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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.

by 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?

by jcrben 7y ago

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?