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> we are seeing insurance carriers refuse to negotiate or offer rates greater than 125% of Medicare... fundamentally is acting as a wage-cap. Sounds good to me

by CPLX 7y ago

> we are seeing insurance carriers refuse to negotiate or offer rates greater than 125% of Medicare... fundamentally is acting as a wage-cap. Sounds good to me. Sorry I feel your pain but medical costs are out of control and you’re part of the problem. Consult with your friends in the industry and figure out how to make billing reasonable and fair or it’s going to be imposed on you.

riahi 7y ago
Right, I'll get on repealing Medicare, EMTALA, and now Balance Billing legislation before I can legally offer a sane bill. /s The proposed solution to balance billing is linking the "out of network rate" to the FAIR health claims database. It keeps the insurers honest and allows competition at the market rate. If you gut everyone, hospitals will close and access to care will shrink.
- ratsmack 7y ago
  The big problem with healthcare in general is administrative churn that eats away at the money available for actual Health Care [1]. [1] https://www.americanprogress.org/issues/healthcare/reports/2019/04/08/468302/excess-administrative-costs-burden-u-s-health-care-system https://www.americanprogress.org/issues/healthcare/reports/2... Everyone pays for the bloated administrative machine that is the elephant in the room that no one seems to ever talk about.
- jcrben 7y ago
  FAIR Health is a claims db. It doesn't have a single price. You think every doctor should be paid at what percentile - 90th? Doesn't make that much sense to me. I know that's typical UCR. Also, you don't have to do everything, but you could start by doing something other than complaining about doctors who have ruined many people's lives getting paid less. I'm working on setting up a Bay Area chapter of https://rightcarealliance.org/ https://rightcarealliance.org/ (which is national) for grassroots healthcare organizing - feel free to hit me up if you'd like to participate.
  - riahi 7y ago
    I'd settle for 75th percentile to force insurance carriers to actually negotiate and not deliberately keep pruning their provider networks by offering terrible rates.
    - dilyevsky 7y ago
      Sounds like they “prune” non-competitive providers with likely inflated rates. WAI
    - CPLX 7y ago
      You can’t have all the doctors paid at the 75th percentile. That’s like saying you want everyone’s children to be above average. It doesn’t make mathematical sense. At some point someone actually has to set the rate for things. If market mechanisms aren’t working there needs to be another method. The point here is that sticking customers with out of control surprise bills they have no way of foreseeing or avoiding needs to be removed from the list of options.
      - riahi 7y ago
        75th percentile would be for when out of network. It would work to reduce ridiculous charge-master surprise bills but still provide a redress mechanism for monopolistic insurance companies playing hardball and cutting reimbursement 60% in one year (see Anthem BC/BS to pathology in multiple states). The argument here is that by destroying the threat of out of network, the insurance company has literally no incentive to offer rates better than Medicare. That’s a huge unfair advantage to insurance companies.
        CPLX 7y ago
        > The argument here is that by destroying the threat of out of network, the insurance company has literally no incentive to offer rates better than Medicare. Yup. Works for me. > That’s a huge unfair advantage to insurance companies. Not so much. Guess what I think the next part of the plan should be?
- subhobroto 7y ago
  > allows competition at the market rate What market rate? For-profit hospitals mark up prices by more than 1,000 percent because there's nothing to stop them: https://publicintegrity.org/health/for-profit-hospitals-mark-up-prices-by-more-than-1000-percent-because-theres-nothing-to-stop-them/ https://publicintegrity.org/health/for-profit-hospitals-mark... What kind of market does not allow me, the customer, to know, at all, what my financial liability is? What kind of market has players mark up prices by more than 1,000 percent because there's nothing to stop them? That's no market - that's extortion, plain and simple. > I'll get on repealing Medicare, EMTALA, and now Balance Billing legislation The EMTALA has been unfunded for decades. Hospitals bill $50k for a sprained ankle, write it off after they harass a patient to pay $5k for it, claim the $45k as a loss and pay $0 in corporate taxes because of all these "losses". Hospitals support the EMTALA because they get these large write offs and federal, state support. Not because of the warmth in their hearts. Balance Billing? As long as we are talking about unethical principles, why don't we talk about withholding all cash funds that patients walk in with as a "security deposit" and deduct $150 of it as "handling fees"? After all, they sat down on the chairs, enjoyed the AC, watched the TV - none of this is free you know. > insurers honest Let your patients worry about their insurers. Your patients, more often than not give the insurers a very hard time, for troubles unlikely caused by the insurance company in the first place. The insurance company happens to collect the money they summarily dispatch to providers and drug companies: the business model they follow actually gains from them reducing their premiums, which they would very much like to, if they could. Infact, the ACA has capped the amount of profit an insurance company can make which has reduced their interest in negotiating better provider rates. Here's a diagram from a very detailed post I wrote: https://qph.fs.quoracdn.net/main-qimg-d68aea3ca1e466f166752e261b9e28d3 https://qph.fs.quoracdn.net/main-qimg-d68aea3ca1e466f166752e... https://www.quora.com/Why-is-private-healthcare-in-the-US-so-expensive/answer/Subhobroto-Sinha-1 https://www.quora.com/Why-is-private-healthcare-in-the-US-so...
  - riahi 7y ago
    EMTALA is precisely the problem. We cannot ask for any money before seeing the patient; nor can we ask for a deposit. Further, we are medicolegally liable for all care we provide even if we don't get a dime. That was the original intent of going out of network; we'd tell the patients "we don't accept your insurance because we could not come to an agreement; if you'd like to continue, we can see you but it will be billed to you. We'd appreciate you telling them you want to see us as a subscriber" However, with the corporatization of medicine, the individual decision making has been lost.
SkyPuncher 7y ago
> Sorry I feel your pain but medical costs are out of control and you’re part of the problem. To put things in perspective, physician salaries are less than 10% healthcare costs. A 25% decrease in salaries would only lead to a 2.5% change in healthcare costs. ---- There are a lot of reasons healthcare is expensive. Most of those come down to processes and practices that are out of the hands of individual physicians.
- bart_spoon 7y ago
  That’s actually an ton. For all of the heat big pharma takes regarding drug prices, the spending on prescription drugs is like 8%. Meaning the entirety of the costs of the pharmaceutical industry is less than just what we are paying for physician salaries.
  - SkyPuncher 7y ago
    IMO, pharmaceuticals aren't the problem either. Most drugs aren't outrageously priced (or have well priced generics). The hysteria over drug prices typically seems to revolve around a small set of outrageous cases. My opinion is insurance as the primary billing method is almost exclusively responsible driving up costs. It adds a ton of complexity and admin work while discouraging general improvements to care.
bassman9000 7y ago
That will be a great incentive to get people into medical careers. I can't see how a race to the bottom salary and factory-like approach to healthcare would be the end result to this.

by CPLX 7y ago

riahi 7y ago

Right, I'll get on repealing Medicare, EMTALA, and now Balance Billing legislation before I can legally offer a sane bill. /s The proposed solution to balance billing is linking the "out of network rate" to the FAIR health claims database. It keeps the insurers honest and allows competition at the market rate. If you gut everyone, hospitals will close and access to care will shrink.

ratsmack 7y ago
The big problem with healthcare in general is administrative churn that eats away at the money available for actual Health Care [1]. [1] https://www.americanprogress.org/issues/healthcare/reports/2019/04/08/468302/excess-administrative-costs-burden-u-s-health-care-system https://www.americanprogress.org/issues/healthcare/reports/2... Everyone pays for the bloated administrative machine that is the elephant in the room that no one seems to ever talk about.
jcrben 7y ago
FAIR Health is a claims db. It doesn't have a single price. You think every doctor should be paid at what percentile - 90th? Doesn't make that much sense to me. I know that's typical UCR. Also, you don't have to do everything, but you could start by doing something other than complaining about doctors who have ruined many people's lives getting paid less. I'm working on setting up a Bay Area chapter of https://rightcarealliance.org/ https://rightcarealliance.org/ (which is national) for grassroots healthcare organizing - feel free to hit me up if you'd like to participate.
- riahi 7y ago
  I'd settle for 75th percentile to force insurance carriers to actually negotiate and not deliberately keep pruning their provider networks by offering terrible rates.
  - dilyevsky 7y ago
    Sounds like they “prune” non-competitive providers with likely inflated rates. WAI
  - CPLX 7y ago
    You can’t have all the doctors paid at the 75th percentile. That’s like saying you want everyone’s children to be above average. It doesn’t make mathematical sense. At some point someone actually has to set the rate for things. If market mechanisms aren’t working there needs to be another method. The point here is that sticking customers with out of control surprise bills they have no way of foreseeing or avoiding needs to be removed from the list of options.
    - riahi 7y ago
      75th percentile would be for when out of network. It would work to reduce ridiculous charge-master surprise bills but still provide a redress mechanism for monopolistic insurance companies playing hardball and cutting reimbursement 60% in one year (see Anthem BC/BS to pathology in multiple states). The argument here is that by destroying the threat of out of network, the insurance company has literally no incentive to offer rates better than Medicare. That’s a huge unfair advantage to insurance companies.
      - CPLX 7y ago
        > The argument here is that by destroying the threat of out of network, the insurance company has literally no incentive to offer rates better than Medicare. Yup. Works for me. > That’s a huge unfair advantage to insurance companies. Not so much. Guess what I think the next part of the plan should be?
subhobroto 7y ago
> allows competition at the market rate What market rate? For-profit hospitals mark up prices by more than 1,000 percent because there's nothing to stop them: https://publicintegrity.org/health/for-profit-hospitals-mark-up-prices-by-more-than-1000-percent-because-theres-nothing-to-stop-them/ https://publicintegrity.org/health/for-profit-hospitals-mark... What kind of market does not allow me, the customer, to know, at all, what my financial liability is? What kind of market has players mark up prices by more than 1,000 percent because there's nothing to stop them? That's no market - that's extortion, plain and simple. > I'll get on repealing Medicare, EMTALA, and now Balance Billing legislation The EMTALA has been unfunded for decades. Hospitals bill $50k for a sprained ankle, write it off after they harass a patient to pay $5k for it, claim the $45k as a loss and pay $0 in corporate taxes because of all these "losses". Hospitals support the EMTALA because they get these large write offs and federal, state support. Not because of the warmth in their hearts. Balance Billing? As long as we are talking about unethical principles, why don't we talk about withholding all cash funds that patients walk in with as a "security deposit" and deduct $150 of it as "handling fees"? After all, they sat down on the chairs, enjoyed the AC, watched the TV - none of this is free you know. > insurers honest Let your patients worry about their insurers. Your patients, more often than not give the insurers a very hard time, for troubles unlikely caused by the insurance company in the first place. The insurance company happens to collect the money they summarily dispatch to providers and drug companies: the business model they follow actually gains from them reducing their premiums, which they would very much like to, if they could. Infact, the ACA has capped the amount of profit an insurance company can make which has reduced their interest in negotiating better provider rates. Here's a diagram from a very detailed post I wrote: https://qph.fs.quoracdn.net/main-qimg-d68aea3ca1e466f166752e261b9e28d3 https://qph.fs.quoracdn.net/main-qimg-d68aea3ca1e466f166752e... https://www.quora.com/Why-is-private-healthcare-in-the-US-so-expensive/answer/Subhobroto-Sinha-1 https://www.quora.com/Why-is-private-healthcare-in-the-US-so...
- riahi 7y ago
  EMTALA is precisely the problem. We cannot ask for any money before seeing the patient; nor can we ask for a deposit. Further, we are medicolegally liable for all care we provide even if we don't get a dime. That was the original intent of going out of network; we'd tell the patients "we don't accept your insurance because we could not come to an agreement; if you'd like to continue, we can see you but it will be billed to you. We'd appreciate you telling them you want to see us as a subscriber" However, with the corporatization of medicine, the individual decision making has been lost.

SkyPuncher 7y ago

> Sorry I feel your pain but medical costs are out of control and you’re part of the problem. To put things in perspective, physician salaries are less than 10% healthcare costs. A 25% decrease in salaries would only lead to a 2.5% change in healthcare costs. ---- There are a lot of reasons healthcare is expensive. Most of those come down to processes and practices that are out of the hands of individual physicians.

bart_spoon 7y ago
That’s actually an ton. For all of the heat big pharma takes regarding drug prices, the spending on prescription drugs is like 8%. Meaning the entirety of the costs of the pharmaceutical industry is less than just what we are paying for physician salaries.
- SkyPuncher 7y ago
  IMO, pharmaceuticals aren't the problem either. Most drugs aren't outrageously priced (or have well priced generics). The hysteria over drug prices typically seems to revolve around a small set of outrageous cases. My opinion is insurance as the primary billing method is almost exclusively responsible driving up costs. It adds a ton of complexity and admin work while discouraging general improvements to care.

bassman9000 7y ago

That will be a great incentive to get people into medical careers. I can't see how a race to the bottom salary and factory-like approach to healthcare would be the end result to this.