Chiropractors - Coalmine Canary?

[Bestwifeever]

A provider can see the group and plan numbers, but if an issuer has numerous plans, what distinguishes or identifies a plan offered on an exchange, and why would a provider even care? The provider is interested in reimbursement, not policy issuance. If an issuer uses the same network for different plans, and some of those plans are offered on the exchange, it is basically irrelevant to the provider. This is certainly the case with many BCBS and Humana PPO plans, as they reference the same national networks used for other group plans they issue. The frequent reports of health care providers being cut out of or not accepting ACA plans sound like providers and insurers are finding it more difficult to negotiate reimbursement....

The article says this practitioners plan to accept no insurance at all. Just like daddy did. I would bet dollars to donuts he will not charge his patients much less for procedures if he really goes cash only.

Judge said his father operated the family chiropractic medicine practice 30 years ago using cash-only to avoid problems with insurance companies.

“Dad shook his head and told me then not to mess around with insurance companies and it looks like its coming full circle,” Judge said. “Many of my friends in chiropractic medicine have gone cash-only and we’re talking about it.”

Judge said that if he goes cash-only he’ll be able to cut overhead and employee costs and charge his patients much less for procedures.

 

[ERhoosier]

A provider can see the group and plan numbers, but if an issuer has numerous plans, what distinguishes or identifies a plan offered on an exchange, and why would a provider even care? The provider is interested in reimbursement, not policy issuance. If an issuer uses the same network for different plans, and some of those plans are offered on the exchange, it is basically irrelevant to the provider. This is certainly the case with many BCBS and Humana PPO plans, as they reference the same national networks used for other group plans they issue.

The frequent reports of health care providers being cut out of or not accepting ACA plans sound like providers and insurers are finding it more difficult to negotiate reimbursement. Over more than a decade, prices rose at a double digit annual pace and were simply passed from provider to insurer to insured. That is no longer [-]acceptable[/-] affordable. Hopefully this leads to more price stability.

Not saying I know how it will work in all regions, but my understanding is that specific Exchange Plans will have specific plan ID #'s. For example, a specific non-Exchange Humana Plan might be 4723 while a specific Exchange Humana Plan might be 3648. This can be very important to providers, facilities, and patients alike since, as has been discussed on ER before, in many regions not all providers are in-network for all plans from a specific insurer. Obviously, being out-of-network means patient pays more (even full cost if no OON coverage in their Plan).

Agree 100% that HC expenditures cannot continue to rise uncontrolled, and that cost containment is critical. But best data suggests rising provider pricing is a secondary contributor. Institute of Medicine study this year (using most recently avail data-2009) found that excess HC costs in US were mainly due to excess services, inefficiency, and administrative overhead, with excess provider prices prices being only ~13% of total. In other words, US HC system wastes big $$$ mainly by delivering too much wasteful care and doing so quite inefficiently
http://economix.blogs.nytimes.com/2013/09/13/waste-vs-value-in-american-health-care/

 

[jimnjana]

We use an upper cervical chiropractor who does not take insurance of any kind. If you don't sign up for a bundle plan, his max rate is $17 bucks an adjustment, we pay $11 for an adjustment. At one time he took insurance, but he said it was too much of a hassle to deal with insurance forms etc. His office records are old school forms, only automation are patient contact info and credit card processing.

 

[Midpack]

Agreed. That "ordinary folks" are talking and thinking more about health care/health insurance costs is a good byproduct of this ACA and the way it has been fielded. These discussions and the national focus on costs will probably accelerate a lot next year when small employers (above 50 FTE) are required to join the fray and a lot more people become participants rather than bystanders. It's too bad it didn't happen this year (as required by the legislation), but it's better late than not at all.
The sooner we break the "employment--> health insurance" link, the better off we'll be. But that is a very tough political road.

+2. Amen. Most people have employer provided health care and most of them are clueless about what health care really costs, no matter how many times and ways they're shown (from my experience). And they don't look at EOBs either. Many of my folks repeatedly asked why they had to pay anything at all (copays or low monthly contributions)...

 

[samclem]

I would bet dollars to donuts he will not charge his patients much less for procedures if he really goes cash only.

It all depends, doesn't it? His costs will be lower (back office help, personal time spent on insurance forms), so he'll certainly have the >flexibility< to charge less and still make the same net pay. And if his customers are paying their own money vs OPM, presumably they will be more sensitive to costs and this would tend to drive his fees lower.
But if demand for services goes up and he's one of fewer providers able to meet that demand (e.g. because he can see a patient who is in pain today, vs 3 weeks from now like those taking insurance), he might be able to charge a bit more than he otherwise would.

 

[jflynn4]

isn't the thread title a bit overdramatic? I'm still waiting for a post that explains how a Doctor, Hospital or any other general medical practitioner is actually going to determine in real life just how to distinguish between an individual BCBS PPO plan purchased on the exchange with one from a group policy when they both use the same network and have the same essential health benefits. Does the article you link explain that? It's behind a paywall, so no way to tell.

If they have the same network, it won't make a difference. Fact is, and I've hit this personally, the networks offered by BCBS vary widely among different policies ... Even those that offer the same (or very similar) benefits. The BCBS of Florida provider directory shows every physician in the system and each one has, literally, more than a dozen different networks listed next to their name. Some have all of them, some have only a few.

Even with a top end platinum exchange plan, the dermatologist I've been seeing for years for recurring skin cancer is no longer in the "right" network so I'll be changing.