The Eye Popping 2016 Obamacare Rate Increases Are Out

[somarco]

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

Docs are free to charge whatever they want. If they participate in a network, and the patient has a managed care plan, the doc can still charge whatever they want but the claim will be repriced on adjudication.

Looks like we are going in circles on this Tyler. What we have is a failure to effectively communicate.

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.

Plenty of free market transparency if you want to pay cash.

You might want to go back and read my comments. Something about my words are not sinking in.

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

I bet your doc would write the Rx if you asked.

Just like Alice's Restaurant, you can get anything you want as long as you are willing to pay for it. But if you want someone else to pay it for you then you have to follow the rules.

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.

We do agree on that. I have been saying the same thing for years.

Most docs want cash ...
But when it comes to oncology organ transplants and things like that they want insurance.

They will take cash for that too.

I had clients at one time that bought plans with $10,000 - $25,000 deductibles. That was before Obama made them illegal.

Also know people who do not have insurance and won't buy it at any price. They have plenty of money and consider health insurance a waste.

I don't agree with them but they are entitled to their opinion.

Too bad Obamacrap eliminated the market for those willing to absorb $25k or so in medical expenses.

 

[scagnt83]

Docs are free to charge whatever they want. If they participate in a network, and the patient has a managed care plan, the doc can still charge whatever they want but the claim will be repriced on adjudication.

Looks like we are going in circles on this Tyler. What we have is a failure to effectively communicate.

Charging whatever you want has nothing to do with transparency. And is only half of the equation of how a free market works.

And my greater point is that when costs are obscured by insurance plans, the consumer is not making cost driven decisions. Which goes back to your comment about health costs being "market driven". To be market driven they would need to be driven by consumers making cost based decisions. My point is that consumers are not making cost based decisions about health care.

 

[yorkriver1]

Re: price shopping tools on insurer websites. I just did that with a client. The puzzling thing is that since the insurer negotiates the maximum price they will pay for a procedure, I don't see how shopping really does much. The difference we found between the hospital chain that owns the insurer (state/regional carrier) had a price maybe 5-10% lower than one of the teaching hospitals where my insured was going. With my insured's 10% coinsurance the difference wasn't that big. Mainly, driving to the hospital chain's closest facility was much less hassle than driving several hours to the medical school hospital. Getting the test orders transferred, haven't checked to see how that's going.
We were also told by the insurer that they are just rolling out the system and they don't have #'s for all providers.
Maybe the tool is good for the insured to see how much their out of pocket will be in advance, taking into account, as most of the insurer calculators do, the current status of the insured's deductible and out of pocket annual max. limit.
Medicare Advantage plans often have a big spread between copays for imaging tests done in hospitals vs. outpatient stand alone facilities. I have not found negotiated rates for imaging procedures to be higher for in hospital tests vs outpatient facilities in PPO or HMO on under 65 plans.

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Part II

We'll reach a point one day where the government will tell everyone with elevated _________ to try and get it down like SMAN did. Only get the pill if you fail. I wonder how Americans will take to this? Those who want the government to control our medical care will be the first to whine.

It would take some freezing in a warm place for pharma campaign contributors/lobbyists to endorse/allow a "try other methods before prescribing drugs" program, judging from how things work now.

 

[AllenChicago]

IMO, attempting to estimate what your condition's medical treatment will cost is akin to a business owner guessing what his annual income will be for HC.gov. It will cause more anger than happiness. No way I want to be a part of helping someone guess what their _________surgery will cost.

I just tell clients that most medical procedures, associated meds, and recovery follow-ups will exceed their deductible/OOP. But with tests, like an MRI, it does pay to shop. ($400 for MRI at the MRI Center vs $2,500 at a general hospital).

 

[somarco]

consumers are not making cost based decisions about health care.

They could be if they weren't so damn lazy.

 

[scagnt83]

They could be if they weren't so damn lazy.

I agree that consumers are to blame as well. Although many do not even know about the cost calculators they have access to. Of course that could be blamed on laziness too.

It is the same reason we have the politicians and government that we do. The general public is too lazy to do anything other than botch.

 

[tonyisme]

Just got a letter from whitehouse.gov POTUS will be speaking tomorrow about HC Reform.....he's going to lean on Ted Kennedy .... He will remind us all why he had to use that nuclear pen in 2010 March
Probably they would like to hear your comments...

https://www.whitehouse.gov/health-c...ontent=email467-text1&utm_campaign=healthcare

 

[somarco]

POTUS will be speaking tomorrow about HC Reform.....he's going to lean on Ted Kennedy ....

 

[FLM2]

Just got a letter from whitehouse.gov POTUS will be speaking tomorrow about HC Reform.....he's going to lean on Ted Kennedy .... He will remind us all why he had to use that nuclear pen in 2010 March
Probably they would like to hear your comments...

https://www.whitehouse.gov/health-c...ontent=email467-text1&utm_campaign=healthcare

He doesn't want my comments about either this law or his disgustingly bad golf game

 

[scagnt83]

Some hospitals marking up treatments by as much as 1,000%: Study

Some hospitals are marking up treatments by as much as 1,000 percent, a new study finds, and the average U.S. hospital charges uninsured patients three times what Medicare allows.
...............

It leads to confusion, and Bai says hospitals are taking unfair advantage of this. "Because it is difficult for patients to compare prices, market forces fail to constrain hospital charges," Bai and Anderson wrote in their report, published in the journal Health Affairs.
............

"I looked at the bill and realized I did not understand the bill," Bai told NBC News. "If I, a CPA, did not understand a hospital bill, how can an average American understand it? We understand the bills for all the other assets we buy. We do not understand the bill for our most valuable asset. That is our health."
................

Hospitals did not used to mark up their charges so much.

"The increases began in the late 1980s and started to accelerate in 2000," Bai and Anderson wrote. "In 1984 the average charge-to-cost ratio was 1.35. In 2004 and 2011 the average charge-to-cost ratio was 3.07 and 3.30, respectively. The markup in 2012, therefore, represents a 10 percent increase from 2004, and 3 percent increase from 2011."