<p>What we need is a little infighting. When an insurance company calls and tells a hospital to take a 20 percent cut in payments, the reaction should be wait a minute, if I get rid of the insurance company, I dont have to take a cut.</p>
<p>Sutter is talking about doing this. Already starting to do this. I am not that creative enough to make this up. Others will follow. </p>
<p>I find it interesting that Sutter, Kaiser, UCSF and Stanford are continuously running commercials where I live. I thought they were going to be swamped.</p>
<p>I agree, dstark. I’m always seeing ads for Sutter, Stanford, Kaiser, UCSF Benioff and Palo Alto Medical Clinic. I guess the doctor shortage hasn’t hit the Bay Area, though I’m willing to believe that there’s a shortage in rural parts of California.</p>
<p>We also have socialized medical insurance for the over-65… with payment apparently design to encourage overtreatment (pays rather little per procedure, but tends not to question anything, so some providers “make it up by volume” by ordering extra tests and procedures). With so many people believing that “more is always better” (even though it is not necessarily true in medicine), the pressure to increase costs is huge in the US.</p>
<p>Examples of where “more is always better” is not necessarily true in a medical context:</p>
<ul>
<li>PSA test as prostate cancer screening.</li>
<li>Mammograms for <50 year old women without elevated breast cancer risk factors.</li>
<li>Giving antibiotics to patients without bacterial infections because patients want “something”.</li>
<li>Many spinal fusion surgeries.</li>
<li>Electrocardiography as screening for adults without elevated heart disease risk.</li>
<li>Prophylactic removal of wisdom teeth.</li>
</ul>
<p>This is from a law firm. There is a NY law that deals with network issues. I would like to see more states enact laws that deal with the network issues.</p>
<p>Thanks for finding this, Dstark! It’s unfair that currently the onus is all on the insured to get reimbursement after the treatment and resolve the “surprise” billings. Hope other states will follow suit and hope this passes, tho it may create another layer of bureaucracy for the independent review. </p>
<p>Yes…this in network for some procedures, but oops sorry, that procedure is out of network has to stop. I would love for Calif to pass a similar law. </p>
<p>This NY law is a good law. Will make it easier to comparison shop and to know what the costs are in advance. Plus, the patient is protected in emergencies.</p>
Think of the employer and employee who are paying the premiums, though. They don’t have the know-how or clout to prevent providers - hospitals and physicians - from just demanding blank checks, and why is there any reason to believe they won’t? What’s to prevent providers from establishing a protocol for a half dozen physician consults and tests to be required for every single person who’s taken for surgery, or push the inpatient admission rate for ER patients to twice the levels of today? Unless there’s a check/balance like the provider also has a vested interest in controlling costs, it’s dangerous to just remove pieces of the system while the rest are left as they are. </p>
<p>It’s not unusual even for employers who are large enough to underwrite the coverage themselves to get an insurance company to actually do the negotiations, and the day-to-day operations just to keep the playing field balanced. And I’m saying this as someone in the industry on the other side of the insurance companies.</p>
<p>Yesterday, I received a renewal notice from Anthem. I don’t like what the notice said about emergency care. The notice said the policy holder may be responsible for out of network charges and additional costs above in network costs. </p>
<p>California needs to have a law like NY that prevents out of network charges in emergencies. </p>
<p>"The modest growth is in line with the historically slow rate of national health spending that has persisted since the recession.“This is a striking result,” said Paul Hughes-Cromwick, a senior health economist with the Altarum Institute. “We’re just not seeing the acceleration that was so widely predicted,” he said. "</p>
<p>“In related news, average premium rates for individual market health plans, including those sold through the ACA’s insurance exchanges, are projected to increase by about 6% for 2015 plans, according to a PricewaterhouseCoopers Health Research Institute analysis, Bloomberg reports.
For the analysis, PwC examined premium rate filings for the 2015 individual insurance market.”</p>
<p>“Several insurers estimate that enrollment in their plans sold through the Affordable Care Act’s exchanges will increase by at least 20% during the upcoming open enrollment period, while some insurers expect enrollment to double in some states, Reuters reports.
Six private and not-for-profit insurers based their expectations on current enrollment interest from consumers who are speaking with their brokers, call centers and sales forces.
Several of the insurers increased their staff two- or three-fold to assist with enrollment, with some insurers experiencing a 30% increase in customer calls in October, even though only individuals with qualifying life events can purchase exchange coverage outside of the open enrollment period.”</p>
<p>Our share of monthly premiums went from $255/mo to $277/mo and employers went up a similar %. Didn’t increase premium at all last year. We’re pretty happy with insurer. This is for us and D until she turns 26 (would cover all other kids we had under age 26 too). No lower premium for just H plus me, once D ages out next year. </p>
<p>Didn’t opt for cheaper coverage since H has Medicare A & B, especially as I don’t qualify for Medicare for many more years. Am likely to keep this policy even after we are both on Medicare due to great coverage and low premiums (unless something dramatic changes in coverages or finances, which is unlikely). </p>
<p>Yes, good coverage with low premiums and no deductible was one of the very attractvw benefits of H’s job. Can’t see any reason to ever cancel the policy. We are very grateful as we have pre-existing conditions and would otherwise be tough to insure. </p>
Others will follow. </p>