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The "cash rate" is not 75% off normal costs, not even close. You may have lucked out and found a doctor that might discount that deeply, but that is not the norm.
I am not talking about a "cash rate" discount. Instead, you present your insurance card for all services at doctors, labs, etc. Then the doctor sends their fee to the insurance company. The insurance company then compares the doctors fee against the prenegotiated rate that is pre-set between the doctor and insurance company. Then the insurance company confirms that the doctor is 'in-network' and sends notice to the doctor that the prenegotated rate must be charged and that the deductible isn't met and the patient is responsible for payment of the pre-negotiated rate. For example, the doctor sends a bill of $178 but the pre-negotiated rate between Doctor and Insurance is $33. The doctor would then bill the patient $33 since the insurance pre-negotiated rate kicks in. The doctor cannot charge more than the prenegotiated rate (it's called balance billing and it's not allowed in the doctor-insurance company agreement).
Just like today, if you haven't met your deductible and you submit your insurance card to the doctor, you are charged the pre-negotiated rate(after the dr submits bill to insurance and insurance replies) if you used an in-network doctor even when the patient pays for the visit because the deductible isn't yet met. What you don't want to do is pay the doctor up-front and decide not to submit the charges to the insurance carrier. You always should give the insurance card to your doctor and ask the doctor to submit to the insurance carrier because the discount for pre-negotiated rate (from insurance carrier) is massive. Do this (always submit charges to insurance) even if you know that your deductible still won't be met.
I would love to get a catastrophic plan with a high deductible because it results in lower monthly premiums. I rarely go to the MD but have the money to pay for the deductible when necessary. For people that don't have the funds or otherwise choose to have a lower deductible, then they should be able to choose a plan with a lower deductible and a higher premium.
I read on an insurance broker's web site that with Obamacare today, on the ACA website you must be under 30 to get a catastrophic plan(aka high deductible). However, I read that people over 30 can purchase a high deductible/catastrophic plan outside of the ACA website, such as purchasing through an insurance agent or directly through the insurance carrier. I don't know if this is true because I didn't verify it.
I guess at this point it doesn't matter because Obamacare is going to be dismantled very soon. Hopefully the preexisting condition clause stays so people can continue to buy insurance in the open market without being tied to an employer.
Last edited by sware2cod; 11-18-2016 at 07:09 AM..
You are probably one of the very few people that want something like this, and maybe have the means to pay for it. Read through other threads here where people won't even save for a $6000 deductible/OOP max, or less even and won't seek treatment for the "small things" because they don't want to pay the $300 or so cost for the office visit.
The "cash rate" is not 75% off normal costs, not even close. You may have lucked out and found a doctor that might discount that deeply, but that is not the norm. Now, Medicare reimbursement rates might be that low, especially with a MA plan, but that doesn't mean that is the cash price.
There are catastrophic plans for the under 30 crowd.
I think that most people who have had to purchase their own health insurance (not employer subsidized) would welcome this type of plan with open arms.
We need to get away from one price for self pay and another deeply discounted price for those fortunate enough to work for employers with thousands of employees. That means that someone who pays full price is subsidizing those who are insured.
Also, why should someone who is self employed pay a higher premium than someone who works for a large employer?
More and more I am leaning toward a single payor option.
Health insurance is just one aspect of the issue. We also need to get some real transparency in provider pricing and costs. At present the provider side is opaque to say the least
We need to get away from one price for self pay and another deeply discounted price for those fortunate enough to work for employers with thousands of employees. That means that someone who pays full price is subsidizing those who are insured.
Also, why should someone who is self employed pay a higher premium than someone who works for a large employer?
More and more I am leaning toward a single payor option.
Single Payer was the original plan which the Republicans were against. The compromise got us Obamacare. It will also just go back to status quo of what it was before.
The ACA depended on young, healthy people signing up to offset the older, sicker, population did not work. Younger, healthier people just decided to pay the penalty and not have health insurance at all. It is very similar to we younger Seniors on Medicare subsidizing the older, sickly, Medicare Beneficiaries. The entire concept is exactly the same. Forget if anyone over 65, healthy or not, has to compete with a 25 year old in an insurers mind.
Universal Healthcare, like in other countries which was originally proposed, is the way to go, but that it not in the for profits agenda of the Republicans. No PROFITS and Insurance Companies would go out of business not selling to the Public.
Preventive Care is going out the door, including vaccinations Suzy, when people have to go back to deductibles and copay for it.
The ACA depended on young, healthy people signing up to offset the older, sicker, population did not work. Younger, healthier people just decided to pay the penalty and not have health insurance at all.
However, if the ACA had survived, after a period of time, that penalty would have been prohibitive to pay, and the person would chose to pay for health care.
Quote:
Preventive Care is going out the door, including vaccinations
How unfortunate. Because if it were set up correctly, preventive care could save both insurance companies and patients thousands of dollars in the long run.
We need to get away from one price for self pay and another deeply discounted price for those fortunate enough to work for employers with thousands of employees. That means that someone who pays full price is subsidizing those who are insured.
Also, why should someone who is self employed pay a higher premium than someone who works for a large employer?
More and more I am leaning toward a single payor option.
Group plans actually cost more than individual plans. With the individual plan, you are lumped into a "group" with everyone else that has that plan. The only deep "discounts" are what your employer pays for you. A large group is usually self-insured and the premiums collected pay the claims and the insurance company gets a small administration fee to administer the paper work/claims, etc. They have their own ratings and their claims experience is unique to their company.
I could get an individual plan off the market place for about half of what the full premium my company pays for our plan, less than half if I get family coverage off the exchange. My employer pays about 90% of the premium for our higher out of pocket plan, your "employer" could do the same thing.
Provider fee opacity is due to how insurance companies pay
Quote:
Originally Posted by Jaggy001
Health insurance is just one aspect of the issue. We also need to get some real transparency in provider pricing and costs. At present the provider side is opaque to say the least
Blame the insurance companies. Essentially, insurance companies are not obligated to disclose ahead of time to providers what they will pay for a procedure - and vary provider reimbursements depending on how aggressively the provider bills.
Read this carefully - more than once - from an actual provider:
Quote:
Originally Posted by toofache32
Here is why the fees charged out are always much higher than what is paid by the insurance company:
Despite what most people think, the insurance companies DO NOT let anyone know what their allowable amounts are (except Medicare). There is no negotiation with private solo providers, only with major hospital systems. This is why the term "negotiated fees" is a laughable misnomer.
The providers actually sign up without having a way to know what they will get paid.
Therefore they must play the insurance company's game created by the insurance company to determine what the insurance company will pay for each code. The initial understanding agreed by all is that the vast majority of codes are reimbursed at significant discounts. But only the insurance company knows their allowable amounts.
If an insurance company actually pays the full amount that is billed, that means the insurance company's "allowable" amount is actually higher than the billed amount (they don't pay extra if their allowable is higher than the billed amount).
When this (uncommon these days) scenario appears, the provider knows that the insurance company is willing to pay more for that code for some reason. So the provider increases their billed fee for that code to capture more of what the insurance company is willing to pay. This continues until the billed amount is higher than the allowed amount.
However, the amount that one insurance plan pays for a given code is not the same as what other insurance plans pay.
But they all require (by contract) the doctor to have a single fee schedule so that all insurers (and non-insured patients) are billed the same amount.
So this same phenomenon happens with a different code under a different insurance plan. So the billed charge for that code is raised for all plans once again.
Multiply this by over 100 plans and thousands of codes in order to capture these rare instances, and eventually ALL the billed charges are ridiculously high because there was one insurance somewhere that paid that amount for some reason.
Remember that insurance company contracts require providers to bill out the same fees for everyone (insured, Medicare, non-insured, EVERYONE) although the insurance companies are contractually allowed to only pay as little as they can get away with.
This is why non-insured patients are billed these ridiculous rates that nobody else pays....because the insurance companies contractually require this in order to push more people towards insurance by making insurance the only "affordable" way to get healthcare.
Provider price opacity is due to how insurance companies pay.
Read this carefully - more than once - from an actual provider:
He is flat our wrong about this too...sure, maybe in the dental field this is the case, but I can tell you exactly how much we will get paid for every procedure we bill from each insurance company...not to mention you COULD go off past experience as well.
sware2cod--your price example is just not realistic, except for Medicare. If a provider is billing that much over usual and customary on a regular basis, they will be dropped from most networks, except Medicare.
Single Payer was the original plan which the Republicans were against. The compromise got us Obamacare. It will also just go back to status quo of what it was before.
The ACA depended on young, healthy people signing up to offset the older, sicker, population did not work. Younger, healthier people just decided to pay the penalty and not have health insurance at all. It is very similar to we younger Seniors on Medicare subsidizing the older, sickly, Medicare Beneficiaries. The entire concept is exactly the same. Forget if anyone over 65, healthy or not, has to compete with a 25 year old in an insurers mind.
Universal Healthcare, like in other countries which was originally proposed, is the way to go, but that it not in the for profits agenda of the Republicans. No PROFITS and Insurance Companies would go out of business not selling to the Public.
Preventive Care is going out the door, including vaccinations Suzy, when people have to go back to deductibles and copay for it.
Single payer is the only way to go. No matter what the naysayers may gripe about, it works well in the UK. Not as good as it used to be, they say, but that has much to do with the unlimited amount of immigrants that the EU allowed into the UK--people who have never even paid into the system. That's what messed up the previously excellent NHS in the UK. But even now a lot of them still love it although these days they complain about longer waiting times. (I hope they can fix it over there!)
Everyone has to pay into health care or it can't work. But the typical issues are that no one wants higher taxes, no one wants to pay for someone else, no one wants co-payments. The list goes on. In reality, nothing comes for free and health is a right, not a luxury. Everyone will need it sooner or later.
Some version of single payer with co-payments. What we obtain for too cheaply, we esteem too lightly --and that applies to medical related issues. I don't claim to begin to understand what a new health care plan would look except all would pay in and all would make co-payments. Co-payments because if someone can go to a doctor for free, they'll be more likely to run into the office for a sniffle or a little cut--things that they can take care of on their own and not use up the doctor's valuable time. Co-payments so that people will value the treatment and not take it for granted.
In the UK the system is fair and that's how it should be here. No one, not matter rich or poor, worries about not being able to afford to go to a doctor or to afford treatment. With their single payer system, if people want more, they can "go private", meaning they can purchase private insurance on top of the free NHS. The private insurance plans don't cost a lot and they're not necessary but older people tend to buy them so that they can their surgery sooner and not be on a waiting list.
I really hope our system can be fixed and not just thrown away. Single payer, not a complicated, wasteful tangle of greedy insurance companies.
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Provider fee opacity is due to how insurance companies pay
