Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
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.
But that is for your cost; it does not tell you what the doctor will be paid.
Quote:
Originally Posted by middle-aged mom
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.
No, the doc has to have a fee schedule. Those fees are what a cash patient will pay. Every patient is billed the same fee for the same service. The insurance applies its discount, determines what part of the discounted price the patient owes, and then pays the balance. The doctor may discount the full price on a patient by patient basis, but if he does it for everyone, the discounted price becomes the new full price. That will lead to insurance companies recalculating what they will pay and a drop in reimbursement from the insurance company. For the same reason, doctors cannot waive the patient's share of the cost on a routine basis, including what the patient owes under Medicare.
Quote:
Originally Posted by Ponderosa
I have not been to a doc in many years or a hospital or any other provider who did not collect the deductible up front. They might agree to bill, but that is truly the exception where I live.
Most docs collect copayments up front but do not collect deductibles. Since the patient may be seeing other doctors, it is hard for him to know what the remaining amount on the deductible is on any given day until he has actually paid it all. Most offices wait until the insurance pays and then bill for any amount that the insurance company applies to the deductible. Otherwise, if they have the patient pay more because the deductible has not been met, they may end up having to refund to the patient if another claim is processed first.
The unanswered question is whether patients with heavily subsidized plans are going to be able to afford their deductibles. If they do not pay them, the doc gets stiffed.
You have to have means testing, copays and deductibles. Otherwise the amount of stuff that gets done on everyone goes right through the roof!
I do not believe that either
I really don't think we are a nation that has that "get my money's worth"
mentality, if we had an affordable single payer health care system via Medicare tax.
Except when it comes to durable medical equipment (much abuse there).
What we have though is no universal rates. A broken limb can cost 20 X's more in one place than
an other. Same for testing with CAT/PT Scans.
None of that sort of stuff is going away under our system now - though if the excessive profit was taken away - it might - with universal rate prices.
Of which America is the only one that does not have that.
I really don't think we are a nation that has that "get my money's worth"
mentality, if we had an affordable single payer health care system via Medicare tax.
Except when it comes to durable medical equipment (much abuse there).
What we have though is no universal rates. A broken limb can cost 20 X's more in one place than
an other. Same for testing with CAT/PT Scans.
None of that sort of stuff is going away under our system now - though if the excessive profit was taken away - it might - with universal rate prices.
Of which America is the only one that does not have that.
Again I have to stress that our solution needs to be an American solution. So the delivery will remain by and large private. And thus prices and costs and HC spending will not be the same everywhere. An American solution means by and large private docs. We will of course need more private docs, and more docs means more stuff being done on more patients. And then more overall costs.
With UHC not only will we have many more patients, but each patient will have more done.
I don't see us going for a pure central UHC system, where the docs are publicly hired and the hospitals are Gov't owned.
That is completely contrary to the experiences of EVERY SINGLE other country in the world with single payer. All of them, and I do mean ALL of them, saw costs not only go down but go down dramatically.
Ration care and place government-imposed limits on payments and that's what happens...
Too Many Republicans Signed Up For Obamacare...McMorris-Rodgers Says it here to stay.
Cathy McMorris Rodgers acknowledging that her conservative districts is a big beneficiary of Obamacare thinks its time to move past trying to repeal the ACA. She if one of the first Republicans to fold on this issue. Of course is it any wonder when about 25% of her supporters are on Medicaid or signed up for the ACA in some parts of her district. Pretty hard to have a town hall meeting expecting the usual suspect Tea Party-Medicare recipients showing up complaining about big gubbermint and finding you have a whole lot of people on Medicaid and and ACA showing up who voted for you asking you why you want to get rid of their health care? The Spokane District she represents is the perfect microcosm of Republican politics...mostly white and very dependent on the government while they complain about the government.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
Too Many Republicans Signed Up For Obamacare...McMorris-Rodgers Says it here to stay.
