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> The policy proposal, which you can read here, essentially bars out-of-network doctors from billing patients directly for their care. Instead, they would have
by arkades 8y ago
> The policy proposal, which you can read here, essentially bars out-of-network doctors from billing patients directly for their care. Instead, they would have to seek payment from the insurance plan. This would mean that in the cases above, the out-of-network doctors couldn’t send those big bills to the patients, who’d be all set after paying their emergency room copays.
I do love "sensible policy changes" that work by extracting money from physicians to cover patient bills rather than actually fixing the systemic dysfunction.
If you're the surgeon to hand, you don't get to refuse to do emergency surgery. You have to take care of that patient, ethically and legally. Oh, turns out they're out of network, and their insurer isn't obligated to give you a dime? Awesome, free surgery!
Here's a sensible solution: when it comes to emergency-based care, insurers must accept all comers as in-network. There's no such thing as "out of network" emergency-related care.
But hey, insurers have powerful leverage and a near-monopoly. What're the odds we'd take a slice off their profit margin?
- godzillabrennus 8y agoPeople should demand an end to private insurers. Makes zero send to have middle men who profit off denying care.
- whatshisface 8y agoThe balance sheets of public insuers would also benefit from denying care.
- jjeaff 8y agoAnd if your government denies care, there is no higher authority to keep them in check.
- moorhosj 8y agoVoters?
- freeone3000 8y agoI'm not entirely sold on the idea of people voting in their self interest anymore.
- leetcrew 8y agoidk about you but i have a zero premium plan with $2300 max out of pocket for in-network services. all i want is a foolproof way to ensure all my providers are in-network.
- antoniotamer 8y agoHow can such a plan exist? Or am I missing something?
- throwaway2048 8y agoYou are missing the fact that its basically his employer self insuring, as a form of unpaid compensation. The only thing the insurer is doing is acting as a billing agent.
- zrail 8y agoIt’s not self-insurance, necessarily. When OP says “zero premium” they mean (even if they don’t know it) that their employer is paying 100% of their premium.
- Fins 8y agoWhat they said, I worked for an outfit with a similar plan (lower max. out of pocket, though). They were self-insured, though, and the latest year I have data for, it was about $20K/year for health coverage.
- user72685 8y agoAlso worth noting that self-funded plans will have their premiums set based on the plan's actual claims experience, which means employers with a sicker risk pool will pay more. This also encourages discrimination against older or unhealthy/disabled workers, since they statistically cost more. (This is illegal, but it happens all the time and is hard to prove.)
- 8y ago
- user72685 8y agoAsk your Representative and Senators to sign on to HR 676 (https://www.congress.gov/bill/115th-congress/house-bill/676 https://www.congress.gov/bill/115th-congress/house-bill/676) and S 1804 (https://www.congress.gov/bill/115th-congress/senate-bill/1804 https://www.congress.gov/bill/115th-congress/senate-bill/180...), if they haven't already.
- forapurpose 8y agoMy concern is the patients, not the doctors; it's hard for me to see them as victims in the U.S. The awful health care system is their creation to a significant degree, and one which many of them protect. They get paid very well, often via absurd billing practices, running up bills on unnecessary treatment, pushing drugs in which they have a financial interest, etc. If I understand correctly, they restrict the number of doctors to a degree that it denies availability to people who need it, AFAICT to constrain supply and drive up their incomes. That they have to give back a little - something people in every walk of life have to do - is not high on my list of concerns.
- MBCook 8y agoI didn’t create the system, I was born into it. By the time I was old enough to vote it was far too established for radical changes to be easy to make. From what I’ve read/seen the system seems to be almost entirely a creation of unintended consequences of Congress, businesses, and well-meaning insurance companies. Sure there are bad actors but I don’t think they created the system, They only take it vantage of what was created (again, possibly unintentionally) by others.
- arcticbull 8y agoDemand change.
- MBCook 8y agoYou think I and tens of millions of voters DON’T?
- forapurpose 8y ago> unintended consequences of Congress, businesses, and well-meaning insurance companies They invest a large amount in very smart people predicting the consequences and then in lobbying (and bribing) politicians, and in supporting public information campaigns, to pass the laws that provide their desired consequences. For them to portray themselves as innocent and naive, if they do, would be cynical and absurd. It always seems to work out they make a lot of money, but probably unintentionally.
- maxxxxx 8y ago"Here's a sensible solution: when it comes to emergency-based care, insurers must accept all comers as in-network. There's no such thing as "out of network" emergency-related care." I actually agree. And to make this work insurers should stop negotiating individual rates with providers and instead providers should have a set price they charge no matter who pays. It's nuts that if you don't have insurance you pay 30k but with insurance suddenly the provider is OK with 7.5k.
- subhobroto 8y agoYes! I hinted about it here: https://news.ycombinator.com/item?id=18108839 https://news.ycombinator.com/item?id=18108839 More details here: https://news.ycombinator.com/item?id=18108870 https://news.ycombinator.com/item?id=18108870
- pc86 8y agoPlease don't just link to other comments, it makes for disjointed and difficult reading.
- tfehring 8y ago>insurers should stop negotiating individual rates with providers and instead providers should have a set price they charge no matter who pays It's not that simple, unfortunately. For one thing, Medicare reimburse at rates that are significantly below market prices [0][1]. Medicaid pays even less on average, and Medicaid reimbursement rates vary significantly from state to state [2]. Care providers need to make up for this by charging a higher rate to those who have private insurance or pay cash. The obvious retort to the above is that providers could charge a single, higher rate for everyone except Medicare and Medicaid. But if you prevent providers from offering reduced rates to insurers that include them in their networks, insurers will have an incentive to make their networks narrower, charging higher out-of-network deductibles and copays for a larger proportion of providers. Eliminating provider networks entirely isn't a good option, since they're one of the only mechanisms keeping costs in check to begin with: insurers can remove providers from their networks if they become too expensive (or if the quality of care declines), pushing policyholders to cheaper (and/or higher-quality) providers. To extend your example, say that instead of charging a 30k out-of-network rate and a 7.5k in-network rate for a particular insurer, a provider charges 15k for everyone. Are all insurers required to pay for the procedure at 15k (subject to deductibles and copays paid by policyholders)? If so, what's to stop the provider from charging 30k next year? And if not, what incentive do insurers have to pay for it? [0] https://www.cbo.gov/system/files/115th-congress-2017-2018/workingpaper/53441-workingpaper.pdf https://www.cbo.gov/system/files/115th-congress-2017-2018/wo... [1] https://www.aaos.org/AAOSNow/2017/Oct/Cover/cover01/ https://www.aaos.org/AAOSNow/2017/Oct/Cover/cover01/ [2] https://www.texmed.org/June16Journal/ https://www.texmed.org/June16Journal/
- user72685 8y ago> I do love "sensible policy changes" that work by extracting money from physicians to cover patient bills rather than actually fixing the systemic dysfunction. The article says insurers are required to pay: > The doctors would instead have to work with patients’ insurance, which would pay the greater of the following two amounts: > > * The median in-network rate negotiated by health plans > * 125 percent of the average amount paid to similar providers in the same geographic area That seems more than reasonable to me. They will get greater than market rate, if you define "market rate" as rates negotiated between insurers and doctors and not whatever nonsense they can get away with charging when the patient does not have pricing information and often isn't in a position to make a decision anyway. > Here's a sensible solution: when it comes to emergency-based care, insurers must accept all comers as in-network. There's no such thing as "out of network" emergency-related care. They are already required to pay for out-of-network emergency care even if the plan ordinarily doesn't cover out-of-network services at all, but they are only required to pay the usual and customary rates for those services, not the inflated nonsense bills (unless it's a state-regulated plan where state law requires the insurer to pay the inflated bills).
- refurb 8y agoThe reason doctors are in-network is the because they agreed to a discounted rate. If you forced insurance companies to accept all-comers, you’ve just drastically increased the cost of ER care. My preference would be for the hospitals to hold the bag.
- subhobroto 8y ago> My preference would be for the hospitals to hold the bag. Fair enough. How about everyone needing to pay the same rate regardless of whether they are insured or not: https://www.quora.com/Would-a-completely-free-market-healthcare-system-with-zero-government-involvement-and-no-subsidies-for-anyone-work-better-in-the-long-run https://www.quora.com/Would-a-completely-free-market-healthc...
- MBCook 8y agoA hospital holding the bag we could quickly go out of business. You would HAVE to implement some sort of backstop against that at the same time.
- refurb 8y agoThe hospitals are the ones giving privileged to these out of network physicians who work in their hospitals. They could hire them with the agreement that they accept the insurer’s in-network rate.
- MBCook 8y agoOr end up with almost no staff until it’s all sorted out.
- refurb 8y agoI assume it wouldnt be “no staff” considering it’s a rare occurrence when a physician is out of network. And i’m not talking about situations where the entire hospital is out of network. It’s when the patient does their homework and the doctor and facility are in network and then some random doc shows up who is out of network and the patient gets screwed.
- subhobroto 8y agoChange needs to happen to the U.S. Healthcare system so that these incidents just stop. This change is not going to happen on its own without people driving change. So you and I agree that change is needed, and action is necesary but what should be the course of action? > Here's a sensible solution: when it comes to emergency-based care, insurers must accept all comers as in-network. There's no such thing as "out of network" emergency-related care. Ah. I see you have good intentions but what you are saying is "Hospitals should be allowed to get paid whatever they charge and insurance companies should pay it" Do you see the problem? An example: https://www.publicintegrity.org/2015/06/15/17474/profit-hospitals-mark-prices-more-1000-percent-because-theres-nothing-stop-them https://www.publicintegrity.org/2015/06/15/17474/profit-hosp... As a person who's extremely passionate about driving change in the U.S. Healthcare system, I communicate a lot with people who have falled on hard times due to a medical bill. Here are two scenarios for you: https://www.quora.com/Recently-my-husband-visited-the-ER-in-the-US-due-to-almost-bleeding-out-were-citizens-and-have-insurance-The-bill-is-24-000-USD-We-do-not-have-that-kind-of-money-What-can-we-do https://www.quora.com/Recently-my-husband-visited-the-ER-in-... https://www.quora.com/Why-did-the-doctor-charge-me-3600-hr-to-drain-my-swollen-elbow https://www.quora.com/Why-did-the-doctor-charge-me-3600-hr-t... When people ask me what I think is "wrong" with the health care in the USA, my answer surprises them: Nothing is wrong with the health care in the USA. It is one of the very best in the world for those who can afford it. The issue is that one should not have to look unexpectedly to a life completely ruined because they suddenly fell sick or got into an accident - they should be able to pick up their lives when they need to do it the most and go on from there. I invite your feedback on: https://www.quora.com/Would-a-completely-free-market-healthcare-system-with-zero-government-involvement-and-no-subsidies-for-anyone-work-better-in-the-long-run https://www.quora.com/Would-a-completely-free-market-healthc... https://www.quora.com/In-the-US-the-majority-of-people-under-65-years-old-have-health-insurance-through-their-employers-What-is-the-logic-behind-tying-health-insurance-to-an-employer/answer/Subhobroto-Sinha-1 https://www.quora.com/In-the-US-the-majority-of-people-under...