Hsa

[scottfanli]

So me and my buddy (we're college students) had an argument about HSA plans the other day about the negotiated rate for Rx and doctor visits and what determines them.

Is it true that doctor visit negotiated rates are predetermined by the area you are in? for example if there were two doctors offices next to each other, an insurance company isn't going to make one doctor's rate higher than anothers right?

Also drugs. Since the cost of drugs is a little more universal from state to state in terms of pricing, is it fair to say that the price of the negotiated rate is fairly the same from area to area?

 

[bluemarlin08]

With my HDHP, BC/BS, no renegotiated rates for RX

 

[Josh]

So me and my buddy (we're college students) had an argument about HSA plans the other day about the negotiated rate for Rx and doctor visits and what determines them.

Is it true that doctor visit negotiated rates are predetermined by the area you are in? for example if there were two doctors offices next to each other, an insurance company isn't going to make one doctor's rate higher than anothers right?

Also drugs. Since the cost of drugs is a little more universal from state to state in terms of pricing, is it fair to say that the price of the negotiated rate is fairly the same from area to area?

It will depend on the carrier but the fees for the doctors fees take many things into account which includes the area. If two doctors have offices next to each other but one has more experience/more customers/etc then he can demand a higher reimbursement from the carrier and get a better fee schedule. There are many things that go into this, but it's fair to say that you're less than 30% right. With the drugs each pharmacy will have a different charge. Take a drug like lipitor and call target, wal-mart, and any other pharmacy and ask them for the cost of the drug and it'll swing by probably close to $40 depending on the dosage you're looking for. With the negotiated rates, not only can two pharmacies in a given area have a different negotiated rate, but the discount level could be different. Using that same drug, the negotiated rate at (and I'm just using an arbitrary example) wal-mart might be 80 and at Target it might be 70.

So the short answer to your question is no, it's not determined solely on geography.

 

[somarco]

Most carriers hand off Rx to PBM's who determine pricing. Cost of med will vary depending on availability, volume, etc. Cost to insureds is based on a formula revolving around AWP plus a dispensing fee which will vary by pharmacy.

Some pharmacy's, like Costco, Sam's, etc heavily discount brand Rx any way and the differential in what you pay with your card vs. just walking in off the street will be nominal.