The Eye Popping 2016 Obamacare Rate Increases Are Out

[MedicareAgent]

It's Obamacare hikes.

 

[justthefacts]

I have a question for you smart individuals here. Are these rate increases going to affect individual Medicare suppliment plans as well or are they mainly the individual plans you get on the national or state exchanges?

My father and grandmother both have a suppliment plan through BcBs Minnesota. I checked the website that contained the rate hike proposals and I didn't see any of their individual medicare plans on there. Thanks

My take dad and grandma will see small premium increases unless MN freezes rates on age group on attained coverage check your doi in your state not their agent ha ha

 

[somarco]

A free market depends on consumer choices driven by transparency. There is nothing transparent in our current system that allows cost driven choices when it comes to medical care.

Routine care from a single provider is/can be transparent in many cases. I know in advance what my eye exam will cost, my physical and dental work.

Brain surgery is not routine and how would your price it? Even if it could be done, do you really want to have the low bidder working on your brain?

A free market informs consumers of prices BEFORE services are rendered. Our healthcare system does that only AFTER services are rendered.

If you want to forego the negotiated pricing you can always pay cash and negotiate up front.

Somehow people forget that.

overhead does not increase at the same rate of premium increases... which equals increased profits.

Care to take a stab at how many carriers made a profit on their Obamacare block for 2014?

 

[justthefacts]

My guess the big bagel0 reported profits!

 

[scagnt83]

Routine care from a single provider is/can be transparent in many cases. I know in advance what my eye exam will cost, my physical and dental work.

I am talking about health care. Not dental or vision.

And routine care from a doctor is not transparent. Have you ever tried to negotiate a cash payment at the time of an appointment? Hell, many doctors will not even accept you if you do not have insurance... even if you say that you will pay in advance.

I am the kind of patient that asks questions about costs since I have a HDHP. The price I am quoted at the time of service is correct maybe 50% of the time. And that has been true at multiple doctors offices, pediatricians, urgent care clinics, & hospitals. Half the time I dont think they even bothered looking, they just threw out some random number. (and they almost always look annoyed when I ask and say "dont you have insurance"?)

Now, I realize that BCBS in some states has an online tool that lets you price negotiated rates at various doctors. But I do not believe that is available in all states. And it is a fairly new tool. And I dont think any other carriers offer it.

Brain surgery is not routine and how would your price it? Even if it could be done, do you really want to have the low bidder working on your brain?

Of course not. But if I priced 10 surgeons and 1 was 1000% more than the median cost I would certainly ask why. And when it comes to surgery, I would rather make my decision based on outcomes vs. cost. My family law attorney costs a sh%t load, but I didnt hire her based on her rate. I hired her based on her history of positive outcomes for her clients. And there are more expensive attorneys I spoke to that had lower win %s than her...

And surgery prices are not always about the surgeon. Th cost of facilities plays a part too. And there is often a much greater variance on that than there are with surgeons in my experience.

If you want to forego the negotiated pricing you can always pay cash and negotiate up front.

Somehow people forget that.

That is IF the doctors office will even accept you without insurance. Most will not. And if you have insurance, even a HDHP, why would you not have the OOP cost go towards your deductible? Basically, we are slaves to the system by design.

Care to take a stab at how many carriers made a profit on their Obamacare block for 2014?

If you know I would love to hear the answer. But either way it is irrelevant. These issues were going on well before Obama took office. Hell, these issues are a large reason why Obamacare got the traction it did... because people wanted to say things were fine when they needed reform ... unfortunately we got reform when a socialist was in office and in the most partisan and politically motivated way possible. So it became big bad insurance reform along with a new welfare program and tax hikes.

 

[somarco]

Have you ever tried to negotiate a cash payment at the time of an appointment?

No need to.

I have insurance and use par providers. Also use the pricing estimator on the carrier site if I anticipate something out of the ordinary.

I am the kind of patient that asks questions about costs since I have a HDHP.

That's what we have too.

Doesn't do any good to ask. They don't know what the network discount will be. That's why the cost estimator is on the carrier site.

I realize that BCBS in some states has an online tool that lets you price negotiated rates at various doctors. But I do not believe that is available in all states. And it is a fairly new tool. And I dont think any other carriers offer it.

Over the last several years we have had BX, Cigna, UHC and Humana.

All of them have cost estimators.

And surgery prices are not always about the surgeon. Th cost of facilities plays a part too. And there is often a much greater variance on that than there are with surgeons in my experience.

Which make it impossible to "shop" complicated procedures. Best thing you can do is use par providers. May be a challenge with gas passers and 2nd chair surgeons, both of which may well be non-par.

IF the doctors office will even accept you without insurance. Most will not.

I have never had a client tell me a doc refuses to treat them for cash.

This applies to general medicine. Surgeons, oncologists and a few other specialties are different.

All of the major carriers lost money on their 2014 block. Co-ops lost big time and some bit the dust. Smaller carriers (including Assurant) have bailed on the major med market.

Before Obamacare the carriers had a small profit on IFP and small group business.

 

[scagnt83]

Which make it impossible to "shop" complicated procedures. Best thing you can do is use par providers. May be a challenge with gas passers and 2nd chair surgeons, both of which may well be non-par.

So how can that be market driven rates? That is exactly my point. The free market does not dictate medical rates in this country.

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No need to.

I have insurance and use par providers.

Again, that is the problem. If you have insurance, why bother worrying about the cost of care? .... even though that cost is what is driving your ever higher insurance premiums... get the irony there?

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That's what we have too.

Doesn't do any good to ask. They don't know what the network discount will be. That's why the cost estimator is on the carrier site.

Which is absolutely ridiculous. What business is unable to tell a person how much they are going to pay? The doctor could very easily have a price sheet to make available to the patients... but if thy did that patients would start asking more and more questions about costs...

Better yet, they easily could prepare an estimated cost sheet for the services that are scheduled to be performed on you for that visit. Before you ever see the doctor you could see the estimated price for your visit. But again, that would get people asking questions... and possibly shopping around if those prices were going to hit their deductible.

Why is medical care the only business that does not disclose an estimated price to the consumer before the services are rendered??? There is absolutely nothing transparent about this system. The online price estimators are a step in the right direction... but they are about 15 years too late to make any real impact. Our medical system works nothing like a free market system.


You made the comparison to pro athletes and why no one questions NBA salaries. But their pay is reviewed all of the time. Both before the contract and after the contract the people paying it review their pay. And it is totally transparent. They can see the exact stats for that player and make an educated decision about what they are worth. The fans are able to make that decision too. They see the performance and can choose to go to the games based on that performance.

Do you know who has the worst attendance in the NBA? The 76ers, 14k fans last year. Do you know what their record was? 18 wins, 64 losses.
Compare that to the Mavs who had 20k fans, and a 50/32 season.
The Mavs have a $77 million dollar payroll.
76ers have a $54 million dollar payroll.

That is a free and transparent free market at work. Better performance equals more attendance. More attendance equals more money.

Our medical system is nothing like that at all.

 

[cadylou]

It is ridiculous. There can be no "free market" type of transparency where pricing is concerned as long as you have an intermediary - an insurance company - negotiating rates & what will & won't be covered, on our behalf. In no other business, does the customer rely on someone else to negotiate pricing & what you're able to get or not get . . . .

At one point in my life, on the way to a cancer diagnosis, I wanted a PET scan & no one would give it to me. I even offered to pay out of pocket cash at an imaging center, but they said they couldn't do it without a doctor's order. No doctor would order one, because I had insurance & we needed to do "x" number of biopsies before they'd approve something like that. . . .took almost 8 months to get a diagnosis, even though I was asking for certain tests that would have gotten us there earlier. In my case, I would have paid whatever they said it cost - but I still couldn't get what I needed due to a 3rd party dictating the pecking order of what had to happen first. I could have died.

There needs to be some sort of base price uniformity (sort of like the auto manufacturers suggested retail price), and insurance should only have to protect against that. Insurance should also go back to being for insuring against catastrophic risk. They used to call it "hospitalization" insurance for a reason.

We've gotten into trouble by making insurance companies the responsible party for all of our routine preventive care & tests. My car insurance doesn't pay for my tune ups - so, my health insurance shouldn't either.

 

[scagnt83]

I have never had a client tell me a doc refuses to treat them for cash.

This applies to general medicine. Surgeons, oncologists and a few other specialties are different.

That is if you have insurance as a back up if for some reason you cant pay or the prepayment does not cover all of the services performed.
I have a friend who is uninsured. His doctor stopped taking uninsured patients, even if they paid before the services were performed. Their reason was that the doctor could order tests that have not been paid for yet. He had to call 6 different offices to find one that would take him without insurance and let him prepay.

But that goes back to the catch22 that I outlined earlier. If you have insurance, you possibly screw yourself by negotiating a cash payment because it does not lower your deductible. So if something big comes along that year, you end up paying more out of pocket than you had to.
So there is no real incentive to do that. But by not doing that it just contributes to inflating the cost of healthcare, which inflates the cost of insurance.

 

[tonyisme]

I agree with somarco.... Most docs want cash ...
But when it comes to oncology organ transplants and things like that they want insurance. We have seen this with our clients.
The services of others are billed in oncology and transplants so it's not just the doc taking cash..