One of the “unexpected” results of the “Affordable” Care Act’s notion of reducing health care costs has been a restriction of in-network providers. This is where quite a few folks found out that if they like their doctor, they can’t keep their doctor. Since most people who signed up through the Exchanges were people who previously had insurance and saw it cancelled, rather than those who did not have insurance, this is important. Also, quite a few hospitals, including the best hospital, have been left out of the networks. How is this working out?
(Bloomberg) Health insurers under pressure to keep premiums low are eliminating some hospitals from coverage in a cost-cutting strategy that threatens to freeze out centers that provide specialized care, limiting patient options. (snip)
The law puts pressure on premiums by requiring insurers to “broaden health benefits, restricting how much premiums can vary with age and adding a new health-insurance tax,†said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, or AHIP, a Washington-based trade group. Narrowing networks to those that accept lower payments in exchange for higher patient volume “is one way to help mitigate profit increase for consumers,†he said.
Insurers say one way to help lower costs is to select medical providers who deliver quality care at a low price. This week, the Health and Human Services Department said insurance plans may be required to include at least 30 percent of “essential community providers†in each county in 2015 from 20 percent this year. That means about 38 percent of current plans would need to broaden their networks, according to the McKinsey study.
So, HHS is going to blow out one of the main cost reduction methods caused by Obamacare and the rules passed by HHS. This could result in skyrocketing costs for the insurers and the insurers dropping out of the Exchanges.
Quite a bit of the article is about the Seattle Children’s Hospital, which is excluded from 5 of the 7 plans in Washington state. They are excluded because they are more expensive than other hospitals. The article forgets to note that they’re more expensive because they are very very good. Their “product” is top notch. Both a Camry and a Maserati are simply cars with four wheels, an engine, and a steering wheel, right? Why does one cost more than another? Exactly.
Many hospitals, doctors, and medical centers want to be in-Network (many don’t, especially doctors). But the Exchange plans have to save costs. In comes government, beyond the aforementioned HHS
(Fox News) Lawmakers in a Washington state Senate committee heard a proposal this week that would reportedly allow health insurance companies to keep offering insurance plans that don’t meet the new federal and state requirements. But they would only be offered to people who were enrolled in such plans as of Oct. 1, 2013.
Senate Bill 6464 also would let insurers from other states sell plans to Washingtonians without requiring the carriers to meet Washington state insurance regulations.
Both of those seem to violate federal law.
Meanwhile, in Mississippi, proposed legislation would bar insurers from cutting off most doctors and hospitals that agree to prices set by insurers. The bill also would prohibit insurers from charging higher copayments at certain doctors’ offices or hospitals, according to The Wall Street Journal.
Many other states are looking at similar legislation. What would this mean? Escalating costs. These will be funded by either the consumer or the pool of taxpayers. This would also mean reduced reimbursement rates to the medical facilities. And reduced care.
Yes, networks have always been restricted with insurance. And you do not always get to keep your doctor when switching. I’ve lost my dentist three times in 20 years because my company changed their dental insurance. Obamacare causes severe restrictions on networks both by the insurance companies and because medical facilities, primarily individual doctors/care professionals, want nothing to do with Ocare. So states and HHS will force the networks to grow. And we can all guess that this will cause Ocare costs to skyrocket.
Crossed at Right Wing News.
Not surprised at all. First, HHS tells docs and hospitals they will have to take less $$ for services. They withdraw from Ocare. Ocare itself limits who will be allowed to be reimbursed for services, and who will be “in-network”.
then when the realization hits that they’ve nearly pushed the entire market out of their business model, they then come back and FORCE insurers to expand their network, which then forces insurers to either increase their costs or reduce benefits.
I’m waiting for the next shoe when HHS tells insurers how much they will charge customers. They already dictate, pretty much, how much they reimburse for services.
Only a few steps away from a total and complete takeover.
And the GOP keeps allowing it. And now, the GOP are pushing to enact their OWN VERSION of ObamaCare. Idiots. Idiots them all.
I have started getting some of the new Obama crap. I needed to get a stress test on a patient who had funky chest pain and a change in EKG. This was going on for several months (for a smartass this was the first time I saw the patient), so it did not require hospitalization. I was then told I had to talk to the insurance “doctor”. As is typical, he had a foreign accent and poor understanding of English. On explanation and informing him to the fact that the woman had at least a 70% chance of coronary artery disease, he started asking specific questions about the EKG, only the type an academic would ask as academics know nothing of patient care or real life medicine. I could have elected to do a cardiac cath, for those knowledgeable in these things, but that is expensive and the patient was too “healthy”, besides, it is not a good idea to put one in the hospital on the first visit, especially if the knowledge can be gleaned as an outpatient. The point of this rant is that even if you have insurance, the insurance companies are working overtime, more so than usual, to make sure you can’t use it.