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Health insurance, a misnomer.
Old 08-22-2013, 11:16 AM   #1
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Health insurance, a misnomer.

In the Wall Street Journal today is an article about getting surgery outside of the bounds of third parties, ie. insurers.


The upshot of the article is that what we call insurance is really an arrangement for providers to get a pre negotiated price for services rendered. Seems, if one has some elective medical work to be done and negotiates with the providers up front, a much lower cost is possible.

The author a doc says all the providers got proper compensation.

This obviously won't work in an emergency situation.

Jeffrey Singer: The Man Who Was Treated for $17,000 Less - WSJ.com

Edit add: By the way there are a lot of gems, previously unknow to me in the article. Ex. If using any form insurance or medicare, the doctor is prohibited by contract to offer a cash price service to that patient. Hmmmm.

The real kicker is at the end, in re: obamacare.
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Old 08-22-2013, 11:32 AM   #2
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Quote:
Originally Posted by ls99 View Post
In the Wall Street Journal today is an article about getting surgery outside of the bounds of third parties, ie. insurers.

The upshot of the article is that what we call insurance is really an arrangement for providers to get a pre negotiated price for services rendered. Seems, if one has some elective medical work to be done and negotiates with the providers up front, a much lower cost is possible.

The author a doc says all the providers got proper compensation.

This obviously won't work in an emergency situation.

Jeffrey Singer: The Man Who Was Treated for $17,000 Less - WSJ.com

Edit add: By the way there are a lot of gems, previously unknow to me in the article. Ex. If using any form insurance or medicare, the doctor is prohibited by contract to offer a cash price service to that patient. Hmmmm.

The real kicker is at the end, in re: obamacare.
The real kicker to me is that the total cost of the procedure was only $3000 (a cost the providers themselves came up with, as the patient could have paid more and was not negotiating). So why was $20,000 supposedly the cost with the insurance?
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Old 08-22-2013, 11:49 AM   #3
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The real kicker to me is that the total cost of the procedure was only $3000 (a cost the providers themselves came up with, as the patient could have paid more and was not negotiating). So why was $20,000 supposedly the cost with the insurance?

The article says that hospitals and docs via AMA quote astronomical reatail prices to the insurers and full fare Freddies aka uninsured and self insured.

Don't know why that is. Someone in the medical underwriting business may be able to shed light on that little detail. Ahem, the may be prohibited from disclosing the details to the great unwashed.
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Old 08-22-2013, 12:27 PM   #4
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I've always wondered why the managed care organizations never productized the concept of "membership without insurance". It would have allowed savvy folks who chose not to purchase insurance to at least obtain the same pricing on a self-pay basis.

All irrelevant in the brave new world of ACA.
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Old 08-22-2013, 04:17 PM   #5
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The article says that hospitals and docs via AMA quote astronomical reatail prices to the insurers and full fare Freddies aka uninsured and self insured.

Don't know why that is. Someone in the medical underwriting business may be able to shed light on that little detail. Ahem, the may be prohibited from disclosing the details to the great unwashed.
Actually less than 20% of US docs are AMA members. Although AMA does lobby Congress, it has nothing to do with specific pricing/payment negotiations between individual HI co's & providers (doc's, hospitals, drug/equipment makers, etc).
https://en.wikipedia.org/wiki/Americ...al_Association

The utterly silly current situation of uninsured folks being charged WAY more than insured has (IMHO) evolved from decades of HI co's demanding increasingly big % "discounts" from "retail", and providers raising their "retail" prices to match. Providers have claimed they cannot offer same discounts to uninsured due to potential contractual or "fraud" issues
Hospitals Charge Uninsured More - CBS News
Agree 100% that this has gotten far out of hand and needs to be fixed.
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Old 08-22-2013, 05:35 PM   #6
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AMA is very much involved in setting the medicare fee schedules which most other insurance rates are based.

AMA’s Role in Setting Medicare Fees Battered

AMA has also been working for decades to limit the supply of DRs and are against using Nurse practitioners

USATODAY.com - Medical miscalculation creates doctor shortage
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