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re: Trump going to war with healthcare industry over Price Transparency
Posted on 5/19/19 at 9:20 pm to Lsujacket66
Posted on 5/19/19 at 9:20 pm to Lsujacket66
He should push for transparency.
More importantly he should make at least part of Medicare subscription based and give vouchers to people to subscribe. Let them keep any money they save by shopping for services.
More importantly he should make at least part of Medicare subscription based and give vouchers to people to subscribe. Let them keep any money they save by shopping for services.
3
Posted on 5/19/19 at 9:24 pm to NC_Tigah
The dems and the insurance companies wrote ACA.
I remember speaking with a person in Mary Landrieu's office about the huge increase in my policy cost in 2008 after ACA. The person said it was going to go up anyway.
She proceeded to tell me how they capped the profits insurance companies would make at 10%. She was proud of that.
How stupid is that?? A 10% after tax net profit is HUGE in most any industry but previously unheard of in the health insurance business.
ACA basically told Americans you had to buy the product of insurance companies and if you didn't have enough money to do it the government would give it to you.
I wish they would pass a law like that for my products.
I remember speaking with a person in Mary Landrieu's office about the huge increase in my policy cost in 2008 after ACA. The person said it was going to go up anyway.
She proceeded to tell me how they capped the profits insurance companies would make at 10%. She was proud of that. How stupid is that?? A 10% after tax net profit is HUGE in most any industry but previously unheard of in the health insurance business.
ACA basically told Americans you had to buy the product of insurance companies and if you didn't have enough money to do it the government would give it to you.
I wish they would pass a law like that for my products.
This post was edited on 5/19/19 at 9:25 pm
Posted on 5/19/19 at 9:25 pm to I B Freeman
Trump should figure out a way to put tariffs on healthcare.
Posted on 5/19/19 at 9:26 pm to Eli Goldfinger
quote:
Trump should figure out a way to put tariffs on healthcare.
If he proposed them most here would support them. They would call anyone that disagrees "un American".
Posted on 5/19/19 at 9:27 pm to I B Freeman
They also forced insurers to take on high risk folks who were going to cost substantially more than any normal insurance model can account for.
Posted on 5/19/19 at 9:28 pm to Eli Goldfinger
quote:
How do insurers dictate higher prices to providers?
They don't. They dictate higher prices to patients, and lower payments to providers . . . by the powers vested in them vis-a-vis obamacare monopolies.
quote:Not what he said. But since you brought it up, they lower payments to facilities and for facility equipment . . . by the powers vested in them vis-a-vis obamacare monopolies
How are insurers responsible for durable medical equipment?
Posted on 5/19/19 at 9:29 pm to Eli Goldfinger
quote:
1. How do insurers dictate higher prices to providers? How would this benefit insurers? That’s like claiming auto insurers are responsible for vehicle price increases.
They've made it more difficult and therefor costly to file and collect. Instead of one person doing billing, we know have 5. Denials that have to be refiled in a timely manner, pre-certs for tests/procedures etc. PA's for meds. Someone's gotta do that shite. Takes my time and then I have to hire someone. If you don't know this, you don't know shite about healthcare and your involvement in the industry was either a really long time ago or a desk clerk.
Insurers don't dictate medical equipment and supplies? Then why is medicare penalizing for not being on EMR that sucks arse or for not having a digital x-ray? And keeping the allowed reimbursement high for MRI's, CT's etc. help keep the costs of these high. Especially when they pay hospitals waaaaay more than outpt facilities. Machines all cost us the same, yet they get way more for the same service. They are willing to pay the higher prices. Can't offer lower prices outpt if you can't afford the machine. It goes on and on.
Posted on 5/19/19 at 9:31 pm to Lsujacket66
Trump’s war with the healthcare industry will cease on the first Tuesday in November of 2020. Plenty smoke and mirrors to be seen.
Posted on 5/19/19 at 9:32 pm to Eli Goldfinger
quote:
They also forced insurers to take on high risk folks who were going to cost substantially more than any normal insurance model can account for.
And they pass that along to providers in lower reimbursement and more bullshite. Pt's that don't get the free or cheap shite pay higher premiums and bigger deductibles. Anyone that thinks BCBS is losing money is an imbecile or extremely uninformed.
Posted on 5/19/19 at 9:32 pm to Eli Goldfinger
quote:And insurance companies ran the actuarials and set their prices. Some did better than others. Regardless, most markets were reduced to a single residual ACA provider. Meaning they can name their price up to the limits of regulation.
They also forced insurers to take on high risk folks who were going to cost substantially more than any normal insurance model can account for.
Posted on 5/19/19 at 9:33 pm to Lsujacket66
Last week I tried to get a price quote on a ultrasound guided shoulder injection of cortisone for bicep tendon tendinitis which I am scheduled to get this Thurs.
I was just curious of the price since I have crap high deductible insurance. Well getting a simple price quote took a full day on the phone getting sent to multiple offices and people that had no idea about anything.
Took me most of the day just to get the code for the procedure. That was like squeezing blood out of a turnip for some odd reason.
Then at the end they told me they can't give me a quote today on the price but will have to "work up" an estimate and that could take several days and we will e-mail you the price.
I was just curious of the price since I have crap high deductible insurance. Well getting a simple price quote took a full day on the phone getting sent to multiple offices and people that had no idea about anything.
Took me most of the day just to get the code for the procedure. That was like squeezing blood out of a turnip for some odd reason.
Then at the end they told me they can't give me a quote today on the price but will have to "work up" an estimate and that could take several days and we will e-mail you the price.
This post was edited on 5/19/19 at 9:34 pm
Posted on 5/19/19 at 9:37 pm to Eli Goldfinger
So what? they let insurance companies raise rates tremendously.
Mine went from $4800 a year to near $16000 with maximum deductible and family of four.
Mine went from $4800 a year to near $16000 with maximum deductible and family of four.
Posted on 5/19/19 at 9:38 pm to I B Freeman
quote:
He should push for transparency.
How's that gonna help? People are free to look up what their insurance allows. Only way to accept less than insurance allowable is to not file insurance. People need to do that shite themselves. Pay at the time of service and I can give you a price. File that shite yourself and YOU fight with them to get your money. Let me cut my overhead by 60% and I can pass that along. Until then, your insurer dictates the price, not the provider. Cash pay is different. Still would be lower if I didn't have to have a billing/coding staff and didn't have nurses and other employees tied up trying to get your insurance to cover your meds/test/scans etc at for ZERO pay. Transparency may help, but it will take a while. The whole system needs to be overhauled.
Posted on 5/19/19 at 9:40 pm to Chief One Word
quote:Ah the stories I could tell. But you're right. And what's more, knowing the price of services would not just help you the consumer/patient. It will probably help facilities and providers reduce charges.
Last week I tried to get a price quote on a ultrasound guided shoulder injection of cortisone for bicep tendon tendinitis which I am scheduled to get this Thurs.
Posted on 5/19/19 at 9:43 pm to I B Freeman
For the record, I'm not against transparency. But it's not as easy as people think. Want a quote? You gonna diagnose yourself and know what tests you need beforehand? You gonna pay me for the time to look that shite up once I decide to see what your insurance allows. Each plan is different and each plan is different. Add to that over 110,000 diagnosis codes and maybe people will realize it's not that simple. If you don't want to use your insurance and pay cash at the time of service? I can give you a number.
Posted on 5/19/19 at 9:44 pm to SmackoverHawg
quote:US Healthcare currently is a bit like ordering from an unpriced menu. Prices are helpful.
He should push for transparency.
How's that gonna help?
Posted on 5/19/19 at 9:47 pm to SmackoverHawg
quote:And in smaller clinics and private practices the admin burden could be quite high. Hopefully implementation will employ common sense in that regard.
But it's not as easy as people think.
Posted on 5/19/19 at 9:48 pm to NC_Tigah
Can a patient not currently call their insurer and see what their allowed charge is? shite, I don't know it. We don't get a menu. You know this. I set my charges based off BCBS. When someone asks, we look up the code and allowable. Honest question, can patients not get the info from their insurer? That's who really sets the prices.
Posted on 5/19/19 at 9:50 pm to SmackoverHawg
quote:
People are free to look up what their insurance allows.
This is provider dependent. You know that. I can’t call my insurance provider and ask how much they’ll pay for an MRI.
Posted on 5/19/19 at 9:51 pm to SmackoverHawg
The health insurance industry is heavily regulated by the gov, and all of the scenarios you listed fall under some type of regulation.
Take the billing issues; these have to be locked down so tight that insuers are scared shitless about mistakes. Add to that, the fact that ICD10 hasn’t solved many of the issues it was intended for and you have the billing issues you’ve experienced.
The regulations which specify the percentage of $ intake which must be put back into patient care is the biggest cloud hanging over most insurers. Losing these regulations would likely allow rates to drop substantially.
However, if an insurer is only allowed to keep $0.20 of ever $1.00 - for even the healthiest members - the insurer has to make that money up in increased rates. This is an example of another well meaning regulation meant to improve patient outcomes, but actually ends up driving up prices for everyone.
Take the billing issues; these have to be locked down so tight that insuers are scared shitless about mistakes. Add to that, the fact that ICD10 hasn’t solved many of the issues it was intended for and you have the billing issues you’ve experienced.
The regulations which specify the percentage of $ intake which must be put back into patient care is the biggest cloud hanging over most insurers. Losing these regulations would likely allow rates to drop substantially.
However, if an insurer is only allowed to keep $0.20 of ever $1.00 - for even the healthiest members - the insurer has to make that money up in increased rates. This is an example of another well meaning regulation meant to improve patient outcomes, but actually ends up driving up prices for everyone.
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