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<p>I doubt it’s that. Chico, population 87,000, is 13 miles from Paradise; it has a state college in it. Probably the insurer was trying to negotiate a lower rate, and the negotiation ended with a higher rate. What a surprise, not. That’s the way those things work.</p>
<p>[WASHINGTON:</a> Doctors are concerned about pay scales under health care law | Health Care | McClatchy DC](<a href=“http://www.mcclatchydc.com/2013/11/20/209165/doctors-are-concerned-about-pay.html]WASHINGTON:”>http://www.mcclatchydc.com/2013/11/20/209165/doctors-are-concerned-about-pay.html)</p>
<p>For a complex office visit for which a commercial plan would pay $100, an exchange plan will pay $60 or $70. (70% just as in the Riverside article).</p>
<p>Somehow I had Paradise located near Lassen National Park. My mistake.</p>
<p>I value health care more than an airplane seat or a particular resort. Isn’t that comparing apples to oranges? :)</p>
<p>We will have to wait and see how all of this plays out. For now, I’m staying away from the exchange policies.
Let’s see how this it looks a year or two from now.</p>
<p>“Physicians are uncomfortable discussing their rates because of antitrust laws, and insurers say the information is proprietary. But information cobbled together from interviews suggests that if the Medicare pays $90 for an office visit of a complex nature, and a commercial plan pays $100 or more, some exchange plans are offering $60 to $70. Doctors say the insurers have not always clearly spelled out the proposed rate reductions.”</p>
<p>What do the doctors receive after co -pays? I dont see any mention of co-pays. </p>
<p>I received my Anthem bill today and it is correct. :)</p>
<p>I havent paid yet. But I will. ;)</p>
<p>In the article from the Riverside Press Enterprise, Blue Shield acknowledged that they were contracting with doctors at ‘discounted’ rates on the exchange plans.</p>
<p>^yes, and from the same Kaiser article that I posted earlier:</p>
<p>“Doctors say the Blue Cross Blue Shield Association plans have generally been more straightforward about the discounted rates --and some doctors who had the opportunity to “opt out” of their exchange plans did so.”</p>
<p>"Dr. Richard E. Thorp, an internist who is president of the California Medical Association and heads a physician-owned multi-specialty primary care group in Paradise, Calif., said one plan sold on that exchange “was going to pay us significantly less for doing that business. And we are already very busy.”</p>
<p>“His practice delayed signing a contract, he said. But about three weeks ago, the group was informed the insurer was short on physicians and was therefore including doctors from other plans at their old rates. So his practice was included at the higher rate.”</p>
<p>“Advocates say that consumers should be wary of information in plan directories and confirm participation with their doctors.”</p>
<p>Pay attention to the last line. Call your doctor and confirm participation in a specific policy. Don’t rely on the lists.</p>
<p>And what about deductibles? The exchange plans have huge deductibles. Do the doctors charge the insurance company discounted rate to the patient? </p>
<p>As a practical matter when the deductibles are $5,000 and $6,000 dollars per year, the doctors will be paid by the patient upfront either check or credit card. The insurance will never kick in unless the patient has a catastrophic illness.</p>
<p>
Keep in mind the Jan 6 deadline for coverage Feb. 1st. I’d phone it in if Anthem will let you (I’m hearing reports that the web site pay link is kind of buggy).</p>
<p>Calmom, we have a 31 day grace period.</p>
<p>Anthem also extended the due date to Jan 10 for new policy holders.</p>
<p>"And what about deductibles? The exchange plans have huge deductibles. Do the doctors charge the insurance company discounted rate to the patient? </p>
<p>As a practical matter when the deductibles are $5,000 and $6,000 dollars per year, the doctors will be paid by the patient upfront either check or credit card. The insurance will never kick in unless the patient has a catastrophic illness."</p>
<p>The insurance does kick in… The patient pays the discounted rate.</p>
<p>When my kid received a bill for 4,000… The insurance company negotaited the rate to 800.
I paid 800. If the deductible was met, I would have paid less than $800. </p>
<p>I did not have to pay 4,000. If the insurance company negotiated a better deal, I would have paid less than $800. </p>
<p>The deals insurance companies negotiate matter.</p>
<p>In a perfect world for patients, insurance companies would negotiate rates down while having huge networks.</p>
<p>Ok. Still most people on exchange plans will pay OOP for a doctors visit, unless they are savvy enough to say its a routine check up, then it’s free. If they mention a problem, they pay until the deductible is met. AIUI.</p>
<p>Well… We pay oop now. :)</p>
<p>There are no specific defined rates between and insurer and a doctor. The same insurer might pay 120$ for one plan, 90$ for another and 50$ for a third plan. So a doctor might choose 1 and 2 but decide not to accept the 3rd.</p>
<p>It is anybody’s guess what different insurers are paying for different type of doctor visits in different markets in the various metal plans. There is no uniform rate dictated and it is impossible for them to negotiate a single rate across markets. </p>
<p>It is being negotiated in the papers when doctors say our rates are low. If the rates were good, the same doctors would be complaining that they are having a hard time getting added to the network instead.</p>
<p>One other piece to remember is competition among the providers. If there are a lot more providers, they have lower premium prices which means doctors and facilities will be squeezed for reductions.</p>
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<p>Thanks, romani. I think we need to keep reminding ourselves that people are buying insurance from private, for-profit market-based insurance companies. “Obamacare” is simply a set of laws which prevents those private, for-profit insurance companies from abusing Americans as they have for 70 or 80 years.</p>
<p>Remember that many people on the exchanges have subsidized deductibles. They don’t have the $5000 and $6000 deductibles that unsubsidized people would have to pay.</p>
<p>TatinG wrote:
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<p>Excuse me, TatinG, but if you reread that article I think you will realize that the actual quote from your article is (with my bold):
</p>
<p>Some plans. And some plans are not. Nobody is holding a gun to doctors’ heads, making them sign contracts. They can choose to participate, or not. We can all decide for ourselves whether we think doctors ought to be on the list of Americans Who Are Tragically Underpaid.</p>
<p>TatinG, that is not how the copay plans work.</p>
<p>Let’s say a person has a standard Silver plan with a $2000 deductible and a $45 copay for office visits, $65 copay for specialist visits. The person goes to the doctor for an annual checkup – that’s free. Then the person gets a sore throat and goes to the doctor for a regular (medical) visit, that’s $45. It doesn’t matter whether the person has met their deductible or not, they have a $45 copay and that is what they pay. But let’s say that the doctor also does some lab work – we’ll say hypothetically the lab charges $100 and the patient has a co-insurance amount of 20%. That is billed to the insurance, and the insurance reduces it to, say, $30. The patient hasn’t met their deductible, so the patient pays the lab bill. If the patient had met the deductible, then the co-insurance would kick in and the patient would pay 20% of the $30 (or $6).</p>
<p>Both the copay amounts and lab bill are applied to the deductible, so in my example above, the patient has incurred $75 of expenses that are applied to the $2000 deductible. But the patient still gets the benefit of the lower copays. </p>
<p>I happen to have opted for a straight co-insurance plan because I wanted the HSA – so in my case I won’t get anything back from my insurance company until I meet the $4500 deductible – but that’s because of my choice of plan. I have a Bronze HSA eligible plan, but if I chose the alternate Bronze plan without the HSA, then I would pay $60 for an office visit. </p>
<p>The deductibles become significant for people on copay plans when there is hospitalization – as that is a situation where coinsurance kicks in for everyone.</p>
<p>“There are no specific defined rates between and insurer and a doctor. The same insurer might pay 120$ for one plan, 90$ for another and 50$ for a third plan. So a doctor might choose 1 and 2 but decide not to accept the 3rd.”</p>
<p>Texaspg, are you sure?</p>
<p>Isnt the negotiation between the provider and insurance company about the price per procedure? </p>
<p>Then each plan will lay out how much the patient pays and how much goes to the deductible. So if Blue Cross negotiates the price of a procedure as 200…</p>
<p>The patient may pay 50, 100, 200 with the insurance company paying the balance of 200. </p>
<p>Some plans may not pay for some procedures.</p>
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<p>Some of the insurance companies are set up as not-for-profit – that’s something for consumers to keep in mind when choosing among companies. It may or may not make a difference as to the premiums charged – a not-for-profit organization still runs with the same budgetary constraints as a for-profit company, and in some cases may have less financial flexibility and so may not be able to offer competitive rates – but I do think that it is important for consumers to at least be aware that they can often choose to go with a not-for-profit carrier.</p>
<p>calmom, you’re right, of course. My own insurance through work is with a non-profit, although the premium is eye-poppingly high. Lucky for me, my employer pays the whole thing. </p>
<p>My point, perhaps not well-stated, is that these carriers are all market-based. The term “Obamacare” carries the connotation IMO that coverage is being provided by the government, which simply isn’t true unless the applicant qualifies for Medicaid.</p>
<p>"Isnt the negotiation between the provider and insurance company about the price per procedure? "</p>
<p>From what I hear from doctor’s practices you also have to add plan to the equation. The rates might be similar across many plans but when something like ACA kicks in, they are being forced to negotiate different prices/procedure just like Medicare and Medicaid.</p>
<p>Despite people here trying to argue there is no such thing as obamacare price (I agree and disagree at the same time since there is no such thing but there are negotiations BECAUSE it exists), we have to remember there are billions being given out as subsidies by the Govt and they are just not going to sit around pay whatever premiums and bills being suggested by insurance companies, doctors and hospitals. So they have put the pressure on insurance companies to get the best deals possible.</p>