Posted on 05/21/2014 12:17:31 PM PDT by Lorianne
You just might want to pay attention to the latest health insurance jargon. It could mean thousands of dollars out of your pocket.
The Obama administration has given the go-ahead for a new cost-control strategy called "reference pricing." It lets insurers and employers put a dollar limit on what health plans pay for some expensive procedures, such as knee and hip replacements.
Some experts worry that patients could be surprised with big medical bills they must pay themselves, undercutting financial protections in the new health care law. That would happen if patients picked a more expensive hospital — even if it's part of the insurer's network.
The administration's decision affects most job-based plans as well as the new insurance exchanges.
(Excerpt) Read more at startribune.com ...
Thanks for posting!
Basically the government would set payment ceilings for certain expensive procedures? How long until hospitals are told how much they can charge? But in the meantime someone should offer Obamacare Supplement Insurance.
See, the regulator is supposed to stop the businesses from screwing you, not get in bed with the businesses and help them screw you even more.
Ahh, yes, the old “control costs by refusing to pay more than a predetermined amount” routine.
Used to run into this when doing insurance repair work a couple of decades ago.
Insurer would decide they would not pay more than $110/square for roofing repairs. Never mind that my cost, for work done by a reputable roofer in the area, was $120, before markup.
So those dealing with these insurers had a number of ways to deal with the issue.
Lose money on the roofing, make it up elsewhere. Requires overcharging for other stuff, which distorts the accounting.
Lose money on the roofing, and just absorb it. A possible option, depending on how big a proportion of your business the roofing repairs were.
Refuse jobs with roofing involved.
Ask the customer to pay the difference. Doesn’t make them at all happy.
Overstate the number of squares repaired to make up for the inadequate price per square. Fraudulent.
Hire fly by night or illegal alien roofers, and/or use substandard materials. Probably the most commonly used approach.
The interesting thing is that whenever a contractor would get “caught” using one of these approaches, the insurer would be “shocked, shocked” that such things were going on.
Medicare has operated on this model for ever. Problem will come from other hospitals not agreeing to govt caps and the patient doesn't know in advance.
I thought this meant they could charge book price for uncovered or charges not meeting the deductible.
I got a bill from the ER doc for $1,083 for about 15 minutes of his time in addition to the $507 the hospital charged for “examination” and the other $1,500 they charged for “other” things.
I wrote the ER group and told them I would pay 60% after I called them and they said it was not negotiable to which I told them I would not pay at all and then they quickly offered a 20% discount to the fee that was not negotiable not two minutes earlier.
$1,083 for 15 minutes is $4,320 an hour or $34,565 an 8 hour day. I told them if got a service that cost that much and survived it I’d be back for more.
The offer I made is still over $2,500 an hour.
We will see what happens but I’m not paying $1,083 for a 15 minute service without prior agreement. Without prior agreement I would not expect to be able to charge at a sky is the limit rate and collect it and neither should they.
Paid $800 for one x-ray in this household. A new machine.
How about dem apples.
We argued with the ins company. Big whoop that did.
We didn’t ask the cost up front, though, so that’s not going to happen again. I hope.
There are usually work around that will arise when prices are artificially set at a low or negative margins.
In the health care field, look for additional charges for ancillary services or products that are not specifically considered “covered” by the insurance. Health care providers only need to ask the patient to sign an advanced beneficiary notice that a certain service is not covered. Of course, the patient can decline the additional uncovered service, but then, the patient might not get the covered service that they want or need.
Exemptions to be made for victimhood groups of course. Some reason I don’t picture insurance companies using this formula unless “White” is checked on the form.
That reminds me. Now that EVERYONE is required to purchase health insurance and will be required to show ID to make sure they are who they say they are, are insurance companies, pharmacists, and hospitals now racist?
Most people already have lifetime caps they’re not aware of.
I had a tooth extraction last week. It has been 4 years since I visited this surgeon’s practice.
He had been mandated by the Feds to install state of the art monitoring equipment. This included a fancy new X-ray machine that does full mouth pics solely from the exterior. Very futuristic. Whole mouth x-rays were $110. Vitals monitors were also very futuristic. Of course, he has been forced into electronic record keeping, too.
All in all, it was evident his practice has been raped and he has had to downsize as far as staff and associates are concerned. Yet, the total cost was only about 50% over the cost in 2010 and included anesthesia.
I paid out of pocket and had no complications.
If they assume you will pay anything they assume too much. It cuts both ways.
I am fortunate. I don’t give a rip about my credit rating. If they want to take it far enough my agreement was with the hospital and not the ER doc firm. I made no contract with them and so I would argue I made not agreement to pay them.
In my case it is not the insurance company but a charge between me and the doctor.
You have a choice to ask and refuse I suppose. Charging this rate at the ER when not taking the service is a bad choice is predatory pricing. I guess our only choice in pure capitalism then is to do without and drive the price down.
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