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The insurance company said otherwise in this situation, regardless of how many physicians think differently.
no they didnt.. the insurance company said the reinbursement for the SAME PLAN would be reinbursed the same, regarldess to where it was bought, they didnt compare it to other plans to discuss reinbursement amounts.
Blue Cross Blue Shield says his reimbursement rate would be the same regardless of where the plan is purchased so Julie thinks this is a political statement.
Again, is BC selling the same plan outside of the exchange? I doubt it
The insurance company said otherwise in this situation, regardless of how many physicians think differently.
You haven't followed the thread. Some people claim that reimbursement rates are the same for all of an insurer's policies, exchange and non-exchange plans. Others, including me, have given links to articles showing rates for exchange plans are lower.
This Arizona doctor might reject Ocare patients for political reasons, financial reasons, or some other reasons. Whatever, he can choose who he wants as a patient.
The reimbursement rates for the ACA plans are lower than traditional plans in SOME cases. Doctors don't want the lower rate, nor do they want to have difficulty collecting payment. The exchange plans would potentially put the doctor in the position of trying to collect payment from the patient directly should the patient default on the insurance premium payment. The insurance company will not pay the physician if there is a default from the insured. Physicians have good reason to be concerned about this.
no they didnt.. the insurance company said the reinbursement for the SAME PLAN would be reinbursed the same, regarldess to where it was bought, they didnt compare it to other plans to discuss reinbursement amounts.
Blue Cross Blue Shield says his reimbursement rate would be the same regardless of where the plan is purchased so Julie thinks this is a political statement.
Again, is BC selling the same plan outside of the exchange? I doubt it
Yes. I don't know about the whole country, but in this state EVERY BCBS plan offered to individuals on their web site was exactly the same and at the same price as plans that were on the federal exchange. The provider list was the same, as were the benefits. If you clicked the link on ACA for policy details you were sent to a page on their website that was the same one that you got had you been researching on the BCBS site. No difference. There were no plans on the Exchange that were not on BCBS and no plans on BCBS that were not on the exchange.
Just because an MD accepts BCBS does not mean they ever accepted all BCBS plans. This was true before the ACA and remains true after ACA.
Some MDs did not accept any insurance plans before ACA and continue to not do so after ACA. Instead, they expect payment in full at the point of service. Patients tend to pay more than the MD would have been reimbursed by any insurer.
Most medical practices bill insurance more than they know they will be paid. This typically shows as a PPO discount on the insurer's statement of benefits. These discounts can be as high as 70% for some plans/providers.
So rather than agreeing to accept .25 on evert $1.00 billed, the provider charges .45 on the $1.00 to patients paying cash. The MD makes more and the patient thinks they are getting a steal of a deal.
The reimbursement rates for the ACA plans are lower than traditional plans in SOME cases. Doctors don't want the lower rate, nor do they want to have difficulty collecting payment. The exchange plans would potentially put the doctor in the position of trying to collect payment from the patient directly should the patient default on the insurance premium payment. The insurance company will not pay the physician if there is a default from the insured. Physicians have good reason to be concerned about this.
It depends on the plan. The lowest cost plans may reimburse less than more costly plans , even though both were purchased on the exchange.
All of this was true before ACA and remains true after ACA. Most insurance includes deductibles. When the patient has not satisfied their deductible, the medical practice has to chase the payment. In the case of surgeons and Cancer Treatment, medical practices usually confirm benefits and require the patient to pay the value of their outstanding deductible upfront, before confirming surgery or starting treatment.
So rather than agreeing to accept .25 on evert $1.00 billed, the provider charges .45 on the $1.00 to patients paying cash. The MD makes more and the patient thinks they are getting a steal of a deal.
Exactly, its why up to ACA I carried catastropic coverage and paid cash for most medical care I received.
This is to be expected. If you look at Medicaid, a lot of doctors don't accept it and some only accept a certain number of patients. We came across that with our adult son who has developmental disabilities. Then, KS switched to KanCare departing from Medicaid and now less accept that or at least in the beginning, that was the case. Another example is VA Healthcare because they can't recruit medical personnel, it takes 10 weeks to get an appointment and you have to have a physical and tests before you can be seen for some relatively simple problem and this must be done yearly or they kick you out of the computer system. They are trying to get additional funding by turning people away yet requiring those not requesting a yearly physical/testing to take it anyway to overload the system which is typical of a government entity. They closed the emergency room at the VA in Topeka because they cannot recruit sufficient physicians. For us, VA Healthcare ends up being worthless without emergency services or the ability to get an appointment in a timely manner. I suspect this is the future of medical care and that those involved with ObamaCareNot knew this.
The PPACA prohibits the expansion of physican owned hospitals. It prevents building of newly owned physician hospitals as well.
Think about that. How would lawyers feel if they made a law that prevented lawyers from owning their own law offices especially those super law firms.
While in this case blue cross blue shield payments will remain the same to the doc regardless if it's insurance from exchange or outside. You must look at the future. As soon as insurers gain enough monopoly or duolopy control of a market on the ACA exchanges (right now individual maket makes up 5% of their revenue). It's expected to grow to 25% in the next 5-7 years.
Insurers like blue cross blue shield can tell docs to take it from behind and low ball them.
You got ACA proponents "experts" say narrow networks mean more patients. That docs can see more patients. You get the explanation and rationization?
They want you to work more for less? Are you crazy?
The average lawyer super partner at mega law firms make in excess of $600-700k. How would they like it if they were asked to see 30% more clients to make the same money? I don't see law firms decreasing their prices? Heck I don't see the spa heater company decreasing their prices either.
Lawyers and docs can certainly own their own offices. But there is is no real lawyer equivalent to a hospital. And there are many good reasons why docs should not be owners/controllers of hospitals. But that should be another topic.
Privates docs can always decide for themselves which plans and which patients they want to see or not. With Obamacare there is great worry that many new enrollees have such high deductibles, and the docs are simply more worried about being able to collect on fees. Real or imagined, I don't think anyone yet knows. And I'm a doc.
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