5 ms·

Kaiser is no longer a low-cost provider. They actually are quite expensive. We go through a very large group to get a better rate but it's still much higher tha

by e40 9y ago

Kaiser is no longer a low-cost provider. They actually are quite expensive. We go through a very large group to get a better rate but it's still much higher than many of the other options that we have in our plan. When you look at how Kaiser is structured, they should be cheaper. I think they're just pocketing the difference between the market rate and what their costs are.

learc83 9y ago
>I think they're just pocketing the difference between the market rate and what their costs are. This is baseless and not really possible. Insurers must spend 80% of premiums (85% for large group plans) on providing care for their insured.
- dv_dt 9y ago
  An allowance 15-20% overhead for health insurance seems like pretty low bar for the industry...
  - s73ver_ 9y ago
    And yet, it was groundbreaking when it was signed into law. People received refund checks after it went into effect.
    - FireBeyond 9y ago
      And immediately after, administration costs shot up to ooh, 15-20%...
      - dv_dt 9y ago
        Yes, I suspect it ends up as something of a perverse disincentive to control costs
      - ethbro 9y ago
        They were already above that. Especially the not-for-profits (e.g. Blues) had to scramble to get under the cap. There was a huge amount of waste in the system. 15-20% is a marked improvement.
- kevin_thibedeau 9y ago
  > "There is no such thing as a legitimate price for anything in health care,” says George Halvorson, former chairman of Kaiser Permanente, the giant health maintenance organization based in California. “Prices are made up depending on who the payer is." When you can game the pricing you can always just slice 80% from an ever increasing pie.
  - learc83 9y ago
    That's not really how it works. The "ever increasing" pie would have to come directly from increasing subscriber premiums, not from cutting costs and pocketing the difference the OP indicated. It doesn't matter how much they play with pricing on the back end, the company can't make more than 20% profit from subscriber premiums.
    - kevin_thibedeau 9y ago
      There is a whole lot of backscratching with the profiteers taking their cut of the 80%. That is why we get $30 Tylenol pills under the guise of "care".
      - learc83 9y ago
        Hospitals aren't charging insurance companies $30 for Tylenol and then paying insurance companies under the table if that's what you're alleging. That's completely illegal and it's just too noticeable for them to do it large scale. The OP was making a baseless claim because they didn't know what they were talking about, and you're now grasping at straws supporting their claim for some reason.
        kevin_thibedeau 9y ago
        None of the stakeholders in American for-profit healthcare have any incentive to reduce costs so everything just keeps ratcheting up. Growth can't be achieved by increasing the population of sick people so the only other option is to raise prices. The insurance companies do benefit from this. They agree to cover the inflated pricing so that their 20% cut can be bigger. If ACA permitted rational price controls this whole problem would have been reigned in.
idlewords 9y ago
Cancer care at Kaiser was outstanding. They may be spending the money on extra staffing and facilities, not just pocketing it. The only place where I believe Kaiser falls short and gives the impression of pinching pennies is mental health care.
- tptacek 9y ago
  Is there any private non-university health chain in the country that does mental health well? Every contact I've seen with any acute mental health care system --- except at the University of Michigan --- has been a catastrophe.
  - karpodiem 9y ago
    Go Blue! (Hope you’re feeling better)
nowarninglabel 9y ago
I'm downvoting you because you stated this as if it is a fact for everyone. We're in a small group plan and paying about the same for Kaiser as we are for Blue Shield, not "much higher". So, I think here's it's more "your mileage may vary."
- megaman22 9y ago
  To be fair, Blue Cross/Blue Shield are usually highway robbery for terrible plans, so... The whole thing is broken. A friend of mine is switching jobs and is going to forking over a third of her paycheck for COBRA until the new job enrolls her in their plan. Almost certainly, nothing will happen in that short time period, and she'll have wasted thousands of dollars. But if something did happen, and she didn't pay the extortion, sorry COBRA, she'd be up shit creek without a paddle and ruined.
  - malyk 9y ago
    She can wait until an incident happens and then activate cobra. You don't have to pay for it upfront.
    - dev360 9y ago
      This was really good to know, had no idea.
    - basementcat 9y ago
      This is not true of all COBRA plans. To be safe, she can delay premium payments a maximum of 45 days and still have coverage for claims that occur before the initial premium payment. https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/cobra-continuation-health-coverage-compliance https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/...
  - IronKettle 9y ago
    I think you can retroactively pay for COBRA, yeah? You can enroll after an event and it'll be as though you had insurance the whole time. You'll have to pay for the retroactive coverage, but it's a pretty smooth way (assuming nothing happens) to avoid paying for COBRA while still technically "having coverage". Though I think there's a time-limit on it.
dv_dt 9y ago
It's been a while since I've worked for a company that had Kaiser as an option, but my recollection was that it was more expensive too. The quality of care in a given service region might be higher, but there's a reason that they haven't completely taken over their market.
Johnny555 9y ago
My employer has a very good kaiser plan, basically I pay $15 for any office visit, and nothing for lab tests, etc. The total unsubsidized price is $1450/month for two people. I don't know if $725/per person is good or not, but when I've looked around at other plan, I've found plans with far worse benefits (high out of pocket costs) for more money.

by e40 9y ago

learc83 9y ago

>I think they're just pocketing the difference between the market rate and what their costs are. This is baseless and not really possible. Insurers must spend 80% of premiums (85% for large group plans) on providing care for their insured.

dv_dt 9y ago
An allowance 15-20% overhead for health insurance seems like pretty low bar for the industry...
- s73ver_ 9y ago
  And yet, it was groundbreaking when it was signed into law. People received refund checks after it went into effect.
  - FireBeyond 9y ago
    And immediately after, administration costs shot up to ooh, 15-20%...
    - dv_dt 9y ago
      Yes, I suspect it ends up as something of a perverse disincentive to control costs
    - ethbro 9y ago
      They were already above that. Especially the not-for-profits (e.g. Blues) had to scramble to get under the cap. There was a huge amount of waste in the system. 15-20% is a marked improvement.
kevin_thibedeau 9y ago
> "There is no such thing as a legitimate price for anything in health care,” says George Halvorson, former chairman of Kaiser Permanente, the giant health maintenance organization based in California. “Prices are made up depending on who the payer is." When you can game the pricing you can always just slice 80% from an ever increasing pie.
- learc83 9y ago
  That's not really how it works. The "ever increasing" pie would have to come directly from increasing subscriber premiums, not from cutting costs and pocketing the difference the OP indicated. It doesn't matter how much they play with pricing on the back end, the company can't make more than 20% profit from subscriber premiums.
  - kevin_thibedeau 9y ago
    There is a whole lot of backscratching with the profiteers taking their cut of the 80%. That is why we get $30 Tylenol pills under the guise of "care".
    - learc83 9y ago
      Hospitals aren't charging insurance companies $30 for Tylenol and then paying insurance companies under the table if that's what you're alleging. That's completely illegal and it's just too noticeable for them to do it large scale. The OP was making a baseless claim because they didn't know what they were talking about, and you're now grasping at straws supporting their claim for some reason.
      - kevin_thibedeau 9y ago
        None of the stakeholders in American for-profit healthcare have any incentive to reduce costs so everything just keeps ratcheting up. Growth can't be achieved by increasing the population of sick people so the only other option is to raise prices. The insurance companies do benefit from this. They agree to cover the inflated pricing so that their 20% cut can be bigger. If ACA permitted rational price controls this whole problem would have been reigned in.

idlewords 9y ago

Cancer care at Kaiser was outstanding. They may be spending the money on extra staffing and facilities, not just pocketing it. The only place where I believe Kaiser falls short and gives the impression of pinching pennies is mental health care.

tptacek 9y ago
Is there any private non-university health chain in the country that does mental health well? Every contact I've seen with any acute mental health care system --- except at the University of Michigan --- has been a catastrophe.
- karpodiem 9y ago
  Go Blue! (Hope you’re feeling better)

nowarninglabel 9y ago

I'm downvoting you because you stated this as if it is a fact for everyone. We're in a small group plan and paying about the same for Kaiser as we are for Blue Shield, not "much higher". So, I think here's it's more "your mileage may vary."

megaman22 9y ago
To be fair, Blue Cross/Blue Shield are usually highway robbery for terrible plans, so... The whole thing is broken. A friend of mine is switching jobs and is going to forking over a third of her paycheck for COBRA until the new job enrolls her in their plan. Almost certainly, nothing will happen in that short time period, and she'll have wasted thousands of dollars. But if something did happen, and she didn't pay the extortion, sorry COBRA, she'd be up shit creek without a paddle and ruined.
- malyk 9y ago
  She can wait until an incident happens and then activate cobra. You don't have to pay for it upfront.
  - dev360 9y ago
    This was really good to know, had no idea.
  - basementcat 9y ago
    This is not true of all COBRA plans. To be safe, she can delay premium payments a maximum of 45 days and still have coverage for claims that occur before the initial premium payment. https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/cobra-continuation-health-coverage-compliance https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/...
- IronKettle 9y ago
  I think you can retroactively pay for COBRA, yeah? You can enroll after an event and it'll be as though you had insurance the whole time. You'll have to pay for the retroactive coverage, but it's a pretty smooth way (assuming nothing happens) to avoid paying for COBRA while still technically "having coverage". Though I think there's a time-limit on it.

dv_dt 9y ago

It's been a while since I've worked for a company that had Kaiser as an option, but my recollection was that it was more expensive too. The quality of care in a given service region might be higher, but there's a reason that they haven't completely taken over their market.

Johnny555 9y ago

My employer has a very good kaiser plan, basically I pay $15 for any office visit, and nothing for lab tests, etc. The total unsubsidized price is $1450/month for two people. I don't know if $725/per person is good or not, but when I've looked around at other plan, I've found plans with far worse benefits (high out of pocket costs) for more money.