 minute general physician checkup and BCBS of Georgia will pay $55 for the visit after your deductible or co-pay. But right now, that's just in Georgia and only to doctors and hospitals "In-Network".
What will happen is this "Network" will get expansion on a national level. BCBS of California will eventually be able to sell their plan in every state and Network with doctors and hospitals outside the state of California. And in doing so, they increase the competition in each state. Which, of course, equates to driving down costs.
If BCBS of California wants me to buy their policy in Georgia, they have to have lower premiums, lower co-pays, lower deductibles and out of pocket exposure, better claims handling, better customer service, and at lease the same size In-Network amount of medical providers or more than the other insurance carriers that already provide coverage in Georgia.
In turn, the carriers already in Georgia better adjust all their rates to compete with the expanse of new insurance companies entering the state.
Insurance carriers couldn't do this before because state laws prevented out of state insurance carriers from creating out of state Networks and negotiating costs for procedure codes. Right now, each state Insurance Commissioner is involved in determining procedure costs in every Network and even having final authority on what insurance companies can offer plans in their state.
Trump's new legislation will take quite a bit of power away from state Insurance Commissioners as a result of doing away with portability and state lines.
But this competition will ultimately allow insurance companies to keep costs down by nationalizing Networks of providers and by obviously increasing the number of available insurance carriers offering plans in each state.
BCBS of California is run and managed by different folks than BCBS of Georgia. Totally different boards of directors. Totally different plan designs. Totally different costs. And totally different In-Network cost coded rating systems.
One of the big changes that will happen is to In-Network cost coding for CPT/procedural codes.
Like CPT code 64105 may be a 45 minute general physician checkup and BCBS of Georgia will pay $55 for the visit after your deductible or co-pay. But right now, that's just in Georgia and only to doctors and hospitals "In-Network".
What will happen is this "Network" will get expansion on a national level. BCBS of California will eventually be able to sell their plan in every state and Network with doctors and hospitals outside the state of California. And in doing so, they increase the competition in each state. Which, of course, equates to driving down costs.
If BCBS of California wants me to buy their policy in Georgia, they have to have lower premiums, lower co-pays, lower deductibles and out of pocket exposure, better claims handling, better customer service, and at lease the same size In-Network amount of medical providers or more than the other insurance carriers that already provide coverage in Georgia.
In turn, the carriers already in Georgia better adjust all their rates to compete with the expanse of new insurance companies entering the state.
Insurance carriers couldn't do this before because state laws prevented out of state insurance carriers from creating out of state Networks and negotiating costs for procedure codes. Right now, each state Insurance Commissioner is involved in determining procedure costs in every Network and even having final authority on what insurance companies can offer plans in their state.
Trump's new legislation will take quite a bit of power away from state Insurance Commissioners as a result of doing away with portability and state lines.
But this competition will ultimately allow insurance companies to keep costs down by nationalizing Networks of providers and by obviously increasing the number of available insurance carriers offering plans in each state.
Posted on 12/5/16 at 3:58 pm to Jim Rockford
Insurance premiums should be unregulated at any level.
You guys that are against doing away with state regulation of insurance premiums and providers are narrow minded focusing on crap like payment codes and coverage areas and things like that we would all like to see disappear.
We need to get rid of the overhead in medicine that the arcane fee for service pricing model that the government forced into the industry created.
I remember when you bought health insurance based on how many dollars a day it would pay for hospitalization---it hasn't been THAT long ago that we had a simple pricing model that was easy to shop.
You guys that are against doing away with state regulation of insurance premiums and providers are narrow minded focusing on crap like payment codes and coverage areas and things like that we would all like to see disappear.
We need to get rid of the overhead in medicine that the arcane fee for service pricing model that the government forced into the industry created.
I remember when you bought health insurance based on how many dollars a day it would pay for hospitalization---it hasn't been THAT long ago that we had a simple pricing model that was easy to shop.
Posted on 12/5/16 at 4:06 pm to roadGator
quote:
quote: The Second Theorem of Doughnut-Hole Economics
Never forget how academia, lobbyists or consultants can and will capitalize on this type of "report". There is big money in grants or outsourcing opinion which is turned into fact based findings, also for profit.
People make money in everything they do.
Posted on 12/5/16 at 4:10 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
If you're going to post something like this, why not take a moment to explain why? That way, I can just type one sentence, instead of a paragraph explaining why you're not correct.
Because if I own a business in several states, obviously all of this had to be done in order for me to obtain worker's compensation, correct? No, it is not correct. The state of residence is the governing state. All on one policy, across state lines.
Posted on 12/5/16 at 4:11 pm to BeefDawg
quote:
Like CPT code 64105 may be a 45 minute general physician checkup and BCBS of Georgia will pay $55 for the visit after your deductible or co-pay. But right now, that's just in Georgia and only to doctors and hospitals "In-Network".
cost of living in Mississippi, and medical expenses, are lower than in NYC.
Posted on 12/5/16 at 4:19 pm to CelticDog
quote:
cost of living in Mississippi, and medical expenses, are lower than in NYC.
So don't buy BCBS of New York if you live in Mississippi. Buy BCBS of Mississippi.
Or, once BCBS of NY realizes they have to adjust their payout amounts for procedure codes to compete in that state, then it might make sense to buy their plan if it comes with other benefits.
See how competition works? Companies have to adjust to each other to earn our business. If they don't, we buy something else.
Right now, it doesn't work like this. Right now insurance companies have mini monopolies in every state and can set their prices higher and procedure payouts lower because lack of competition.
This post was edited on 12/5/16 at 4:21 pm
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