Healthcare pricing insanity

[ucbalumnus]

<p>

@LasMa

No, cancer treatment usually isn’t an emergency. It’s only life-or-death. If we shop around for chemo based on price, eventually those who don’t have insurance, or those who can’t afford the higher price, will be driven to the cheapest providers/treatments, which in a price-based market, will inevitably mean inferior care. And what about those who can’t afford even the cheapest treatment?

</p>

<p>As opposed to now, where there is not a lot of ability to compare quality, and even less ability to compare price, often resulting in substandard care at a premium price (US medical care consumes a much higher percentage of GDP than that of other rich countries, while getting no better results for most and significantly worse results for many). Meanwhile, everyone indirectly pays the premium price, either through employment or government.</p>

[ucbalumnus]

<p>

@interesteddad

On the other hand, if the provision of no denied coverage goes into effect that allows you to enroll on the spot if you are hospitalized – with no penalty, no waiting period – I may seriously consider dropping my health insurance entirely. It would be a LOT cheaper to pay out of pocket for my annual physical and routine screening and the fine than it is to pay for a year of insurance. If you can sign up on the spot at any time at the same price risk-free, you’d have to be crazy to pay for insurance until you need it… The only thing that has kept people from doing that has been the waiting periods and exclusions if you have have a break in coverage.

</p>

<p>That’s why the ACA links the popular no-pre-existing-condition-limitation to the unpopular individual mandate (or pay an extra tax instead), to avoid this kind of adverse selection.</p>

<p>Of course, even if you were able to do this type of thing (or decided to just pay the extra tax), you would still have to self-insure the risk of emergency medical care (e.g. if you get hit by a car while crossing the street and don’t wake up in the hospital until after hundreds of thousands of dollars of emergency medical care).</p>

[LasMa]

<p>ucbalum, you won’t get an argument from me that both pricing and quality need to be much, more more transparent. Sunshine is the best disinfectant, and this is one of many things which need to be done. But free-marketism alone won’t solve our healthcare problems, unless we believe that access to, and quality of, medical care should be based on ability to pay.</p>

[hops_scout]

<p>

Single-payer would have been quicker, easier, and more cost-effective, but that was never going to happen. ACA is what we have, and it’s far, far better than what we had.

</p>

<p>Well I’m glad somebody’s willing to pay twice for health insurance!</p>

[LasMa]

<p>Pay twice? I’m not following.</p>

[dietz199]

<p>

So premiums are coming in lower than expected in California, Oregon and Washington. I wonder how ACA opponents are going to spin that?

</p>

<p>Into each life, if one is lucky, an unexpected pleasant surprise out of left field may fall.</p>

<p>But…what remains to be seen and is a big concern is…once we are all INSURED what actual ACCESS to care will remain. My guess, those that can will purchase into concierge practices or pay for higher cost gap polices. My PCP informed me that his group practice has stopped accepting Medicare/MediCal patients. Now, if exchange policies reimburse at rates similar to Medicare/MediCal then I expect more and more practices will be closed to patients carrying this type of policy.</p>

[geeps20]

<p>

geeps20: Are you buying insurance on your own or is it through your employer? If you’re buying it on your own, then you’ll be able to use the health exchange to select your plan and should be able to get a competitive price.

</p>

<p>direct pay, exchange prices listed on BC/BS RI website are almost identical to their own rates. The problem is that healthy people are now being lumped together with everyone else…I was very happy with my HDHP and thought the premium was fair…$6k for a family plan. Now, there are no more family plans per say…you take everyone’s age in your family and add up those premiums for that age(up to a max of 4). Bottom line 50% increase because of Obamacare…and please don’t say it’s not, my premiums went up about 5% only the last few years. The letter also stated obamacare as the primary reason.</p>

<p>link for proposed exchange rates in RI</p>

<p><a href=“https://www.bcbsri.com/sites/default/files/DPAY-13359_RATE_SHEET-Purchased_thru_HealthBenefitExchange.pdf[/url]”>https://www.bcbsri.com/sites/default/files/DPAY-13359_RATE_SHEET-Purchased_thru_HealthBenefitExchange.pdf&lt;/a&gt;&lt;/p&gt;

<p>link for BC/BS rates
<a href=“https://www.bcbsri.com/sites/default/files/DPAY-13360_RATE_SHEET-Purchased_from_BCBSRI.pdf[/url]”>https://www.bcbsri.com/sites/default/files/DPAY-13360_RATE_SHEET-Purchased_from_BCBSRI.pdf&lt;/a&gt;&lt;/p&gt;

[dstark]

<p>Ok geeps20, I see. </p>

<p>6,000 is better than 9,000…</p>

[ucbalumnus]

<p>

@dietz199

My guess, those that can will purchase into concierge practices or pay for higher cost gap polices. My PCP informed me that his group practice has stopped accepting Medicare/MediCal patients. Now, if exchange policies reimburse at rates similar to Medicare/MediCal then I expect more and more practices will be closed to patients carrying this type of policy.

</p>

<p>The small group primary care practice is already being squeezed out of existence. Finding a new primary care physician outside of a large multispecialty practice has been getting increasingly difficult over the years, probably because primary care physicians have much greater billing and insurance overhead (lots of small things, versus a smaller number of large things that other specialists may bill for).</p>

[2016BarnardMom]

<p>Geeps: you may find that another plan is a much better deal. The Blues are known to carry the highest premiums. A lot of other insurance plans should be available when the exchange is up. There are also companies starting up where you will be able to go, input information and they tell you which plans are the best deals for your family’s needs. Some are independent of any plan but at least one of those is owned by several Blues. If you decide to use one of those, make sure you find out who owns it!</p>

[LasMa]

<p>

My guess, those that can will purchase into concierge practices or pay for higher cost gap polices.

</p>

<p>This is nothing new; the wealthiest always get the best. What’s different now is that ACA sets a floor for access to health care to which ALL Americans have a right, not just the wealthy.</p>

<p>

My PCP informed me that his group practice has stopped accepting Medicare/MediCal patients. Now, if exchange policies reimburse at rates similar to Medicare/MediCal then I expect more and more practices will be closed to patients carrying this type of policy.

</p>

<p>Physicians who refuse to accept ACA policy rates aren’t going to have a lot of patients left.</p>

[geeps20]

<p>

The Blues are known to carry the highest premiums.

In RI, there are just 3 carriers and the premiums are almost identical… big surprise.</p>

[LasMa]

<p>geeps, is RI doing something similar to CA? We have 4 tiers to choose from. Benefits packages are identical, but there’s a tradeoff between premiums and out-of-pocket. If I’m willing to accept higher co-pays and deductibles, I can lower my premium by quite a bit. Or vice versa.</p>

[marybee333]

<p>After all of the research and effort you have done, get the test! I cannot believe the time you’ve spent investigating this. Pay the lowest price you can negotitate.<br>
P.S. Can you negotiate my next car purchase? I am serious!</p>

[geeps20]

<p>Lasma…I have the highest deductible now at $10k…This plan is going up 50% starting in 2014. I do not know the details of the exchange but as I posted before, the proposed exchange premiums are almost identical to direct pay premiums.</p>

[BCEagle91]

<br>

<p>I have the highest deductible now at $10k…This
plan is going up 50% starting in 2014. I do not know
the details of the exchange but as I posted </p>

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<p>Part of the idea of the ACA is to spread the cost around. Your costs are relatively low so you get to be a donor. The young, single folks that go without insurance are going to get a much bigger percentage increase.</p>

[interesteddad]

<p>As a follow up, I got the bill for the lab tests or, at least, the notification of what the bill will be after Anthem Blue Cross’s in-network provider.</p>

<p>I had three tests and I can’t at this point decipher which one is which on the bill: the fancy NMR lipid panel (cholesterol test), the standard 13 test metabolic panel (blood glucose, kidney function, yadda, yadda), and TSH thyroid panel.</p>

<p>The list price was $341 for all three. Anthem’s negotiated price was $76 for all three combined. Why they couldn’t have told me the price ahead of time, I have no idea. In any case, getting this test done through my doc and billed to Anthem was MUCH, MUCH cheaper than walking in off the street.</p>

<hr>

<p>Here’s the next round. According to my policy, colonoscopy tests and other routine wellness screenings are covered 100% and not subject to my annual deductable (i.e. Anthem pays, not me). But, here’s the kicker. That really only applies to your first colonoscopy. If you have ever had one previously and had polyps found, then any subsequent colonoscopies for the rest of your life are “medical”, not “routine screening” and are subject to the annual deductable (i.e. I pay). But, of course, nobody can tell me how much a colonoscopy will cost until after I have the procedure!</p>

<p>As soon as you have a diagnosis on your health chart (like “polyps removed” or “hypercholesterolemia”), then what were previously routine screening tests become medical treatment tests and no longer covered under these wonderful “free” preventative screenings… Just something to keep in mind…</p>

[cnp55]

<p>Another example of health care pricing craziness … </p>

<p>I was on the west coast for a family crisis when I <em>became</em> the crisis and needed a pacemaker inserted on an emergency basis.</p>

<p>The bills have started to come in. It looks like the full price of this procedure would have been close to $50K. My insurance company will get a whopping discount/negotiated rate, and will actually pay about $15K. And I will have to pay maybe $500 all together for various co-pays etc.</p>

<p>On what planet does this make any sense at all?</p>

[KKmama]

<p>My husband recently went to the ER for a rapid heartbeat and then spent the night under observation. $15K. They ran EKG strips every hour or so, at $385 per. My daughter, a budding PA, said the actual cost to the hospital is less than $5.</p>

<p>My insurance company paid some, and we are left with $1000 or so in copays.</p>

[Lergnom]

<p>The NYT ran a long piece about US births being much more expensive than other nations. One example was France, where mothers may stay in the hospital for a week to learn baby care and deal with nursing issues. The article is [url=&lt;a href=“American Way of Birth, Costliest in the World - The New York Times”&gt;American Way of Birth, Costliest in the World - The New York Times]here[/url</a>].</p>

<p>They cite a couple whose health insurance didn’t cover birth so she called her hospital to ask: “the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000.” BTW, 62% of plans not provided by an employer did not cover births. Prices rose 49% between 2004 and 2010 - not otherwise a period of high inflation - and the “average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866.” Out-of-pocket costs are now about $3,400, which is up from about $0 twenty years ago.</p>

<p>Comparisons? Switzerland is about $4k. France is about $3500. Holland and Britain about $2600. That’s less than the out-of-pocket costs we now pay in the US.</p>