The Eye Popping 2016 Obamacare Rate Increases Are Out

[somarco]

Consumers don't pay hospital bills.

And therein lies a big part of the problem.

Some hospitals uncompensated care runs close to 30%. A "good" hospital might collect 85%+.

Too often these "studies" focus on gross billed charges which no one ever pays. Retail pricing is just for accounting purposes and means nothing. Kind of like the sticker price on a car.

A higher percentage of the bill is paid by Medicare & Medicaid. Patients with private insurance may have 80% or more of their bill paid by the carrier. Hospitals might collect half of the remainder if they are lucky.

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

"The increases began in the late 1980s

Late 80's is when managed care started to bloom. BX always got a big discount because of the patient volume.

Carriers paid about 10% more than BX and were not tax exempt like many of the Blues were at that time. MCO's were formed to establish networks and negotiate repricing strategies. Suddenly the hospitals were forced to recognize these new players (MCO's) that had clients that represented the other 30% or so of the market with insurance that wasn't Blue.

As more patients entered the doors with managed care plans the carriers (and docs, labs, etc) countered by raising prices even more.

Mangled care was a short term fix for a long term problem. Late 80's was also when copay plans became more popular, especially for Rx. The copay led to significant increases in utilization which impacted claims and premiums.

Even with mangled care utilization has continued to rise over the years resulting in higher claim expenditures.

 

[SusieQ2]

When someone is without insurance a "not-for profit" hospital will mark up and charge as much as they possibly can so they can show an outlandish bill to the government that the patient did not get paid and then they will get paid a % of that inflated bill.

Therefore, when you're in the hospital without insurance getting treated like $%^&* the "not-for profit" hospital is still probably getting paid as much as if you had insurance.

It's a racket. IMHO.

Sorry didn't see scagnt83 post about the same thing before I posted.

 

[RayNY]

You're right Somarco, it's just like sticker prices at the dealer, if only they were billing $180,000 for a Honda Civic and didn't tell you what it costs until a bill comes in the mail weeks later.

I realize that using gross billed is an unrealistic representation of what actually gets billed/paid, but the moral is, that number is still on the bill for that procedure.

 

[GreenSky]

When someone is without insurance a "not-for profit" hospital will mark up and charge as much as they possibly can so they can show an outlandish bill to the government that the patient did not get paid and then they will get paid a % of that inflated bill.

Therefore, when you're in the hospital without insurance getting treated like $%^&* the "not-for profit" hospital is still probably getting paid as much as if you had insurance.

It's a racket. IMHO.

Sorry didn't see scagnt83 post about the same thing before I posted.

You assume that people without insurance can pay $30-50K for a hospital bill? When they don't pay is that as much as the hospital receives from the insurance company?

Rick

 

[somarco]

a "not-for profit" hospital will mark up and charge as much as they possibly can so they can show an outlandish bill to the government that the patient did not get paid and then they will get paid a % of that inflated bill.

Really?

Who will pay the % of the inflated bill?

Not Medicaid. They have their own fee structure.

when you're in the hospital without insurance getting treated like $%^&* the "not-for profit" hospital is still probably getting paid as much as if you had insurance.

You must be reading Ezra Klein's garbage.

 

[justthefacts]

Really?

Who will pay the % of the inflated bill?

Not Medicaid. They have their own fee structure.



You must be reading Ezra Klein's garbage.

It depends on the state my state fl has medicaid needy hospitals can be compensated for "actual costs" for the uninsured once they have been admitted pt or completed treatment.Tampa bay times liberal rag did investigate billings and many reimbursements did excede average insured pt costs.In my state suzyq is dead on right maybe different elsewhere."IN FLORIDA WE ARE EITHER UNDERWATER OR UNDER INDICTMENT"ha ha

 

[AllenChicago]

Well, what do you know.. The warnings of big premium increases were just false alarms!

"The average insurance premium under ObamaCare is probably not headed toward a double-digit hike next year, new data shows.

Premiums for silver plans on the federal insurance exchanges are slated to increase an average of 5.8 percent in the eight states where all data is available, according to an analysis by Avalere Health."

Story: ObamaCare plans headed for 'modest' rate hikes, report says | TheHill

Open the champagne and celebrate if you're in a 5.8% state!

 

[RayNY]

"most plans are proposing more modest increases" is one heck of a stretch when all they consider is the average of the lowest cost silver plans, for individuals, on exchange, for 8 states.

It's like only watching 8 channels of basic cable at 3am and concluding "all that's on TV is infomercials"

 

[AllenChicago]

"most plans are proposing more modest increases" is one heck of a stretch when all they consider is the average of the lowest cost silver plans, for individuals, on exchange, for 8 states.

It's like only watching 8 channels of basic cable at 3am and concluding "all that's on TV is infomercials"

ObamaScare is faltering so badly, liberal pollsters and publications are taking the rare, local instances ACA successes, and reporting them as if they're a big-time good news story.

The same meaning behind the "all politics is local" phrase, applies to health insurance too. When 9 out of 10 QHP customers in IL realize that they're going to get hammered with a 32% premium increase in 7 months, they won't give a rat's arse what the nationwide average premium increase is.

Interestingly, there was only a bit of print media about this upcoming increase, and zero coverage by TV and Radio news this week. They probably think that HHS is going to force BCBSIL to scale back the requested increase, so why report it and scare people needlessly? HHS and the State ALWAYS grant BCBSIL the rate increase it asks for, just like the 27% it requested/received for January 1, 2015. Media is too lazy to do a 5 minute search and learn this for themselves, though.

 

[cadylou]

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

I did ask them to write the order for the scan and they insisted that I had to have other tests first